Transient ischemic attacks on turning the head to one side, with immediate remission of symptoms when the head returned to the neutral position.

http://medicine-greece.blogspot.com/2017/05/transient-ischemic-attacks-on-turning.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Masseteric to buccal branch nerve transfer.

Purpose of review: To review recent literature pertaining to the use of masseteric-facial nerve neurorrhaphy (MFNN) for facial reanimation in patients with facial paralysis. Recent findings: First, MFNN effectively restores some midface tone and function, including the ability to smile. Second, use of the masseteric nerve minimizes synkinesis, dysarthria, and dysphagia that frequently occur after hypoglossal-facial nerve neurorrhaphy. Third, concurrent cable grafting to the zygomatic branch from an intact proximal facial nerve remnant - when available - can restore dynamic eye closure. Summary: Masseteric nerve transfer is an alternative to hypoglossal nerve transfer that improves midface appearance and function for properly selected patients with facial paralysis. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2rbT6wA

Denaturing gradient gel electrophoresis profiles of bacteria from the saliva of twenty four different individuals form clusters that showed no relationship to the yeasts present

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Manjula M Weerasekera, Chris H Sissons, Lisa Wong, Sally A Anderson, Ann R Holmes, Richard D Cannon
ObjectivesThe aim was to investigate the relationship between groups of bacteria identified by cluster analysis of the DGGE fingerprints and the amounts and diversity of yeast present.MethodsBacterial and yeast populations in saliva samples from 24 adults were analysed using denaturing gradient gel electrophoresis (DGGE) of the bacteria present and by yeast culture.ResultsEubacterial DGGE banding patterns showed considerable variation between individuals. Seventy one different amplicon bands were detected, the band number per saliva sample ranged from 21 to 39 (mean±SD=29.3±4.9). Cluster and principal component analysis of the bacterial DGGE patterns yielded three major clusters containing 20 of the samples. Seventeen of the 24 (71%) saliva samples were yeast positive with concentrations up to 10³cfu/mL. Candida albicans was the predominant species in saliva samples although six other yeast species, including Candida dubliniensis, Candida tropicalis, Candida krusei, Candida guilliermondii, Candida rugosa and Saccharomyces cerevisiae, were identified. The presence, concentration, and species of yeast in samples showed no clear relationship to the bacterial clusters.ConclusionDespite indications of in vitro bacteria-yeast interactions, there was a lack of association between the presence, identity and diversity of yeasts and the bacterial DGGE fingerprint clusters in saliva. This suggests significant ecological individual-specificity of these associations in highly complex in vivo oral biofilm systems under normal oral conditions.

Graphical abstract

http://ift.tt/2qIsIH1

Agomelatine, a MT1/MT2 melatonergic receptor agonist with serotonin 5-HT2C receptor antagonistic properties, suppresses Prevotella intermedia lipopolysaccharide-induced production of proinflammatory mediators in murine macrophages

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): Jin-Yi Hyeon, Eun-Young Choi, So-Hui Choe, Hae Ryoun Park, Jeom-Il Choi, In Soon Choi, Sung-Jo Kim
ObjectiveThis study was performed in an attempt to examine the influence of agomelatine in mitigating the generation of proinflammatory mediators in RAW264.7 murine macrophages exposed to lipopolysaccharide (LPS) obtained from Prevotella intermedia, a gram-negative anaerobic bacterium that is related with various types of periodontal diseases, and the molecular mechanisms behind its effects.DesignLPS from P. intermedia strain ATCC 25611 was prepared employing the conventional phenol-water procedure. Conditioned culture media were analyzed for the levels of nitric oxide (NO), interleukin-1β (IL-1β) and IL-6. Real-time PCR analysis was carried out to determine the mRNA levels of inducible NO synthase (iNOS), IL-1β, IL-6 and SOCS1. Protein expression levels were evaluated by immunoblot test. NF-κB-dependent SEAP reporter assay was performed using a reporter cell line. DNA-binding activities of NF-κB subunits were analyzed utilizing the ELISA-based kits.ResultsAgomelatine was found to down-regulate significantly the generation of iNOS-derived NO, IL-1β and IL-6 as well as the expression of their mRNAs in cells activated with P. intermedia LPS. Agomelatine decreased NF-κB-dependent SEAP release caused by P. intermedia LPS. Agomelatine did not inhibit NF-κB transcription induced by LPS at the level of IκB-α degradation. Instead, LPS-induced nuclear translocation and DNA binding of NF-κB p50 subunit was blocked by agomelatine. P. intermedia LPS-elicited activation of STAT1 and STAT3 was reduced notably by co-treatment with agomelatine. Agomelatine showed a tendency to enhance mRNA level of SOCS1 in LPS-activated cells as well.ConclusionsAgomelatine merits further evaluation to reveal its usefulness on the host modulation of periodontal disease.



http://ift.tt/2qIql7h

Aims & Scope/Editorial board

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80





http://ift.tt/2rdwkEu

Plica neuropathica (matting hair) in an autistic patient

http://ift.tt/2rn3xfe

Patterns of regional recurrence in papillary thyroid cancer patients with lateral neck metastases undergoing neck dissection

Practice variability exists for the extent of neck dissection undertaken for papillary thyroid carcinoma (PTC) metastatic to the lateral neck nodes, with disagreement over routine level V dissection.

http://ift.tt/2qI009a

Eosinophilic esophagitis induced by aeroallergen sublingual immunotherapy in an enteral feeding tube–dependent pediatric patient

Eosinophilic esophagitis (EoE) is an increasingly recognized eosinophilic gastrointestinal disorder that affects children and adults, with a prevalence of 5 per 10,000 inhabitants in Europe and the United States.1 Food antigens trigger more than 90% of cases; however, data suggest that aeroallergens may also play a pathogenic role.2,3 In addition, sublingual immunotherapy (SLIT) is being increasingly used for the treatment of allergic rhinitis and allergic asthma. In this report, we describe a 9-year-old enteral feeding tube–dependent boy who developed increased esophageal eosinophilia, suggesting EoE after initiating aeroallergen SLIT.

http://ift.tt/2rmmuia

Prospective evaluation of electronic medical record penicillin allergy documentation at a tertiary community teaching hospital

The global threat of increasing antibiotic resistance has driven regulatory organizations to advocate for the judicious and prudent use of antibiotics through robust antibiotic stewardship programs. Recently published antibiotic stewardship guidelines detail recommended strategies to optimize antibiotic use in a variety of health care settings.1 One such strategy includes a thorough penicillin allergy history assessment and, if indicated, subsequent penicillin skin testing in patients with a reported penicillin allergy.

http://ift.tt/2qClklt

VideoEndocrinology™ High-Impact Videos

VideoEndocrinology™
Latest Impact Factor: 3.784
The Official Journal of: American Thyroid Association

FREE ACCESS through June 14, 2017.

Transoral Endoscopic Parathyroid Cyst Removal
Jonathon O. Russell, Mai G. Al Khadem, Ralph P. Tufano

Needle-Assisted Endoscopic Lateral Neck Dissection Through Bilateral Areola Approach for Papillary Thyroid Carcinoma Patients
Wen-Xin Zhao, Bo Wang, Shou-Yi Yan, Li-Yong Zhang, Jia Wen

 

The post VideoEndocrinology™ High-Impact Videos appeared first on American Thyroid Association.

http://ift.tt/2rqIeLB

Uncovering the pathogenesis of microtia using bioinformatics approach

Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Liu Lei, Liu Zhenzhong, Lin Lin, Pan Bo
ObjectiveBioinformatics is widely used in the field of cancer research, but in the research of pathogenesis of congenital malformations the situation is different. The aim of this study was to explore the underlying mechanism using bioinformatics approach.MethodsThe data were available from Mouse Genome Informatics and Pubmed. Protein–protein interaction (PPI) network of pathogenic genes was conducted using STRING. Gene ontology and pathway enrichment analyses were also performed to pathogenic genes.ResultsTotal 63 genes were identified as pathogenic genes in the study. The PPI networks for pathogenic genes were constructed, which contained 62 nodes and 228 edges with PAX6, FGFR1 and CTNNB1 as the hub genes. All the genes were linked to 921 pathways in biological processes, 31 pathways in cell component, 41 pathways in molecular function, and 76 pathways in the KEGG. These genes were discovered significantly enriched in embryonic organ development, ear morphogenesis, ear development, and regulation of RNA synthesis and processing.Conclusionsbioinformatics methods were utilized to analysis pathogenic genes involved in microtia development, including pathogenic genes identifying, PPI network construction and functional analysis. And we also predicted that several potential mechanisms might contribute to occurrence of microtia by disturbing GO terms and pathways. This approach could be useful for the study of the etiology and pathogenesis of microtia.



http://ift.tt/2soDYcO

Comparison of HER2 amplification status among breast cancer subgroups offers new insights in pathways of breast cancer progression

Abstract

Although the prognostic and predictive significance of human epidermal growth factor receptor 2 (HER2) in invasive breast cancer is well established, its role in ductal carcinoma in situ (DCIS) remains unclear. Reports on combined evaluation of both HER2 protein expression and HER2 amplification status in pure DCIS and DCIS adjacent to invasive ductal carcinoma (i.e., admixed DCIS) are scarce. In this study, immunohistochemistry and fluorescence in situ hybridization (FISH) were used to assess HER2 status in 72 cases of pure DCIS, 73 cases of DCIS admixed with invasive ductal carcinoma (IDC), and 60 cases of pure IDC. HER2 copy number-based amplification was present in 49% of pure DCIS, 16% of admixed DCIS, 18% of admixed IDC, and 8% of pure IDC. Amplified pure DCIS with clusters of HER2 signals showed a significantly lower HER2 copy number than amplified admixed DCIS with clusters. Whereas pure DCIS and admixed DCIS presented significant differences, the in situ and invasive component of admixed tumors showed striking similarities regarding mean HER2 and chromosome 17 centromere (CEP17) copy number, grade, and estrogen and progesterone receptor expression. The discrepant prevalence of HER2 amplification among breast cancer subgroups indirectly suggests that HER2 may not play a crucial role in the transition of in situ to invasive breast cancer. The similarities in HER2 amplification status between the in situ and invasive component of admixed tumors hint at a common biological pathway for both components. Our data support the theory that pure DCIS, pure IDC, and admixed lesions have a common progenitor, but can progress as separate lineages.

http://ift.tt/2qBXd2k

Psoriasis Updates and Side-by-Side Treatment Review

A look at the latest psoriasis news and most effective treatments.
Medscape Dermatology

http://ift.tt/2rpYnRp

Apatinib Treatment for Advanced Esophagus Cancer

Condition:   Advanced Esophagus Cancer
Intervention:   Drug: Apatinib
Sponsors:   Henan Cancer Hospital;   Jiangsu HengRui Medicine Co., Ltd.
Recruiting - verified May 2017

http://ift.tt/2rljCSF

Genomic Profiling of Nodular Thyroid Disease and Thyroid Cancer

Conditions:   Thyroid Nodule;   Thyroid Cancer;   Thyroid Diseases;   Thymic Carcinoma
Intervention:  
Sponsor:   Aventura Hospital and Medical Center
Recruiting - verified May 2017

http://ift.tt/2qBItVd

Gastric Pull up Versus Free Flap Reconstruction for Laryngo-pharyngeal Defects

Conditions:   Head and Neck Neoplasms;   Pharyngectomy;   Reconstructive Surgical Procedures
Interventions:   Procedure: Gastric Pull Up;   Procedure: Free Flap Surgery
Sponsor:   University of British Columbia
Recruiting - verified May 2017

http://ift.tt/2rlA2KA

Masseteric to buccal branch nerve transfer.

