No abstract available
http://ift.tt/2iMwXTp
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Πέμπτη 31 Αυγούστου 2017
Long-term Functioning of Allogeneic Islets in Subcutaneous Tissue Pretreated with a Novel Cyclic Peptide without Immunosuppressive Medication.
Background: There exists a need for a minimally invasive method of islet transplantation without immunosuppressive drugs for the treatment of type 1 diabetes. Methods: In diabetic ACI rats, an agarose rod containing the cyclic oligopeptide SEK-1005 (agarose-SEK rod) was implanted at 2 dorsal subcutaneous sites. Then these rods were removed, and 1500 islets isolated from F344 rats were transplanted into each of the pockets. Results: Ten days after implantation of agarose-SEK rods, vascularized pockets were present. Nonfasting blood glucose levels confirmed long-term survival of the allogeneic islet grafts, without immunosuppressive therapy, in 8 of 10 recipients. Flow cytometry and gene expression analyses were performed to investigate the mechanisms underlying graft acceptance. Agarose-SEK rod implantation led to the formation of granulomatous tissue containing regulatory T cells that suppressed immune reactions against the allogeneic islet grafts. Conclusions: These results indicate that the use of an agarose-SEK rod to prevascularize a subcutaneous site may be a useful method for achieving successful allogeneic islet transplantation without immunosuppression. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
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http://ift.tt/2enKHi6
Preface to the proceedings of the Workshop on Eosinophils in Allergy and Related Diseases 2016
Publication date: September 2017
Source:Allergology International, Volume 66, Supplement
Author(s): Kohei Yamauchi
http://ift.tt/2wn8Wa5
Influence of Parasitic Worm Infections on Allergy Diagnosis in Sub-Saharan Africa
Abstract
Epidemiological studies from Sub-Saharan Africa indicate that allergies are on the rise in this region especially in urban compared to rural areas. This increase has been linked to improved hygiene, lifestyle changes, and lower exposure to pathogens in childhood. Reduced exposure to parasitic worm (helminth) infections and allergy outcomes has been the focus of a number of population studies over the years. Paradoxically, there are parallels in the immune responses to helminths and to allergies. Both conditions are associated with elevated levels of immunoglobulin E, high numbers of T helper 2 cells, eosinophils, and mast cells. These immune parallels have meant that the diagnosis of allergies in parts of the world where helminths are endemic can be hampered. The aim of this review is to examine observations from population studies conducted in Sub-Saharan Africa that demonstrate how helminth infections influence the parameters used to diagnose allergy outcomes in this region. We explore specifically how helminth infections hinder the in vitro diagnosis of allergic sensitization, influence the clinical manifestations of allergy, and also the effect of anthelmintic treatment on allergy outcomes. Advancing our understanding of how helminths influence allergy diagnosis is imperative for the development of improved tools to assess, diagnose, and treat allergic disorders in both helminth-endemic and non-endemic countries worldwide.
http://ift.tt/2etJb1C
Influence of Parasitic Worm Infections on Allergy Diagnosis in Sub-Saharan Africa
Abstract
Epidemiological studies from Sub-Saharan Africa indicate that allergies are on the rise in this region especially in urban compared to rural areas. This increase has been linked to improved hygiene, lifestyle changes, and lower exposure to pathogens in childhood. Reduced exposure to parasitic worm (helminth) infections and allergy outcomes has been the focus of a number of population studies over the years. Paradoxically, there are parallels in the immune responses to helminths and to allergies. Both conditions are associated with elevated levels of immunoglobulin E, high numbers of T helper 2 cells, eosinophils, and mast cells. These immune parallels have meant that the diagnosis of allergies in parts of the world where helminths are endemic can be hampered. The aim of this review is to examine observations from population studies conducted in Sub-Saharan Africa that demonstrate how helminth infections influence the parameters used to diagnose allergy outcomes in this region. We explore specifically how helminth infections hinder the in vitro diagnosis of allergic sensitization, influence the clinical manifestations of allergy, and also the effect of anthelmintic treatment on allergy outcomes. Advancing our understanding of how helminths influence allergy diagnosis is imperative for the development of improved tools to assess, diagnose, and treat allergic disorders in both helminth-endemic and non-endemic countries worldwide.
http://ift.tt/2etJb1C
Triple synchronous primary lung cancer: a case report and review of the literature
Multiple primary lung cancer may present in synchronous or metachronous form. Synchronous multiple primary lung cancer is defined as multiple lung lesions that develop at the same time, whereas metachronous mu...
http://ift.tt/2vNNRlA
Is voice therapy effective for the treatment of dysphonic patients with benign vocal fold lesions?
Source:Auris Nasus Larynx
Author(s): Makoto Ogawa, Hidenori Inohara
ObjectiveTo update our knowledge regarding the effectiveness of voice therapy for the treatment of vocal disturbance associated with benign vocal fold lesions, including vocal polyps, nodules and cysts, and for determining the utility of voice therapy in treating organic voice disorders, while highlighting problems for the future development of this clinical field.MethodsWe conducted a review of the most recent literature on the therapeutic effects of voice therapy, vocal hygiene education or direct vocal training on vocal quality, the lesion appearance and discomfort felt by patients due to the clinical entity of benign vocal fold mass lesions.ResultsAlthough voice therapy is principally indicated for the treatment of functional dysphonia without any organic abnormalities in the vocal folds, a number of clinicians have attempted to perform voice therapy even in dysphonic patients with benign mass lesions in the vocal folds. The two major possible reasons for the effectiveness of voice therapy on vocal disturbance associated with benign vocal fold lesions are hypothesized to be the regression of lesions and the correction of excessive/inappropriate muscle contraction of the phonatory organs. According to the current literature, a substantial proportion of vocal polyps certainly tend to shrink after voice therapy, but whether or not the regression results from voice therapy, vocal hygiene education or a natural cure is unclear at present due to the lack of controlled studies comparing two groups with and without interventions. Regarding vocal nodules, no studies have investigated the effectiveness of voice therapy using proper experimental methodology. Vocal cysts are difficult to cure by voice therapy without surgical excision according to previous studies. Evidences remains insufficient to support the use of voice therapy against benign vocal fold lesions.ConclusionEvidences at present is therefore still insufficient to support the use of voice therapy for the treatment of benign vocal fold lesions.
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Basal cell carcinoma of the Auricular concha
Mohammad Waheed El-Anwar, Mohamed Salah
Indian Journal of Otology 2017 23(3):200-202
Basal cell carcinoma (BCC) is the most common skin cancer. Eighty percent of BCC affect the facial skin. The important challenge is removing all tumor cells to avoid recurrence because recurrent tumor is more difficult to cure. The current study describes the first surgically removed BCC of the concha and describes its management. A 65-year-old woman presented with left painless fixed conchal swelling proved by punch biopsy to be BCC. This mass was totally removed with 0.5 safety margin with excision of all the conchal cartilage and lower part of ascending ramus of the helix. Postauricular raw area was left to be healed with frequent dressing. Histopathological examination confirmed the diagnosis of BCC and proved free surgical margin. The patient was cosmetically satisfied and symptom free up to date without complication or recurrence. A case of BCC of the conchae was reported and could be safely and completely removed. This directs surgeon attention to BCC as a cause of conchal swelling as an early diagnosis when it is still small allows easy, safe removal without the need for reconstruction.
http://ift.tt/2iL5gKI
Indian Journal of Otology 2017 23(3):200-202
Basal cell carcinoma (BCC) is the most common skin cancer. Eighty percent of BCC affect the facial skin. The important challenge is removing all tumor cells to avoid recurrence because recurrent tumor is more difficult to cure. The current study describes the first surgically removed BCC of the concha and describes its management. A 65-year-old woman presented with left painless fixed conchal swelling proved by punch biopsy to be BCC. This mass was totally removed with 0.5 safety margin with excision of all the conchal cartilage and lower part of ascending ramus of the helix. Postauricular raw area was left to be healed with frequent dressing. Histopathological examination confirmed the diagnosis of BCC and proved free surgical margin. The patient was cosmetically satisfied and symptom free up to date without complication or recurrence. A case of BCC of the conchae was reported and could be safely and completely removed. This directs surgeon attention to BCC as a cause of conchal swelling as an early diagnosis when it is still small allows easy, safe removal without the need for reconstruction.
http://ift.tt/2iL5gKI
Speech language development after cochlear implants in prelingual children according to the age of implantation
Alexandre Caixeta Guimarães, Henrique Furlan Pauna, Silvia Badur Curi, Vagner Rodrigues Silva, Alexandre S. M Duarte, Arthur Menino Castilho
Indian Journal of Otology 2017 23(3):185-188
Objectives: The purpose of this article is to evaluate the results regarding speech development of implanted children according to the age of implantation. Materials and Methods: This is a retrospective study with all implanted children at a tertiary hospital from 2003 to 2010. Children were grouped according to the age of the activation of the cochlear implant (CI), gender, and etiology. The degree of oral communication and the speech development using the MacArthur-Bates scale were evaluated. Results: Fifty-six children were included, 23 of them were activated before 3 years of age and 33 between 3 and 6 years. The average time of CIs use was 66 months with no significant difference between groups. Oral communication and the MacArthur-Bates Communicative Development Inventories were significantly better in children activated before 3 years (P = 0.018). Conclusion: The oral communication and speech development of children implanted before 3 years of age were significantly better than children implanted after 3 years of age.
http://ift.tt/2emXKAu
Indian Journal of Otology 2017 23(3):185-188
Objectives: The purpose of this article is to evaluate the results regarding speech development of implanted children according to the age of implantation. Materials and Methods: This is a retrospective study with all implanted children at a tertiary hospital from 2003 to 2010. Children were grouped according to the age of the activation of the cochlear implant (CI), gender, and etiology. The degree of oral communication and the speech development using the MacArthur-Bates scale were evaluated. Results: Fifty-six children were included, 23 of them were activated before 3 years of age and 33 between 3 and 6 years. The average time of CIs use was 66 months with no significant difference between groups. Oral communication and the MacArthur-Bates Communicative Development Inventories were significantly better in children activated before 3 years (P = 0.018). Conclusion: The oral communication and speech development of children implanted before 3 years of age were significantly better than children implanted after 3 years of age.
