Withdrawn: Prenatal thoraco-amniotic chest drain insertion to manage a case of fetal hydrops secondary to FOXC2

http://bit.ly/2MCL7l4

Prophylactic human papilloma virus vaccination in head and neck: indications and future perspectives

Purpose of review To gain the evidence-based knowledge concerning the efficacy of HPV vaccination for oropharyngeal sites and to highlight the trials and strategies for vaccine administration in HPV-dependent head and neck diseases. Recent findings Vaccination can be provided in two injections. There is increasing anecdotal evidence that therapeutic vaccination is effective in treatment of recurrent respiratory papillomatosis. Summary The availability and broadening spectrum of HPV vaccines make possible the prevention of cervical and other HPV-dependent diseases. Vaccination is now included in the national immunization programs of most industrial countries and will be used, it is hoped, in developing countries within the next few years. In developing countries, few women are screened for cervical precancerous lesions, making immunization even more important. In affluent countries and matured societies, with high coverage of cervical screening, the focus of interest will shift to other HPV-related diseases. The HPV vaccination is effective in preventing oral infection with types targeted by the vaccines. Correspondence to Professor Frederik G. Dikkers, MD, PhD, Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. Tel: +31 20 566 3789; e-mail: f.g.dikkers@amc.nl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2G7H0fM

Systemic treatment in elderly head and neck cancer patients: recommendations for clinical practice

Purpose of review Despite the constantly growing number of elderly patients with squamous cell carcinoma of the head and neck (SCCHN), the majority of clinical trials have been focusing on their younger counterparts. However, because of age-related changes and the resulting higher prevalence of frailty, senior people need an adapted evidence-based approach. Recent findings Recommendations presented in this article proceed from those relevant for the general patient population taking into consideration the individual process of aging. In this respect, categorization into fit, vulnerable and frail elderly patients was used to guide systemic treatment. Summary The fit and vulnerable subgroups with locoregionally advanced SCCHN may still benefit from curative treatment, whereas for the remaining cases only palliative measures are usually appropriate. Advanced calendar age is not a contraindication for cisplatin making part of the standard regimens in locally advanced (high-dose 3-weekly schedule concurrent with radiotherapy) and recurrent/metastatic disease (in combination with 5-fluorouracil and cetuximab). In the latter setting, modern immunotherapy with immune checkpoint inhibitors, particularly the antiprogrammed cell death protein-1 (anti-PD-1) agents nivolumab and pembrolizumab, changed clinical practice. These drugs have a favourable toxicity profile making them good candidates even for management of vulnerable patients. Regardless of the chosen strategy, attentive supportive care is of paramount importance. Correspondence to Petr Szturz, MD, PhD, Medical Oncology, Department of Oncology, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland. Tel: +41 079 556 76 67; e-mail: szturz@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2FWXiZI

Unknown primary of the head and neck: a new entry in the TNM staging system with old dilemmas for everyday practice

Purpose of review To summarize the most recent nuances in diagnosis, management, and prognostic stratification of carcinoma of unknown primary of the head and neck (CUPHN), in light of its recent re-assessment in the eighth edition of the TNM Classification Manual. Recent findings At least in Western Countries, most CUPHN are expected to be Human Papilloma Virus (HPV)-positive with an oropharyngeal origin. Their appropriate diagnosis starts with fine needle aspiration cytology and/or core biopsy of pathologic lymph node(s) with staining for p16 by immunohistochemistry and subsequent HPV detection by PCR. If these exams are negative (especially in Eastern Countries), in-situ hybridization for Epstein–Barr virus detection should be added. Thorough clinical examination should encompass white light videoendoscopy with the adjunction of bioendoscopic techniques (such as narrow band imaging). Radiologic workup (by CT, MR and/or PET) should be limited to cases that are persistently negative after comprehensive endoscopic evaluation. Invasive diagnostic procedures, such as unilateral or bilateral palatine tonsillectomy and base of tongue mucosectomy, may play a staging as well as a therapeutic role in CUPHN management. Summary Every effort should be made to identify and remove the primary site of a CUPHN: in doing so, possible subsequent de-intensification protocols by irradiation of the neck alone (with or without previous neck dissection according to the cN category, patient's risk profile, and general status) can be taken into consideration on a case-by-case basis. Correspondence to Cesare Piazza, MD, Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, University of Milan, Via Giacomo Venezian 1, 20133 Milan, Italy. E-mail: cesare.piazza@istitutotumori.mi.it, ceceplaza@libero.it Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2GeWbUe

Glucose control in the ICU

Purpose of review Critically ill patients usually develop hyperglycemia, which is associated with adverse outcome. Controversy exists whether the relationship is causal or not. This review summarizes recent evidence regarding glucose control in the ICU. Recent findings Despite promising effects of tight glucose control in pioneer randomized controlled trials, the benefit has not been confirmed in subsequent multicenter studies and one trial found potential harm. This discrepancy could be explained by methodological differences between the trials rather than by a different case mix. Strategies to improve the efficacy and safety of tight glucose control have been developed, including the use of computerized treatment algorithms. Summary The ideal blood glucose target remains unclear and may depend on the context. As compared with tolerating severe hyperglycemia, tight glucose control is well tolerated and effective in patients receiving early parenteral nutrition when provided with a protocol that includes frequent, accurate glucose measurements and avoids large glucose fluctuations. All patient subgroups potentially benefit, with the possible exception of patients with poorly controlled diabetes, who may need less aggressive glucose control. It remains unclear whether tight glucose control is beneficial or not in the absence of early parenteral nutrition. Correspondence to Greet Van den Berghe, MD, PhD, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium. Tel: +32 16 344021; fax +32 16 344015; e-mail: greet.vandenberghe@kuleuven.be Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2DGGzHt

Thoracic trauma in military settings: a review of current practices and recommendations

Purpose of review To examine current literature on thoracic trauma related to military combat and to explore its relevance to the civilian population. Recent findings Damage control resuscitation (DCR) has improved the management of hemorrhaging trauma patients. Permissive hypotension below 110 mmHg and antifibrinolytic use during DCR is widely accepted, whereas the use of freeze-dried plasma and whole blood is gaining popularity. The Modified Physiologic Triaging Tool can be used for primary triage and it may have applications in civilian trauma systems. Although Tactical Combat Casualty Care protocol recommends the Cric-Key device for surgical cricothyroidotomies, other devices may offer comparable performance. Recommendations for regional anesthesia after blunt trauma are not well defined. Increasing amounts of evidence favor the use of extracorporeal membrane oxygenation for refractory hypoxemia and resuscitative endovascular balloon occlusion of the aorta (REBOA) for severe hemorrhage. REBOA outcomes are potentially improved by partial occlusion and small 7 Fr catheters. Summary The Global War on Terror has provided opportunities to better understand and treat thoracic trauma in military settings. Trauma registries and other data sources have contributed to significant advancements in the management of thoracic trauma in military and civilian populations. Correspondence to Robert Mansky, 545 First Ave, Apt 8I, New York, NY 10016, USA. Tel: +1 516 672 5589; e-mail: rmansky@gmail.com Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2UoSVJW

Noninvasive ventilation versus oxygen therapy in patients with acute respiratory failure

Purpose of review High-flow nasal cannula oxygen therapy (HFOT) is becoming an alternative to noninvasive ventilation (NIV) and standard oxygen in management of patients with acute respiratory failure. Recent findings Patients with de novo acute respiratory failure should be managed with HFOT rather than NIV. Indeed, the vast majority of patients with de novo respiratory failure meet the criteria for ARDS, and NIV does not seem protective, as patients generate overly high tidal volume that may worsen underlying lung injury. However, NIV remains the first-line oxygenation strategy in postoperative patients and those with acute hypercapnic respiratory failure when pH is equal to or below 7.35. During preoxygenation, NIV also seems to be more efficient than standard oxygen using valve-bag mask to prevent profound oxygen desaturation. In postoperative cardiothoracic patients, HFOT could be an alternative to NIV in the management of acute respiratory failure. Summary Recent recommendations for managing patients with acute respiratory failure have been established on the basis of studies comparing NIV with standard oxygen. Growing use of HFOT will lead to new studies comparing NIV versus HFOT in view of more precisely defining the appropriate indications for each treatment. Correspondence to Jean-Pierre Frat, Médecine Intensive Réanimation, CHU de Poitiers, 2 rue la Milétrie, 86021 Poitiers Cedex, France. Tel: +33 5 49 44 40 07; e-mail: jean-pierre.frat@chu-poitiers.fr Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2DJ5pa0

The effectiveness of noise interventions in the ICU

Purpose of review Excessive noise has direct adverse physiological and psychological effects, and may also have indirect negative health consequences by reducing sleep quality and quantity. This review presents a synthesis of the epidemiology of noise in the ICU, and the potential interventions designed to attenuate noise and protect patients. Recent findings Noise increases cortisol release, oxygen consumption, and vasoconstriction. ICU noise levels are excessive throughout the 24-h cycle, irrespective of level of intervention or whether the patient is in a side room or open ward. Direct measurement suggests that noise is a substantial contributor to poor sleep quantity and quality in the ICU and is frequently recalled by survivors of critical illness as a negative experience of ICU admission. Noise abatement, environmental masking and pharmacological interventions may all reduce the impact of noise on patients. However, the sustainability of behavioural interventions remains uncertain and high-quality evidence demonstrating the benefit of any intervention on patient-centered outcomes is lacking. Summary Noise levels in the ICU are consistently reported to reach levels likely to have both direct and indirect adverse health consequences for both patients and staff. Noise reduction, abating the transmission of noise and pharmacological modulation of the adverse neural effects of noise are all potentially beneficial strategies, although definitive evidence of improved patient-centered outcomes is lacking. Correspondence to Lori Delaney, MIHM, MN, PGD Crit Care, PGC Ed, Faculty of Nursing, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia. E-mail: Lori.delaney@qut.edu.au Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2UpOJJV

Telemedicine in the ICU: clinical outcomes, economic aspects, and trainee education

Purpose of review The evidence base for telemedicine in the ICU (tele-ICU) is rapidly expanding. The last 2 years have seen important additions to our understanding of when, where, and how telemedicine in the ICU adds value. Recent findings Recent publications and a recent meta-analysis confirm that tele-ICU improves core clinical outcomes for ICU patients. Recent evidence further demonstrates that comprehensive tele-ICU programs have the potential to quickly recuperate their implementation and operational costs and significantly increase case volumes and direct contribution margins particularly if additional logistics and care standardization functions are embedded to optimize ICU bed utilization and reduce complications. Even though the adoption of tele-ICU is increasing and the vast majority of today's medical graduates will regularly use some form of telemedicine and/or tele-ICU, telemedicine modules have not consistently found their way into educational curricula yet. Tele-ICU can be used very effectively to standardize supervision of medical trainees in bedside procedures or point-of-care ultrasound exams, especially during off-hours. Lastly, tele-ICUs routinely generate rich operational data, as well as risk-adjusted acuity and outcome data across the spectrum of critically ill patients, which can be utilized to support important clinical research and quality improvement projects. Summary The value of tele-ICU to improve patient outcomes, optimize ICU bed utilization, increase financial performance and enhance educational opportunities for the next generation of providers has become more evident and differentiated in the last 2 years. Correspondence to Christian D. Becker, MD, PhD, Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York Medical College, Valhalla, NY 10595, USA. Tel: +1 914 493 1040; fax: +1 914 493 8373; e-mail: christian.becker@wmchealth.org Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2DHWsxz