Purpose of review: To review recent literature pertaining to the use of masseteric-facial nerve neurorrhaphy (MFNN) for facial reanimation in patients with facial paralysis. Recent findings: First, MFNN effectively restores some midface tone and function, including the ability to smile. Second, use of the masseteric nerve minimizes synkinesis, dysarthria, and dysphagia that frequently occur after hypoglossal-facial nerve neurorrhaphy. Third, concurrent cable grafting to the zygomatic branch from an intact proximal facial nerve remnant - when available - can restore dynamic eye closure. Summary: Masseteric nerve transfer is an alternative to hypoglossal nerve transfer that improves midface appearance and function for properly selected patients with facial paralysis. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2rbT6wA

Hailey–Hailey disease with classic pemphigus vulgaris pathology: A case study

The patient is a 61-year-old white female with a 2-year history of painful and pruritic rash that began on the neck and progressed to involve the face, eyelids, scalp, neck, chest, back, bilateral upper extremities, axillae, popliteal fossae, and the groin. The patient has multiple family members with the same condition. Examination of the skin revealed erythematous macerated eroded plaques involving over 60% BSA. No mucosal or nail changes were identified. The patient had failed multiple therapies including topical and oral steroids, acitretin, dapsone, and valacyclovir.

http://ift.tt/2rFdYO4

Hailey–Hailey disease successfully controlled with low-dose naltrexone

Hailey–Hailey disease, or familial benign pemphigus, is a chronic, autosomal dominant or rarely sporadic condition characterized by painful erosions and macerations in the skin folds. Classically, treatment options for this condition include topical steroids, topical and systemic retinoids, and immunomodulators such as methotrexate. Although low-dose naltrexone (LDN) has never been reported in the literature as a treatment for Hailey–Hailey, patients on online blogs, websites, and Facebook support groups have attested to the success of this relatively benign medication in the treatment of their disease.

http://ift.tt/2serw0d

Low-level red LED light inhibits inflammation induced by unsaturated fatty acid in vitro

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous units (PSU). Light therapy has attracted medical interest as a safe, alternative treatment for acne. Both blue and red light therapies at high doses >10 J/cm2 have demonstrated marked effects on inflammatory acne lesions. However, few studies have investigated the effects of lower doses of light. In this study, the biological effects of low red light doses were investigated using an in vitro model previously developed to mimic the inflammation, and hyperkeratinization seen clinically in acne.

http://ift.tt/2seHKX2

A sword that cuts deeper than the skin

Background: Morphea en coup de sabre (ECDS), which literally means "blow from a sword," is a type of linear morphea affecting the frontoparietal scalp and/or the paramedian forehead. Neurologic findings are common with ECDS, most common being complex partial seizures and headaches. Brain involvement evident on neuroimaging can be seen both in symptomatic and asymptomatic patients. Here we present a rare case of ECDS and epilepsy with MRI findings of ipsilateral porencephalic brain cyst.

http://ift.tt/2rFfqjF

Periprocedural anxiolytic agents in dermatologic surgery: Quantitative experience and systematic literature review of the effective differences

Background: Procedural dermatology, including Mohs micrographic surgery (MMS), hair transplantation (HT), and cosmetic surgery can induce significant patient anxiety. While pre-procedural anxiolysis has been documented in other fields, there is only one study published for its usage in procedural dermatology and MMS. Herein, we perform a systematic literature review and discuss our center's experience with pre-procedural anxiolytics (PPA) in MMS and HT.

http://ift.tt/2sejCnl

Cutaneous nontuberculous mycobacterial infection presenting as the cubital forearm sign

Background: Cutaneous nontuberculous mycobacterium (NTM) infection has a range of cutaneous features from nodulopustules and verrucous plaques to nonspecific erythema commonly misdiagnosed as cellulitis. It is important to have a high index of suspicion in recognizing this entity.

http://ift.tt/2rFdSGc

Quality of life and psychosocial implications in hidradenitis suppurativa

Background: Hidradenitis suppurativa (HS) is a long-term skin disorder associated with high levels of psychological distress and significant life impact.

http://ift.tt/2seNXCg

A case of granulomatous pigmented purpuric dermatosis

Background: Pigmented purpuric dermatosis (PPD), or capillaritis, is an inflammatory skin disorder of unclear etiology most classically presenting as petechiae and red-brown macules on the lower extremities. PPD is characterized histologically by perivascular lymphocytes with extravasation of erythrocytes and hemosiderin deposition. PPD includes multiple subtypes including Schamberg's disease, Purpura annularis telangiectoides of Majocchi, pigmented purpuric lichenoid dermatitis of Gougerot and Blum, eczematid-like purpura of Doucas and Kapetanakis and Lichen aureus, as well as the newly described granulomatous PPD.

http://ift.tt/2rFnp0b

Niacinamide leave-on formulations provide long-lasting protection against bacteria in vivo

Antimicrobial peptides (AMPs) form a part of the skin's innate immune system. Their primary activity is to provide antimicrobial benefits and hence protect from infections. During the course of an infection or an injury, these AMPs become activated and provide protection against pathogens. Major AMPs that are present constitutively on human skin include psoriasin, RNAse7, and lysozyme while other AMPs like LL-37, HBD2, and HBD3 are induced after infection, injury or inflammation. Niacinamide is a well-known cosmetic ingredient that has been used traditionally for skin lightening, antiaging and skin barrier building benefits.

http://ift.tt/2seyDFR

“Fungus amungus” - A common disease state that is commonly missed: A survey based study

Background: Dermatophyte infections involving the skin, hair, or nails affect an estimated 25% of the world's population, and accounted for 51 million outpatient visits over a 10-year period (1995-2004) in the United States alone. Dermatomycosis is routinely managed by dermatologists, though given the diversity of clinical presentations, is sometimes misdiagnosed, which can result in inappropriate therapy, worsening of symptoms, and even result in additional skin and soft tissue infections.

http://ift.tt/2rFf0tz

Rhinophyma graft for repair of the phymatous nasal ala

Nasal reconstruction in the setting of rhinophyma poses some unique challenges. Traditional options for nasal ala reconstruction, such as bilobed flaps, nasolabial transposition flaps, and skin grafts, are often unable to provide an adequate tissue match for rhinophymatous skin. Second intention healing is a viable option for small defects on concave surfaces, but there is a risk of alar notching at the free margin. We present a unique technique for reconstruction of a 1.4 cm nasal ala defect with concomitant moderate rhinophyma after Mohs micrographic surgery.

http://ift.tt/2seBJcM

Hidradenitis suppurativa presenting as genital “kissing lesions”

Background: Hidradenitis suppurativa (HS), a component of the follicular occlusion triad, is a chronic inflammatory condition of the terminal hair follicle that has a predilection for the apocrine gland–bearing areas, including the axillary, inguinal, and anogenital regions. An infectious component has been suspected in the condition, but it is challenging to prove a pathologic component as bacteria can grow without presence of infection. "Kissing lesions" are lesions that appear on opposing surfaces that come into contact, and they typically signify transfer of an infectious agent such as sexually transmitted infections, including chancres seen in primary syphilis.

http://ift.tt/2rFeyeB

Primary cutaneous anaplastic large cell lymphoma

CD30 -positive lymphoproliferative skin diseases are the second most common form of cutaneous T cell lymphoma and have an excellent prognosis. We present a case of a primary cutaneous anaplastic large cell lymphoma. A 76-year-old man presented with an asymptomatic and recurring lesion on the anterior aspect of the left arm and forearm. On examination, confluent, infiltrated erythematous papules with superficial lichenification were seen. Histologic examination showed extensive lichenoid infiltrate without epidermotropism and immunohistochemical study showed great amount (more than 75%) of CD30+ lymphocytes confirming the diagnosis of primary cutaneous anaplastic large cell lymphoma (PCALCL).

http://ift.tt/2seFGhL

A 10-year retrospective review of cutaneous nontuberculous mycobacterium infection in adult patients

Background: Nondermatologists can be unfamiliar with cutaneous nontuberculous mycobacterium (NTM) and this leads to delayed diagnosis and poorer outcomes.

http://ift.tt/2rFb5wE

Pancreatic panniculitis sans pancreatitis in a newly diagnosed diabetes mellitus patient

Pancreatic panniculitis is a rare inflammatory disease affecting the subcutis in a small percentage of patients with pancreatic disease, postulated to be due to enzymatic degradation of adipose tissue by pancreatic lipase and amylase. Elevated serum lipase and amylase levels can occur in patients with diabetic ketoacidosis (DKA), even without evidence of pancreatitis. We report a case of a newly diagnosed diabetes mellitus patient presenting with DKA and subsequent pancreatic panniculitis lesions over her lower limbs, but without evidence of pancreatitis.

http://ift.tt/2seEjzv

A 10-year retrospective analysis of leprosy cases in a hospital setup in India: Scenario in post MDT era

Background: Despite achievement of elimination status of leprosy in India in 2000, it continues to harbour more than two-thirds of the world's leprosy population. Certain states and union territories continue to report high prevalence of the disease. The current study provides an insight into the current disease trends in a tertiary care hospital in New Delhi, India.

http://ift.tt/2rFaifj

Modeling epidermal gene expression in skin cells in vitro

We have reported previously that women whose facial skin appears exceptionally youthful have distinct patterns of epidermal gene expression as compared to women who appear average or older than their actual chronological age. The majority of these epidermal genes (80%) showed a strong negative age-dependency in older-appearing women; by cluster analysis these could be categorized into 20 expression patterns capturing distinct biological pathways. In the current work we used a combined in vitro and in silico approach to determine the extent to which combinations of materials may affect expression of these genes.

http://ift.tt/2sejvYX

A blend of botanical extracts improves the dermal structure of stretch marks on ex vivo and in vivo skin

Striae distensae, or stretch marks, is a common condition associated with continuous and progressive stretching of the skin, such as with rapid weight gain, puberty, or pregnancy. Typically, these lesions involve the abdomen, breasts, or hips. Striae distensae initially appear as raised pink or purple linear streaks that run perpendicular to the direction of skin tension. Over time, these streaks mature into hypopigmented, depressed, and finely wrinkled scar-like bands. Although stretch marks are not physically dangerous, their appearance is often distressful to individuals.