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Significance of round window niche drilling for cochlear implant surgery
Deepak Dalmia, Sanjaya Kumar Behera
Indian Journal of Otology 2017 23(3):141-145
Aim: The aim of this study is to determine the extent of round window niche (RWN) drilling for optimal visualization of the round window membrane (RWM) during cochlear implant surgery. Materials and Methods: This is a prospective study of 38 candidates between 1 and 8 years for cochlear implant surgery from March 2014 to March 2016. We classified the visibility of RWM and its cover by RWN on the surgical view through the posterior tympanotomy during surgery into four types (1) Type 1 - fully visible, (2) Type 2-2/3rd (75%–99%) of RWM visible, (3) Type 3 - ½–2/3rd (50%–74%) of RWM visible, and (4) Type IV - ¼th–½ (25%–49%) of RWM visible. Extent of drilling of RWN into (1) drilling of anterosuperior and superior lip, (2) drilling of anterosuperior, superior, and posterosuperior lip, (3) drilling of the anterior lip with anterosuperior, superior, and posterosuperior lip, and (4) drilling of the posterior lip with Type III drilling. Results: Type-4 RWN is the most common and Type-1 least common. The extent of drilling most commonly performed was Type IV drilling of anterosuperior, superior, and posterosuperior and anterior and posterior lip of RWN. Conclusion: Sufficient drilling of the bony overhang is essential for complete exposure of RWM for insertion of electrodes without any hindrance.
http://ift.tt/2iNzHQu
Indian Journal of Otology 2017 23(3):141-145
Aim: The aim of this study is to determine the extent of round window niche (RWN) drilling for optimal visualization of the round window membrane (RWM) during cochlear implant surgery. Materials and Methods: This is a prospective study of 38 candidates between 1 and 8 years for cochlear implant surgery from March 2014 to March 2016. We classified the visibility of RWM and its cover by RWN on the surgical view through the posterior tympanotomy during surgery into four types (1) Type 1 - fully visible, (2) Type 2-2/3rd (75%–99%) of RWM visible, (3) Type 3 - ½–2/3rd (50%–74%) of RWM visible, and (4) Type IV - ¼th–½ (25%–49%) of RWM visible. Extent of drilling of RWN into (1) drilling of anterosuperior and superior lip, (2) drilling of anterosuperior, superior, and posterosuperior lip, (3) drilling of the anterior lip with anterosuperior, superior, and posterosuperior lip, and (4) drilling of the posterior lip with Type III drilling. Results: Type-4 RWN is the most common and Type-1 least common. The extent of drilling most commonly performed was Type IV drilling of anterosuperior, superior, and posterosuperior and anterior and posterior lip of RWN. Conclusion: Sufficient drilling of the bony overhang is essential for complete exposure of RWM for insertion of electrodes without any hindrance.
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Multimodality approach in evaluation of common crus aplasia
Sai Kiran Pendem, Rajeswaran Rangasami, S Sanjeev Mohanty, Prabhu Radhan Radhakrishnan
Indian Journal of Otology 2017 23(3):211-215
Common crus aplsia is a rare congenital anomaly caused due to abnormal reabsorption of neuroectodermal tissue of membranous common crus. Three patients came to the Department of Otorhinolaryngology with the complaints of poor response to sound. Audiometry examination revealed bilateral sensorineural hearing loss. They were referred to radiology department for high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) temporal bone as a part of preoperative cochlear implant work up. In the present study, we discuss the HRCT and MRI findings helpful in the diagnosis of this rare anomaly in three cases.
http://ift.tt/2emUkxJ
Indian Journal of Otology 2017 23(3):211-215
Common crus aplsia is a rare congenital anomaly caused due to abnormal reabsorption of neuroectodermal tissue of membranous common crus. Three patients came to the Department of Otorhinolaryngology with the complaints of poor response to sound. Audiometry examination revealed bilateral sensorineural hearing loss. They were referred to radiology department for high resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) temporal bone as a part of preoperative cochlear implant work up. In the present study, we discuss the HRCT and MRI findings helpful in the diagnosis of this rare anomaly in three cases.
http://ift.tt/2emUkxJ
Comparative assessment of grommets with topical intranasal steroid in cases of otitis media with effusion
Sushil Suresh Chavan, Prakash S Nagpure
Indian Journal of Otology 2017 23(3):146-150
Aim: This study of 56 patients is to assess the effectiveness of grommet insertion compared with non-surgical treatment steroids (topical intranasal) in otitis media effusion (OME) cases and study complications related to the grommet and topical intranasal steroid. Material: A total subjects of various age groups attending out patient department of ENT, Kasturba Hospital, MGIMS Sevagram, Hospital, Wardha from june 2013 to august 2015 who meet the inclusion criteria and give their written consent in local language will be included in the study. Method: Comparison of medical and surgical management were done. Medical management include topical intranasal steroids by Mometasone fuorate. The recommended dose for treatment of the nasal symptoms is 1 spray (50 microgram of mometasone furoate in each spray). Recommended duration of spray is 2 to 4 weeks and the stated achievement of effect of spray is approximately 1 to 2 weeks. Surgical management include myringotomy with grommet insertion. Generally, myringotomy is performed in conjunction with the insertion of a polyethylene tube called as grommet. Infants and small children are best managed by performing this procedure under a general anesthetic. In older children and adults, local anesthetic can be used as a single block in posterior canal wall so as it block Arnold"s nerve. Results: From this present study cases of children 10 (47.62%) patients shows improvement and 17 (48.57%) adult patient shows improvement having minimal difference. Similarly failure of treatment in children is 1 (4.76%) complications in 2 (9.52%) and in adult patients 0 (0%) complication in 2 (5.71%) it was not showing significant differences. p value was not significant and showing that the differences in value was not having any level of significance in same group. It is concluded that topical nasal steroids are not so effective as surgical drainage of exudative material (myringotomy). Conclusion: Use of steroid causes nasal irritation and temporary relief only and in some patient causes only retention of fluid. Sometimes grommet retained in tympanic membrane and not extruded out needed manual removel. Beside that Overall results are in the favour of myringotomy with grommet insertion as a better modality.
http://ift.tt/2iJE4ff
Indian Journal of Otology 2017 23(3):146-150
Aim: This study of 56 patients is to assess the effectiveness of grommet insertion compared with non-surgical treatment steroids (topical intranasal) in otitis media effusion (OME) cases and study complications related to the grommet and topical intranasal steroid. Material: A total subjects of various age groups attending out patient department of ENT, Kasturba Hospital, MGIMS Sevagram, Hospital, Wardha from june 2013 to august 2015 who meet the inclusion criteria and give their written consent in local language will be included in the study. Method: Comparison of medical and surgical management were done. Medical management include topical intranasal steroids by Mometasone fuorate. The recommended dose for treatment of the nasal symptoms is 1 spray (50 microgram of mometasone furoate in each spray). Recommended duration of spray is 2 to 4 weeks and the stated achievement of effect of spray is approximately 1 to 2 weeks. Surgical management include myringotomy with grommet insertion. Generally, myringotomy is performed in conjunction with the insertion of a polyethylene tube called as grommet. Infants and small children are best managed by performing this procedure under a general anesthetic. In older children and adults, local anesthetic can be used as a single block in posterior canal wall so as it block Arnold"s nerve. Results: From this present study cases of children 10 (47.62%) patients shows improvement and 17 (48.57%) adult patient shows improvement having minimal difference. Similarly failure of treatment in children is 1 (4.76%) complications in 2 (9.52%) and in adult patients 0 (0%) complication in 2 (5.71%) it was not showing significant differences. p value was not significant and showing that the differences in value was not having any level of significance in same group. It is concluded that topical nasal steroids are not so effective as surgical drainage of exudative material (myringotomy). Conclusion: Use of steroid causes nasal irritation and temporary relief only and in some patient causes only retention of fluid. Sometimes grommet retained in tympanic membrane and not extruded out needed manual removel. Beside that Overall results are in the favour of myringotomy with grommet insertion as a better modality.
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Preauricular sinus: A comparative study between different surgical approaches
Ahmed Shaker ElAassar, Mohammad Abd-El Hady, Sherif M Askar, Hazem Said Amer, Mohammad Waheed El-Anwar
Indian Journal of Otology 2017 23(3):193-196
Background: The preauricular sinus is a congenital abnormality of the external ear that is usually asymptomatic. However, if recurrent infection, persistent discharge or abscess formation occurs, complete surgical excision of the sinus is required. Objective: The objective of the study is to compare the long-term results of the preauricular sinus excision by simple sinectomy, microscopic-assisted sinectomy, and supra-auricular approach. Patients and Methods: Patients who had symptomatic preauricular sinus scheduled for surgical excision were randomly categorized into three groups: Group A (sinectomy) for whom preauricular sinus was excised by simple sinectomy using methylene blue; Group B (microscopic-assisted sinectomy) treated by simple sinectomy using the microscopic to follow, dissect out and excise the sinus tract(s); and Group C (supra-auricular approach) treated by the supra-auricular approach. Results: Excisions of 68 preauricular sinuses were carried out in 58 patients. The mean follow-up period was 19.7 months with a range of 9–30 months. The overall recurrence rate was 13.4% (9 cases). The timing of recurrence ranged from 3 to 6 months (3–12 months). The simple sinectomy technique had the highest recurrence rate (28%). The recurrence rate of the microscopic-assisted technique was 15% while the supra-auricular approach had the lowest recurrence rate (3.4%). Conclusion: The supra-auricular approach offers the most favorable outcome for the management of the preauricular sinus.
http://ift.tt/2emQfcV
Indian Journal of Otology 2017 23(3):193-196
Background: The preauricular sinus is a congenital abnormality of the external ear that is usually asymptomatic. However, if recurrent infection, persistent discharge or abscess formation occurs, complete surgical excision of the sinus is required. Objective: The objective of the study is to compare the long-term results of the preauricular sinus excision by simple sinectomy, microscopic-assisted sinectomy, and supra-auricular approach. Patients and Methods: Patients who had symptomatic preauricular sinus scheduled for surgical excision were randomly categorized into three groups: Group A (sinectomy) for whom preauricular sinus was excised by simple sinectomy using methylene blue; Group B (microscopic-assisted sinectomy) treated by simple sinectomy using the microscopic to follow, dissect out and excise the sinus tract(s); and Group C (supra-auricular approach) treated by the supra-auricular approach. Results: Excisions of 68 preauricular sinuses were carried out in 58 patients. The mean follow-up period was 19.7 months with a range of 9–30 months. The overall recurrence rate was 13.4% (9 cases). The timing of recurrence ranged from 3 to 6 months (3–12 months). The simple sinectomy technique had the highest recurrence rate (28%). The recurrence rate of the microscopic-assisted technique was 15% while the supra-auricular approach had the lowest recurrence rate (3.4%). Conclusion: The supra-auricular approach offers the most favorable outcome for the management of the preauricular sinus.
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Impact of smoking and tobacco addiction on sensorineural hearing loss among normal healthy participants: A cross-sectional cohort study
Balaji Sekher, Vikas Sinha, Sushil G Jha
Indian Journal of Otology 2017 23(3):151-154
Background: Cigarette smoking and tobacco addiction is one of the major health issues worldwide. Tobacco addiction is generally related to health issues such as chronic obstructive pulmonary disease and heart disease hypertension. It is also said that tobacco addiction causes sensorineural hearing loss (SNHL). Aim and Objective: The aim of this study was to show direct correlation between tobacco addiction and SNHL. Materials and Methods: In our study, sixty participants who are addicted to tobacco products at least minimum of 20 years were taken as subjects and matched with age-specific controls who do not have any tobacco addiction. They were asked to undergo basic history taking session, otoscopy, and pure tone audiometry, and results were analyzed. Results: SNHL is more common in tobacco users than the age-specific control group. Conclusion: TObacco addiction (both smoking and tobacco chewing) is associated with increased risk of developing SNHL.
http://ift.tt/2iK2FR0
Indian Journal of Otology 2017 23(3):151-154
Background: Cigarette smoking and tobacco addiction is one of the major health issues worldwide. Tobacco addiction is generally related to health issues such as chronic obstructive pulmonary disease and heart disease hypertension. It is also said that tobacco addiction causes sensorineural hearing loss (SNHL). Aim and Objective: The aim of this study was to show direct correlation between tobacco addiction and SNHL. Materials and Methods: In our study, sixty participants who are addicted to tobacco products at least minimum of 20 years were taken as subjects and matched with age-specific controls who do not have any tobacco addiction. They were asked to undergo basic history taking session, otoscopy, and pure tone audiometry, and results were analyzed. Results: SNHL is more common in tobacco users than the age-specific control group. Conclusion: TObacco addiction (both smoking and tobacco chewing) is associated with increased risk of developing SNHL.