Prophylactic human papilloma virus vaccination in head and neck: indications and future perspectives

Purpose of review To gain the evidence-based knowledge concerning the efficacy of HPV vaccination for oropharyngeal sites and to highlight the trials and strategies for vaccine administration in HPV-dependent head and neck diseases. Recent findings Vaccination can be provided in two injections. There is increasing anecdotal evidence that therapeutic vaccination is effective in treatment of recurrent respiratory papillomatosis. Summary The availability and broadening spectrum of HPV vaccines make possible the prevention of cervical and other HPV-dependent diseases. Vaccination is now included in the national immunization programs of most industrial countries and will be used, it is hoped, in developing countries within the next few years. In developing countries, few women are screened for cervical precancerous lesions, making immunization even more important. In affluent countries and matured societies, with high coverage of cervical screening, the focus of interest will shift to other HPV-related diseases. The HPV vaccination is effective in preventing oral infection with types targeted by the vaccines. Correspondence to Professor Frederik G. Dikkers, MD, PhD, Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. Tel: +31 20 566 3789; e-mail: f.g.dikkers@amc.nl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2G7H0fM

Systemic treatment in elderly head and neck cancer patients: recommendations for clinical practice

Purpose of review Despite the constantly growing number of elderly patients with squamous cell carcinoma of the head and neck (SCCHN), the majority of clinical trials have been focusing on their younger counterparts. However, because of age-related changes and the resulting higher prevalence of frailty, senior people need an adapted evidence-based approach. Recent findings Recommendations presented in this article proceed from those relevant for the general patient population taking into consideration the individual process of aging. In this respect, categorization into fit, vulnerable and frail elderly patients was used to guide systemic treatment. Summary The fit and vulnerable subgroups with locoregionally advanced SCCHN may still benefit from curative treatment, whereas for the remaining cases only palliative measures are usually appropriate. Advanced calendar age is not a contraindication for cisplatin making part of the standard regimens in locally advanced (high-dose 3-weekly schedule concurrent with radiotherapy) and recurrent/metastatic disease (in combination with 5-fluorouracil and cetuximab). In the latter setting, modern immunotherapy with immune checkpoint inhibitors, particularly the antiprogrammed cell death protein-1 (anti-PD-1) agents nivolumab and pembrolizumab, changed clinical practice. These drugs have a favourable toxicity profile making them good candidates even for management of vulnerable patients. Regardless of the chosen strategy, attentive supportive care is of paramount importance. Correspondence to Petr Szturz, MD, PhD, Medical Oncology, Department of Oncology, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland. Tel: +41 079 556 76 67; e-mail: szturz@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2FWXiZI

Unknown primary of the head and neck: a new entry in the TNM staging system with old dilemmas for everyday practice

Purpose of review To summarize the most recent nuances in diagnosis, management, and prognostic stratification of carcinoma of unknown primary of the head and neck (CUPHN), in light of its recent re-assessment in the eighth edition of the TNM Classification Manual. Recent findings At least in Western Countries, most CUPHN are expected to be Human Papilloma Virus (HPV)-positive with an oropharyngeal origin. Their appropriate diagnosis starts with fine needle aspiration cytology and/or core biopsy of pathologic lymph node(s) with staining for p16 by immunohistochemistry and subsequent HPV detection by PCR. If these exams are negative (especially in Eastern Countries), in-situ hybridization for Epstein–Barr virus detection should be added. Thorough clinical examination should encompass white light videoendoscopy with the adjunction of bioendoscopic techniques (such as narrow band imaging). Radiologic workup (by CT, MR and/or PET) should be limited to cases that are persistently negative after comprehensive endoscopic evaluation. Invasive diagnostic procedures, such as unilateral or bilateral palatine tonsillectomy and base of tongue mucosectomy, may play a staging as well as a therapeutic role in CUPHN management. Summary Every effort should be made to identify and remove the primary site of a CUPHN: in doing so, possible subsequent de-intensification protocols by irradiation of the neck alone (with or without previous neck dissection according to the cN category, patient's risk profile, and general status) can be taken into consideration on a case-by-case basis. Correspondence to Cesare Piazza, MD, Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, University of Milan, Via Giacomo Venezian 1, 20133 Milan, Italy. E-mail: cesare.piazza@istitutotumori.mi.it, ceceplaza@libero.it Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2GeWbUe

Genome‐wide association study of inhaled corticosteroid response in admixed children with asthma

Abstract

Background

Inhaled corticosteroids (ICS) are the most widely prescribed and effective medication to control asthma symptoms and exacerbations. However, many children still have asthma exacerbations despite treatment, particularly in admixed populations, such as Puerto Ricans and African Americans. A few genome‐wide association studies (GWAS) have been performed in European and Asian populations, and they have demonstrated the importance of the genetic component in ICS response.

Objective

We aimed to identify genetic variants associated with asthma exacerbations in admixed children treated with ICS, and to validate previous GWAS findings.

Methods

A meta‐analysis of two GWAS of asthma exacerbations was performed in 1,347 admixed children treated with ICS (Hispanics/Latinos and African Americans), analyzing 8.7 million genetic variants. Those with p≤5x10^‐6 were followed up for replication in 1,697 asthmatic patients from six European studies. Associations of ICS response described in published GWAS were followed up for replication in the admixed populations.

Results

A total of 15 independent variants were suggestively associated with asthma exacerbations in admixed populations (p≤5x10^‐6). One of them, located in the intergenic region of APOBEC3B and APOBEC3C, showed evidence of replication in Europeans (rs5995653, p = 7.52x10^‐3) and was also associated with change in lung function after treatment with ICS (p = 4.91x10^‐3). Additionally, the reported association of the L3MBTL4‐ARHGAP28 genomic region was confirmed in admixed populations, although a different variant was identified.

Conclusions & Clinical Relevance

This study revealed the novel association of APOBEC3B and APOBEC3C with asthma exacerbations in children treated with ICS and replicated previously identified genomic regions. This contributes to the current knowledge about the multiple genetic markers determining responsiveness to ICS which could lead in the future the clinical identification of those asthma patients who are not able to respond to such treatment.

This article is protected by copyright. All rights reserved.

http://bit.ly/2RVbuJ0

Cutaneous granulomatous lesions in a patient with mucosa‐associated lymphoid tissue (MALT) lymphoma

http://bit.ly/2Ba8ON3

Inherited desmoplastic trichoepitheliomas

http://bit.ly/2WoosO5

Takotsubo cardiomyopathy triggered by status epilepticus: case report and literature review

Takotsubo cardiomyopathy (TC) is acute stress-induced cardiomyopathy with characteristic transient wall motion abnormalities. TC has a clinical presentation similar to an acute coronary syndrome, including chest pain or dyspnoea, ECG changes and elevated cardiac enzymes. TC often occurs after emotional stress. There are approximately 50 TC cases reported related to seizure activity, and our review revealed 15 articles which were associated with status epilepticus. This condition can be a serious complication of seizures. We report a case of TC after status epilepticus in a patient who had been seizure-free for 20 years.

http://bit.ly/2DI3TVy

Stroke or side effect? dofetilide associated facial paralysis after direct current cardioversion for atrial fibrillation

Dofetilide is a class III antiarrhythmic drug that has proven efficacious in maintaining sinus rhythm in up to 60% of patients with persistent atrial fibrillation. Dofetilide's most concerning adverse effect is QT prolongation and polymorphic VT, but providers should be aware of other rare significant side effects. We report a case of dofetilide associated Bell's palsy masquerading as stroke that developed shortly after a cardioversion. The patient's facial weakness, a side effect of dofetilide, resolved relatively quickly after discontinuation of the medication and a short course of oral corticosteroids.

http://bit.ly/2UsZSd3

Intra-atrial course of the right coronary artery: depiction of a potentially hazardous entity on dual-source CT

http://bit.ly/2Upm8o7

Proximal tibiofibular joint dislocation: a rare entity

A 37-year-old woman was diagnosed with an isolated proximal tibiofibular joint dislocation (PTJD) after an accident during gymnastic exercise. The dislocation has a low incidence rate and is often missed in the emergency department as physical and radiology signs are subtle. Treatment consists of closed or open reduction and immobilisation. When it is not recognised it is associated with significant peroneal nerve injury.

http://bit.ly/2DIVcuc

Placental chorioangioma associated with polyhydramnios and hydrops fetalis

A 27-year-old multigravida woman was noted on routine growth scan at 27 weeks gestation to have a central placental hypoechoic area measuring 6.7x6.0x4.4 cm. A subsequent magnetic resonance scan confirmed a solid mass in the placenta lying anteriorly; therefore, a preliminary diagnosis of giant placental chorioangioma was made. A repeat ultrasound scan at 30 weeks gestation indicated that the mass had increased, with the presence of polyhydramnios. The patient experienced reduced fetal movements at 31 weeks gestation. There was persistent fetal tachycardia at 33 weeks gestation, and consequently the neonate was delivered by emergency caesarean section. The placenta revealed a large chorioangioma. The neonate's birth weight was 2.85 kg and non-immune hydrops fetalis was diagnosed. The neonate improved significantly in the neonatal intensive care unit and is currently well with no medical problems.

http://bit.ly/2Upm4ET

Erythema ab igne as a complication of cannabinoid hyperemesis syndrome

http://bit.ly/2DI1cmH

Bacteraemia and multiple liver abscesses due to Fusobacterium nucleatum in a patient with oropharyngeal malignancy

Fusobacterium infections can have a wide clinical spectrum, ranging from mild infections to severe sepsis and abscess formation. This range depends partly on the patient's underlying conditions, such as immunosuppression or malignancy. Fusobacteria are commensal rods in the oropharyngeal cavity and digestive tract, but should mucosal barrier disruption occur, in the presence of the above-mentioned predisposing conditions, fusobacteria can spread and cause infections in the soft tissues, liver and so on. An elderly woman was admitted with an altered level of consciousness (lethargy). The ensuing workup revealed a posterior oral cavity tumour (squamous cell carcinoma), Fusobacterium nucleatum bacteraemia and liver abscesses. Due to the severe sepsis, the patient was referred to our intensive care unit, but she passed away despite antibiotic treatment.

http://bit.ly/2Upm1sH

Alports syndrome and intracranial aneurysm: mere coincidence or undiscovered causal relationship

A 44-year-old Caucasian man with a history of deceased donor renal transplant for end-stage renal disease from Alport's syndrome (AS), presented with a spontaneous subarachnoid haemorrhage and hydrocephalus. Following an external ventricular drain for the hydrocephalus, a CT angiography revealed a dissection of the left vertebral artery extending into vertebro-basilar junction necessitating a bypass between left occipital artery to left posterior inferior cerebellar artery. He had a posterior fossa Craniectomy, C1 laminectomy and coiling off, of the left vertebral artery. Postprocedure course was prolonged but uneventful with complete recovery and normal renal function 18 months postpresentation. AS, a disease caused by abnormalities in the synthesis of type IV collagen, can cause aneurysms with severe and permanent neurological sequalae. We present a case of AS with intracranial arterial dissection with potential life-threatening consequences and discuss the genetic and molecular basis of AS along with review of the relevant literature.

http://bit.ly/2DI3Vg8

Disseminated intestinal basidiobolomycosis with mycotic aneurysm mimicking obstructing colon cancer