http://ift.tt/2rFlWXG

High patient satisfaction and improved cosmetic outcomes after a 3-day field treatment of actinic keratoses with ingenol disoxate on the face, chest, and balding scalp

Introduction and Objectives: Ingenol disoxate (IngDsx, LEO 43204) is a novel ingenol derivative selected based on improved thermostability and biologic properties over those of ingenol mebutate (IngMeb). Previous studies demonstrated satisfaction and cosmetic improvements in patients treated with IngMeb. As part of a phase 2 trial, we investigated these outcomes for field treatment with IngDsx in patients with actinic keratoses (AK) on face/chest (F/C) and scalp (S) (NCT02305888).

http://ift.tt/2sewg5X

A case of adult onset Langerhans cell histiocytosis with neurodegenerative central nervous system disease

A 75-year-old woman presented with 2-year history of persistent pruritic dermatitis on her trunk. She had been treated by topical corticosteroids without improvement. Around the same time, she felt numbness on her face, and became unsteady on her feet. She also had appetite loss and sick feelings, with 5-kg weight loss in 9 months. As there were no abnormal findings with endoscopy and blood tests, she had been treated as dysautonomia. According to her family, she seems to have personality change.

http://ift.tt/2rFfgJ5

Background and Room Illumination in Color Identification of Skin Lesions

This study examines the variability in color identification and perception of skin lesions in the context of background color and room illumination.

http://ift.tt/2rpgtmO

Sodium Thiosulfate for Lupus Panniculitis With Cutaneous Calcinosis

This case report describes the use of intralesional sodium thiosulfate injections to treat lupus panniculitis with localized cutaneous calcinosis.

http://ift.tt/2snlh9v

Vesicular Rash in a Neutropenic Infant

A female infant with relapsed refractory infantile acute lymphoblastic leukemia presented with several vesicles with an erythematous base on the lower back and left thigh 17 days after reinduction chemotherapy. What is your diagnosis?

http://ift.tt/2rptgWd

Protein Kinase C ε and MCPyV-Induced Merkel Cell Carcinoma

This study of 11 Merkel cell carcinoma samples explored the association of activated protein kinase C ε and Merkel cell carcinoma–associated polyoma virus.

http://ift.tt/2snqnT2

Correlates of Confocal Descriptors in Pigmented Facial Macules

This study compares the use of reflectance confocal microscopy with other measures used in diagnosis of pigmented facial macules.

http://ift.tt/2rp26Pi

Efficacy and Tolerance of Anti-TNF α Agents in Cutaneous Sarcoidosis

This large multicenter observational study explores the efficacy and safety of anti–tumor necrosis factor α agents in treating cutaneous sarcoidosis.

http://ift.tt/2sncOmP

Shrimp TAB1 interacts with TAK1 and p38 and activates the host innate immune response to bacterial infection

Publication date: August 2017
Source:Molecular Immunology, Volume 88
Author(s): Sheng Wang, Mengqiao Li, Bin Yin, Haoyang Li, Bang Xiao, Kai Lǚ, Zhijian Huang, Sedong Li, Jianguo He, Chaozheng Li
Mammalian TAB1 has been previously identified as transforming growth factor-β (TGF-β)-activated kinase 1 (TAK1) binding protein, which functions as the activator of TAK1 and p38. This report, for the first time, identified and characterized the homolog of TAB1 in shrimp, to be specific, the homolog gene from Litopenaeus vannamei, containing a 1560-bp open reading frame (ORF) that encoded a putative protein of 519 amino acids with the conserved PP2Cc (Serine/threonine phosphatases, family 2C, catalytic) domain in N-terminal and a TAK1 binding motif in C-terminus, has been cloned and named LvTAB1. LvTAB1 was most abundant in gills and its expression could respond significantly to a series of stimuli, including LPS, Vibrio parahemolyticus and Staphylococcus aureus. Moreover, Co-immunoprecipitation (Co-IP) experiments showed that LvTAB1 could combine with LvTAK1 as well as Lvp38, two members of IMD-NF-κB/MAPK pathway, which meant LvTAB1 could have a role in regulating the activities of these kinases. Over-expression of LvTAB1 in drosophila S2 cells could improve the transcriptional levels of antimicrobial peptide genes (AMPs) such as Diptericin (Dpt), the hallmark of drosophila NF-κB activated genes, indicating its activation effect on NF-κB pathway. Furthermore, suppression of LvTAB1 expression in vivo by RNA-interference increased the sensibility of shrimps to V. parahaemolyticus infection, implying its protective role against bacterial infection. In conclusion, these results provide some insight into the function of LvTAB1 during bacterial infection.



http://ift.tt/2seb5kd

Complement in clinical medicine: Clinical trials, case reports and therapy monitoring

Publication date: Available online 31 May 2017
Source:Molecular Immunology
Author(s): Daniel Ricklin, Andreas Barratt-Due, Tom Eirik Mollnes
Research during past decades made it evident that complement is involved in more tasks than fighting infections, but has important roles in other immune surveillance and housekeeping functions. If the balance between complement activation and regulation is out of tune, however, complement can quickly turn against the host and contribute to adverse processes that result in various clinical conditions. Whereas clinical awareness was initially focused on complement deficiencies, excessive activation and insufficient regulation are frequently the dominant factors in complement-related disorders. The individual complement profile of a patient often determines the course and severity of the disease, and the pathophysiological involvement of complement may be highly diverse. As a consequence, complement assays have evolved as essential tools not only in initial diagnosis but also for following disease progression and for monitoring complement-targeted therapies, which become increasingly available in routine clinical use. We herein review the current state of complement-directed drug candidates in clinical evaluation and provide an overview of extended indications considered for the FDA-approved inhibitor eculizumab. Furthermore we review the literature describing cases reports and case series where eculizumab has been used "off-label". Finally, we give a summary of the currently available tests to measure complement profiles and discuss their suitability in diagnostics and treatment monitoring. With complement finally entering the clinical arena, there are intriguing opportunities for treating complement-mediated diseases. However, this progress also requires a new awareness about complement pathophysiology, adequate diagnostic tools and suitable treatment options among clinicians treating patients with such disorders.



http://ift.tt/2rF0z8V

New concepts on the therapeutic control of complement anaphylatoxin receptors

Publication date: Available online 30 May 2017
Source:Molecular Immunology
Author(s): Owen A. Hawksworth, Xaria X. Li, Liam G. Coulthard, Ernst J. Wolvetang, Trent M. Woodruff
The complement system is a pivotal driver of innate immunity, coordinating the host response to protect against pathogens. At the heart of the complement response lie the active fragments, C3a and C5a, acting through their specific receptors, C3aR, C5aR1, and C5aR2, to direct the cellular response to inflammation. Their potent function however, places them at risk of damaging the host, with aberrant C3a and C5a signaling activity linked to a wide range of disorders of inflammatory, autoimmune, and neurodegenerative etiologies. As such, the therapeutic control of these receptors represents an attractive drug target, though, the realization of this clinical potential remains limited. With the success of eculizumab, and the progression of a number of novel C5a-C5aR1 targeted drugs to phase II and III clinical trials, there is great promise for complement therapeutics in future clinical practice. In contrast, the toolbox of drugs available to modulate C3aR and C5aR2 signaling remains limited, however, the emergence of new selective ligands and molecular tools, and an increased understanding of the function of these receptors in disease, has highlighted their unique potential for clinical applications. This review provides an update on the growing arsenal of drugs now available to target C5, and C5a and C3a receptor signaling, and discusses their utility in both clinical and pre-clinical development.



http://ift.tt/2se4BC1

Clinical significance of epithelial-to-mesenchymal transition in laryngeal carcinoma: its role in the different subsites

Abstract

Background

During epithelial-to-mesenchymal transition, cancer cells lose adhesion capacity gaining migratory properties. The role of the process on prognosis has been evaluated in 50 cases of laryngeal carcinoma.

Methods

E-cadherin, N-cadherin, β-catenin, α-catenin, γ-catenin, caveolin-1, and vimentin immunohistochemical expression were evaluated using a double score based on staining intensity and cellular localization.

Results

Cytoplasmic E-cadherin and α/γ catenin staining were associated with a decrease in survival, cytoplasmic β-catenin was associated with advanced stage, and N-cadherin and vimentin expression were associated with poor differentiation and tumor relapse. On the basis of cancer cells, epithelial or mesenchymal morphological and immunophenotypic similarity we identified 4 main subgroups correlated with a transition to a more undifferentiated phenotype, which have a different pattern of relapse and survival.

Conclusion

The negative prognostic role of epithelial-to-mesenchymal transition has been confirmed and a predictive role in glottic tumors has been suggested, leading us to propose epithelial-to-mesenchymal transition as an additional adverse feature in laryngeal carcinoma.

http://ift.tt/2smVJJC

Outcomes for olfactory neuroblastoma treated with induction chemotherapy

Abstract

Background

Oncologic outcomes for induction chemotherapy and its role in patients with advanced olfactory neuroblastoma (ONB) remain unclear.

Methods

A retrospective review of 15 consecutive patients with extensive local invasion and/or nodal disease treated with induction chemotherapy with curative intent followed by definitive local therapy.

Results

The majority of patients were treated with cisplatin and etoposide. The response to chemotherapy was 68% (10/15). Response was 78% (7/9) in the high Hyams high-grade group and 50% (3/6) in the Hyams low-grade group. Seven patients had complete response (CR) and 3 patients were able to avoid orbital exenteration. The 5-year disease-free survival (DFS) and overall survival (OS) were 71% and 78%, respectively, with a trend toward improved survival in patients with CR.

Conclusion

ONB is a chemosensitive tumor and induction chemotherapy is an acceptable strategy for aggressive and locoregional advanced disease. Hyams grade may predict chemosensitivity and CR may be associated with improved survival.

http://ift.tt/2roTp7y

Outcomes and patterns of failure for sinonasal undifferentiated carcinoma (SNUC): The Mayo Clinic Experience

Abstract

Background

Sinonasal undifferentiated carcinoma (SNUC) is a rare aggressive disease arising in the nasal cavity and paranasal sinuses with poor prognosis and unclear optimal management.

Methods

Forty patients were analyzed. Nasal cavity was the most common primary site. Most patients presented with T4 disease, received trimodality therapy, and were treated with intensity-modulated radiotherapy (IMRT).

Results

Median follow-up was 6.9 years. Sixteen patients (40%) experienced recurrent disease, 5 local (12.5%), 1 regional (2.5%), and 10 distant (25%). The 5-year overall survival (OS), recurrence-free survival (RFS), and locoreginal control (LRC) were 44%, 39%, and 71%, respectively. Patients treated with trimodality therapy had better outcomes compared to single modality therapy. Improved OS was noted with IMRT and with doses ≥60 Gy. The most common cause of death was distant metastasis.