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Left mastoid abscess and right automastoidectomy: Two rare complications of cholesteatoma in a patient
Boon Chye Gan, Mohd Khairi Md Daud
Indian Journal of Otology 2017 23(3):205-207
In most cases of cholesteatoma, patients have a history of occasional scanty ear discharge, tinnitus, and gradual progression of hearing loss that may not bother their daily activities. Therefore, late presentation may occur when this group of patients attributes little importance to the otological symptoms. We report a patient with bilateral cholesteatoma who presented with mastoid abscess on the left ear and automastoidectomy on the right ear. Early detection and management of cholesteatoma is crucial in preventing its complication.
http://ift.tt/2emXLo8
Indian Journal of Otology 2017 23(3):205-207
In most cases of cholesteatoma, patients have a history of occasional scanty ear discharge, tinnitus, and gradual progression of hearing loss that may not bother their daily activities. Therefore, late presentation may occur when this group of patients attributes little importance to the otological symptoms. We report a patient with bilateral cholesteatoma who presented with mastoid abscess on the left ear and automastoidectomy on the right ear. Early detection and management of cholesteatoma is crucial in preventing its complication.
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Evaluation of effects of diabetes mellitus type 2 and hyperlipidemia on hearing
Sandip M Parmar, Pushkar Khare, Meenu Chaudhary
Indian Journal of Otology 2017 23(3):155-161
Background: Age related hearing loss or Presbyacusis may be defined as mid to late onset, bilateral, progressive sensorineural hearing loss, where underlying causes have been excluded. In recent decades there has been a rapid progression in population aging, and with advancing age, chronic diseases and functional impairments become more common. Varying ranges of the prevalence of sensorineural deafness in subjects with diabetes and hyperlipidemia has been reported. The present study was undertaken to determine whether or not diabetes mellitus type 2 and hyperlipidemia induced auditory dysfunction. Materials and Methods: A cross sectional observational study was undertaken which comprised of a total of 200 subjects who were divided in 4 groups, which comprised of 50 control subjects in one group and 150 case subjects in the other 3 groups with presence of diabetes mellitus type 2, hyperlipidemia and those having both diabetes mellitus type 2 and hyperlipidemia. All subjects were evaluated by conducting pure tone audiometry and blood investigations like lipid profile and fasting and postprandial blood sugars. Results: It was observed that hearing loss was more prevalent (62%) and highly significant (P 0.001) as compared to controls in patients with both diabetes mellitus type 2 and hyperlipidemia together. The hearing loss was significantly more for higher frequencies in air and bone conduction thresholds. Conclusion: The prevalence of sensorineural hearing loss was increased in subjects having both diabetes mellitus type 2 and hyperlipidemia and these subjects are at a higher risk of developing sensorineural hearing loss. The hearing loss was progressive, bilateral and affected mainly higher frequencies.
http://ift.tt/2iLHwWE
Indian Journal of Otology 2017 23(3):155-161
Background: Age related hearing loss or Presbyacusis may be defined as mid to late onset, bilateral, progressive sensorineural hearing loss, where underlying causes have been excluded. In recent decades there has been a rapid progression in population aging, and with advancing age, chronic diseases and functional impairments become more common. Varying ranges of the prevalence of sensorineural deafness in subjects with diabetes and hyperlipidemia has been reported. The present study was undertaken to determine whether or not diabetes mellitus type 2 and hyperlipidemia induced auditory dysfunction. Materials and Methods: A cross sectional observational study was undertaken which comprised of a total of 200 subjects who were divided in 4 groups, which comprised of 50 control subjects in one group and 150 case subjects in the other 3 groups with presence of diabetes mellitus type 2, hyperlipidemia and those having both diabetes mellitus type 2 and hyperlipidemia. All subjects were evaluated by conducting pure tone audiometry and blood investigations like lipid profile and fasting and postprandial blood sugars. Results: It was observed that hearing loss was more prevalent (62%) and highly significant (P 0.001) as compared to controls in patients with both diabetes mellitus type 2 and hyperlipidemia together. The hearing loss was significantly more for higher frequencies in air and bone conduction thresholds. Conclusion: The prevalence of sensorineural hearing loss was increased in subjects having both diabetes mellitus type 2 and hyperlipidemia and these subjects are at a higher risk of developing sensorineural hearing loss. The hearing loss was progressive, bilateral and affected mainly higher frequencies.
http://ift.tt/2iLHwWE
Comparative study of speech and language development in children with normal hearing and cochlear implant in Iran
Hamed Ahmadi, Hamed Mahmoudian Sani, Gholamreza Farnoosh, Mohammad Reza Mahmoudian Sani
Indian Journal of Otology 2017 23(3):135-140
Today, cochlear implant provides an appropriate opportunity for the development of speech and language in children. In some studies, the age of children at the time of surgery has been stated as the most important factor in the development of speech and language of children after cochlear implant, while in other studies factors, including participation in rehabilitation programs, parental educational level, and lack of other disability have been regarded as key factors in the development of speech and language in these children. This review aims to assess the conducted studies in Iran to identify factors contributing to improving the auditory perception, language, and other skills in children with cochlear implants in comparison to children with normal hearing. The purpose of this study is to review the results of studies conducted on speech and language abilities in children with cochlear implant compared to the normal group in Iran. Directory of Open Access Journals, Google Scholar, PubMed (NLM), LISTA (EBSCO), and Web of Science have been searched. cochlear implants in deaf children before language learning results in the acquisition of speech and language skills in children. Timely detection of hearing impairment, early implantation, duration of hearing, and parental involvement in the rehabilitation process are important factors that affect the development of speech and language. The child's age at the time of implantation, continued participation in rehabilitation programs and the lack of associated problems directly impact the development of auditory perception, speech and language of children with cochlear implant while family education level indirectly impacts this developmental process.
http://ift.tt/2emXBgw
Indian Journal of Otology 2017 23(3):135-140
Today, cochlear implant provides an appropriate opportunity for the development of speech and language in children. In some studies, the age of children at the time of surgery has been stated as the most important factor in the development of speech and language of children after cochlear implant, while in other studies factors, including participation in rehabilitation programs, parental educational level, and lack of other disability have been regarded as key factors in the development of speech and language in these children. This review aims to assess the conducted studies in Iran to identify factors contributing to improving the auditory perception, language, and other skills in children with cochlear implants in comparison to children with normal hearing. The purpose of this study is to review the results of studies conducted on speech and language abilities in children with cochlear implant compared to the normal group in Iran. Directory of Open Access Journals, Google Scholar, PubMed (NLM), LISTA (EBSCO), and Web of Science have been searched. cochlear implants in deaf children before language learning results in the acquisition of speech and language skills in children. Timely detection of hearing impairment, early implantation, duration of hearing, and parental involvement in the rehabilitation process are important factors that affect the development of speech and language. The child's age at the time of implantation, continued participation in rehabilitation programs and the lack of associated problems directly impact the development of auditory perception, speech and language of children with cochlear implant while family education level indirectly impacts this developmental process.
http://ift.tt/2emXBgw
Effects of nonlinear amplification on differential sensitivity measures in individuals with cochlear hearing impairment
N Devi, G Amritha, Kishore Tanniru
Indian Journal of Otology 2017 23(3):162-167
Objective: The current study focused on exploring the influence of multichannel amplification with wide dynamic range compression (WDRC) on frequency, intensity, and duration discrimination measures at two frequencies in different channels of amplification. Methods: Discrimination measures were performed on twenty ears with moderate flat sensorineural hearing loss using 2-down and 1-up adaptive procedure to achieve 70.7% response on the psychometric function. All stimuli were generated through AUX script and presented using Psycon version 2.18 experimental software and delivered through the speakers oriented at an angle of 0° azimuth. Discrimination measures were performed in both aided and unaided conditions for two pure tone frequencies of 750 and 1500 Hz with 500 ms duration (on/off ramp duration of 80 ms to avoid spectral splatter) presented at a level of 20 dBSL (with reference to the threshold separately in each condition). The responses were recorded through three interval alternative forced choice paradigm with visual feedback. An average of final four reversals out of eight was considered for discrimination threshold estimation. Results and Conclusions: Results revealed a statistically significant deterioration in intensity discrimination and a significant improvement in difference limen for frequency and duration with nonlinear amplification. The deteriorated intensity discrimination scores were explained in perspectives of WDRC acting in amplification device.
http://ift.tt/2iLeOoX
Indian Journal of Otology 2017 23(3):162-167
Objective: The current study focused on exploring the influence of multichannel amplification with wide dynamic range compression (WDRC) on frequency, intensity, and duration discrimination measures at two frequencies in different channels of amplification. Methods: Discrimination measures were performed on twenty ears with moderate flat sensorineural hearing loss using 2-down and 1-up adaptive procedure to achieve 70.7% response on the psychometric function. All stimuli were generated through AUX script and presented using Psycon version 2.18 experimental software and delivered through the speakers oriented at an angle of 0° azimuth. Discrimination measures were performed in both aided and unaided conditions for two pure tone frequencies of 750 and 1500 Hz with 500 ms duration (on/off ramp duration of 80 ms to avoid spectral splatter) presented at a level of 20 dBSL (with reference to the threshold separately in each condition). The responses were recorded through three interval alternative forced choice paradigm with visual feedback. An average of final four reversals out of eight was considered for discrimination threshold estimation. Results and Conclusions: Results revealed a statistically significant deterioration in intensity discrimination and a significant improvement in difference limen for frequency and duration with nonlinear amplification. The deteriorated intensity discrimination scores were explained in perspectives of WDRC acting in amplification device.