Basidiobolomycosis is a rare fungal infection that may affect the gastrointestinal tract. It is caused by Basidiobolus ranarum and less than 80 cases have been reported in the literature. The incidence seems to be higher in the Middle East and in particular Saudi Arabia where most cases are diagnosed in the south-western region. An 18-year-old woman presented to the emergency department with an obstructing caecal mass initially suspected to be malignant. Surgical resection was complicated by bowel perforation, histology and cultures confirmed basidiobolomycosis infection. The postoperative course was complicated by an enterocutaneous fistula, fungal intra-abdominal abscesses, liver and lung abscesses, formation of mycotic hepatic artery aneurysm and meningoencephalitis. The patient eventually expired due to sepsis despite aggressive treatment. Diagnosis and management of such rare cases are very challenging and require a multidisciplinary approach. Complications are common and associated with a high mortality.

http://bit.ly/2UplW8n

Fusobacterium necrophorum sepsis after tonsillitis/pharyngitis

Fusobacterium necrophorum is a rare infection most notable for causing Lemierre's syndrome. This consists of a primary oropharyngeal infection and septic thrombophlebitis, and one or more metastatic focus. Prior to the widespread use of antibiotics, Lemierre's syndrome commonly followed a rapidly progressing course, with a high mortality. We describe a case of a previously well 18-month-old boy who presented to the emergency department with a 3-week history of progressive, right-sided, painful neck swelling and systemic sepsis. He was initially treated conservatively with intravenous antibiotics, but ultimately required surgical drainage. Lemierre's syndrome is a rare condition with increasing incidence which can have significant adverse outcomes including death. Early recognition and treatment are essential, but identifying Lemierre's disease is challenging.

http://bit.ly/2DJfFPp

Emergency management of massive haemoptysis

In this manuscript, we present a rare case of massive haemoptysis secondary to rupture of a pulmonary artery aneurysm, which was unusual for having occurred in the absence of tuberculosis or a vasculitis. We describe the emergency management of this that ultimately resulted in the patient's survival from both an anaesthetic and surgical perspective, as well as discuss the role of interventional radiology in this situation.

http://bit.ly/2UwbJqV

Invasive aspergillosis complicating treatment with tyrosine kinase inhibitors

We describe three cases of pulmonary aspergillosis (PA) in three patients without traditional risk factors for invasive aspergillosis infection, such as prolonged neutropenia or high dose systemic corticosteroid therapy. All three patients developed PA while taking tyrosine kinase inhibitors (TKI) and sustained greater clinical improvement once TKI were withdrawn. Our case series supports the theory TKI treatment can increase susceptibility to PA without causing neutropenia. Recognition that TKI treatment may predispose to invasive aspergillosis will allow for rapid recognition of affected patients and more effective management of future cases.

http://bit.ly/2UplJlB

Tubulointerstitial nephritis and uveitis syndrome in a female adult

Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disease characterised by the association of acutetubulointerstitial nephritis and uveitis. It affects mainly children and young women. Drugs and infections may be precipitating factors. It is a diagnosis of exclusion. The mainstays of treatment are topical and systemic corticosteroids. Prognosis is usually favourable. We report a case of TINU which occurred in our unit. A 37-year-old woman presented with an influenza-like illness, bilateral ocular pain and blurred vision. Ophthalmological evaluation revealed bilateral anterior uveitis and later renal involvement was seen as acute tubulointerstitial nephritis. A diagnosis of TINU was assumed after exclusion of other systemic diseases. She was treated with topical corticosteroids for the uveitis and evolved favourably, with resolution of ocular symptoms and normalisation of serum creatinine and proteinuria. This case highlights the importance of a high degree of clinical suspicion to make the diagnosis of TINU syndrome.

http://bit.ly/2DK2EVT

Acute ischaemic stroke-related choreoathetosis treated with arterial thrombectomy

A rare case of acute choreoathetosis after acute stroke is presented. This 66-years-old, right-handed Caucasian woman presented with weakness of her right arm and right leg with dysarthria, which resolved by the time she arrived in the emergency department. No obvious focal sign apart from the abnormal choreoathetoid movement of the right arm and leg and of the neck was present. Her medical history included atrial fibrillation without anticoagulation. CT head was nil acute (Alberta Stroke Program Early CT Score of 10). CT angiography of the carotids showed a hyperdense M2 segment of the left middle cerebral artery. Intravenous thrombolysis immediately followed by thrombectomy was decided. Using the Penumbra aspiration device (ACE 68) two clots were removed with two aspirations. A small distal clot remained but partial recanalisation (Thrombolysis in Myocardial Infarction/Thrombolysis in Cerebral Infarction 2b) was achieved. 30 seconds after restoring blood flow, the choreoathetoid movements ceased. The patient was brought to intensive care for further monitoring, which was uneventful.

http://bit.ly/2Um2CsG

Persistent sciatic artery resembles a soft-tissue sarcoma in presentation

Persistent sciatic artery (PSA) is a rare vascular anomaly with estimated incidence of 0.03%–0.06%. It has high incidence of complications including aneurysmal formation and ischaemia that may lead to amputation. During early embryonic development, the sciatic artery (which usually supply fetal lower buds and caudal part) disappears when the superficial femoral artery develops properly and the lower limbs grow. On clinical examination, usually a pulsating gluteal mass (the aneurysm) is appreciated with weak or absent femoral artery (Cowie's sign). However, our patient had presented in a different way. She was referred from peripheral clinic as a case of possible liposarcoma in the gluteal region. On examination, there was obvious asymmetry between both buttocks. The affected side was hard, firm in consistency with no appreciable pulsation. Nevertheless, on auscultation there was a bruit of low grade. Peripheral pulses were palpable. Our clinical impression was towards a sarcoma namely a liposarcoma. MRI was requested to evaluate the mass. The radiology report suggested that most probably it is an angiosarcoma with slim possibility of being a cavernous haemangioma. The trucut biopsy was deferred, in view of the high vascular nature of the lesion. The plan was as follow: To do angiography and embolisation of the main feeding vessels, with the possibility of biopsy in a second incident if indicated.During the conventional angiography, the pathology revealed itself. The patient was type 3 according to Pillet-Gauffre classification (PSA is limited to gluteal area and the popliteal artery arising from the femoral artery) associated with huge arteriovenous malformation. Embolisation with different materials including coils, beads and foam was ineffective. Finally, the radiologist excluded the root of the sciatic artery by a stent bridging from common iliac to external iliac artery. This successfully occluded the PSA.

http://bit.ly/2DIn55e

Congenital lateral cleft palate with unilateral craniofacial microsomia and lateral ankyloglossia

Craniofacial microsomia is a group of anomalies that occur due to developmental defects in the first and second branchial arches during the embryological period. The disease has various craniofacial and extracraniofacial presentation patterns. Lateral cleft palate is distinct from the most common palate clefts because it is located lateral to the uvula. The presence of a lateral cleft palate has been very rarely reported in the literature, and the aetiopathogenesis of the disease is still not well understood. We aimed to report a case of the coexistence of lateral cleft palate and craniofacial microsomia and discuss the aetiopathogenesis of these diseases.

http://bit.ly/2Un2mte

Headache and inflammatory bowel disease: think cerebral vein!

Cerebral vein thrombosis is a severe complication of inflammatory bowel disease, can cause non-specific symptoms and hence lead to delay in diagnosis. We report the case of an adolescent with inflammatory bowel disease who developed extensive cerebral vein thrombosis requiring a ventriculoperitoneal shunt. Diagnosis was markedly delayed due to repeated misinterpretation of clinical signs and laboratory findings and the lack of reconsidering the working diagnosis despite the involvement of several medical subspecialties. The patient does not suffer from any neurological impairment. This case report highlights the need for clinicians to maintain vigilance for complications of chronic disease and encourages to cast doubt on the working diagnosis constantly.

http://bit.ly/2DI3Tow

Rivaroxaban-related acute kidney injury in a patient with IgA vasculitis

Anticoagulants have recently been recognised as a cause of acute kidney injury (AKI). We describe the case of a 75-year-old man with IgA vasculitis and atrial fibrillation treated with rivaroxaban, who presented with macroscopic haematuria and an acute decline in renal function. Two months before referral, he noted palpable purpuric lesions and was diagnosed with IgA vasculitis based on skin biopsy findings; the skin lesion disappeared following treatment with a steroid external preparation. Renal biopsy revealed glomerular haemorrhage and red blood cell casts. Although rivaroxaban was withdrawn, his kidney function worsened and he was started on haemodialysis. His renal function did not recover. To the best of our knowledge, this is the first case of direct oral anticoagulant (DOAC)-related AKI in systemic vasculitis. During DOAC therapy, close monitoring of a patient's urinalysis results and their renal function may be required for patients with systemic vasculitis to avoid AKI.

http://bit.ly/2DImUqA

Synovial sarcoma in an HIV-positive pregnant woman and review of literature

We present a first case of synovial sarcoma in an HIV-positive pregnant woman. This 28-year-old woman was diagnosed with synovial sarcoma, a high-grade malignant soft tissue sarcoma, involving her left thigh during the first trimester of her pregnancy. She underwent surgical treatment in the form of hip disarticulation at 30 weeks' gestation. She was subsequently delivered by emergency caesarean section (CS) at 34 weeks' gestation when she presented with wound sepsis and a scan revealed static growth in a small for gestational age fetus. Prompt diagnosis and treatment of this aggressive tumour is important and should involve a multidisciplinary approach, with a balanced consideration of the maternal and fetal outcomes.

http://bit.ly/2UrKCgi

Gross anterior segment ischaemia following vitreoretinal surgery for sickle-cell retinopathy

We report the case of a 32-year-old Afrocaribbean man with known stage 3 proliferative sickle-cell retinopathy who presented with a mixed picture of tractional and rhegmatogenous macula off detachment. He underwent left primary 25 g vitrectomy with silicone oil, delamination and endolaser photocoagulation under a general anaesthetic. He, however, presented 48 hours postoperatively with gross anterior segment ischaemia. His pain and ocular signs settled over the course of a few days following administration of supplemental oxygen, oral steroids, analgesia and intravenous hydration. Examination showed resolution of his proptosis and orbital signs as well as anterior segment inflammation. He remains under follow-up.

http://bit.ly/2DImO2c

Treatment of Ethylene Glycol Poisoning with Oral Ethyl Alcohol

Ethylene glycol poisoning is not uncommon in India. The ill effects are primarily caused by its toxic metabolites: glycolic acid and oxalic acid. A 70-year-old female presented to our hospital with ataxia after ingestion of ethylene glycol. The reported case describes the management of ethylene glycol poisoning using oral ethyl alcohol as an alternative to the recommended intravenous ethyl alcohol and fomepizole that are not available for use in India. The need for high degree of clinical suspicion, targeted investigations, and early instigation of treatment is of prime importance in cases of ethylene glycol poisoning as it can lead to long-term complications or even death.

http://bit.ly/2B9Jbfs

Comparison of NOSE Scores Following Functional Septorhinoplasty Using Autologous versus Cadaveric Rib

Facial plast Surg
DOI: 10.1055/s-0039-1677718

In functional septorhinoplasty (FSRP), alternative grafting material is used if septal cartilage is insufficient for reconstructive needs. Autologous costal cartilage (ACC) and irradiated homologous costal cartilage (IHCC) are compared via the Nasal Obstruction Symptom Evaluation (NOSE) scale. One-hundred forty-one patients who underwent FSRP with ACC or IHCC between January 2013 and March 2018 were administered the NOSE scale pre- and postoperatively at 2, 4, 6, and 12 months. There was no significant difference in mean NOSE scores between the ACC and IHCC cohorts at the preoperative visit (68.5 [standard deviation, SD 24.1] and 71.7 [20.1], respectively; p < 0.6) or first postoperative visit (30.4 [26.6] and 33.9 [30.4], respectively; p < 0.6) or subsequent visits. NOSE scores demonstrated a clinically and statistically significant improvement at all follow-up time points for both the ACC and IHCC groups. Patients who underwent grafting with IHCC were significantly older than those with ACC; average age of 55.6 [SD: 17.3] versus 40.1 [SD:12.1]; (p < 0.001). Two IHCC (0.05%) patients had postoperative infections; both resolved with antibiotics, but one required revision surgery. Both ACC and IHCC provide reliable grafting material when septal cartilage is insufficient. In FSRP for nasal airway obstruction, ACC and IHCC both provide a clinically and statistically significant reduction in NOSE scores postoperatively that remain stable between follow-up time points. The authors find no difference in NOSE scores between the ACC and IHCC groups; however, IHCC did have a higher rate of postoperative infection. Both materials should be discussed with patients and are an important part of the informed consent process.
[...]