Conclusion

SNUC is an aggressive malignancy with a high tendency to metastasize. Better outcomes were obtained with a trimodality approach. Modern radiotherapy (RT) techniques and doses ≥ 60 Gy were associated with improved OS.

http://ift.tt/2smHlkH

Cases in head and neck cancer: A multidisciplinary approach Bari Hoffman Ruddy, Henry Ho, Christine Sapienza, Jeffrey J. Lehman Plural Publishing, San Diego, CA, 2016, USD 130, 279 pages

http://ift.tt/2roFazS

Image-guided surgery: Fundamentals and clinical applications in otolaryngology Robert Labadie, J. Michael Fitzpatrick Plural Publishing, San Diego CA, 2016, USD 149.95, 215 pages

http://ift.tt/2smVQEU

Head and neck imaging Gaurang Vrindavan Shah, Jeffrey Robert Wesolowski, Jeanie Choi, Elliott Friedman Thieme Medical Publishers, New York, NY, 2016, USD 59.99 (pbk), 224 pages.

http://ift.tt/2rozPIJ

Patterns of regional recurrence in papillary thyroid cancer patients with lateral neck metastases undergoing neck dissection

Abstract

Background

Practice variability exists for the extent of neck dissection undertaken for papillary thyroid carcinoma (PTC) metastatic to the lateral neck nodes, with disagreement over routine level V dissection.

Methods

We performed a retrospective medical record review of PTC patients with lateral neck nodal metastases treated at University Health Network from 2000 to 2012. Predictive factors for regional neck recurrence, including extent of initial neck dissection, were analyzed using Cox regression.

Results

Out of 204 neck dissections in 178 patients, 110 (54%) underwent selective and 94 (46%) had comprehensive dissection including level Vb. Mean follow-up was 6.3 years (SD). Significant predictors of regional failure were the total number of suspicious nodes on preoperative imaging (p = 0.029), largest positive node on initial neck dissection (p < 0.01), and whether patients received adjuvant radiotherapy (p = 0.028). The 5-year ipsilateral regional recurrence rate was 8 and 9% with selective and comprehensive dissection, respectively (p = 0.89).

Conclusion

The extent of neck dissection did not predict the probability of regional recurrence in PTC patients presenting with lateral neck metastases.

http://ift.tt/2qAMhWq

Visual recognition memory is impaired in rhesus monkeys repeatedly exposed to sevoflurane in infancy

Abstract

Background. Experimental studies in animals have shown that exposure to general anaesthesia in infancy can cause loss of cells in the central nervous system and long-term impairments in neurocognitive function. Some human epidemiological studies have shown increased risk of learning disability after repeated anaesthesia exposure in early childhood. Thus, we investigated in a highly translational rhesus monkey model, whether repeated exposure in infancy to the inhalation anaesthetic sevoflurane is associated with impaired visual recognition memory during the first two yr of life.Methods. Rhesus monkeys of both sexes were exposed to sevoflurane inhalation anaesthesia on approximately postnatal day 7 and then again 14 and 28 days later, for four h each time. Visual recognition memory was tested using the visual paired comparison task, which measures memory by assessing preference for looking at a new image over a previously-viewed image. Monkeys were tested at 6–10 months of age, again at 12–18 months of age, and again at 24–30 months of age.Results. No memory impairment was detected at 6–10 months old, but significant impairment (reduced time looking at the novel image) was observed at 12–18 and 24–30 months old.Conclusions. Repeated exposure of infant rhesus monkeys to sevoflurane results in visual recognition memory impairment that emerges after the first yr of life. This is consistent with epidemiological studies that show increased risk of learning disability after repeated exposure to anaesthesia in infancy/early childhood. Moreover, these deficits may emerge at later developmental stages, even when memory performance is unaffected earlier in development.

http://ift.tt/2qGn9ZK

Triple low, double low: it’s time to deal Achilles heel a single deadly blow

Since the report by Monk and colleagues¹ of an association between a cumulative duration of the bispectral index (BIS) <45 and postoperative mortality there has been debate regarding the plausibility that relatively excessive anaesthetic depth is deadly. It is not surprising that this premise has ignited a scientific controversy and that anaesthetists are both intellectually and emotionally vested in its resolution. If this hypothesis were indeed true, the concentration of (volatile) anaesthetic promoting death would be within what is currently considered the therapeutic window. Furthermore, if a minor increase in anaesthetic administration were truly fatally injurious, we would expect to see a marked increase in mortality with general compared with regional anaesthesia. Also, since some clinicians administer more anaesthesia than others, we would predict that these variations would manifest as differences in postoperative morbid and mortal outcomes. And yet, differences in major adverse outcomes, based on anaesthetic technique or individual anaesthetists, have not been apparent in several studies.^2–9

http://ift.tt/2rba0eM

Sputum Basophils and Asthma Diagnosis: Dawn of a New Era?

Abstract

More than 40 years ago, Kimura et al. discovered that basophils are enriched in sputum samples of asthma patients (1). Since then, various scientific approaches have attempted to elucidate the role of basophils in the pathophysiology of asthma. The scarcity of basophils and technical limitations of earlier studies have made it difficult to increase our understanding how basophils affect the disease course in asthma.

This article is protected by copyright. All rights reserved.

http://ift.tt/2ropRa7

Sublingual immunotherapy provides long-term relief in allergic rhinitis and reduces the risk of asthma: a retrospective, real-world database analysis

Abstract

Background

Allergy immunotherapy (AIT) is the only treatment for allergic rhinitis (AR) and/or allergic asthma (AA) with long-term efficacy. However, there are few real-life data on the progression of AR and/or AA in patients receiving AIT.

Objectives

To assess the real-world, long-term efficacy of grass-pollen sublingual immunotherapy (SLIT) tablets in AR and their impact on asthma onset and progression.

Methods

In a retrospective analysis of a German longitudinal prescription database, AR patients treated with grass pollen SLIT tablets were compared with a control group not having received AIT. Multiple regression was used to compare changes over time in rescue symptomatic AR medication use after treatment cessation, asthma medication use, and the time to asthma onset in the two groups.

Results

After applying all selection criteria, 2851 SLIT and 71275 Control patients were selected for the study.After treatment cessation, AR medication use was 18.8 percentage points lower (after adjustment for covariates, and relative to the pre-treatment period) in SLIT tablet group than in the non AIT group (p<0.001). Asthma onset was less frequent in SLIT tablet group than in non AIT group (odds ratio: 0.696, p=0.002), and time to asthma was significantly longer (hazard ratio: 0.523; p=0.003). After SLIT cessation, asthma medication use fell by an additional 16.7 percentage points (relative to the pre-treatment period) in the SLIT tablet group vs. the non AIT group (p=0.004).

Conclusions

Real-world treatment of AR patients with grass pollen SLIT tablets was associated with slower AR progression, less frequent asthma onset and slower asthma progression

This article is protected by copyright. All rights reserved.

http://ift.tt/2sme7Cv

A Global Bibliometric Analysis of Otolaryngology, Head and Neck Surgery Literature

Abstract

Objective

Bibliometrics uses analysis of content and citations of journal articles to quantify trends in published data. We aim to use bibliometric analysis to identify the global contribution by country to the ENT surgical literature over a five-year period.

Data Source

The top 20 countries for number of articles published in surgery and the 11 English Language Otolaryngology surgical journals with the highest impact factors (IF) were included. Numbers of scientific articles per year (2009-2013) per country for each journal were identified through PubMed. As a marker of quality, a mean IF for each country was calculated, using number of articles and journal IF. This data was compared against population, GDP and dollars spent on research.

Results

In total, 10,574 articles were included. The USA was the largest contributor, with 4462 articles published over 5 years. The second largest was the UK (1215 articles). Spain's mean IF was 2.136, followed by Taiwan (2.110). The Netherlands (19.7) and the UK (18.9) had the highest number of publications per million population (PMP). When considering overall research spending per country, Greece had the most cost-effective publication output. The least cost-effective country was Japan. India, Greece and Japan had the greatest increase in publication quality.

Conclusions

Bibliometric analysis can be used to identify not only major centres of English language ENT surgical research, such as the USA and UK but centres that are producing high-quality data, such as Spain, and cost-effective research, such as the UK. It can also highlight areas of increasing success in ENT research.

This article is protected by copyright. All rights reserved.

http://ift.tt/2rkeKgC

Apokrines Schweißdrüsenkarzinom der Axilla mit atypischem Verlauf

Zusammenfassung

Wir berichten über den atypischen klinischen Verlauf eines Patienten mit einem seltenen apokrinen Schweißdrüsenkarzinom, bereits initial vorliegender lymphogener Metastasierung und einer metachronen solitären Fernmetastase mit einer jetzt erreichten Überlebenszeit von mehr als 4 Jahren und verbinden die Falldarstellung mit einer aktuellen Literaturübersicht. Es gibt nur eine sehr kleine Zahl von Patienten mit dieser Tumorentität. Die Empfehlungen zur Diagnostik und Therapie sind nicht durch prospektiv randomisierte Studien abgesichert und beruhen sowohl auf Einzelfallberichten als auch auf neuen immunhistochemischen und genetischen Markerprofilen.

http://ift.tt/2smeUmZ

Standarddatensatz für die Evaluation bei Selektivverträgen bei Ulcus cruris

Zusammenfassung

Hintergrund

Selektivverträge gewinnen in der Versorgungsgestaltung immer mehr an Bedeutung. Bis heute existieren keine konsentierten Standardempfehlungen zu ihrer Evaluation.

Ziel der Arbeit

Vor diesem Hintergrund wurde durch die bundesweite Konsensuskonferenz zur Versorgung von Menschen mit chronischen Wunden eine Empfehlung zur Evaluation von Selektivverträgen bei Patienten mit einem Ulcus cruris (UC) entwickelt und konsentiert.

Material und Methoden

Auf der Basis einer systematischen Literaturrecherche mit anschließender Handrecherche über weitere mögliche Evaluationsindikatoren in der Versorgung von Patienten mit einem UC wurde ein Delphi-gestützter Konsensusprozess durch wissenschaftliche Fachgesellschaften, Berufsverbände, Krankenkassen und Versorgungsnetze durchgeführt.

Ergebnisse

Zur Bewertung von Wirtschaftlichkeit und Qualität der Versorgung wurde in 6 moderierten Präsenzsitzungen und 5 mehrstufigen Online-Umfragen eine Empfehlung zur Evaluation von Selektivverträgen bei Patienten mit einem UC konsentiert. Insgesamt n = 44 Evaluationsindikatoren wurden in die Teilbereiche Struktur‑, Prozess- und Ergebnisqualität untergliedert. Die Ergebnisqualität wurde zudem weiter in die Bereiche klinische, patientenberichtete und kostenbezogene Indikatoren unterteilt.