http://ift.tt/2iLeOoX
Comparison of myringostapediopexy and malleostapediopexy tympanoplasty with sculptured incus in case of hearing reconstruction in tubotympanic chronic otitis media: A case series
Virendra Pratap Singh, Neha Sharma, Chetan Bansal
Indian Journal of Otology 2017 23(3):189-192
Introduction: Chronic suppurative otitis media (CSOM) is a burden on Indian population due to hearing loss due to deformation of the ossicular chain which needs reconstruction (ossiculoplasty). This study is an attempt to analyze the use of autogenous incus in ossiculoplasty for the same. Aim: The aim of this study is comparison of malleostapediopexy and myringostapediopexy in seventy cases of tubotympanic CSOM. Materials and Methods: Seventy patients with CSOM were operated and tympanoplasty was done. Ossiculoplasty was done using incus interposition as malleostapediopexy and myringostapediopexy and results analyzed. Results: In the present study, the pre- and post-operative air-bone gap values for myringostapediopexy cases were 38.00 ± 6.84 and 27.28 ± 5.12, respectively, and for type malleostapediopexy were 37.95 ± 7.51 and 18.08 ± 4.34, respectively. Statistical Test Used: Unpaired t-test. Conclusion: A better outcome was seen in malleostapediopexy than myringostapediopexy.
http://ift.tt/2emSugb
Indian Journal of Otology 2017 23(3):189-192
Introduction: Chronic suppurative otitis media (CSOM) is a burden on Indian population due to hearing loss due to deformation of the ossicular chain which needs reconstruction (ossiculoplasty). This study is an attempt to analyze the use of autogenous incus in ossiculoplasty for the same. Aim: The aim of this study is comparison of malleostapediopexy and myringostapediopexy in seventy cases of tubotympanic CSOM. Materials and Methods: Seventy patients with CSOM were operated and tympanoplasty was done. Ossiculoplasty was done using incus interposition as malleostapediopexy and myringostapediopexy and results analyzed. Results: In the present study, the pre- and post-operative air-bone gap values for myringostapediopexy cases were 38.00 ± 6.84 and 27.28 ± 5.12, respectively, and for type malleostapediopexy were 37.95 ± 7.51 and 18.08 ± 4.34, respectively. Statistical Test Used: Unpaired t-test. Conclusion: A better outcome was seen in malleostapediopexy than myringostapediopexy.
http://ift.tt/2emSugb
Beck depression Inventory-II in hearing impaired elderly patients: A presbycusis study
Mohammad Hossein Nilforoush, Mahsa Sepehrnejad, Zahra Habibi
Indian Journal of Otology 2017 23(3):168-170
Background and Objective: Hearing impairment is one of the most common sensory deficits in human communities. Recent studies have shown that presbycusis happens earlier than before. Hearing loss due to the aging process, or presbycusis, can cause inability to interpret sounds in speech, decreased ability to communicate and withdrew from society. Therefore these factors may lead to psychological problems such as depression. Since there are few studies evaluating the side effects of presbycusis in Iran, we started the study of depression in presbycusis clients referred to the audiology clinics of Isfahan University of medical science, Isfahan, Iran. Materials and Methods: In this cross-sectional study, the relationship between demographic characteristics and depression was determined. In order to collect information and evaluate depression, Beck Depression Inventory-II (BDI-II) was utilized and conducted on 35 cases. Results: Results indicated that 8.6fcr% had minimal depression, 14.3% with mild, 20.0% moderate depression and 57.1% had severe depression. No significant correlation between age, gender and depression was achieved. Conclusion: Using depression questionnaire such as BDI-II during aural rehabilitation process could be valuable. More complications were found in acceptance of hearing aids in elderly people with depression. Psychological treatment can be suitable while audiological management was accomplished simultaneously for this group.
http://ift.tt/2iLPjnz
Indian Journal of Otology 2017 23(3):168-170
Background and Objective: Hearing impairment is one of the most common sensory deficits in human communities. Recent studies have shown that presbycusis happens earlier than before. Hearing loss due to the aging process, or presbycusis, can cause inability to interpret sounds in speech, decreased ability to communicate and withdrew from society. Therefore these factors may lead to psychological problems such as depression. Since there are few studies evaluating the side effects of presbycusis in Iran, we started the study of depression in presbycusis clients referred to the audiology clinics of Isfahan University of medical science, Isfahan, Iran. Materials and Methods: In this cross-sectional study, the relationship between demographic characteristics and depression was determined. In order to collect information and evaluate depression, Beck Depression Inventory-II (BDI-II) was utilized and conducted on 35 cases. Results: Results indicated that 8.6fcr% had minimal depression, 14.3% with mild, 20.0% moderate depression and 57.1% had severe depression. No significant correlation between age, gender and depression was achieved. Conclusion: Using depression questionnaire such as BDI-II during aural rehabilitation process could be valuable. More complications were found in acceptance of hearing aids in elderly people with depression. Psychological treatment can be suitable while audiological management was accomplished simultaneously for this group.
http://ift.tt/2iLPjnz
Simultaneous labyrinthectomy and cochlear implantation for a case of otosclerosis with intractable vertigo
Joyce Pascal Rozario, Anjali Lepcha, John Mathew
Indian Journal of Otology 2017 23(3):197-199
Stapedotomy, though a common surgical procedure for otosclerosis, if inadequately performed, can cause dreaded complications of vertigo and profound hearing loss. Labyrinthectomy with cochlear implantation can be considered in cases of intractable vertigo, as numerous reports have shown that the cochlea still remains responsive to electrical stimulation postlabyrinthectomy. This report presents a case of otosclerosis, with severe to profound deafness and intractable vertigo poststapedotomy surgery, which was treated with simultaneous labyrinthectomy and cochlear implantation. This patient had good control of vertigo postoperatively and the Dizziness Handicap Index score pre- and post-operative were 80 and 38, respectively, with significant improvement in speech perception.
http://ift.tt/2en1nGv
Indian Journal of Otology 2017 23(3):197-199
Stapedotomy, though a common surgical procedure for otosclerosis, if inadequately performed, can cause dreaded complications of vertigo and profound hearing loss. Labyrinthectomy with cochlear implantation can be considered in cases of intractable vertigo, as numerous reports have shown that the cochlea still remains responsive to electrical stimulation postlabyrinthectomy. This report presents a case of otosclerosis, with severe to profound deafness and intractable vertigo poststapedotomy surgery, which was treated with simultaneous labyrinthectomy and cochlear implantation. This patient had good control of vertigo postoperatively and the Dizziness Handicap Index score pre- and post-operative were 80 and 38, respectively, with significant improvement in speech perception.
http://ift.tt/2en1nGv
Comparison of manual and computer-assisted measurement of cochlear nerve obtained from magnetic resonance imaging
S Jeevakala, A Brintha Therese, Rajeswaran Rangasami
Indian Journal of Otology 2017 23(3):171-175
Objectives: Cochlear implantation of sensorineural hearing loss requires accurate measurement of cochlear nerve (CN). The precise measurement of very small structures can be improved by automated segmentation and measurement. The variability and reproducibility of the computer-assisted measurement were compared with manual measurements. Materials and Methods: The 3D-constructive interference in steady state magnetic resonance imaging (MRI) images of twenty patients who were referred for MRI in the assessment of giddiness/vertigo or fitness for cochlear implant during the period from June 2013 to June 2014 were analyzed. The CN sizes were measured manually by two independent radiologists. The automatic measurements were then performed on the same images, and its correlation and agreement were calculated between automated and manual measurements. Results: The intra-observer correlation coefficients were significantly larger for cross-sectional area (CSA) of CN using automated measurements when compared to manual measurement (intra-observer r: 0.94021 vs. 0.91437). Similarly, the inter-observer correlation for CSA of CN is also higher in automated measurements (inter measurement r: 0.94786 vs. 0.92013). Conclusions: Using computer-assisted CN dimension measurement, the intra- and inter-observer correlation can be improved when compared to manual measurements. The automated measurement can assist the radiologist in eliminating the need for tedious manual tracing and thus, the time and effort for manual segmentation are also significantly reduced.
http://ift.tt/2iLEguj
Indian Journal of Otology 2017 23(3):171-175
Objectives: Cochlear implantation of sensorineural hearing loss requires accurate measurement of cochlear nerve (CN). The precise measurement of very small structures can be improved by automated segmentation and measurement. The variability and reproducibility of the computer-assisted measurement were compared with manual measurements. Materials and Methods: The 3D-constructive interference in steady state magnetic resonance imaging (MRI) images of twenty patients who were referred for MRI in the assessment of giddiness/vertigo or fitness for cochlear implant during the period from June 2013 to June 2014 were analyzed. The CN sizes were measured manually by two independent radiologists. The automatic measurements were then performed on the same images, and its correlation and agreement were calculated between automated and manual measurements. Results: The intra-observer correlation coefficients were significantly larger for cross-sectional area (CSA) of CN using automated measurements when compared to manual measurement (intra-observer r: 0.94021 vs. 0.91437). Similarly, the inter-observer correlation for CSA of CN is also higher in automated measurements (inter measurement r: 0.94786 vs. 0.92013). Conclusions: Using computer-assisted CN dimension measurement, the intra- and inter-observer correlation can be improved when compared to manual measurements. The automated measurement can assist the radiologist in eliminating the need for tedious manual tracing and thus, the time and effort for manual segmentation are also significantly reduced.
http://ift.tt/2iLEguj
Unrare but unfamiliar preauricular pilomatricoma mimicking parotid tumor
Anna Park, Jeong Hwan Choi
Indian Journal of Otology 2017 23(3):203-204
Pilomatricoma is a benign skin tumor arising from the outer root sheath cell of the hair follicle that usually present in the head and neck region. Pilomatricoma usually presents as an asymptomatic, solitary, firm or hard, freely mobile, dermal or subcutaneous nodule, and exhibits no fixation to neighboring tissues and has a cartilage-like hardness. The characteristic image findings are reported as well-defined subcutaneous masses with or without visible calcification. Despite these general clinical characteristics, the preoperative diagnosis-based solely on the clinical examination is often difficult because of various manifestations frequently presented by the tumor.
http://ift.tt/2emQBjG
Indian Journal of Otology 2017 23(3):203-204
Pilomatricoma is a benign skin tumor arising from the outer root sheath cell of the hair follicle that usually present in the head and neck region. Pilomatricoma usually presents as an asymptomatic, solitary, firm or hard, freely mobile, dermal or subcutaneous nodule, and exhibits no fixation to neighboring tissues and has a cartilage-like hardness. The characteristic image findings are reported as well-defined subcutaneous masses with or without visible calcification. Despite these general clinical characteristics, the preoperative diagnosis-based solely on the clinical examination is often difficult because of various manifestations frequently presented by the tumor.