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

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

http://bit.ly/2sSFUN1

Detecting the recruitment phenomenon in adults using 80-Hz auditory steady-state response

The ASSR is used widely as an objective measurement of hearing in clinical settings because of its high frequency specificity. The recruitment phenomenon is generally detected using subjective evaluations which require direct communication with the patient. If the recruitment phenomenon can be detected with ASSR, it would facilitate diagnosis in patients with developmental disorders and infants.

http://bit.ly/2CQO2lV

Use of Aloe Vera and Turmeric Paste as a Supplementary Medicine in Oral Submucosal Fibrosis: A Pilot Study

Abstract

Oral submucosal fibrosis is the major health issue affecting 2.5 million Indian population under the age of 40 years. All the available treatments give only symptomatic relief which is short lived.The incidence of Oral submucosal fibrosis still rising alarmingly and there is a dire need to search for an effective and safe remedy because of lack of present therapies to either provide a complete cure or treating the patients at the cost of adverse effects. A total of 140 clinically diagnosed patients with Oral submucosal fibrosis (diagnosed on the basis of reduction in interincisal distance on maximum mouth opening and palpable fibrous bands involving oral mucosa) within the age range of 18–50 years with decreased interincisal opening were selected (time period 1.5 year). These patients were given Inj. Triamcinolone (40 mg) and Inj Hyaluronidase every 21 days. Pt was divided in 2 groups (each containing both males and females) those receiving Triamcinolone ointment alone BD (control) and those receiving Triamcinolone ointment BD along with turmeric & aloe vera paste combination (test). A statistically significant improvement was seen in both burning sensation and mouth opening in both males and females. The result of the study shows that the synergistic action of these herbs results in higher efficacy and highly potent Oral submucosal fibrosis treatment.

http://bit.ly/2RpyzhM

Vestibular Evoked Myogenic Potentials After Epleys Manoeuvre Among Individuals with Benign Paroxysmal Positional Vertigo

Abstract

VEMP abnormalities in individuals with BPPV are often reported to be associated with utricle and saccule degeneration. The aim of the present study is to assess the frequency of VEMP abnormalities using vestibular evoked myogenic potentials in individuals with Posterior canal Benign Paroxysmal Positional Vertigo (BPPV) after Epley's manoeuvre. 36 individuals (36 ears) with definite posterior canal BPPV and 36 healthy controls were considered for the present study. All the them underwent otoscopic examination, Dix–Hallpike manoeuvre to diagnose posterior canal BPPV. Further Audiological Evaluation including pure tone audiometry was carried out to rule out vestibular disorders associated with hearing loss. Epley's manoeuvre was performed on all individuals with BPPV by an experienced otorhinolaryngologist. Cervical and Ocular Vestibular Evoked Myogenic Potentials (VEMP) were used to investigate the saccule and utricle functions following Epley's manoeuvre. Cervical VEMP and ocular VEMP abnormalities were observed in 8/36 (22.22%) and 18/36 (50%) affected ears with BPPV respectively. Cervical VEMP responses were reduced in amplitude among 1/36 (2.77%) and absent in 7/36 (19.44%) of affected ears with BPPV. Ocular VEMP responses were reduced in amplitude on 11/36 (30.55%), followed by absent responses in 5/36 (13.88%) ears with BPPV. Two patients with posterior canal BPPV i.e., 4/64 (5.55%) ears had bilateral absence of ocular VEMP responses. Two ears with BPPV 2/36 (5.55%) had absence of both cervical and ocular VEMP responses in BPPV affected ear. T test showed significant difference (p < 0.01) in the amplitude of ocular VEMP among posterior canal BPPV individuals when compared to cervical VEMP. The present study highlights individuals with Posterior canal BPPV may have otoconia dislodgement or macular degeneration of utricle, saccule, both utricle and saccule unilaterally, or bilaterally. VEMP may be useful in evaluating degeneration of both otolith organs associated with BPPV.

http://bit.ly/2WpEszg

Plasma TNF‐α and adiponectin levels differentiate psoriatic arthritis from psoriasis patients

Abstract

Psoriasis (PsO) and psoriatic arthritis (PsA) are inflammatory disorders. Circulating biomarkers of inflammation such as interleukin‐6 (IL‐6), Tumor Necrosis Factor‐α (TNF‐α), and C‐reactive protein (CRP) have been associated with disease severity and progression of PsO and PsA. Adiponectin and leptin are adipose derived cytokines, recognized as key regulator of body weight and metabolism². Whether circulating levels of these inflammatory and metabolic biomarkers may predict the risk of PsA in psoriasis populations remains unclear.

This article is protected by copyright. All rights reserved.

http://bit.ly/2sTKgnh

Physician Perceptions of Primary Care‐based Skin Cancer Screening in a Veterans Affairs Pilot Study

Abstract

Understanding primary care practitioner (PCP) barriers and facilitators to performing clinical skin examination (CSE) for skin cancer screening is necessary before widespread implementation. Time constraints, competing comorbidities, and patient embarrassment have been reported as obstacles. In 2016, the United States Preventative Services Task Force deemed the worldwide evidence as insufficient to assess the balance of benefits versus harms of skin cancer screening (I statement), neither recommending for nor against CSE. While the impact of primary care‐based skin cancer screening on melanoma incidence and mortality has been investigated, qualitative studies describing PCP feedback and diverse contextual factors that may help or hinder program implementation are lacking.

This article is protected by copyright. All rights reserved.

http://bit.ly/2MEgtYK

Use of Aloe Vera and Turmeric Paste as a Supplementary Medicine in Oral Submucosal Fibrosis: A Pilot Study

Abstract

Oral submucosal fibrosis is the major health issue affecting 2.5 million Indian population under the age of 40 years. All the available treatments give only symptomatic relief which is short lived.The incidence of Oral submucosal fibrosis still rising alarmingly and there is a dire need to search for an effective and safe remedy because of lack of present therapies to either provide a complete cure or treating the patients at the cost of adverse effects. A total of 140 clinically diagnosed patients with Oral submucosal fibrosis (diagnosed on the basis of reduction in interincisal distance on maximum mouth opening and palpable fibrous bands involving oral mucosa) within the age range of 18–50 years with decreased interincisal opening were selected (time period 1.5 year). These patients were given Inj. Triamcinolone (40 mg) and Inj Hyaluronidase every 21 days. Pt was divided in 2 groups (each containing both males and females) those receiving Triamcinolone ointment alone BD (control) and those receiving Triamcinolone ointment BD along with turmeric & aloe vera paste combination (test). A statistically significant improvement was seen in both burning sensation and mouth opening in both males and females. The result of the study shows that the synergistic action of these herbs results in higher efficacy and highly potent Oral submucosal fibrosis treatment.

http://bit.ly/2RpyzhM

Vestibular Evoked Myogenic Potentials After Epleys Manoeuvre Among Individuals with Benign Paroxysmal Positional Vertigo

Abstract

VEMP abnormalities in individuals with BPPV are often reported to be associated with utricle and saccule degeneration. The aim of the present study is to assess the frequency of VEMP abnormalities using vestibular evoked myogenic potentials in individuals with Posterior canal Benign Paroxysmal Positional Vertigo (BPPV) after Epley's manoeuvre. 36 individuals (36 ears) with definite posterior canal BPPV and 36 healthy controls were considered for the present study. All the them underwent otoscopic examination, Dix–Hallpike manoeuvre to diagnose posterior canal BPPV. Further Audiological Evaluation including pure tone audiometry was carried out to rule out vestibular disorders associated with hearing loss. Epley's manoeuvre was performed on all individuals with BPPV by an experienced otorhinolaryngologist. Cervical and Ocular Vestibular Evoked Myogenic Potentials (VEMP) were used to investigate the saccule and utricle functions following Epley's manoeuvre. Cervical VEMP and ocular VEMP abnormalities were observed in 8/36 (22.22%) and 18/36 (50%) affected ears with BPPV respectively. Cervical VEMP responses were reduced in amplitude among 1/36 (2.77%) and absent in 7/36 (19.44%) of affected ears with BPPV. Ocular VEMP responses were reduced in amplitude on 11/36 (30.55%), followed by absent responses in 5/36 (13.88%) ears with BPPV. Two patients with posterior canal BPPV i.e., 4/64 (5.55%) ears had bilateral absence of ocular VEMP responses. Two ears with BPPV 2/36 (5.55%) had absence of both cervical and ocular VEMP responses in BPPV affected ear. T test showed significant difference (p < 0.01) in the amplitude of ocular VEMP among posterior canal BPPV individuals when compared to cervical VEMP. The present study highlights individuals with Posterior canal BPPV may have otoconia dislodgement or macular degeneration of utricle, saccule, both utricle and saccule unilaterally, or bilaterally. VEMP may be useful in evaluating degeneration of both otolith organs associated with BPPV.

http://bit.ly/2WpEszg

Facial masculinity does not appear to be a condition-dependent male ornament and does not reflect MHC heterozygosity in humans [Anthropology]

Recent studies have called into question the idea that facial masculinity is a condition-dependent male ornament that indicates immunocompetence in humans. We add to this growing body of research by calculating an objective measure of facial masculinity/femininity using 3D images in a large sample (n = 1,233) of people of...

http://bit.ly/2Tm5DZR

Long-term effects of institutional rearing, foster care, and brain activity on memory and executive functioning [Psychological and Cognitive Sciences]

Children experiencing psychosocial deprivation as a result of early institutional rearing demonstrate many difficulties with memory and executive functioning (EF). To date, there is scant evidence that foster care placement remediates these difficulties during childhood. The current study examined longitudinal trajectories of memory and EF from childhood to adolescence in...

http://bit.ly/2BbE52c

Unraveling the seasonal epidemiology of pneumococcus [Population Biology]

Infections caused by Streptococcus pneumoniae—including invasive pneumococcal diseases (IPDs)—remain a significant public health concern worldwide. The marked winter seasonality of IPDs is a striking, but still enigmatic aspect of pneumococcal epidemiology in nontropical climates. Here we confronted age-structured dynamic models of carriage transmission and disease with detailed IPD incidence data...

http://bit.ly/2Tm5sOb

Feeding state sculpts a circuit for sensory valence in Caenorhabditis elegans [Neuroscience]