Diskussion

Die entwickelten und konsentierten Evaluationsindikatoren bilden die Versorgungsqualität bei Patienten mit einem UC ab und können individuell eingesetzt werden, je nach vereinbarten vertragsspezifischen Versorgungszielen. Nach bundesweiter Implementierung dieses Standards wird die Vergleichbarkeit von Selektivverträgen bei Patienten mit einem UC gewährleistet und verstetigt.

http://ift.tt/2rkaL3C

Psoriasis capitis und seborrhoisches Ekzem der Kopfhaut

Zusammenfassung

Der behaarte Kopf kann durch vielfältige Erkrankungen in ebenso vielfältiger Weise betroffen werden. Neben Rötung und Schuppung findet sich häufig quälender Juckreiz, der zu massiven Beeinträchtigungen der Patienten führt. Die Kopfpsoriasis und das seborrhoische Kopfekzem gehören zu den häufigsten Erkrankungen, die im klassischen Fall einfach zu unterscheiden sind, aber auch Überschneidungen und klinische Ähnlichkeiten zeigen können. Die scharf begrenzten, die Stirn-Haar-Grenze überschreitenden erythematosquamösen Plaques der Psoriasis stehen eher unscharf begrenzten, düsterroten Erythemen mit einer gelblich-fettigen Schuppung des seborrhoischen Ekzems gegenüber. Bei Letzterem findet sich häufig eine diffuse Alopezie, während Haarausfall bei der Psoriasis eher selten ist, aber auch als unerwünschte Wirkung verschiedener Therapeutika auftreten kann. Die Behandlung richtet sich nach Akuität und Ausdehnung der Erkrankung wie auch Einschränkung der Betroffenen. Sie ist zunächst topisch unter Einsatz von Kortikosteroiden, bei der Psoriasis auch von Vitamin-D-Derivaten, beim seborrhoischen Ekzem von topischen Antimykotika. In schweren Fällen unter Beteiligung des übrigen Integuments bedarf insbesondere die Psoriasis einer systemischen Therapie mit den klassischen Wirkstoffen Methotrexat, Fumaraten oder Ciclosporin bis zu den Biologika, die Tumornekrosefaktor-α, Interleukin-12/23 oder Interleukin-17 hemmen. Eine Systemtherapie des seborrhoischen Ekzems ist nur selten nötig und kann mit Kortikosteroiden, Antimykotika oder Vitamin-A-Derivaten erfolgen. Wichtig ist eine intensive Beratung der Patienten über die Notwendigkeit einer konsequenten und lang währenden Anwendung der Therapeutika sowie zur Anwendung von hautschonenden Pflegeprodukten und Maßnahmen.

http://ift.tt/2qA6hbT

Klinisches und histologisches Spektrum der Palisadengranulome

Zusammenfassung

Die Palisadengranulome umfassen eine Gruppe verschiedener Erkrankungen mit gleichartigem histomorphologischem Bild der Granulombildung in der Haut. Histologisch kennzeichnend sind dermal und subkutan lokalisierte Herde mit verschiedenartig degeneriertem Bindegewebe, die von einem palisadenartig angeordneten Infiltrat aus Histiozyten und Riesenzellen umgeben sind (nekrobiotisches Granulom). Im Zentrum finden sich Ablagerungen von Muzin und Fibrin. Die beiden klassischen Hauterkrankungen, die histologisch ein Palisadengranulom ausbilden, sind das Granuloma anulare und die Necrobiosis lipoidica. Daneben können palisadenartig angeordnete Granulome in der Haut auch im Rahmen von Systemerkrankungen auftreten wie bei Rheumaknoten und nekrobiotischem Xanthogranulom. Über die Ätiopathogenese der Erkrankungen ist wenig bekannt. Klinisch präsentieren sie sich variabel. Therapeutisch sind sie häufig schwer zu beeinflussen.

http://ift.tt/2ro5b1W

Thread lifting: a minimally invasive surgical technique for long-standing facial paralysis

Abstract

Background

Chronic facial paralysis induces degenerative facial muscle changes on the involved side, thus, making the individual seem as older than their actual age. Furthermore, contralateral facial hypertrophy aggravates facial asymmetry. A thread-lifting procedure has been used widely for correction of a drooping or wrinkled face due to the aging process. In addition, botulinum toxin injection can be used to reduce facial hypertrophy. The aim of study was to evaluate the effectiveness of thread lifting with botulinum toxin injection for chronic facial paralysis.

Methods

A total 34 of patients with chronic facial paralysis were enrolled from March to October 2014. Thread lifting for elevating loose facial muscles on the ipsilateral side and botulinum toxin A for controlling the facial muscle hypertrophy on the contralateral side were conducted. Facial function was evaluated using the Sunnybrook grading system and dynamic facial asymmetry ratios 1 year after treatment.

Results

All 34 patients displayed improved facial symmetry and showed improvement in Sunnybrook scores (37.4 vs. 83.3) and dynamic facial asymmetry ratios (0.58 vs 0.92). Of the 34 patients, 28 (82.4%) reported being satisfied with treatment.

Conclusion

The application of subdermal suspension with a reabsorbable thread in conjunction with botulinum toxin A to optimize facial rejuvenation of the contralateral side constitutes an effective and safe procedure for face lifting and rejuvenation of a drooping face as a result of long-lasting facial paralysis.

http://ift.tt/2rjXwzK

Malignization of a vestibular schwannoma 13 years after radiation therapy

Abstract

This article presents a case of malignant transformation of vestibular schwannoma 13 years after stereotactic radiation therapy, which lead to an acute life-threatening condition. Although the observation is currently only based on case reports, an increasing number of these support the hypothesis that there is a relevant risk of malignant transformation in the long-term course of previously irradiated vestibular schwannomas. Therefore, long-term MRI follow-up should be considered.

http://ift.tt/2qAhycb

Lack of K140 immunoreactivity in junctional epidermolysis bullosa skin and keratinocytes associates with misfolded laminin EGF-like (LE) motif 2 of the β3 short arm

Abstract

Recessive mutations in the LAMA3A, LAMB3 and LAMC2 genes coding for laminin-332 (α3aβ3γ2) chains cause different junctional epidermolysis bullosa (JEB) subtypes. Biallelic truncating mutations in any of the three genes usually lead to lack of protein expression resulting in the severe generalized JEB subtype, while missense or splicing mutations in at least one allele lead to reduced expression typical of generalized intermediate or localized JEB. Here, we molecularly characterized an adult JEB patient showing negative skin staining for the anti-β3 chain mAb K140. This antibody recognizes an as yet unidentified epitope within the β3 short arm. The patient harbours a homozygous splicing mutation resulting in major aberrant transcripts with partial skipping of the LAMB3 exon coding for the laminin EGF-like (LE) motif 2 of the β3 short arm (β3-LE2). At protein level, mutation consequences predict a misfolded β3-LE2 motif and, indeed, we found that laminin-332 is correctly assembled but retained in the endoplasmic reticulum (ER) where it co-localizes with the lumenal ER chaperone BiP, leading to dramatically reduced secretion. Lack of K140 reactivity to mutant laminin-332 was confirmed by immunoprecipitation and Western blot analyses. Our findings identify the β3-LE2 subdomain as the region recognized by K140 mAb. In addition, they further show that misfolding of laminin-332 structural motifs and subsequent ER protein retention is a common pathomechanism in JEB generalized intermediate. In addition to be useful for antigen mapping diagnosis of JEB subtypes, this knowledge is relevant to the design of therapeutic strategies aimed at releasing ER-retained laminin-332 in JEB.

This article is protected by copyright. All rights reserved.

http://ift.tt/2rnvkhu

Guideline for the diagnosis and treatment of scabies in Japan (third edition)

Abstract

In the current work, we present our new guideline for the diagnosis and treatment of scabies which we, the Executive Committee convened by the Japanese Dermatological Association, developed to ensure proper diagnosis and treatment of scabies in Japan. Approval of phenothrin topical use under the National Health Insurance in August 2014 led to this action. Permethrin, a topical anti-scabietic medication belonging to the same pyrethroid group as phenothrin, is already in use worldwide. In this guideline, we introduce criteria for a proper diagnosis of scabies, treatment algorithm for common and crusted (hyperkeratotic) scabies, and prevention. The major change from our second edition is the treatment algorithm. As phenothrin is now available, the first-line therapy for common scabies is either topical phenothrin lotion or oral ivermectin. The second-line option for topical treatment is sulfur-containing ointments, crotamiton cream or benzyl benzoate lotion. γ-Benzene hexachloride ointment is no longer provided for clinical use. In an immunosuppressed patient, the treatment option is still the same, but with close follow up. If the symptoms persist, diagnosis and treatment must be reassessed. For hyperkeratotic scabies and nail scabies, removal of thick crust, cutting of nails and occlusive dressing are additionally required. The safety and effectiveness of combined treatment with topical and oral medications are not yet confirmed. Further assessment is needed. In addition to appropriate treatment, it is essential to educate patients and health-care workers and to conduct epidemiological studies to prevent further spread of the disease through effectively utilizing available resources including manpower, finance, logistics and time.

http://ift.tt/2rjEREd

Inferior thyroid artery ligation increases hypocalcemia after thyroidectomy: A meta-analysis

Objective

To assess the effect of truncal ligation of the inferior thyroid artery in comparison with ligation of secondary branches as a risk factor for postoperative hypocalcemia.

Data Sources

A search was conducted using the Medical Subject Headings and free-text terms "thyroid*" and "truncal ligation*" in PubMed Central, PubMed, Embase, and Latin American and Caribbean Health Sciences Literature databases for trials published between January 1985 and October 2016. A Google search with the same terms, and a "snowball" approach was designed to retrieve the largest number of articles.

Review Methods

Controlled trials (randomized or not) of adults who underwent total/bilateral subtotal thyroidectomy were searched, and truncal ligation versus nontruncal ligation of the inferior thyroid artery was compared. Data were acquired following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Methodological quality of randomized controlled trials was assessed in accordance with Cochrane Collaboration guidelines, and for nonrandomized controlled trials, the Newcastle-Ottawa quality assessment scale for cohort studies was used. Pooled results are presented as risk differences with a random effects model. The main outcome was postoperative temporary and definitive hypocalcemia.

Results

We found 11 nonrandomized controlled trials and nine randomized controlled trials with 1940 patients: 977 patients in the trunk ligation group and 963 patients in the nontruncal ligation group. The risk difference for biochemical hypocalcemia was 6% (95% confidence interval [CI]: 2% to 11%), for symptomatic hypocalcemia 6% (95% CI: 1% to 10%), and definitive hypocalcemia 0% (95% CI: −1% to 1%) in the whole group.

Conclusions

Truncal ligation of the inferior thyroid artery increases the risk of temporary and symptomatic hypocalcemia but not the risk of definitive hypocalcemia. Laryngoscope, 2017

http://ift.tt/2rjhV8k

Adjunct steroids in the treatment of peritonsillar abscess: A systematic review

Objectives

This study systematically reviews the existing literature on the efficacy of adjuvant corticosteroids in improving clinical outcomes after peritonsillar abscess (PTA) drainage.

Study Design

Systematic review.

Methods

We performed a literature search of MEDLINE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Scopus, Embase, and ClinicalTrials.gov from inception to June 2016. Inclusion criteria included randomized controlled trials (RCTs) evaluating adjuvant corticosteroids after PTA drainage. Data were systematically collected on study design, patient demographics, and clinical characteristics. Two independent investigators reviewed all manuscripts and summarized the data.