http://ift.tt/2emQBjG
Radiological changes in anatomy of temporal bone in cases of unsafe chronic suppurative otitis media: A retrospective study
Vinit Kumar Sharma, Neeraj Prajapati, Rohit Sharma, Zafar Iqbal, Shubham Dadoo
Indian Journal of Otology 2017 23(3):176-179
Introduction: The ability of high-resolution computed tomography (HRCT) to depict the status of structure of the temporal bone represents a major advance in delineating pathology before surgical exploration of ear in cases of unsafe chronic suppurative otitis media (CSOM) or cholesteatoma. Aims and Objectives: The aim of this study was to evaluate the role of HRCT temporal bone in cases of unsafe CSOM and to assess the erosion of various structures in middle ear cleft. Study Design: This was a retrospective analysis. Materials and Methods: Fifty HRCT scans of temporal bone of the patients who were diagnosed as case of unsafe CSOM were selected and analyzed retrospectively. Criterion for inclusion was CSOM with cholesteatoma or granulations or polyp or posterior canal wall sagging or foul smelling discharge. In HRCT scans, 1 mm thickness sections were studied in both axial and coronal planes. Criterion for exclusion was history of previous ear surgery, history suggestive of head injury or skull base trauma in the past or known cases of temporal bone neoplastic pathology. Results: Maximum number of patients belonged to the age group of 21–30 years. Ossicular erosion was the most common (90%) finding followed by scutum erosion (84%). Erosion of sigmoid sinus plate was seen in only one case (2%). Cochlear promontory fistula was seen in none of the computed tomography scans. In ossicular chain, incus was the most common ossicle to be necrosed (92%) followed by malleus (66%). Conclusion: HRCT temporal bone delineates the location and extent of the disease and provides information on anatomical variations and complications.
http://ift.tt/2gmIcgD
Indian Journal of Otology 2017 23(3):176-179
Introduction: The ability of high-resolution computed tomography (HRCT) to depict the status of structure of the temporal bone represents a major advance in delineating pathology before surgical exploration of ear in cases of unsafe chronic suppurative otitis media (CSOM) or cholesteatoma. Aims and Objectives: The aim of this study was to evaluate the role of HRCT temporal bone in cases of unsafe CSOM and to assess the erosion of various structures in middle ear cleft. Study Design: This was a retrospective analysis. Materials and Methods: Fifty HRCT scans of temporal bone of the patients who were diagnosed as case of unsafe CSOM were selected and analyzed retrospectively. Criterion for inclusion was CSOM with cholesteatoma or granulations or polyp or posterior canal wall sagging or foul smelling discharge. In HRCT scans, 1 mm thickness sections were studied in both axial and coronal planes. Criterion for exclusion was history of previous ear surgery, history suggestive of head injury or skull base trauma in the past or known cases of temporal bone neoplastic pathology. Results: Maximum number of patients belonged to the age group of 21–30 years. Ossicular erosion was the most common (90%) finding followed by scutum erosion (84%). Erosion of sigmoid sinus plate was seen in only one case (2%). Cochlear promontory fistula was seen in none of the computed tomography scans. In ossicular chain, incus was the most common ossicle to be necrosed (92%) followed by malleus (66%). Conclusion: HRCT temporal bone delineates the location and extent of the disease and provides information on anatomical variations and complications.
http://ift.tt/2gmIcgD
Reimplantation of an amputated pinna: A case report and review of literature
Brajpal Singh Tyagi, Sushant Tyagi
Indian Journal of Otology 2017 23(3):208-210
Management of the partial or total amputations of the external ear has always stayed a difficult problem for otolaryngologists and plastic surgeons. For successful reimplantations of these amputations, multidisciplinary approach consisting of aggressive medical therapy with broad-spectrum intravenous antibiotics, anticoagulation, and reperfusion in conjunction with efficient surgical approach is needed. The surgeon's main objective is to obtain the best cosmetic result without damaging the auricular area to allow for subsequent future ear reconstruction in case any failure occurs after replantation. To enhance the survival of a reattached ear segment, Mladick et al. have advocated the use of the retroauricular pocket. This technique involves deepithelialization of the amputated part of the avulsed cartilage, followed by reattachment to the amputation stump and then burial into a retroauricular skin pocket. This increases the surface area of the avulsed segment in contact with surrounding nutrients, maximizing the probability of graft uptake and survival. We have used this technique successfully in our case and found acceptable results with it.
http://ift.tt/2wmsgEq
Indian Journal of Otology 2017 23(3):208-210
Management of the partial or total amputations of the external ear has always stayed a difficult problem for otolaryngologists and plastic surgeons. For successful reimplantations of these amputations, multidisciplinary approach consisting of aggressive medical therapy with broad-spectrum intravenous antibiotics, anticoagulation, and reperfusion in conjunction with efficient surgical approach is needed. The surgeon's main objective is to obtain the best cosmetic result without damaging the auricular area to allow for subsequent future ear reconstruction in case any failure occurs after replantation. To enhance the survival of a reattached ear segment, Mladick et al. have advocated the use of the retroauricular pocket. This technique involves deepithelialization of the amputated part of the avulsed cartilage, followed by reattachment to the amputation stump and then burial into a retroauricular skin pocket. This increases the surface area of the avulsed segment in contact with surrounding nutrients, maximizing the probability of graft uptake and survival. We have used this technique successfully in our case and found acceptable results with it.
http://ift.tt/2wmsgEq
Pseudomonas aeruginosa and its sensitivity spectrum in chronic suppurative otitis media: A study from Garhwal hills of Uttarakhand State, India
Deepak Juyal, Munesh Sharma, Vikrant Negi, Rajat Prakash, Neelam Sharma
Indian Journal of Otology 2017 23(3):180-184
Introduction: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid cavity, with recurrent ear discharge through a perforated tympanic membrane. It is a major health problem in developing countries causing serious local damage and life-threatening complications. The advent of sophisticated systemic antibiotics and their irrational use has led to the emergence of multidrug-resistant (MDR) bacterial strains and disease complication in return. Pseudomonas aeruginosa, one of the most common organisms to cause CSOM, is a notorious pathogen and is known for its MDR attribute. Objective: The aim of this study was to know the prevalence of P. aeruginosa among the patients suffering from CSOM, to analyze their antimicrobial susceptibility pattern, and to find out MDR P. aeruginosa strains. Materials and Methods: A total of 571 patients clinically diagnosed of CSOM were enrolled in the study (559 patients with unilateral and 12 with bilateral discharge), and 583 samples were obtained from them. Sample processing and identification was done by standard bacteriological methods. One hundred eighty-seven strains were identified as P. aeruginosa and were subjected to antimicrobial susceptibility testing for 10 different antibiotics categorized into five classes. Results: Of total 583 samples collected, growth was seen in 576 (98.8%) samples. P. aeruginosa strains were isolated from 187 (32.1%) samples. Piperacillin-tazobactam (75.4%), amikacin (74.3%), imipenem (70.6%), and cefepime (69.0%) were found to be the most effective antibiotics. Twenty-nine (15.5%) strains were resistant to all the five classes of antibiotics tested. The rate of resistance to fluoroquinolones (48.7%) was highest, followed by antipseudomonal penicillin (41.7%), and was lowest for carbapenems (29.4%). Conclusion: Knowing the etiological agents of CSOM and their antibiogram is of paramount importance for an efficient treatment and prevention of both disease complications and antimicrobial resistance.
http://ift.tt/2gmHXCi
Indian Journal of Otology 2017 23(3):180-184
Introduction: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid cavity, with recurrent ear discharge through a perforated tympanic membrane. It is a major health problem in developing countries causing serious local damage and life-threatening complications. The advent of sophisticated systemic antibiotics and their irrational use has led to the emergence of multidrug-resistant (MDR) bacterial strains and disease complication in return. Pseudomonas aeruginosa, one of the most common organisms to cause CSOM, is a notorious pathogen and is known for its MDR attribute. Objective: The aim of this study was to know the prevalence of P. aeruginosa among the patients suffering from CSOM, to analyze their antimicrobial susceptibility pattern, and to find out MDR P. aeruginosa strains. Materials and Methods: A total of 571 patients clinically diagnosed of CSOM were enrolled in the study (559 patients with unilateral and 12 with bilateral discharge), and 583 samples were obtained from them. Sample processing and identification was done by standard bacteriological methods. One hundred eighty-seven strains were identified as P. aeruginosa and were subjected to antimicrobial susceptibility testing for 10 different antibiotics categorized into five classes. Results: Of total 583 samples collected, growth was seen in 576 (98.8%) samples. P. aeruginosa strains were isolated from 187 (32.1%) samples. Piperacillin-tazobactam (75.4%), amikacin (74.3%), imipenem (70.6%), and cefepime (69.0%) were found to be the most effective antibiotics. Twenty-nine (15.5%) strains were resistant to all the five classes of antibiotics tested. The rate of resistance to fluoroquinolones (48.7%) was highest, followed by antipseudomonal penicillin (41.7%), and was lowest for carbapenems (29.4%). Conclusion: Knowing the etiological agents of CSOM and their antibiogram is of paramount importance for an efficient treatment and prevention of both disease complications and antimicrobial resistance.
http://ift.tt/2gmHXCi
Malnutrition among children having otitis media: A Hospital-based cross-sectional study in Lucknow District
Mahmood Dhahir Al-Mendalawi
Indian Journal of Otology 2017 23(3):216-216
http://ift.tt/2gmDZd4
Indian Journal of Otology 2017 23(3):216-216
http://ift.tt/2gmDZd4
Hymenoptera-induced anaphylaxis: is it a mast cell driven hematological disorder?
Purpose of review: Hymenoptera-induced allergy (HVA) is a common cause of anaphylaxis and may be fatal. It is associated with systemic mastocytosis in about 7% of adult patients. Systemic mastocytosis is a proliferative disorder of hematopoietic mast cell progenitors. There is recent data on the association between systemic mastocytosis and HVA. Recent findings: Hymenoptera venoms are the most common immunoglobulin E-mediated elicitors of anaphylaxis in patients with mastocytosis. Some patients with systemic mastocytosis do not have cutaneous involvement and have only been identified because of HVA. These patients do have distinct demographic, clinical, and laboratory features as compared with patients with mastocytosis with skin lesions. They show a male predominance, more severe (cardiovascular) as compared to skin symptoms, lower baseline serum tryptase, less bone marrow mast cell aggregates, and KIT mutations restricted to mast cell lineage. Summary: Although hymenoptera-induced anaphylaxis is not primarily a mast cell-driven hematological disorder, the latter is present in a significant proportion of patients and has to be excluded by basal serum tryptase determination, skin inspection as well as exclusion of systemic mastocytosis by D816V mutation analysis in peripheral blood and/or bone marrow examination in selected patients.http://ift.tt/2gmDlMm
Novel molecular defects associated with very early-onset inflammatory bowel
Purpose of review: Immune dysregulation disorders present with common clinical features of multiorgan autoimmunity. Gastrointestinal involvement is the hallmark of an impaired immune homeostasis. This review will give an overview on the novel phenotypes, highlighting the major points that will help to enable early diagnosis and treatment. Recent findings: The rapid progress on DNA sequencing technologies have led to the identification of monogenic defects that adversely impact the control of immune homeostasis. Lymphocytes may be present but dysfunctional, allowing for the development of excessive autoreactivity and resultant autoimmune disease. Regulatory T cells (Tregs) play an essential role in enforcing immune tolerance. Here we illustrate disorders caused by impairment of mechanisms ensuring Tregs function (Tregs related) in which autoimmunity is a hallmark of the clinical disease presentation and other disorders, affecting molecules more broadly involved in immune responses and indirectly causing immune dysregulation (Tregs unrelated). Clinical presentation is sometime mischievous and often symptoms are analogous in different diseases and can mislead diagnosis. Summary: The increasing comprehension of immunological concepts behind immune dysregulation diseases will allow better and in some cases possibly even targeted treatment. A genetic diagnosis therefore becomes important information in this group of patients, especially as some patients might require hematopoietic stem cell transplantation.http://ift.tt/2gmDhw6
Do advanced glycation end-products cause food allergy?