Hunger affects the behavioral choices of all animals, and many chemosensory stimuli can be either attractive or repulsive depending on an animal's hunger state. Although hunger-induced behavioral changes are well documented, the molecular and cellular mechanisms by which hunger modulates neural circuit function to generate changes in chemosensory valence are...

http://bit.ly/2B9znSx

Transient receptor potential melastatin 2 governs stress-induced depressive-like behaviors [Neuroscience]

Major depressive disorder (MDD) is a devastating disease that arises in a background of environmental risk factors, such as chronic stress, that produce reactive oxygen species (ROS) in the brain. The chronic stress-induced ROS production involves Ca2+ signals; however, the mechanism is poorly understood. Transient receptor potential melastatin type 2...

http://bit.ly/2TmNiM8

Extinction learning with social support depends on protein synthesis in prefrontal cortex but not hippocampus [Neuroscience]

Extinction of contextual fear conditioning (CFC) in the presence of a familiar nonfearful conspecific (social support), such as that of others tasks, can occur regardless of whether the original memory is retrieved during the extinction training. Extinction with social support is blocked by the protein synthesis inhibitors anisomycin and rapamycin...

http://bit.ly/2B7ygTy

Vaccine protection against SIVmac239 acquisition [Microbiology]

The biological characteristics of HIV pose serious difficulties for the success of a preventive vaccine. Molecularly cloned SIVmac239 is difficult for antibodies to neutralize, and a variety of vaccine approaches have had great difficulty achieving protective immunity against it in rhesus monkey models. Here we report significant protection against i.v....

http://bit.ly/2Tm5vcP

Noncontiguous operon is a genetic organization for coordinating bacterial gene expression [Microbiology]

Bacterial genes are typically grouped into operons defined as clusters of adjacent genes encoding for proteins that fill related roles and are transcribed into a single polycistronic mRNA molecule. This simple organization provides an efficient mechanism to coordinate the expression of neighboring genes and is at the basis of gene...

http://bit.ly/2B5vXQH

Suppression of chemotherapy-induced cytokine/lipid mediator surge and ovarian cancer by a dual COX-2/sEH inhibitor [Medical Sciences]

Although chemotherapy is a conventional cancer treatment, it may induce a protumorigenic microenvironment by triggering the release of proinflammatory mediators. In this study, we demonstrate that ovarian tumor cell debris generated by first-line platinum- and taxane-based chemotherapy accelerates tumor progression by stimulating a macrophage-derived "surge" of proinflammatory cytokines and bioactive...

http://bit.ly/2TmNlYk

Comparison of immune infiltrates in melanoma and pancreatic cancer highlights VISTA as a potential target in pancreatic cancer [Immunology and Inflammation]

Immune checkpoint therapy (ICT) has transformed cancer treatment in recent years; however, treatment response is not uniform across tumor types. The tumor immune microenvironment plays a critical role in determining response to ICT; therefore, understanding the differential immune infiltration between ICT-sensitive and ICT-resistant tumor types will help to develop effective...

http://bit.ly/2BbUgNc

The functional importance of human foot muscles for bipedal locomotion [Evolution]

Human feet have evolved to facilitate bipedal locomotion, losing an opposable digit that grasped branches in favor of a longitudinal arch (LA) that stiffens the foot and aids bipedal gait. Passive elastic structures are credited with supporting the LA, but recent evidence suggests that plantar intrinsic muscles (PIMs) within the...

http://bit.ly/2Tm5yp1

Arid1a is essential for intestinal stem cells through Sox9 regulation [Medical Sciences]

Inactivating mutations of Arid1a, a subunit of the Switch/sucrose nonfermentable chromatin remodeling complex, have been reported in multiple human cancers. Intestinal deletion of Arid1a has been reported to induce colorectal cancer in mice; however, its functional role in intestinal homeostasis remains unclear. We investigated the functional role of Arid1a in...

http://bit.ly/2BaK3Ay

ABL kinase inhibition promotes lung regeneration through expansion of an SCGB1A1+ SPC+ cell population following bacterial pneumonia [Cell Biology]

Current therapeutic interventions for the treatment of respiratory infections are hampered by the evolution of multidrug resistance in pathogens as well as the lack of effective cellular targets. Despite the identification of multiple region-specific lung progenitor cells, the identity of molecules that might be therapeutically targeted in response to infections...

http://bit.ly/2B47E5V

Human cytomegalovirus G protein-coupled receptor US28 promotes latency by attenuating c-fos [Microbiology]

Human cytomegalovirus (HCMV) is a ubiquitous pathogen that undergoes latency in cells of the hematopoietic compartment, although the mechanisms underlying establishment and maintenance of latency remain elusive. We previously reported that the HCMV-encoded G protein-coupled receptor (GPCR) homolog US28 is required for successful latent infection. We now show that US28...

http://bit.ly/2B8NozS

PP2C phosphatases promote autophagy by dephosphorylation of the Atg1 complex [Cell Biology]

Macroautophagy is orchestrated by the Atg1-Atg13 complex in budding yeast. Under nutrient-rich conditions, Atg13 is maintained in a hyperphosphorylated state by the TORC1 kinase. After nutrient starvation, Atg13 is dephosphorylated, triggering Atg1 kinase activity and macroautophagy induction. The phosphatases that dephosphorylate Atg13 remain uncharacterized. Here, we show that two redundant...

http://bit.ly/2TmNxa0

Structure of the lipoprotein lipase-GPIHBP1 complex that mediates plasma triglyceride hydrolysis [Medical Sciences]

Lipoprotein lipase (LPL) is responsible for the intravascular processing of triglyceride-rich lipoproteins. The LPL within capillaries is bound to GPIHBP1, an endothelial cell protein with a three-fingered LU domain and an N-terminal intrinsically disordered acidic domain. Loss-of-function mutations in LPL or GPIHBP1 cause severe hypertriglyceridemia (chylomicronemia), but structures for LPL...

http://bit.ly/2B9qx7s

Cross-species hybridization and the origin of North African date palms [Evolution]

Date palm (Phoenix dactylifera L.) is a major fruit crop of arid regions that were domesticated ∼7,000 y ago in the Near or Middle East. This species is cultivated widely in the Middle East and North Africa, and previous population genetic studies have shown genetic differentiation between these regions. We...

http://bit.ly/2B6GVFK

Varroa destructor feeds primarily on honey bee fat body tissue and not hemolymph [Physiology]

The parasitic mite Varroa destructor is the greatest single driver of the global honey bee health decline. Better understanding of the association of this parasite and its host is critical to developing sustainable management practices. Our work shows that this parasite is not consuming hemolymph, as has been the accepted...

http://bit.ly/2Babuul

A rigorous measure of genome-wide genetic shuffling that takes into account crossover positions and Mendel’s second law [Evolution]

Comparative studies in evolutionary genetics rely critically on evaluation of the total amount of genetic shuffling that occurs during gamete production. Such studies have been hampered by the absence of a direct measure of this quantity. Existing measures consider crossing-over by simply counting the average number of crossovers per meiosis....

http://bit.ly/2TmNwCY

In vivo measurement of trabecular meshwork stiffness in a corticosteroid-induced ocular hypertensive mouse model [Medical Sciences]

Ocular corticosteroids are commonly used clinically. Unfortunately, their administration frequently leads to ocular hypertension, i.e., elevated intraocular pressure (IOP), which, in turn, can progress to a form of glaucoma known as steroid-induced glaucoma. The pathophysiology of this condition is poorly understood yet shares similarities with the most common form of...

http://bit.ly/2TmNw5W

Pediatric simulation training: Tips to make it effective for medics

Educators need to provide realistic simulation training to ensure pediatric patient clinical competence

http://bit.ly/2BaRxDD

Follow‐up of large thyroid nodules without surgery: Patient selection and long‐term outcomes

Abstract

Background

The management of large thyroid nodules remains controversial. Mandatory resection is recommended by some authors.

Methods

All patients with thyroid nodules ≥3 cm between January 2009 and January 2013 were followed until August 2017. Follow‐up data were collected using an integrated hospital‐community system.

Results

A total of 141 nodules were included. Of these, 37/141 (26%) nodules were initially referred to surgery, resulting in a 32% malignancy rate (12/37). The remaining 104/141 (74%) were referred to follow‐up. During the follow‐up period, 24 additional operations were done, resulting in a 4% malignancy rate (1/24). An indication of nonbenign cytology was significantly associated with malignancy compared with other indications. Median follow‐up was 53.5 months. No patient developed regional or distal diseases. The mean change in nodule size during the follow‐up period was a 7% reduction, with no significant trend of change over time.

Conclusion

Careful patient selection based on clinical, sonographic, and cytologic features can reduce diagnostic surgery allowing for safe follow‐up of large thyroid nodules without surgery.

http://bit.ly/2WuUvf1

Prognostic factors and treatment outcomes of advanced maxillary gingival squamous cell carcinoma treated by intra‐arterial infusion chemotherapy concurrent with radiotherapy

Abstract

Background

The aim of this study was to evaluate the prognostic factors and treatment outcomes of advanced maxillary gingival squamous cell carcinoma (SCC) treated with intra‐arterial infusion chemotherapy concurrent with radiotherapy.

Methods

A total of 46 patients were reviewed retrospectively in this study. The treatment schedule comprised intra‐arterial chemotherapy (total, 60 mg/m² docetaxel and 150 mg/m² cisplatin) and three‐dimensional computed tomography based, daily conventional radiotherapy (total, 60 Gy/30 fr) for 6 weeks.

Results

The median follow‐up period was 40 months (range, 3‐110 months). The 3‐year overall survival and locoregional control rates for all patients were 64.3% and 84.3%, respectively. The OS rate of the patients with N0‐1 was significantly higher than that of the patients with N ≥ 2 (P < .05). No grade 5 toxicities were observed.

Conclusions

Intra‐arterial infusion chemotherapy concurrent with radiotherapy was effective for advanced maxillary gingival SCC.

http://bit.ly/2Rr6y9w

Performance of a 31‐gene expression profile test in cutaneous melanomas of the head and neck

Abstract

Background

We report the performance of a gene expression profile test to classify the recurrence risk of cutaneous melanoma tumors of the head and neck as low‐risk Class 1 or high‐risk Class 2.

Methods

Of note, 157 primary head and neck cutaneous melanoma tumors were identified. Survival analyses were performed using Kaplan‐Meier and Cox methods.

Results

Gene expression profile class and node status stratified tumors into significantly different 5‐year survival groups by Kaplan‐Meier method (P < .0001 for all end points), and both were independent predictors of recurrence in multivariate analysis. Overall, 74% of distant metastases and 88% of melanoma‐specific deaths had Class 2 risk.