Results

Three RCTs comprising 153 patients were included. The results were not pooled due to heterogeneity in the method in which outcomes were measured and reported. The trials also varied on the type of steroid (dexamethasone, methylprednisolone) administered and method of drainage (incision, aspiration). All three RCTs reported statistically significant improvement in body temperature from adjuvant steroid administration compared to placebo. Pain scores, mouth opening, time to painless oral intake, and duration of hospitalization were significantly improved in only one or two of the three RCTs between the steroid and control group. No adverse side effects from steroid administration were reported.

Conclusions

Steroids as an adjunct therapy to the treatment of PTA may result in faster recovery. However, further investigation with larger RCTs and standardized outcomes are warranted.

Level of Evidence

1a Laryngoscope, 2017

http://ift.tt/2qzAvvM

Bilateral vestibulopathy with positive Tullio phenomenon

We describe the case of a 34-year-old patient presenting with the unique combination of bilateral vestibulopathy in combination with noise- and pressure-induced nystagmus. Bilateral vestibular dysfunction was demonstrated by pathological results in video-based head impulse testing as well as in caloric testing. In contrast, cervical vestibular-evoked myogenic potentials were normal, demonstrating normal sacculus function. Due to the positive Tullio phenomenon, semicircular dehiscence syndrome was excluded. Recently, this symptom combination was related to the histopathological finding of vestibular atelectasis.

Level of Evidence

N/A Laryngoscope, 2017

http://ift.tt/2qzUiew

The impact of developing a speech and swallow rehab program: Improving patient satisfaction and multidisciplinary care

Objectives/Hypothesis

The objective of this study was to evaluate the impact of developing an integrated head and neck cancer speech and swallowing rehabilitation program on physician/team focus on functional outcomes.

Study Design

Prospective cross-sectional design.

Methods

Surveys regarding physician behavior and patient satisfaction with speech and swallowing were administered in an academic oncology practice prior to and 1 year following establishment of a dedicated head and neck speech and swallowing rehabilitation program. Participants included new and established head and neck cancer patients recruited consecutively. The primary outcome was physician behavior regarding speech and swallowing outcomes (as measured by discussion of function, providing suggestions regarding function, and referral to speech-language pathology services).

Results

A total of 199 surveys were returned at the first time point and 271 at the second. Demographic variables were comparable between the two groups. The later cohort was more likely to report team discussion and suggestions regarding speech and swallowing function than the former (P < .001, 95% confidence interval [CI]: −0.775 to −0.265; P < .001, 95% CI: −0.928 to −0.035, respectively). Although there was no significant difference between the groups in regard to satisfaction with speech (P = .07), more favorable satisfaction with swallowing was reported by the later cohort (P = .028, 95% CI: −0.531 to −0.029).

Conclusions

Integration of speech and swallowing rehabilitation into head and neck cancer programs is associated with increased physician focus on functional outcomes and greater patient satisfaction in regard to swallowing function. We advocate for standard integration of such services into the multidisciplinary head and neck cancer care team.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2rjqY90

Outcome after one year of upper airway stimulation for obstructive sleep apnea in a multicenter German post-market study

Objective/Hypothesis

Upper airway stimulation (UAS) of the hypoglossal nerve has been implemented in the routine clinical practice for patients with moderate-to-severe obstructive sleep apnea (OSA) who could not adhere to continuous positive airway pressure. This study reports objective and patient-reported outcome after 12 months of implantation.

Study Design

Multicenter prospective single-arm study.

Methods

Consecutive patients who received the UAS system (Inspire Medical Systems, Inc., Minneapolis, Minnesota, Maple Grove, MN, U.S.A.) were enrolled in three German centers. Key study exclusion criteria included body mass index > 35 kg/m², apnea–hypopnea index (AHI) < 15 or > 65, or complete concentric collapse at the soft palate during sedated endoscopy. Data collection at 6- and 12-month visit include home sleep test and patient-reported outcome measures.

Results

Among the total of 60 participants, the median AHI reduced from 28.6 to 9.5 from baseline to 12 months. Patient-reported outcome measured in Epworth Sleepiness Scale and Functional Outcomes of Sleep Questionnaire both improved significantly from baseline to 12 months. The average usage time was 39.1 ± 14.9 hours per week among all participants based on recordings by the implanted device. One patient requested a removal of the device for cosmetic and other personal reasons and was completed without sequelae.

Conclusion

This study supported that UAS is a safe and effective treatment option for patients with OSA in routine clinical practice.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2qzTzdb

Pretreatment albumin level predicts survival in head and neck squamous cell carcinoma

Objectives/Hypothesis

Poor nutritional status in patients with head and neck squamous cell carcinoma (HNSCC) is associated with tumor progression and survival. This study examined the prognostic value of nutritional and hematological markers in patients with HNSCC who received definitive treatments.

Study Design

A prospective observational cohort study.

Methods

This study included 338 consecutive patients who underwent surgery and/or radiotherapy/chemoradiotherapy for treatment-naïve HNSCC. Body weight and nutritional and hematological parameters were regularly measured before and after treatment. Univariate and multivariate analyses using Cox proportional hazards models were performed to identify factors associated with disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS).

Results

Body weight, serum total protein and albumin levels, and hematological variables significantly decreased after treatment. Univariate analyses illustrated that age, tumor site, T and N classifications, overall stage, pretreatment serum albumin (<3.5 g/dL) and hemoglobin (<12 g/dL) levels, and neutrophil-lymphocyte ratio were significantly associated with DFS, CSS, and OS (all P < .05). Multivariate analyses identified age, tumor site, N classification, and pretreatment albumin levels as independent predictors of DFS, CSS, and OS (all P < .05). Patients with low serum albumin levels prior to treatment experienced approximately sixfold increases in the risks of tumor progression and cancer-specific and overall mortality compared to the findings in their counterparts.

Conclusions

Our results suggest that pretreatment serum albumin levels predict DFS, CSS, and OS in patients who received definitive treatment for HNSCC. These findings might help to predict treatment outcome and guide nutritional intervention in patients with HNSCC.

Level of Evidence

2b Laryngoscope, 2017

http://ift.tt/2rjtf4f

Stapes prosthesis length and hearing outcomes

Objectives

First, to determine if prosthesis length plays a role in optimizing successful hearing outcomes in stapedotomy surgery; and second, to determine if patient factors such as height are correlated with prosthesis length.

Study Design

Retrospective chart review.

Methods

Retrospective chart review of patients undergoing stapedotomy surgeries with adequate follow up. Length of prosthesis, pre-/postoperative audiograms, and follow-up data were obtained.

Results

The primary group consisted of 227 cases. The prosthesis length ranged from 3.75 mm to 4.75 mm (median 4.25 mm). The greatest improvement in postoperative air–bone gap (ABG) occurred in the 4.25 mm group, and the least in the 3.75 mm group. Patient height showed a positive, although weak, correlation with prosthesis length. No findings reached statistical significance.

Conclusion

Accurate measurement of prosthesis length is important for successful postoperative hearing outcomes. There is a positive but not significant correlation between patient height and prosthesis length.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2qzOQYP

Bone wax extrusion through postauricular wounds: A case series

Bone wax is an effective hemostatic agent that generally is considered safe. However, because it is nonabsorbable, significant complications can occur. We present the first two reported cases of delayed migration and extrusion of bone wax through postauricular wounds due to foreign body reaction and granuloma formation following mastoid surgery. We also present a literature review of complications associated with intraoperative bone wax use and discuss alternative hemostatic agents. Laryngoscope, 2017

http://ift.tt/2rjBtJw

Barriers to generating PDX models of HPV-related head and neck cancer

Objectives/Hypothesis

Delineate factors impacting the creation and use of patient-derived xenografts (PDXs) of human papilloma virus-related (HPV+) head and neck squamous cell carcinomas (HNSCCs).

Study Design

Laboratory-based translational study.

Methods

Fifty-one surgically resected HNSCCs, including 31 HPV + cancers, were implanted into NOD/SCID/IL-2Rγ^-/- (NSG) mice using standardized methodology. Clinical and pathologic factors were tested for association with engraftment. The gross, histologic, and molecular features of established HPV + PDXs were analyzed in comparison to their tumors of origin.

Results

Negative HPV status and perineural invasion (PNI) were independent, additive factors associated with increased PDX formation. Epstein-Barr virus–positive (EBV+) human large B-cell lymphomas grew from 32% of HPV + HNSCC cases that failed to engraft. Successfully established HPV + PDXs retained basaloid histology and often developed cystic growth patterns typical of HPV + nodal metastases. They also maintained elevated p16^INK4A levels and expression of E6/E7 viral oncogene transcripts.

Conclusion

Reduced engraftment by HPV + tumors lacking PNI likely results in selection biases in HNSCC PDX models. Formation of EBV + lymphomas in NSG mice further reduces the generation of HPV + models and must be ruled out before long-term use of PDXs. Nevertheless, the retention of distinctive pathologic traits and viral oncogene expression by HPV + PDXs provides a viable in vivo platform for basic and translational studies as well as a resource for generating advanced in vitro models.

Level of Evidence

NA. Laryngoscope, 2017

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Smoking and olfactory dysfunction: A systematic literature review and meta-analysis

Objectives/Hypothesis

A systematic review and meta-analysis of the literature was undertaken, examining the association between tobacco smoking and olfactory function in humans, utilizing PubMed and Web of Science (1970–2015) as data sources.

Study Design

Systematic literature review and meta-analysis.

Methods

This database review of studies of smoking and olfaction, with a focus on identifying high-quality studies (based on modified versions of the Newcastle-Ottawa Scale), used validated olfactory tests among the generally healthy population.

Results

We identified 11 studies meeting inclusion criteria. Of 10 cross-sectional studies, two were excluded from meta-analysis because the cohorts they studied were included in another article in the review. In meta-analysis, current smokers had substantially higher odds of olfactory dysfunction compared to never smokers (odds ratio [OR] = 1.59, 95% confidence interval [CI] = 1.37–1.85). In contrast, former smokers were found to have no difference in risk of impaired olfaction compared to never smokers (OR = 1.05, 95% CI = 0.91–1.21). The single longitudinal study reviewed found a trend toward increased risk of olfactory decline over time in ever smokers; this trend was stronger in current as compared to former smokers.

Conclusions

Current smoking, but not former smoking, is associated with significantly increased risk of olfactory dysfunction, suggesting that the effects of smoking on olfaction may be reversible. Future studies that prospectively evaluate the impact of smoking cessation on improvement in olfactory function are warranted.