Purpose of review: The aim of this study was to appraise the evidence relating to dietary advanced glycation end-products (AGEs), their influence on innate and adaptive immune responses and their possible role in the increasing rate of food allergy that is being observed globally. Recent findings: The western pattern of diet is high in both AGEs and their substrates and this has been increasing in the last 30 years. AGEs mimic alarmins such as S100 proteins and the high molecular group box 1 (HMBG1), binding to the Receptor for Advanced Glycation End Products (RAGE), which in turn influences innate and adaptive immune responses. AGEs can directly cause mast cell activation and degranulation. Population data from USA and Australia have correlates with the rise in food allergy and sources of AGEs in the diet and this is also reinforced by urban and regional data within countries. The function of the RAGE receptor is inter-twined with Toll-like receptor (TLR) signalling and vitamin D levels. Activation of the RAGE receptor results in loss of epithelial integrity. Animal models studies have shown that dietary compounds that reduce the formation of AGEs can protect from the development of food allergies; however, this has not been shown in humans. Summary: Dietary sources of AGEs and their substrates are a plausible contributor to the increasing prevalence of food allergy, which requires prospective evaluation in human populations.http://ift.tt/2gmDcIO
Neuropathic symptoms of the ocular surface: dryness, pain, and itch
Purpose of review: This review aims to describe the recent findings on epidemiology, pathophysiology, and management of neuropathic symptoms of the ocular surface, with a focus on potential similarities between sensations of dry eye, pain and itch. Recent findings: A narrative review of the literature was undertaken. Key references from research in dry eye, neuropathic symptoms of the ocular surface, ocular pain and itch, as well as general references on itch and pain neurobiology were included. Recent findings suggest aspects of dry eye, chronic ocular pain and itch symptomatology are driven by neuropathic pain mechanisms involving peripheral and central sensitization processes. Summary: Ocular dryness, pain, and itch are prevalent complaints with several of shared features. Multiple lines of evidence suggest that peripheral and central neuronal sensitization processes are involved in generating and maintaining ocular sensory symptoms. Research is warranted on the epidemiology of ocular sensations, molecular mechanisms involved in nociception and pruriception in the eye, electrophysiological alterations in animal models of eye conditions, and therapeutic modalities that can alleviate unpleasant ocular sensations.http://ift.tt/2gmxtD2
Risk of anaphylaxis in complementary and alternative medicine
Purpose of review: Complementary and alternative medicine (CAM) use is widespread across the world. Patients with asthma and allergy regularly use CAM therapies. Allergic and anaphylactic reactions to CAM have been reported. Recent findings: Recent attempts to regulate and monitor adverse reaction to these therapies have given us further insight into potential causes of severe allergic reactions. Several culprits identified including Andrographis paniculata, Echinacea species, bee products, Ginkgo biloba and Ginseng are discussed here. Summary: Knowing the factors that increase the risk of anaphylaxis allows reactions to be recognized, reported and further investigated. Research to identify key causative allergens is necessary in the future. Collaboration between the allergy community and CAM practitioners can allow better understanding of allergy to these therapies.http://ift.tt/2gmChIo
Anaphylaxis and intimate behaviour
Purpose of review: Intimate behaviours may represent an unusual way of exposure to a culprit allergen, or the frame for sex-related allergies due to triggers typically linked to that situation. The present review aims at summarizing the state of the art about the topic, in order to spread the awareness and the basic know-how in the field of sexual-related allergies. Recent findings: Kiss-related IgE-mediated reactions are caused in sensitized partners mainly by the passive transport of allergenic molecules through saliva, skin or oral mucosa. It has also been recently suggested that kissing may act as an epicutaneous way for induction of allergic sensitization. Among food and drugs, not only but mostly, peanuts and beta-lactams, respectively, are the usual trigger. Although controversial, 1-hour wait before kissing and a proper mouth cleaning have been suggested as prevention strategies. Sexual intercourse related local or systemic symptoms can be caused by seminal plasma hypersensitivity, an IgE-mediated/type IV reaction due to prostate-specific antigen, which carries high homology to the canine prostatic kallikrein (Can f 5). Although applied to few patients, successful desensitization and immunotherapy protocols have been proposed. Summary: Intimate behaviours are possible modalities of contact with the allergen. The exact prevalence of such hypersensitivity reactions is not known, but for its implications on Quality of Life and reproductive wishes, the possible link between sex and allergy should become part of the personal culture of clinical allergists and every clinician, in order to extend and improve the diagnosis of unusual or unexplained conditions.http://ift.tt/2gmL7pM
When nutrition and allergy collide: the rise of anaphylaxis to plant foods
Purpose of review: Interest in nutrition is increasing, but in the world of internet health gurus, whilst the nutritional benefits of fruits and vegetables are extolled, wheat is often vilified. This review will assess the positive nutritional effects of plant foods in relation to allergy prevention, the effectiveness of gluten-avoidance and the likelihood of anaphylaxis to fruits and vegetables. Recent findings: Although the numbers of people who report gluten sensitivity is rising, hard evidence of mass sensitivity to gluten is scant. Also, the avoidance of wheat containing foods could lead to nutritional imbalance and effects on the gut microbiome. The evidence that fruits and vegetables have a protective effect on the development of allergy is inconsistent, although fruit juices may promote beneficial changes to gut microflora. Fruits and vegetables can cause severe allergic reactions, especially due to the presence of lipid transfer proteins, but this is not just a Mediterranean phenomenon, and not limited to peaches. Summary: These findings emphasise the importance of a keeping an open mind about reported reactions to plant foods, to ensure the correct diagnosis is made and nutrition is optimised to prevent any adverse effects of avoidance on the gut microbiome.http://ift.tt/2gmGDPX
Component resolved diagnostics for hymenoptera venom allergy
Purpose of review: Component-resolved diagnostics makes use of defined allergen molecules to analyse IgE-mediated sensitizations at a molecular level. Here, we review recent studies on the use of component-resolved diagnostics in the field of Hymenoptera venom allergy (HVA) and discuss its benefits and limitations. Recent findings: Component resolution in HVA has moved from single molecules to panels of allergens. Detection of specific immunoglobulin E (sIgE) to marker and cross-reactive venom allergens has been reported to facilitate the discrimination between primary sensitization and cross-reactivity and thus, to provide a better rationale for prescribing venom immunotherapy (VIT), particularly in patients sensitized to both honeybee and vespid venom. Characterization of IgE reactivity to a broad panel of venom allergens has allowed the identification of different sensitization profiles that in honeybee venom allergy were associated with increased risks for side effects or treatment failure of VIT. In contrast, component resolution so far has failed to provide reliable markers for the discrimination of sensitizations to venoms of different members of Vespidae. Summary: Component-resolved diagnostics allows a better understanding of the complexity of sensitization and cross-reactivities in HVA. In addition, the enhanced resolution and precision may allow identification of biomarkers, which can be used for risk stratification in VIT. Knowledge about the molecular composition of different therapeutic preparations may enable the selection of appropriate preparations for VIT according to individual sensitization profiles, an approach consistent with the goals of personalized medicine.http://ift.tt/2gmD4ci
Climate changes and Hymenoptera venom allergy: are there some connections?
Purpose of review: This review aims to update the world status of the main allergenic stinging Hymenoptera. Recent findings: In this review, we consider the problems that social Hymenoptera (bees, wasps and ants) could represent in the nearest future for human health in different parts of the world. Summary: Distribution and consistency of allergenic species including venomous insects are interested by accelerated dynamics caused by climate changes and globalization. Owing to the expansion of ranges of native species and colonization of invasive ones, even in the uncertainty of present available models, new challenges presented by stinging Hymenoptera should be expected in the future.http://ift.tt/2gmD3Fg
Ocular surface lubricants
Purpose of review: The purpose of this article is to provide an overview of the ocular lubricants currently available, consider the components of the various formulations and highlight the status of preservative use in the treatment of anterior ocular surface diseases. Recent findings: The primary components of ocular surface lubrication have been, in the past, based on various cellulose formulations that increase hydration. Advances in lubrication have come from areas of the human body requiring lubrication such as the skeletal joints as well as examining the use of natural components of the tear fluid. These have resulted in novel modifications of existing tear components, for example, thiolated carboxymethyl hyaluronic acid which creates crosslinking to mechanically increase retention time for ocular surface hydration. Other proteoglycans such as lubricin, having one of the lowest coefficients of friction in nature, to a lipopolysaccharide derivative of tamarind seed, may provide a unique delivery system for lubricants and medications. Summary: The present state of ocular surface lubrication is slowly advancing from the routine use of cellulose-based solutions and gels to more advanced replacement with natural tear components. The advances that are occurring on other lubricating surfaces of the musculoskeletal system are also providing some insights into potential use on the ocular surface.http://ift.tt/2wraheF
MiR-375 and YAP1 expression profiling in medullary thyroid carcinoma and their correlation with clinical–pathological features and outcome
Abstract
Medullary thyroid cancer (MTC) is a tumor marked by an indolent growth for which few prognostic factors and therapeutic strategies are actually available. Different studies have recently appraised well-differentiated thyroid cancers are characterized by a dysregulation in different microRNA sets; however, only few of them investigated the role of miRNA expression in MTCs. In this study, we have assessed the miR-375 expression in a series of 130 MTCs (104 are sporadic and 26 familial) with a median follow-up of 39 months (range 1–138) and then we have correlated our results with the clinical–pathological features and the patients' outcome.
Moreover, we have appraised YAP1 (Yes-associated protein 1) immunohistochemical expression in the same MTC series and in 5 C-cells hyperplasia (CCH) samples as well. We observed a significant upregulation of miR-375 in all MTCs, when compared to the normal thyroid tissues. Besides, miR-375 expression was found to be closely linked to neoplastic size, a chance of thyroid capsule infiltration, the risk of lymph node metastasis, and the staging of the tumor. At the end of follow-up, only 10% (13/130) showed a tumor progression and a higher miR-375 expression was found to be closely linked to a worst patient' outcome. On the contrary, YAP1 immunohistochemical expression was sharply downregulated in tumors, whereas it was weakly expressed in CCHs. Our results suggest miR-375 plays a central role in MTC progression and, therefore, we seek following the idea that miR-375 pathway may be an effective target in novel MTC therapeutic strategies.
http://ift.tt/2vNyycA
Response to omalizumab using patient enrichment criteria from trials of novel biologics in asthma
Abstract
Background
Recent efficacy studies of asthma biologics have included highly enriched patient populations. Using a similar approach, we examined factors that predict response to omalizumab to facilitate selection of patients most likely to derive the greatest clinical benefit from therapy.