Conclusion

The gene expression profile test identifies cases at increased risk for metastasis and death independent of a clinically or pathologically negative nodal status, suggesting that incorporation of this molecular tool could improve clinical management of patients with head and neck cutaneous melanoma, especially in those with a negative sentinel lymph node biopsy.

http://bit.ly/2WsW4KL

JCD Editorial January 2019

http://bit.ly/2RWRqWN

Issue Information

http://bit.ly/2CSLxiZ

The Capital Gazette Shooter: Injustice Collector

Violence and Gender, Ahead of Print.


http://bit.ly/2RWP7TD

Eruptive Epidermoidzysten nach Imiquimod-Therapie eines rezidivierenden Basalzellkarzinoms

Zusammenfassung

Eruptive Epidermoidzysten stellen eine seltene Nebenwirkung von Imiquimod zur Behandlung von Basalzellkarzinomen dar. Bis dato wurden 8 Fälle in der Literatur beschrieben. Wir präsentieren den Fall einer 75-jährigen kaukasischen Patientin mit einem 8‑mal rezidivierten Basalzellkarzinom der Nase. Nach mehrfachen Exzisionen und Therapie mit Vismodegib erhielt die Patientin schließlich Imiquimod 5 % Creme in der Standarddosierung 5‑mal wöchentlich für die Dauer von 6 Wochen. Zwei Monate nach dem Absetzen von Imiquimod zeigten sich eruptive Epidermoidzysten.

http://bit.ly/2SbZQZD

Working with the past: Making history of struggle part of the struggle

Flinn, AD; (2017) Working with the past: Making history of struggle part of the struggle. In: Choudry, A and Vally, S, (eds.) Reflections on Knowledge, Learning and Social Movements: History's Schools. (pp. 21-41). Routledge: London, UK.

http://bit.ly/2ThahIp

Multimodality, style and the aesthetic: the case of the digital werewolf

Burn, AN; Kress, G; (2018) Multimodality, style and the aesthetic: the case of the digital werewolf. In: Seip Tønnessen, E and Forsgren, F, (eds.) Multimodality and Aesthetics. (pp. 15-36). Routledge: New York, NY, USA.

http://bit.ly/2B8jfRe

Embodiment and technology-enhanced learning environments: Cultivating a new community of design research

Lindgren, R; Price, S; (2018) Embodiment and technology-enhanced learning environments: Cultivating a new community of design research. In: Leigh, J, (ed.) Conversations on Embodiment Across Higher Education: Teaching, Practice and Research. (pp. 173-189). Routledge: London, UK.

http://bit.ly/2TjhjfP

Sites and Demonstrations in STAIR Scholarship

Carr, MM; (2019) Sites and Demonstrations in STAIR Scholarship. In: Singh, J P and Carr, M and Marlin-Bennett, R, (eds.) Science, Technology and Art in International Relations. Routledge (In press).

http://bit.ly/2B5b4Fh

Understanding traditional and other culture-based approaches to mental illness in lower and middle income contexts

Calabrese, JD; (2019) Understanding traditional and other culture-based approaches to mental illness in lower and middle income contexts. In: Davidson, L, (ed.) The Routledge Handbook of International Development, Mental Health and Wellbeing. Routledge (In press).

http://bit.ly/2TlBPwi

X the Rods: Enhancing interaction within urban settings using light and sound stimuli

Petrusevski, I; Fatah gen. Schieck, A; (2017) X the Rods: Enhancing interaction within urban settings using light and sound stimuli. In: Yamu, C and Poplin, A and Devish, O and De Roo, G, (eds.) The Virtual and the Real in Planning and Urban Design: Perspectives, Practices and Applications. (pp. 252-266). Routledge: London, UK. Green open access

http://bit.ly/2B96hCW

Making It Against the Odds: A Developmental-Contextual Approach to the Study of Resilience

Schoon, I; (2016) Making It Against the Odds: A Developmental-Contextual Approach to the Study of Resilience. In: Peterson, AC and Koller, S and Motti-Stefanidi, F and Verma, S, (eds.) Positive youth development in global contexts of social and economic change. (pp. 62-81). Routlege: New York, NY, USA. Green open access

http://bit.ly/2Th9uqV

The embodied academic: Body work in teacher education

Brown, N; (2018) The embodied academic: Body work in teacher education. In: Leigh, J, (ed.) Conversations on Embodiment Across Higher Education. Routledge: Abingdon, Oxon.

http://bit.ly/2B8mybp

Geography, Capabilities and the Educated Person

Lambert, DM; (2018) Geography, Capabilities and the Educated Person. In: Shin, E and Witham Bednarz, S, (eds.) Spatial Citizenship Education: Citizenship Through Geography. (pp. 22-40). Routledge: Abingdon, Oxon.

http://bit.ly/2TkOeRo

Reading popular histories of economics

Mata, TJ; (2018) Reading popular histories of economics. In: Düppe,, T and Weintraub, ER, (eds.) A Contemporary Historiography of Economics. Routledge: Abingdon, Oxon.

http://bit.ly/2B8mqIX

Building Sacred Modernity: Buddhism, secularism and a geography of religion in southern Sri Lanka

Jazeel, T; (2018) Building Sacred Modernity: Buddhism, secularism and a geography of religion in southern Sri Lanka. In: Bartolini, N and Mackian, S and Pile, S, (eds.) Spaces of Spirituality. (pp. 54-66). Routledge: Abingdon, Oxon.

http://bit.ly/2TlBr0O

Jean-Luc Mélenchon and France Insoumise: The Manufacturing of Populism

Marliere, P; (2019) Jean-Luc Mélenchon and France Insoumise: The Manufacturing of Populism. In: Katsambekis, G and Kioupkiolis, A, (eds.) The Populist Radical Left in Europe. Routledge: Abingdon, Oxon. (In press).

http://bit.ly/2B5b2x9

Private consultants, planning reform, and the marketisation of local government finance

Raco, M; (2018) Private consultants, planning reform, and the marketisation of local government finance. In: Ferm, J and Tomaney, J, (eds.) Planning Practice: Critical Perspectives from the UK. (pp. 132-137). Routledge: New York, NY, USA.

http://bit.ly/2TkMyHr

The politics of the (global) urban: city strategies as repeated instances

Robinson, JD; (2018) The politics of the (global) urban: city strategies as repeated instances. In: Oosterlynck, S and Beeckmans, L and Bassens, D and DeRudder, B and Segaert, B and Braeckmans, L, (eds.) The City As a Global Political Actor. (pp. 100-131). Routledge: Abingdon, Oxon.

http://bit.ly/2Bc2zbF

Randomized Control Trials: Limitations for Explaining and Improving Learning Outcomes

Oketch, MO; (2019) Randomized Control Trials: Limitations for Explaining and Improving Learning Outcomes. In: Gorur, R and Sellar, S and Steiner-Khamsi, G, (eds.) World Yearbook of Education 2019 Comparative Methodology in an Era of Big Data and Global Networks. (pp. 35-52). Routledge: Abingdon, Oxon.

http://bit.ly/2TmntvF

Consequences of hearing aid acclimatization on ALLRs and its relationship with perceived benefit and speech perception abilities

Abstract

Objective

The study aimed to track long latency responses over a period of hearing aid use in naïve hearing aid users, and study its relationship with change in speech perception abilities and perceived benefit.

Methods

Thirty adults in the age range of 23–60 years with moderate sensorineural hearing loss participated in the study. Auditory late latency responses (ALLRs), signal-to-noise ratio − 50 (SNR-50), and scores of speech spatial and qualities questionnaire (SSQ) were measured three times over a period of 2 months of hearing aid use.

Results

ALLRs showed a significant decrease in the P1 and N1 latency across the three measurements. Significant increase in the scores of SSQ and significant decrease in the SNR-50 were also found. The change in ALLRs did not correlate with change in scores of either SSQ or SNR-50.

Conclusions

The study provides evidence for improvements in neural processing of auditory cortical areas with hearing aid acclimatization. The improvements seen in perceived benefit and speech perception are not related to the improvements in ALLRs. This is the first study in the domain with a younger group compared to the previous studies and the results show evidence for neural plasticity influencing hearing aid acclimatization benefits.

http://bit.ly/2RUPhdT

Tinnitus: psychosomatische Aspekte

Zusammenfassung

Tinnitus ist ein häufiges Symptom unklarer Genese, das multifaktoriell bedingt und aufrechterhalten sein kann. Es ist oftmals, aber nicht zwingend, mit Hörverlust assoziiert. Emotionale Belastung oder maladaptive Copingstrategien, die sich in Reaktion auf Tinnitus entwickeln oder durch ihn verstärkt werden können, stellen Schlüsselfaktoren für psychosoziale Interventionen dar. Hierzu eignen sich – nach Abklärung somatischer Einflussfaktoren – entkatastrophisierende Informationsvermittlung und ggf. psychotherapeutische Interventionen. Maßnahmen zur Verbesserung der Hörwahrnehmung (z. B. Hörgeräte oder Cochleaimplantate) können über direkte (Verbesserung der Hörwahrnehmung) oder indirekte Effekte (Verbesserung des emotionalen Befindens oder der Lebensqualität) ebenfalls zur Tinnitushabituation beitragen.

http://bit.ly/2HEIy35

Ethnic Variation of Sinonasal Anatomy on CT Scan and Volumetric Analysis

Abstract

To determine Ethnic differences in the frequency of the relatively common anatomical variants along with difference in anatomy of sinonasal region with surgical importance. A study was conducted to determine the frequency of anatomical variants, volumes of paranasal sinuses using computed tomography and to identify any difference between Group A consisting of people of Indian subcontinent and Group B consisting of people from north east Asian region. Volumetric analysis done using cumulative of area multiplied by slice thickness. The results were compared using Chi square test, p value < 0.05 was considered statistically significant. Among the common and uncommon anatomical variants (Agger nasi, pneumatized uncinate, concha bullosa etc.) there was no significant difference between the two groups. In both the groups Keros Type 1 was the most common type of ethmoid roof seen. On volumetric analysis sphenoid sinus volume was found to be higher in Indians without mongoloid features. Hence it's ideal that in this era of endoscopic sinus surgery we tailor make approaches to address individual anatomical variation.

http://bit.ly/2UonIqk

Ulcères de jambe nécrotiques après application locale de chlorméthine

Publication date: Available online 28 January 2019

Source: Annales de Dermatologie et de Vénéréologie

Author(s): C. Gary, V. Gautier, I. Lazareth, M. Bagot, R. Asgari, P. Priollet

Résumé

Introduction

La chlorméthine en applications locales est très largement utilisée, et ce depuis plusieurs années, dans le traitement du mycosis fongoïde de stade précoce. Les réactions cutanées à type d'irritation et de prurit représentent ses principaux effets secondaires. Nous rapportons un effet indésirable rare, mais sévère, à type d'ulcères de jambe nécrotiques.

Observation

Une femme de 82 ans, hypertendue, se présentait pour des ulcérations cutanées des membres inférieurs évocatrices d'angiodermite nécrotique atypique. Ces ulcérations étaient survenues à la suite d'un traumatisme local, un mois après le début d'applications locales de chlorméthine (Valchlor^®) pour un mycosis fongoïde. Le bilan étiologique trouvait une artériopathie oblitérante des membres inférieurs modérée, qui constituait un facteur aggravant, mais ne pouvait expliquer qu'en partie la survenue de ces ulcérations du fait de leur aspect clinique. De plus, devant leur chronologie de survenue, une origine médicamenteuse était suspectée. Le traitement par chlorméthine était remplacé par des dermocorticoïdes et des soins locaux étaient prodigués sur les ulcères. L'évolution était favorable.

Conclusion

L'imputabilité de cet effet indésirable potentiel de la chlorméthine repose sur des critères chronologiques et sémiologiques. Il implique des conséquences thérapeutiques pratiques. Il s'agit du premier cas publié d'ulcère de jambe induit par le Valchlor^®.

Summary

Background

Topical chlormethine has been widely used in the early stages of mycosis fungoides for many years. Cutaneous reactions (skin irritation and itch) are the most frequent adverse effects. Herein we report a rare side effect: severe necrotic leg ulcers.