Level of Evidence

N/A. Laryngoscope, 2017

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Multimodale Therapie des Ösophaguskarzinoms

Zusammenfassung

Das Ösophaguskarzinom ist in Deutschland eher selten, die Häufigkeit von Tumoren des distalen Ösophagus und des gastroösophagealen Übergangs nimmt jedoch zu. Aufgrund des oft fortgeschrittenen Tumorstadiums bei der Diagnosestellung ist diese Entität ein Paradebeispiel für die Notwendigkeit einer optimalen interdisziplinären Zusammenarbeit von Chirurgie, Strahlentherapie und Onkologie. Beim Plattenepithelkarzinom ist ab einem Stadium cT3 eine präoperative Radiochemotherapie indiziert. Bei Plattenepithelkarzinomen im oberen Drittel des Ösophagus stellt die definitive Radiochemotherapie ohne Operation oft die bevorzugte Option dar. Bei Adenokarzinomen ab einem Stadium cT3 sollen entweder eine präoperative Radiochemotherapie oder eine perioperative Chemotherapie durchgeführt werden, da dadurch das Überleben im Vergleich zur alleinigen Operation verbessert wird. Eine Induktionschemotherapie vor Radiochemotherapie ist vielversprechend, jedoch außerhalb von Studien noch nicht belegt.

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Repair of Thoracoabdominal Aortic Aneurysm with Thrombosed Infrarenal Component: A Modified Hybrid Technique without Aortic Cross Clamping

The authors report the successful repair of a Crawford type III thoracoabdominal aortic aneurysm (TAAA) with a thrombosed infrarenal component using a modified hybrid technique without aortic clamping in a high-risk patient. A 64-year-old male with a history of hypertension, diabetes, and severe chronic obstructive pulmonary disease presented with acute on chronic backache and bilateral short distance claudication. A computerized tomography scan demonstrated a large, nonleaking Crawford type III TAAA with thrombosed infrarenal component of the aneurysm. In addition, both common iliac arteries were occluded with the chronic thrombus. A single-stage, modified hybrid procedure involving an aortobifemoral bypass without aortic clamping, debranching of right renal, superior mesenteric, and celiac arteries as well as an endovascular repair of the thoracic aneurysm was performed. Unfortunately, despite a technically sound repair, the patient died postoperatively from a massive pulmonary embolism. TAAA with a thrombosed infrarenal aorta and bilateral common iliac arteries can be repaired using a single-stage modified hybrid procedure without aortic clamping in high-risk patients who cannot tolerate thoracotomy and aortic cross clamping.

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The role of nailfoldcapillaroscopy in the assessment of internal organ involvement in Systemic Sclerosis: A critical review

Publication date: Available online 30 May 2017
Source:Autoimmunity Reviews
Author(s): Stergios Soulaidopoulos, Eva Triantafyllidou, Alexandros Garyfallos, George D. Kitas, Theodoros Dimitroulas
Endothelial dysfunction and microvascular damage constitute the hallmarks of systemic sclerosis (SSc), explaining much of the pathophysiology and clinical manifestations of the disease. Nailfold videocapillaroscopy (NVC) is an established method for the assessment of the microvasculature, aiding in distinguishing different types of structural vascular abnormalities. Until recently, NVC was used in the diagnosis of SSc as well as in the assessment and follow-up of peripheral digital vasculopathy. On the top of digital ulcers, internal organ involvement such as myocardial dysfunction, pulmonary vascular and/or parenchymal lung disease characterizes severe SSc imparting a high risk of mortality. There is growing evidence suggesting that the extent of peripheral microvascular changes reflects the severity of the disease, especially in terms of life-threatening cardiopulmonary complications. The possible use of nailfold videocapillaroscopy as a useful, non-invasive modality to improve the ability to identify patients at higher risk for these devastating complications of the disease remains to be established.The aim of this review is to critically summarize and discuss current literature regarding the relationship between morphological alterations of nailfold dermal papillary vessels and several manifestations of SSc, focusing on visceral organ involvement, as well as their association with surrogate markers of macrovascular disease.



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Knowledge, perception, and practice of patients about pityriasis versicolor in Kaduna, North Central Nigeria

Abstract

Background

Although pityriasis versicolor (PV) is a common fungal infection of the skin affecting up to 50% of the population in the tropics, little is known about what patients know, believe, or feel about the condition.

Methods

In a cross-sectional questionnaire study of 608 consecutive patients attending the General Outpatient Department and Skin Clinic of a public hospital in Kaduna, Nigeria, self-report of PV, knowledge about its causes, treatments used by patients, and perception and feelings about the condition were assessed.

Results

Overall 608 patients were studied (239/594 [40.2%] males, 355/594 [59.8%] females, age 11–49 years, mean ± SD age of 29.3 ± 10.1). Lifetime self-report prevalence of PV was 271/606 (44.7%) (males: 117/239 [50.0%] females: 148/355 [41.7%] P = 0.09). Three hundred and twenty-seven of 608 (53.8%) patients believed PV was transmitted from another person while 204/608 (33.6%) believed the condition was caused by poor personal hygiene. One hundred and thirty of 608 (21.4%) thought PV was caused by fungi living on the skin. Virtually all respondents who had PV had used at least one preparation with more than half visiting a healthcare facility. A total of 305/608 (50.2%), 189/608 (31.1%), and 142/608 (23.4%) respondents reported feeling or likely feeling uncomfortable, embarrassed, or ashamed, respectively, about PV. Being considered a dirty person (45.6%) and being avoided by other people (28%) were common concerns of respondents.

Conclusion

Most patients did not know what caused PV, and many were uncomfortable, embarrassed, and ashamed, and feared being considered dirty and avoided by others.

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A case of multifocal scarring alopecia

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„Indolenter“ pigmentierter Hauttumor seit mehr als 20 Jahren

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Lokaltherapie mit Farbstoff-Rezepturzubereitungen

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Lanadelumab

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Alports syndrome with type 4 renal tubular acidosis

This case report details a 51-year-old man with Alport's syndrome resulting in chronic nephritis with stable renal function and sensorineural deafness. The patient was being investigated for persistently raised potassium refractory to dietary and pharmacological modification. Subsequently, the patient was found to have type 4 renal tubular acidosis, and potassium normalised with the addition of fludrocortisone.

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Linagliptin-associated blistering and ulceration

We present the case of 60-year-old man with type 2 diabetes who developed blistering after two sequential exposures to linagliptin. Linagliptin is one of the dipeptidyl peptidase 4 (DPP-4) inhibitors, a group of oral hypoglycaemic agents used commonly for the treatment of type 2 diabetes. On the first exposure to linagliptin, he developed blisters on the hands which resolved after stopping the drug. After repeat exposure, he developed two large blisters on the left foot, which burst giving rise to secondary infection, requiring hospital admission for treatment. We discuss the latest research linking DPP-4 inhibitors with adverse skin reactions and the effect of ulcers on the morbidity and mortality of patients with diabetes. This case report highlights skin reactions as an important, rare and lesser known side effect of DPP-4 inhibitors.

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Incidental finding of a filamentous mass in the left atrium in a patient investigated for endocarditis

Description

A previously fit and well middle-aged woman presented with a 24-hour history of deteriorating breathlessness and rigors. The patient showed signs of acute respiratory distress. She was febrile, tachycardic and had a loud pansystolic murmur at the cardiac apex. A chest radiograph showed right lower zone consolidation, and an ECG showed sinus tachycardia. Blood tests showed raised inflammatory markers with white cell count of 11.8x10⁹/L (normal range 4–10x10⁹/L) and C reactive protein 56 mg/L (normal range 0–10 mg/L). A transthoracic echocardiogram identified severe mitral regurgitation secondary to posterior mitral valve leaflet prolapse with a hyperdynamic left ventricle. Peripheral blood cultures were negative.

The patient was treated for community-acquired pneumonia and presumed endocarditis. A transoesophageal echocardiogram (TOE) confirmed severe mitral regurgitation secondary to a flail posterior mitral valve scallop (P2) with ruptured primary and secondary chords. There was also a posterior leaflet calcium spur and a vegetation. In addition, the TOE demonstrated a...

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Postoperative drug-induced priapism

We presented a case of a postoperative patient with low-flow priapism, possibly initiated by propofol-based anaesthesia or epidural anaesthesia. The delay in diagnosing priapism resulted in emergency interventions with a partially successful effect and eventually permanent erectile dysfunction. Due to the delay in treatment, erectile dysfunction ensued and was manageable with medication; hence, the patient decided against a penile prosthesis.

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Rectosigmoid malakoplakia

We present a rare case of rectosigmoid malakoplakia treated with fluoroquinolone.

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A rare cause of anuria in a case of pre-B acute lymphoblastic leukaemia

Renal failure in cases of acute lymphoblastic leukaemia during induction is mainly because of sepsis and tumour lysis syndrome. This 18-year-old man had sudden onset anuria with increase in creatine. At this time, patient did not have any overt signs or laboratory features suggestive of sepsis. Imaging studies documented bilateral hydronephrosis. Ureteroscopy was done, and it showed presence of soft tissue mass obstructing the ureter. On the the left side, it was noted in its middle part and on the right, at the ureteropelvic junction. The mass on the left side was removed under ureteroscopic guidance and was sent for histopathology examination. It was confirmed to be fungal ball on histopathology examination. Though rare, even in immunocompromised patients, bilateral fungal ball should be considered in differential diagnosis in cases of acute leukaemia with sudden onset anuria. We share our experience in managing this case for which there are no clear guidelines.

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Hypercalcaemic encephalopathy due to metastatic parathyroid carcinoma

A 49-year-old man presented in the emergency department with altered sensorium and renal failure and was placed on a ventilator. Evaluation with MRI of the brain showed enhancing lesion in the occipital lobe. Biochemical tests revealed elevated calcium and parathyroid hormone (PTH) levels. Further evaluation revealed multiple lesions at both lobes of the lungs and nodular lesion in the right inferior pole of the thyroid. Diagnosis of metastatic parathyroid carcinoma was suspected. Patient was stabilised with bisphosphonates and haemodialysis and planned for surgery. Intraoperatively a hard lesion was found in the right inferior parathyroid infiltrating the surrounding structures. En bloc resection was done. General condition of the patient improved and he was weaned from the ventilator. Histopathology confirmed the diagnosis of parathyroid carcinoma. Postoperatively, there was persistent elevation of PTH in spite of a fall in calcium levels indicating functioning brain and pulmonary metastases. Due to extensive metastases, the patient was given palliative cinacalcet and was kept under follow-up.

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Fascioliasis--a rare cause of hepatic nodules

Fascioliasis is a zoonotic disease that can sometimes affect humans. It presents with non-specific signs and symptoms which makes it difficult to establish an early definitive diagnosis. This can be particularly true in non-endemic countries where a high degree of suspicion is needed to make the diagnosis. Another confounding factor is that many of the initial complains and findings are very similar to those of malignancy. We report a case of an otherwise healthy 47 year-old male presenting with abdominal pain, night-time sweating, anorexia, weight loss and loose stools that had several hepatic nodules visible in the abdominal CT scan. Although the initial hypothesis was hepatic malignancy or liver metastasis of unknown primary neoplasm, the workup performed led us to the correct diagnosis. He was treated successfully for hepatic fascioliasis, with a full recovery.