Methods
Data from two phase III clinical trials of omalizumab in patients with allergic asthma were examined. Differences in rates of asthma exacerbations between omalizumab and placebo groups during the 16-week inhaled corticosteroid (ICS) dose-stable phase were evaluated with respect to baseline blood eosinophil counts (eosinophils <300/μL [low] vs ≥300/μL [high]) and baseline markers of asthma severity (emergency asthma treatment in prior year, asthma hospitalization in prior year, forced expiratory volume in 1 second [FEV1; FEV1 <65% vs ≥65% predicted], inhaled beclomethasone dipropionate dose [<600 vs ≥600 μg/day], long-acting beta-agonist [LABA] use [yes/no]).
Results
Adults/adolescents (N = 1071) were randomized to receive either omalizumab (n = 542) or placebo (n = 529). In the 16-week ICS dose-stable phase, rates of exacerbations requiring ≥3 days of systemic corticosteroid treatment were 0.066 and 0.147 with omalizumab and placebo, respectively, representing a relative rate reduction in omalizumab-treated patients of 55% (95% CI, 32–70%; P = 0.002). For patients with eosinophils ≥300/μL or with more severe asthma, this rate reduction was significantly more pronounced.
Conclusion
In patients with allergic asthma, baseline blood eosinophil levels and/or clinical markers of asthma severity predict response to omalizumab.
This article is protected by copyright. All rights reserved.
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Allergic FcεRI- and pseudo-allergic MRGPRX2-triggered mast cell activation routes are independent and inversely regulated by SCF
Abstract
While allergic mast cell (MC) degranulation occurs by FcεRI-aggregation and varies in strength among subjects, the analogous pseudo-allergic route was recently uncovered to proceed via MRGPRX2. Here, we examine inter-individual variability in skin MC responses to FcεRI-triggering versus those evoked by MRGPRX2. While population-based variability is comparable between the routes, FcεRI- and MRGPRX2-stimulated pathways are completely independent from each other, and responsiveness to one has therefore no predictive value for the other. Conversely, degranulation triggered by compound 48/80 is highly correlated to the process elicited by Substance P. MRGPRX2 mRNA shows pronounced population-based variability (coefficient of variation 102.9%). Surprisingly, SCF as the MC-supportive mediator par excellence potently inhibits pseudo-allergic degranulation, while it simultaneously promotes allergic stimulation via FcεRI. We conclude that SCF can have selective MC-dampening functions. Clinically, the data imply that subjects highly reactive in one pathway are not automatically hyper-responsive in terms of the alternative route.
This article is protected by copyright. All rights reserved.
http://ift.tt/2wVJxFS
Selective release of miRNAs via extracellular vesicles is associated with house dust mite allergen-induced airway inflammation
Abstract
Background
MicroRNAs (miRNAs) may facilitate cell-to-cell communication via extracellular vesicles (EVs). The biological roles of miRNAs in EVs on allergic airway inflammation is unclear.
Methods
Airway secreted EVs (AEVs) were isolated from bronchoalveolar lavage fluid (BALF) of control and house dust mite (HDM) allergen-exposed HDM-sensitized mice. The expression of miRNAs in AEVs or miRNAs and mRNAs in lung tissue was analyzed using miRNA microarray.
Results
The amount of AEV increased 8.9-fold in BALF from HDM-exposed mice compared with that from sham-control mice. HDM exposure resulted in significant changes in the expression of 139 miRNAs in EVs and 175 miRNAs in lung tissues, with 54 miRNAs being common in both samples. Expression changes of these 54 miRNAs between miRNAs in AEVs and lung tissues after HDM exposure were inversely correlated. Computational analysis revealed that 31 genes, including IL-13 and IL-5Ra, are putative targets of the miRNAs upregulated in AEVs but downregulated in lung tissues after HDM exposure. The amount of AEV in BALF after HDM exposure was diminished by treatment with the sphingomyelinase inhibitor GW4869. The treatment with GW4869 also decreased Th2 cytokines and eosinophil counts in BALFs and reduced eosinophil accumulation in airway walls and mucosa.
Conclusion
These results indicate that selective sorting of miRNA including Th2 inhibitory miRNAs into AEVs and increase release to the airway after HDM exposure would be involve in the pathogenesis of allergic airway inflammation.
This article is protected by copyright. All rights reserved.
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Natural History and Tumor Volume Kinetics of Papillary Thyroid Cancers
This cohort study examines the probability, rate, and magnitude of tumor growth in patients with papillary thyroid cancer during active surveillance.
http://ift.tt/2wMBtXM
http://ift.tt/2wMBtXM
Head-Trunk Coordination Deficits After Unilateral Vestibular Hypofunction
This cross-sectional study quantifies the extent of head and trunk kinematic abnormalities and the particular areas of deficit in head-trunk motion among patients who underwent recent vestibular schwannoma resection.
http://ift.tt/2vMPcJH
http://ift.tt/2vMPcJH
Active Surveillance for Thyroid Cancer
Thyroid cancer has been recognized as the most rapidly increasing cancer in the United States, tripling in incidence over the past 3 decades. It is estimated that there will be 56 870 new cases in the United States (42 470 in women and 14 400 in men) in 2017. The mortality from thyroid cancer has remained stable and low, with 2010 deaths estimated this year. Increased diagnostic testing, particularly with ultrasonography, has been responsible for much of this rise in incidence. Acknowledging that many subclinical papillary thyroid cancers (PTCs) are being detected that may not cause symptoms or death and that treatment toxic effects may not be inconsequential, strategies to personalize treatment have been explored. Most recently, active surveillance has been endorsed for the first time by the American Thyroid Association guidelines as an alternative to a traditional treatment approach in carefully selected patients. Although support for active surveillance has been established in Japan, there has been limited evidence in the United States or other countries for this approach.
http://ift.tt/2wMkUep
http://ift.tt/2wMkUep
Intra-operative Rapid Identification of Lymph Node and Parathyroid
Conditions: Thyroid Cancer; Parathyroid; Absent; Hypocalcemia; Hypoparathyroidism Postprocedural
Intervention: Diagnostic Test: Intraoperative identification method
Sponsor: Xijing Hospital
Recruiting - verified August 2017
http://ift.tt/2gsN5sf
Intervention: Diagnostic Test: Intraoperative identification method
Sponsor: Xijing Hospital
Recruiting - verified August 2017
http://ift.tt/2gsN5sf
Impact of Compliance With Fluoride Use on Caries Incidence After Cancer Therapy
Conditions: Dental Caries; Oral Cavity Cancer; Oral Complications of Chemotherapy and Head/Neck Radiation
Interventions: Other: Tray; Other: Brush
Sponsor: A.T. Still University of Health Sciences
Recruiting - verified August 2017
http://ift.tt/2eHKdUK
Interventions: Other: Tray; Other: Brush
Sponsor: A.T. Still University of Health Sciences
Recruiting - verified August 2017
http://ift.tt/2eHKdUK
Effects of Avmacol® in the Oral Mucosa of Patients Following Curative Treatment for Tobacco-related Head and Neck Cancer
Conditions: Head and Neck Cancer; Head and Neck Squamous Cell Carcinoma; Head and Neck Carcinoma; Head and Neck
Intervention: Dietary Supplement: Avmacol
Sponsor: University of Pittsburgh
Recruiting - verified August 2017
http://ift.tt/2gu07Wn
Intervention: Dietary Supplement: Avmacol
Sponsor: University of Pittsburgh
Recruiting - verified August 2017
http://ift.tt/2gu07Wn
Gabapentin for the Reduction of Radiation Therapy Induced Pain During the Treatment of Oropharyngeal Cancer
Condition: Oropharynx Cancer
Interventions: Drug: Gabapentin; Drug: Placebo Oral Capsule
Sponsor: Henry Ford Health System
Recruiting - verified August 2017
http://ift.tt/2eHTRGM
Interventions: Drug: Gabapentin; Drug: Placebo Oral Capsule
Sponsor: Henry Ford Health System
Recruiting - verified August 2017
http://ift.tt/2eHTRGM
Retrospective 8-year analysis of negative pressure wound therapy in dermatosurgery: A single center experience
Abstract
Negative pressure wound therapy (NPWT) is an established treatment modality in dermatologic surgery, but proof of evidence for efficacy is inconclusive. Purpose: To evaluate patient characteristics, treatment modalities, and outcomes in a single dermatosurgery center with NPWT applied over chronic and acute surgical wounds. Methods: Of all surgical patients between 2008 and 2015, we selected those who were treated and hospitalized due to NPWT for treatment of acute and chronic wounds. The medical records of 188 patients were retrospectively evaluated and statistically calculated. Results: Method of surgical defect closure depends significantly on localization of the surgical defect, cardiovascular co-morbidity and age. Hence, outcome depends significantly on the surgical situation that indexes NPWT, the underlying diagnosis, and the vacuum system used, but is not associated with distinct treatment modalities or gender of the patients. Hospitalization significantly depends on the vacuum system used, surgical situation that indexes NPWT, and underlying diagnoses. Conclusion: NPWT has a fixed role in distinct, well-defined clinical indications in dermatosurgery as the treatment of acute surgical wounds, fixation of skin grafts, and treatment of skin substitutes, as well as an important treatment option for refractory, superinfected chronic wounds in dermatologic patients.
This article is protected by copyright. All rights reserved.
http://ift.tt/2xALFju
Optical coherence tomography for the investigation of frontal fibrosing alopecia
Abstract
Background
FFA is a cicatricial alopecia that affects the frontotemporal hairline, eyebrows, and body hair. OCT is a non-invasive imaging technique useful in understanding skin architecture and vascularization.
Objective
To describe structural and vascular findings in FFA using OCT.
Methods
This was a case-control study conducted from the months of December 2016-February 2017. The study was IRB approved and conducted at the University of Miami Hospital outpatient dermatology hair and nail clinic in Miami, FL. Four patients with biopsy proven FFA, and three healthy age and sex-matched controls participated. OCT scans were taken on cicatricial alopecic band, inflammatory hairline, eyebrow, uninvolved scalp, facial papules, glabellar red dots, and arm. The same body regions were evaluated in controls.
Results
Patients and controls were women aged 42-66. Results reveal epidermal thickness is increased in the inflammatory hairline (0.13 mm) and decreased in the alopecic band (0.08 mm) compared to controls (0.10 mm). Attenuation coefficient is increased the inflammatory hairline, and decreased in the alopecic band compared to controls. Vascular flow in the alopecic band is decreased compared to inflammatory scalp and controls in the superficial levels, but increased at deeper levels as compared to controls. Inflammatory tissue is consistently more vascular at all levels (p< 0.01). Vascular flows in each stage are significantly different than one another (p< 0.01).
Conclusions
Increased vascular flow of the deep plexus in cicatricial stages can be a consequence of superficial tissue ischemia or fibrosis. It is difficult to establish if the increased flow in the inflammatory stage is due to neovascularization as seen in other ischemic diseases, or is the result of the inflammatory response. OCT may be a useful non-invasive tool in imaging FFA. Not only can the technology assist in monitoring disease activity in a non-invasive manner, but it may elucidate new pathophysiologic findings.