Patients and methods

An 82-year-old woman with a history of high blood pressure developed hyperalgesic necrotic ulcers on the lower limbs following local trauma one month after initiation of topical chlormethine (Valchlor^®) to treat mycosis fungoides. Aetiological examination showed moderate peripheral arterial disease which, while constituting an aggravating factor, did not account fully for these skin ulcers. Moreover, drug-induced ulcer was suspected on account of the chronology. Dermal corticoids and topical treatment were prescribed in place of chlormethine and led to a favourable outcome.

Conclusion

Incrimination of chlormethine was based on the chronological and semiological criteria. This is the first published case of leg ulceration induced by Valchlor^®.

http://bit.ly/2Sg4vd4

Methotrexate efficacy and tolerance in plaque psoriasis. A prospective real-life multicentre study in France

Publication date: Available online 28 January 2019

Source: Annales de Dermatologie et de Vénéréologie

Author(s): A. Tournier, A. Khemis, F. Maccari, Z. Reguiai, E. Bégon, A.-C. Fougerousse, M. Amy de la Breteque, N. Beneton, J. Parier, T. Boyé, M. Avenel-Audran, C. Girard, V. Pallure, J.-L. Perrot, M. Bastien, E. Mahé, A. Beauchet, GEM Resopso

Summary

Background

Methotrexate (MTX) is a major systemic treatment for moderate to severe plaque psoriasis. A randomized trial has recently been published evaluating a single weekly dosage (17.5 mg), but few prospective real-life data are available. The main objective of this study was to prospectively evaluate the efficacy of MTX in real-life. The secondary objectives were to evaluate predictive parameters for treatment efficacy and the frequency of adverse events.

Patients and methods

A prospective cohort involving consecutive at in 25 centres belonging to GEM RESOPSO included all adults with plaque psoriasis in whom MTX treatment was initiated. The efficacy criterion was achievement of PASI 75 at week (W) 12/16. The impact of demographic data, psoriasis characteristics (duration, topography, rheumatism), dosage (W12/16 dosage, cumulative dose after 4 weeks), and mode of administration (subcutaneous vs. oral, concomitant use of folic acid) on efficacy was evaluated. Intention-to-treat (ITT),per protocol (PP), and multivariate analyses were performed.

Results

Two hundred and fifty-six patients (F/M: 105/151; mean age: 45.0 years; rheumatism: 12.6%) with plaque psoriasis were included. 99 patients were not analysed at W12/16 (16 because of inefficacy, 16 because of intolerance, 56 were lost to follow-up or had data missing). PASI 75 was achieved in 98 patients, with efficacy of 38.3% in the ITT analysis and 58.3% in the PP analysis. In the ITT analysis, absence of previous use of cyclosporine (P = 0.01) and a cumulative dose of MTX > 60 mg after 4 weeks (P < 0.0001) were associated with higher PASI 75 rates. In the PP analysis, only absence of previous use of cyclosporine (P = 0.0009) was associated with a better PASI 75 results. There was no association between PASI 75 and patient characteristics (including body mass index), clinical aspects of psoriasis, route of administration, combination with folic acid, or W12/16 dose. Adverse events were reported by 34.8% of patients. These consisted mainly of digestive disorders (nausea, abdominal pain), asthenia and moderate hepatic cytolysis. The frequency of adverse events was correlated with methotrexate dosage.

Discussion

The efficacy of MTX in plaque psoriasis in this real-life study of 256 patients is consistent with the data in the literature, including the recently published randomized trial (41% PASI 75). This rate was unaffected by patient weight, route of administration and combined use of folic acid. Absence of previous use of cyclosporine appears to be associated with better efficacy although there is no clear explanation for this. The initial dosage (high dose in the first month) appears to be associated with superior efficacy for W12/W16.

Résumé

Le méthotrexate (MTX) est un des traitements systémiques du psoriasis en plaques modéré à sévère. Peu de données sont disponibles en pratique quotidienne. L'objectif de cette étude était d'évaluer de façon prospective l'efficacité du MTX en pratique quotidienne. Les objectifs secondaires étaient d'évaluer les paramètres prédictifs de l'efficacité du traitement, et la fréquence des évènements indésirables.

Patients et méthode

Cohorte prospective par inclusions consécutives dans 25 centres du GEM RESOPSO de tous les patients adultes présentant un psoriasis en plaques chez qui était débuté un traitement par MTX. Le critère d'efficacité était l'obtention d'un PASI75 à la semaine (S) 12/S16. Les paramètres évalués pouvant modifier l'efficacité étaient les paramètres démographiques, les caractéristiques du psoriasis (ancienneté, topographie, rhumatisme), la dose (dose à S12/S16, dose cumulée à 1 mois), le mode d'administration (sous-cutané vs oral), l'utilisation concomitante d'acide folique. Des analyses en intention de traiter (ITT) et per protocole (PP) ont été réalisées ainsi qu'une analyse multidimensionnelle.

Résultats

Deux cent cinquante-six patients (F/H : 105/151 ; âge moyen : 45,0) ont été inclus (analyse ITT), 168 (analyse en PP) ont été analysés à S12/S16 (16 arrêts pour échec, 16 pour intolérance, 56 perdus de vue ou avec données manquantes). Un PASI 75 était obtenu chez 98 patients, soit un taux d'efficacité de 38,3 % en ITT et 58,3 % en PP. En ITT, la non-utilisation préalable de ciclosporine (p = 0,01), la dose cumulée de MTX > 60 mg le premier mois (p < 0,0001), la dose cumulée moyenne à S4 (p < 0,0001) et la dose à S12/S16 > 20 mg (p = 0,005) étaient associées à un taux de PASI75 plus élevé. En PP, la non-utilisation préalable de ciclosporine (p = 0,0009) et la dose cumulée moyenne à S4 (p = 0,047) étaient associées à un taux de PASI75 plus élevé. Ni les caractéristiques des patients, ni leurs comorbidités, ni les aspects cliniques du psoriasis, ni le mode d'administration, ni l'association à de l'acide folique ou la dose à S12/S16 n'étaient associés à une augmentation de fréquence d'obtention du PASI75. Des évènements indésirables ont été rapportés par 34,8 % des patients. Il s'agissait principalement de troubles digestifs (nausées, douleurs abdominales), asthénie et cytolyse hépatique modérée. La fréquence des évènements indésirables non graves était directement corrélée à la dose de méthotrexate.

Discussion

Le taux d'efficacité du MTX dans le psoriasis en plaques dans cette étude menée en pratique quotidienne portant sur 256 patients est concordant avec les données de la littérature dont l'essai randomisé récemment publié (41 % de PASI75). Ni le poids du patient, ni la voie d'administration ou l'association à de l'acide folique ne semblent modifier ce taux efficacité. La non-utilisation préalable de ciclosporine serait associée à une meilleure efficacité, sans que l'on ait d'explication. Une dose cumulée élevée pendant premier mois serait associée à une meilleure efficacité à S12/S16.

http://bit.ly/2HE2ZgI

Léiomyomes cutanés et carcinome rénal

Publication date: Available online 28 January 2019

Source: Annales de Dermatologie et de Vénéréologie

Author(s): M. Fialek, C. Desvignes, M. Levavasseur, C. Lavogiez, D. Staumont-Sallé

http://bit.ly/2Sh8d5W

Ethnic Variation of Sinonasal Anatomy on CT Scan and Volumetric Analysis

Abstract

To determine Ethnic differences in the frequency of the relatively common anatomical variants along with difference in anatomy of sinonasal region with surgical importance. A study was conducted to determine the frequency of anatomical variants, volumes of paranasal sinuses using computed tomography and to identify any difference between Group A consisting of people of Indian subcontinent and Group B consisting of people from north east Asian region. Volumetric analysis done using cumulative of area multiplied by slice thickness. The results were compared using Chi square test, p value < 0.05 was considered statistically significant. Among the common and uncommon anatomical variants (Agger nasi, pneumatized uncinate, concha bullosa etc.) there was no significant difference between the two groups. In both the groups Keros Type 1 was the most common type of ethmoid roof seen. On volumetric analysis sphenoid sinus volume was found to be higher in Indians without mongoloid features. Hence it's ideal that in this era of endoscopic sinus surgery we tailor make approaches to address individual anatomical variation.

http://bit.ly/2UonIqk

Introduction: Education, remembrance and the Holocaust: Towards pedagogic memory work

Pearce, AR; (2018) Introduction: Education, remembrance and the Holocaust: Towards pedagogic memory work. In: Pearce, A, (ed.) Remembering the Holocaust in Educational Settings. (pp. 1-22). Routledge: Abingdon, Oxon.

http://bit.ly/2FTVq3P

Reliability of clinical diagnosis of masses of the cerebellopontine angle: A retrospective multi-institutional study

Publication date: Available online 28 January 2019

Source: American Journal of Otolaryngology

Author(s): Alexander L. Luryi, Elias M. Michaelides, Seilesh Babu, Dennis I. Bojrab, John F. Kveton, Robert S. Hong, John Zappia, Eric W. Sargent, Christopher A. Schutt

Abstract

Objectives

To assess the accuracy of pre-operative diagnosis of masses of the cerebellopontine angle (CPA) when compared to surgical pathology.

Design

Retrospective chart review.

Participants

Patients who underwent surgery for CPA masses at two tertiary care institutions from 2007 to 2017.

Main outcome measures

Percent concordance between pre-operative and surgical pathologic diagnosis; sensitivity, specificity, positive predictive value, and negative predictive value for predicted diagnoses.

Results

Concordance between pre-operative diagnosis and surgical pathology was 93.2% in 411 sampled patients. Concordance was 57.9% for masses other than vestibular schwannoma. Prediction of vestibular schwannoma and meningioma had high positive (0.95 and 0.97, respectively) and negative (0.76 and 0.99, respectively) predictive values. Prediction of facial neuroma had sensitivity of 0.13 and positive predictive value of 0.25. Headache (p = 0.001) and facial weakness (p = 0.003) were significantly associated with different pathologic profiles. Hearing loss was associated with differences in diagnostic prediction (p = 0.02) but not with differences in surgical pathology (p > 0.05).

Conclusions

Comparison between pre-operative predicted diagnosis and surgical pathology for cerebellopontine angle masses is presented. Vestibular schwannoma and meningioma were effectively identified while rarer CPA masses including facial neuroma were rarely identified correctly. Clinicians caring for patients with CPA masses should be mindful of diagnostic uncertainty which may lead to changes in treatment plan or prognosis.

http://bit.ly/2DEEpYT

The factors associated with the early diagnosis of nasal NK/T-cell lymphoma with prominent ocular symptoms and general nasal NKTL

Publication date: Available online 28 January 2019

Source: American Journal of Otolaryngology

Author(s): Zhenzhen Hu, Ying Wang

Abstract

Aim

This study explored the clinical features of nasal natural killer/T-cell lymphoma (NKTL) in patients with prominent ocular symptoms and those with general nasal NKTL to improve the early diagnosis of nasal NKTL.

Method

A retrospective cohort study was performed with 278 patients with nasal NKTL admitted to the First Affiliated Hospital of Zhengzhou University between January 2011 and December 2017. Of these cases, 56 presented with nasal NKTL and prominent ocular symptoms, and 222 presented with general nasal NKTL.