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Radiographic imaging of an intra-aortic balloon pump impersonating a misplacement in the superior vena cava due to a right-sided aortic arch

Description

A 48-year-old man with a history of coronary heart disease underwent a left heart catheterisation for non-ST-segment myocardial infarction. Coronary angiography revealed significant stenosis of the left anterior descending artery and right coronary artery (LAD/RCA). Transthoracic echocardiogram showed severely dilated left ventricle (LV), moderate concentric LV hypertrophy, an LV ejection fraction of 26% and elevated right ventricular systolic pressure of 40–45 mm Hg. An intra-aortic balloon pump (IABP) was placed for haemodynamic support through a right femoral artery insertion site. The patient later received a saphenous vein graft (SVG) to the RCA, an SVG to the left obtuse marginal artery and a left internal mammary artery graft to the LAD. On the postoperative chest X-ray, the IABP was visualised overlying the right hilar region, thatevoked alarming concern of possible misinsertion into the superior vena cava (SVC) through an arteriovenous fistula or through the femoral vein (figure 1). Delayed...

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Double-blind randomized phase III study comparing a mixture of natural agents versus placebo in the prevention of acute mucositis during chemoradiotherapy for head and neck cancer

Abstract

Background

There is no widely accepted intervention in the prevention of acute mucositis during chemoradiotherapy for head and neck carcinoma. In the present double-blind study, we tested 4 natural agents, propolis, aloe vera, calendula, and chamomile versus placebo.

Methods

Patients undergoing concomitant chemo-intensity-modulated radiotherapy (IMRT) were given natural agent or matched placebo; grade 3 mucositis on physical examination according to Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 was the primary endpoint. Various covariates were tested at logistic regression, including the individual amount of mucosa receiving at least 9.5 Gy per week (V9.5w).

Results

One hundred seven patients were randomized from January 2011 to July 2014, and 104 were assessable (51%-49% were assigned to the placebo group and 53%-51% were assigned to the natural agent). Overall, 61 patients developed peak grade 3 mucositis with no difference between arms (P = .65). Conversely, V9.5w (P = .007) and primary site (P = .037) were independent predictors.

Conclusion

The selected natural agents do not prevent mucositis, whereas the role of V9.5w is confirmed.

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p16 protein expression and correlation with clinical and pathological features in osteosarcoma of the jaws: Experience of 37 cases

Abstract

Background

In literature, no markers have been reported as predictive and prognostic factors in osteosarcoma of the jaw.

Methods

A retrospective analysis of p16 expression was performed in 37 patients with high-grade osteosarcoma of the jaw to investigate its potential prognostic and predictive value.

Results

p16 positivity was found in 56.7% of cases. The absence of p16 expression was associated with an adverse disease-free survival (P = .003). At the multivariate Cox regression, positive margins were the only independent factor. In the subgroup of 17 patients who underwent neoadjuvant chemotherapy, a significant association was noted between p16 expression and pathological response to chemotherapy (P = .015) and the negativity of p16 increased the risk of negative outcome (P = .01).

Conclusion

Our data indicate that the wide surgical margin is the most important prognostic factor. The expression of p16 confers greater sensitivity to chemotherapy and its loss of expression is associated with a worse prognosis.

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Impact of positive margins on outcomes of oropharyngeal squamous cell carcinoma according to p16 status

Abstract

Background

Currently, positive surgical margins in head and neck cancer are considered to be an indicator for postoperative chemoradiotherapy (CRT) over radiotherapy (RT) alone. However, there are less data regarding the impact of margin status on human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (SCC).

Methods

We performed a retrospective review of 55 patients with oropharyngeal SCC undergoing primary surgical treatment. The impact of margin status on disease-specific survival (DSS) was studied according to p16 status.

Results

Twenty-one patients had positive margins. Adjuvant treatment in these cases was CRT (n = 6), RT alone (n = 14), and none (n = 1). Among p16-negative patients, positive margins and dysplasia at margins predicted significantly worse DSS. Among patients with p16-positive disease, margin status had no impact on DSS.

Conclusion

Patients with p16-positive oropharyngeal SCC and positive margins after excision maintain a low risk of recurrence despite most receiving RT alone as adjuvant treatment. These findings raise questions regarding the additional benefit of postoperative CRT in this group.

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Evaluation of ultrasound reporting for thyroid cancer diagnosis and surveillance

Abstract

Background

Despite the importance of ultrasound imaging in thyroid disease care, ultrasound reports vary greatly in the features described. It is essential that ultrasound reports contain and present all components necessary for a clinical decision in a reader-friendly format.

Methods

One hundred ninety thyroid and neck ultrasound reports were scored using the universal ultrasound report template developed by Su et al, along with the American Thyroid Association (ATA) and the American Association of Clinical Endocrinologists/Associazione Medici Endocrinologi/European Thyroid Association (AACE/AME/ETA) guidelines. All ultrasounds were performed on patients seen between August and November 2015 by a single surgeon (M.L.U), and originated from a variety of physicians and institutions.

Results

An average of 30.9% of Su et al's criteria was satisfactorily included in the reports. Similar results were reached when the ATA and the AACE/AME/ETA guidelines were applied as scoring templates.

Conclusion

Our results reveal the wide variation in ultrasound reporting. The standardization of ultrasound reporting would help to improve physicians' ability to properly diagnose and manage patients with thyroid disease. © 2017 Wiley Periodicals, Inc. Head Neck, 2017

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Comparison of the immunogenicity of BM32, a recombinant hypoallergenic B cell epitope-based grass pollen allergy vaccine with allergen extract-based vaccines

Publication date: Available online 31 May 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Milena Weber, Katarzyna Niespodziana, Birgit Linhart, Angela Neubauer, Hans Huber, Rainer Henning, Rudolf Valenta, Margarete Focke-Tejkl




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Emphysematous gastritis with hepatic portal venous gas: a shift towards conservative management

Description

A female aged 94 years with a history of diabetes presented with acute onset abdominal pain, haematemesis and altered mental status. She denied alcoholism, corrosive ingestion, pancreatitis or abdominal trauma. She appeared toxic and was hypotensive. Her hemogram showed leucocytosis at 14.8 x 10^9/L. CT scan of the abdomen showed air scattered within the liver, portal vein and gastric wall (figures 1 and 2). Also, dense calcifications of the aorta and abdominal arteries were noted (figure 3). Due to the high risk of surgery, she was managed conservatively with proton pump inhibitors, broad-spectrum antibiotics, nasogastric decompression and intravenous hydration, with progressive improvement noted.

Figure 1

Axial CT scan of the abdomen and pelvis without contrast showing air within the portal vein (white arrows) and in the stomach wall (black arrow).

Figure 2

Coronal CT scan...

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The effect of subinhibitory concentrations of gentian violet on the germ tube formation by Candida albicans and its adherence to oral epithelial cells

Publication date: October 2017
Source:Archives of Oral Biology, Volume 82
Author(s): T. Mafojane, S.L. Shangase, M. Patel
ObjectiveThis study investigated the effect of subinhibitory concentrations of gentian violet on the germ tube formation by Candida albicans and its adherence ability to oral epithelial cells.MethodsThirty strains of C. albicans isolated from denture wearers, normal healthy individuals and HIV positive patients were used in the study. The antifungal property (Minimum Fungicidal Concentration) of gentian violet was determined at various time intervals using a microdilution technique. The effect of subinhibitory concentrations of gentian violet on the adherence ability (0.000244%) and on germ tube formation ((0.000244%, 0.000122%, 0.000061% and 0.000031%) was determined. In both experiments, water was used as a control. The test results were compared using the Kruskal-Wallis test.ResultsAt 60min a high concentration (0.0078%) of gentian violet was required to completely kill C. albicans. Subinhibitory concentrations of gentian violet significantly reduced the adherence ability of C. albicans by 57% (p<0.01) and equally inhibited germ tube formation (p<0.01) compared with the controls. The inhibition was concentration dependent, with up to 98% reduction at a concentration of 0.000244%. Germ tube reduction was significantly higher in the isolates from the HIV positive patients than in the isolates from denture wearers.ConclusionAt high concentrations, gentian violet killed C. albicans, whereas at subinhibitory concentrations it reduced its virulence by preventing the adherence ability and germ tube formation. This suggests that the beneficial effects of gentian violet would last beyond the fungicidal concentrations in the treatment of candidiasis.

Graphical abstract

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Podcast Interviews

ATA Members give podcast interviews on Thyroid Topics at www.docthyroid.com

Información Importante Sobre los Nódulos Tiroideos con la Dra Regina Castro de la Clínica Mayo
Interviewed and produced by Philip James | May 4, 2017 | Endocrine, Pathology, Podcast

You Have a Thyroid Nodule, What Happens Next? with Dr. Regina Castro from The Mayo Clinic
Interviewed and produced by Philip James | Apr 2, 2017 | Pathology, Podcast, Surgery

 

The post Podcast Interviews appeared first on American Thyroid Association.

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The Role of Patients

Shared decision-making affords patients and their families the autonomy to make difficult decisions after receiving comprehensive information about medical facts and treatment options. It is essential that patients' values are respected. The essential steps include first informing patients of the need for a decision, then explaining the various facts involved; after which, it is important to elicit patients' preferences and goals. Once the treatment options and outcomes important to patients are identified, an actual decision can be made. This activity is complex and requires a commitment of time and is enhanced through employment of a multidisciplinary team approach.

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Decision Making for Diagnosis and Management

The diagnosis and treatment of head and neck cancer is extremely complex. As a result, multiple medical providers are involved in a patient's care, and the multidisciplinary tumor boards provide a forum whereby they can share and discuss the intricacies of each individual patient's case. When recommendations are presented to the patient and decisions are to be finalized, the patient should benefit from the collective wisdom of a team of providers to achieve and implement a patient-centric and clinically sound consensus.

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Safer VL intubation: Don't lift or displace the tongue

Another tip for safer intubations.

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Flap Basics I

In many cases of complex facial defects, because of advanced cutaneous malignancies, primary wound closure is impossible. In these instances, ideal results can be obtained through recruitment of adjacent tissue with the use of local flaps. Advances in local flap techniques have raised the bar in facial reconstruction; however, acceptable results to surgeon and patient require high levels of planning and surgical technique. Defects resulting from Mohs surgery and other traumatic injuries can typically be repaired with local flaps. A well-planned and executed local flap can lead to excellent cosmetic results with minimal distortion of the surrounding facial landmarks.

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Anatomy of the Skin and the Pathogenesis of Nonmelanoma Skin Cancer

Skin is composed of the epidermis, dermis, and adnexal structures. The epidermis is composed of 4 layers—the stratums basale, spinosum, granulosum, and corneum. The dermis is divided into a superficial papillary dermis and deeper reticular dermis. Collagen and elastin within the reticular dermis are responsible for skin tensile strength and elasticity, respectively. The 2 most common kinds of nonmelanoma skin cancers are basal cell and squamous cell carcinoma. Both are caused by a host of environmental and genetic factors, although UV light exposure is the single greatest predisposing factor.

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