Results

No significant differences in gender and age distribution were found between patients with general nasal NKTL and those with nasal NKTL and prominent ocular symptoms (p > 0.05). Cases of nasal NKTL and prominent ocular symptoms were usually complicated with B symptoms(48.2% vs 32.9%, p < 0.05). Patients with nasal NKTL and prominent ocular symptoms were more likely to progress to stage III disease (p < 0.01). The median time from first onset to diagnosis was 2.5 months. Most patients with general nasal NKTL had a longer history (69.6% vs 45.0%, p < 0.01). The misdiagnosis rate of the first visit of patients with general nasal NKTL was 29.3%, and that of patients with prominent ocular symptoms was 51.8%; this difference was significant (p < 0.01). Patients with nasal NKTL and prominent ocular symptoms showed a higher positive rate of EBV DNA (p < 0.01), which was significantly associated with staging (p < 0.01).

Conclusions

Compared with patients with general nasal NKTL, the early diagnosis of patients with prominent ocular symptoms is difficult and easy to misdiagnose. Patients with nasal NKTL and prominent ocular symptoms mostly present with advanced disease stages, and most patients have B symptoms and a high positive rate of EBV DNA.

http://bit.ly/2Ur3TyF

Pain perception and functional/occlusal parameters in sleep bruxism subjects following a therapeutic intervention

Abstract

Background

This study was conducted to assess the individual pain perception in sleep bruxism (SB) subjects. Moreover, the effects of a cognitive behavioural therapy (CBT) compared to an occlusal appliance (OA) on pain perception and a possible continuative impact on several functional parameters were investigated.

Methods

A total of 57 SB subjects participated in this investigation. The diagnosis of SB was based on the clinical criteria of the American Academy of Sleep Medicine (AASM). Twenty-eight SB subjects were randomly allocated to the CBT group and 29 to the OA group. The therapeutic intervention took place over a period of 12 weeks, whereby both groups were examined at baseline, immediately after termination of the intervention, and at a 6-month follow-up for pain perception and functional parameters. At each of the three measurement periods, participants completed the pain perception scale and ten functional/occlusal parameters were recorded.

Results

Of the 12 parameters recorded, statistically significant main effects were found for the affective pain perception (p < 0.05) and for the three functional variables. Interestingly, the values obtained for the affective pain perception were considerably below that of a reference group. Apart from the determined statistically significant results, the values recorded for all functional/occlusal variables as well as those obtained for the sensory pain perception were clearly located within normative ranges.

Conclusions

Within the limitations of this study, it might be concluded that the significantly reduced affective pain perception in SB subjects is the expression of an adaptation mechanism.

http://bit.ly/2BbFWUP

“To Biologic or Not to Biologic?: The Question of Cost-Effectiveness”

Publication date: Available online 28 January 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): William C. Anderson, Stanley J. Szefler

http://bit.ly/2BbClpN

Economic burden of food allergy- A systematic review

Publication date: Available online 28 January 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Lucy A. Bilaver, Priyam Doshi, Avneet S. Chadha, Linda O'Dweyer, Ruchi S. Gupta

http://bit.ly/2TlbxKO

Modulation of inflammatory gene transcripts in psoriasis vulgaris: differences between ustekinumab and etanercept

Publication date: Available online 29 January 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Carrie Brodmerkel, Katherine Li, Sandra Garcet, Karen Hayden, Andrea Chiricozzi, Inna Novitskaya, Judilyn Fuentes-Duculan, Mayte Suarez-Farinas, Kim Campbell, James G. Krueger

http://bit.ly/2FUJ6Af

Blockade of Repulsive guidance molecule b (RGMb) inhibits allergen-induced airways disease

Publication date: Available online 29 January 2019

Source: Journal of Allergy and Clinical Immunology

Author(s): Sanhong Yu, Krystle M. Leung, Hye-Young Kim, Sarah E. Umetsu, Yanping Xiao, Lee A. Albacker, Hyun-Jun Lee, Dale T. Umetsu, Gordon J. Freeman, Rosemarie H. DeKruyff

Abstract

Background

Allergic asthma causes morbidity in many individuals and novel precision-directed treatments would be valuable.

Objective

To examine the role of a novel innate molecule, repulsive guidance molecule b (RGMb), in murine models of allergic asthma.

Methods

In models of allergic asthma using OVA or cockroach allergen, mice were treated with anti-RGMb or control mAb and examined for airway inflammation and airway hyperreactivity (AHR), a cardinal feature of asthma. The mechanisms by which RGMb causes airways disease were also examined.

Results

We found that blockade of RGMb by treatment with anti-RGMb mAb effectively blocked the development of airway inflammation and AHR. Importantly, blockade of RGMb completely blocked the development of airway inflammation and AHR, even if treatment occurred only during the challenge (effector) phase. IL-25 played an important role in these models of asthma, since IL-25 receptor deficient mice failed to develop disease. RGMb was expressed primarily by innate cells in the lungs, including bronchial epithelial cells (known producers of IL-25), activated eosinophils and interstitial macrophages, which in the inflamed lung expressed the IL-25 receptor and produced IL-5 and IL-13. We also found that NEO1, the canonical receptor for RGMb, was expressed by interstitial macrophages and bronchial epithelial cells in the inflamed lung, suggesting that an innate RGMb-NEO1 axis might modulate allergic asthma.

Conclusions

These results demonstrate an important role for a novel innate pathway in regulating type 2 inflammation in allergic asthma, involving RGMb and RGMb-expressing cells such as interstitial macrophages and bronchial epithelial cells. Moreover, targeting this previously unappreciated innate pathway might provide an important treatment option for allergic asthma.

Graphical abstract

http://bit.ly/2G60Yre

Surgical planning in pediatric skull base surgery

Publication date: Available online 28 January 2019

Source: Operative Techniques in Otolaryngology-Head and Neck Surgery

Author(s): Randall A. Bly, Angelique M. Berens, Jonathan A. Perkins, Craig Miller, Manuel Ferreira, Jason S. Hauptman, Kris S. Moe

Treatment of pediatric skull base disorders is complex and requires individual planning. Compared to adult patients, the pathologies are more congenital and benign. Advanced surgical planning has been shown to improve outcomes and involves a variety of different software platforms to enable sophisticated review of image data sets, including virtual endoscopy and the details of surgical approach options. There are greater than 50 open and endoscopic surgical approaches described. Endoscopic approaches in patients under age 4 are extremely challenging due to the underdeveloped sinuses and overall smaller size of the craniofacial skeleton and nasal cavity. A multidisciplinary surgical team should develop and review surgical plan options with the patient and family.

http://bit.ly/2TliQlF

JAK/STAT proteins and their biological impact on NK cell development and function

Publication date: Available online 28 January 2019

Source: Molecular Immunology

Author(s): Alexander Vargas-Hernández, Lisa R. Forbes

Abstract

NK cells are important early effectors in the innate immune response to a variety of viral infections and for elimination of tumor cells. The JAK/STAT signaling cascade is critical for NK cell development, maturation, survival, and proliferation, therefore, it is important to understand the role of this pathway in NK cell biology. Many cytokines can activate multiple JAK/STAT protein family members, creating a severe phenotype when mutations impair their function or expression. Here we discuss the impact of defective JAK/STAT signaling pathways on NK cell development, activation and cytotoxicity.

http://bit.ly/2B8KqLL

Trousseau syndrome in a patient with advanced oral squamous cell carcinoma: a case report

Trousseau syndrome is known as a variant of cancer-associated thrombosis. Trousseau syndrome commonly occurs in patients with lung or prostate cancer. Hypercoagulability is thought to be initiated by mucins pr...

http://bit.ly/2UpuMCS

STAT6 decoy oligodeoxynucleotide (ODN)-containing ointment more potently inhibits mouse skin inflammation when formulated with ionic liquid technology than as a traditional Vaseline ointment

Publication date: Available online 28 January 2019

Source: Allergology International

Author(s): Yutaro Handa, Tsukasa Ugajin, Ken Igawa, Hidetoshi Hamamoto, Katsunori Kobayashi, Takao Komatsuno, Toshinori Yamamoto, Kazuo Kawahara, Hiroo Yokozeki

http://bit.ly/2TfQclU

Case series of allergic bronchopulmonary aspergillosis treated successfully and safely with long-term mepolizumab

Publication date: Available online 28 January 2019

Source: Allergology International

Author(s): Seiko Soeda, Masako To, Yuta Kono, Satoshi Yamawaki, Ryuta Tsuzuki, Otohiro Katsube, Naoto Watanabe, Yasuo To

http://bit.ly/2BaQ0NK

Pediatric Lateral Graft Tympanoplasty A Review of 78 Cases

Publication date: Available online 28 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Kevin Y. Zhan, Kasey W. Rawlins, Jameson K. Mattingly, Prashant S. Malhotra, Oliver F. Adunka

Abstract

Objectives

The optimal timing and technique for repairing chronic tympanic membrane (TM) perforations in pediatric patients remains controversial. The objectives are to determine the surgical and hearing outcomes of pediatric lateral graft tympanoplasty at a tertiary teaching hospital.

Methods

A retrospective review was conducted for pediatric lateral graft tympanoplasties performed for chronic TM perforations by a single surgeon over a four-year period. Primary and secondary outcomes were graft failure rate and hearing outcomes, respectively.

Results

78 cases were analyzed. The mean age at time of surgery was 10.3 years (range 5-18 years). Mean follow-up was 11.0 months; 27 patients had follow-up >1 yr. Most patients were non-syndromic (85.9%), had a history of bilateral Eustachian tube dysfunction (ETD) (59%) and presented with marked myringosclerosis (73.1%). Thirty-three percent of cases were revision tympanoplasties. A learner surgeon (resident or fellow) was present in 89.7% of cases. Successful closure of the TM was achieved in 97.4% (76/78) of cases and 92.6% (25/27) of cases with >1-year follow-up. No obvious difference in graft failure was noted with regards to age at time of surgery, perforation size, history of bilateral ETD, presence of a learner surgeon, myringosclerosis, presence of syndromic features, or history of prior tympanoplasty. Ninety-one percent of patients either improved hearing or preserved their conductive hearing deficit. Poorer hearing outcomes were only associated with post-operative blunting.

Conclusions

Pediatric lateral graft tympanoplasty is effective in repairing chronic perforations with excellent hearing outcomes. Common quoted predictors of surgical outcome such as age at the time of surgery, syndromic features, history of previous myringoplasty, perforation size, and ETD dysfunction were not associated with graft failure in our series.

http://bit.ly/2Uni9IB

Severe cryopyrin-associated periodic syndrome first characterized by early childhood-onset sensorineural hearing loss – case report and literature review

Publication date: Available online 28 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Amaris Hui, Liane B. Johnson, Rony Greemberg, Lynette Penney, Suzanne Ramsey

Abstract

Infant-onset bilateral sensorineural hearing loss is a key presenting symptom of the autoinflammatory cryopyrin-associated periodic syndrome. Other symptoms include periodic fever, cold-induced urticaria-like rash, chronic aseptic meningitis, polyarticular arthralgias, and renal AA amyloidosis. Early recognition and treatment with interleukin-1 blockade are critical for preventing disabling or fatal complications. We describe a patient with severe cryopyrin-associated periodic syndrome who presented at age 18 months with macrocephaly and moderate sensorineural hearing loss, later developing systemic sequelae. The pathogenic nature of the de novo NLRP3 gene variant identified was supported by a markedly elevated serum amyloid A level and sustained clinical response to anti-IL-1 therapy.

http://bit.ly/2DFcQim