This article is protected by copyright. All rights reserved.
http://ift.tt/2wMgowJ
Cosmetic Surgery Advertising on Instagram Misleading
Most Instagram posts offering plastic surgery services were not from board-certified plastic surgeons, a study found. Noneligible physicians, foreign surgeons, and nonphysicians made most of the posts.
Medscape Medical News
http://ift.tt/2esdsOi
Comparison of the effect of aerosolized fibrin sealant and biodegradable synthetic polyurethane foam on hemostasis and wound healing after endoscopic sinus surgery: a prospective randomized study
Background
Use of absorbable packing materials after functional endoscopic sinus surgery (FESS) is associated with increased patient comfort and a lack of need for packing removal. Different materials may induce different patterns of mucosal healing and hemostasis. This study investigated the effect of fibrin sealant (FS; Tisseel) or biodegradable synthetic polyurethane foam (Nasopore®) packing on hemostasis and wound healing after FESS.
Methods
This prospective randomized controlled trial included 35 consecutive patients who underwent bilateral FESS for chronic rhinosinusitis. The patients were randomized to receive FS through aerosol spraying on 1 side and Nasopore packing on the opposite side. They were followed at 1, 2, 4, 8, and 12 weeks after surgery. Endoscopically visible packing material, crusting, adhesion, bleeding, granulation tissue formation, frontal sinus patency, and adverse effects were assessed. Subjective symptoms related to nasal packing were evaluated by using questionnaires quantified with a visual analogue scale.
Results
No significant differences were found between the FS-treated side and the Nasopore-packed side with respect to postoperative bleeding, adhesion, or frontal sinus patency. However, crusting and granulation were significantly lower in FS-treated nostrils (p < 0.01). The patients' satisfaction and willingness to reuse the material were not significantly different between FS and Nasopore. There were no allergic reactions to either material.
Conclusion
FS and Nasopore were equally successful in achieving hemostasis and patient satisfaction after FESS. However, our results suggest that differential mucosal healing patterns may be induced by alternative absorbable hemostatic materials. FS-treated sides showed more optimal healing patterns than Nasopore-packed sides.
http://ift.tt/2vvdsVf
Significance of human papillomavirus positivity in sinonasal squamous cell carcinoma
Background
The role of human papillomavirus (HPV) in sinonasal squamous cell carcinoma (SNSCC) is not well understood.
Methods
The National Cancer Database was queried for cases of SNSCC with known HPV status. Demographics, socioeconomic variables, TNM stage, histology, grade, treatment modalities, and overall survival (OS) through 5 years were compared between HPV-positive and HPV-negative tumors. Cox proportional hazard regression analyses were performed.
Results
Seven hundred seventy (770) cases were identified; 526 were HPV-negative (68.3%) and 244 (31.7%) were HPV-positive. Patients with HPV-positive tumors were younger (58.0 vs 63.7 years, p < 0.0001). Nasal cavity (49.4%) tumors were more likely to be HPV-positive (p < 0.05) than maxillary (18.8%), ethmoid (18.8%), and frontal (18.2%) sinus tumors. Large cell nonkeratinizing (42.4%), papillary (42.1%), and basaloid (56.5%) tumors were more likely than keratinizing (25.2%) tumors to be HPV-positive (p < 0.05). Well-differentiated (grade I) tumors (9.0%) were less likely than higher grade tumors to be HPV-positive (p < 0.05). Gender, race, facility type, insurance type, median income, education level, Charlson-Deyo comorbidity score, overall stage, T stage, N stage, M stage, tumor size, treatment modality, surgical approach, and surgical margins did not vary by HPV status (p ≥ 0.05). HPV-positive tumors had higher OS than HPV-negative tumors (p < 0.0001). At 5 years, OS was 68.1% and 51.5% for HPV-positive and HPV-negative tumors, respectively. On multivariate analyses, HPV positivity remained a favorable prognostic factor (hazard ratio, 0.49; 95% confidence interval, 0.34-0.70).
Conclusion
HPV positivity is more common in nasal cavity SCC and nonkeratinizing SNSCC. It is also a favorable prognostic factor in SNSCC. Future studies on SNSCC should take HPV positivity into consideration.
http://ift.tt/2wqfjaV
Τετάρτη 30 Αυγούστου 2017
Clinicopathologic and immunophenotypic features of eosinophilic fasciitis and morphea profunda: A comparative study of 27 cases
Eosinophilic fasciitis (EF) and morphea profunda (MP) are inflammatory and sclerosing disorders of the subcutis that can exhibit clinical and pathologic presentations that overlap.
http://ift.tt/2wpgO9F
Managing sharps injuries and other occupational exposures to HIV, HBV, and HCV in the dermatology office
Dermatologists and their staff are at risk for needlestick injuries and exposures to body fluids. Despite the availability of treatment to reduce the risk of blood-borne infection, many exposures go unreported. This paper identifies current recommendations and the specific details for response to occupational exposures to HIV, hepatitis B virus, and hepatitis C virus in the dermatology office. Issues surrounding each virus are discussed individually, and a summary step-by-step algorithm of how to proceed in the event of an occupational exposure is presented.
http://ift.tt/2wKMBEj
Anaesthetic depth control using closed loop anaesthesia delivery system vs. target controlled infusion in patients with moderate to severe left ventricular systolic dysfunction
To compare the efficacy of anaesthetic depth control using Closed Loop Anaesthesia Delivery System (CLADS) and Target Controlled Infusion (TCI) in patients with moderate to severe left ventricular dysfunction (LVSD).
http://ift.tt/2wTQ2cq
Determination of ochratoxin A in tissues of wild boar ( Sus scrofa L.) by enzymatic digestion (ED) coupled to high-performance liquid chromatography with a fluorescence detector (HPLC-FLD)
Abstract
Ochratoxin A (OTA) is a secondary toxic metabolite synthesized by Aspergillus or Penicillium species, which can contaminate various crops. The International Agency for Research on Cancer (IARC) classified OTA as a group 2B possible human carcinogen. The aim of the present study was to assess OTA concentrations in tissues of wild boar (Sus scrofa L.) from Tuscany (Italy). Over a period of 2 years, samples of muscle, liver, and kidney from 48 wild boars were collected and concentrations of OTA were determined by enzymatic digestion (ED) coupled to high-performance liquid chromatography with a fluorescence detector (HPLC-FLD). The highest concentrations of OTA were found in the kidneys of the 48 wild boars analyzed. No difference in concentrations was found based on years of collection and sex while a significantly higher OTA concentration was found in the kidney of the young wild boars with respect to the adult one. Monitoring the quality of meat destined for transformation is a priority in order to decrease the possibility of toxin carry-over to humans. The present study showed that contamination of wild boar meat products by OTA represents a potential emerging source of OTA.
http://ift.tt/2wL3cbi
Evaluation of periprocedural hypersensitivity reactions
Identifying the cause of periprocedural hypersensitivity reactions (HSRs) remains challenging because of the multitude of medications involved. Antibiotics are the most common cause in the United States, whereas neuromuscular blocking agents are most common in Europe.
http://ift.tt/2wjRLpV
Unique heterozygous presentation in an infant with DNA ligase IV syndrome
DNA ligase IV deficiency, or ligase 4 (LIG4) syndrome, is a rare autosomal recessive disorder associated with impaired DNA damage-repair mechanisms, resulting in different clinical presentations. The repair of DNA double-stranded breaks through the nonhomologous end-joining pathway is essential in the early stages of B- and T-cell differentiation as they undergo recombination of variable, diverse, and joining gene segments to generate antigen-specific cell receptors.1 Defects in this pathway, as seen in ligase IV deficiency, lead to an extreme form of severe combined immunodeficiency disease with a lymphocyte phenotype described as T-cell negative, B-cell negative, and natural killer cell positive (T−B−NK+).
http://ift.tt/2xzeZqQ
Parental perception of anxiety in children with eosinophilic esophagitis in a tertiary care center
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated, atopic disease characterized by eosinophil infiltration into the esophageal epithelium, resulting in fibrosis and dysfunction.1 During the past 20 years, its prevalence has increased exponentially in children in Western countries up to 50.5 in 10,000, which is similar to that of pediatric inflammatory bowel disease.1 The pediatric population presents with a broad spectrum of symptoms that vary with age. These, in ascending order of age, include feeding difficulty, failure to thrive, acid reflux, vomiting, abdominal pain, dysphagia, and food impaction; in contrast, adults primarily present with dysphagia and food impaction.
http://ift.tt/2wj7oOi
Filaggrin mutations and Molluscum contagiosum skin infection in patients with atopic dermatitis
Although mutations in the filaggrin (FLG) gene have been reported to predispose patients with atopic dermatitis (AD) skin infection susceptibility, to date, the data reported in the literature are still controversial.
http://ift.tt/2xzzqE6
Management around invasive procedures in mastocytosis
Mastocytosis is a chronic hematologic disorder that is characterized by the accumulation of aberrant mast cells and typically involves the skin and/or bone marrow. Patients with mastocytosis are at increased risk of anaphylaxis. Based on theoretical assumptions, medical procedures requiring general anesthesia or radiocontrast media are deemed hazardous for patients with mastocytosis. The objective of this article is to provide a comprehensive overview of the actual risk of iatrogenic anaphylaxis and provide recommendations for daily practice.
http://ift.tt/2wjIiiu
Identification and validation of asthma phenotypes in Chinese population using cluster analysis
Asthma is a heterogeneous airway disease, so it is crucial to clearly identify clinical phenotypes to achieve better asthma management.
http://ift.tt/2xyPber
Eosinophil-derived neurotoxin as a biomarker for disease severity and relapse in recalcitrant atopic dermatitis
Eosinophils are encountered in many skin diseases, but the role of eosinophils in atopic dermatitis (AD) remains uncertain.
http://ift.tt/2wjIgqS
Clinical and biological response to rituximab treatment in 3 patients with acquired C1-inhibitor deficiency
Acquired C1 inhibitor (C1-INH) deficiency (ACID) is a rare cause of recurrent subcutaneous and submucosal edema without urticaria. The mechanisms of ACID include excessive C1-INH consumption because of an underlying lymphoid malignant tumors (often undiagnosed) or the presence of anti–C1-INH autoantibodies, often with an isolated monoclonal gammopathy or a lymphoproliferative disorder.1–3 The primary therapy for ACID is treatment of the underlying condition; however, management is complex, and all patients must have a medication for acute angioedema.
http://ift.tt/2xz07IR
On ciprofloxacin concentration in chronic rhinosinusitis
Source:Acta Otorrinolaringológica Española
Author(s): José Gameiro dos Santos, Rosário Figueirinhas, José P. Liberal, João C. Almeida, Joana Sousa, Amílcar Falcão, Corália Vicente, João Paço, Cecília A. Sousa
ObjectiveConsidering that all the evidence indicates that chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP) are distinct entities, the aim of this study was to compare the concentrations obtained in plasma and in sinonasal mucosa with oral and nasal topical ciprofloxacin, in patients with and without nasal polyps, without evaluating the effectiveness of the use of an antibiotic.MethodsProspective clinical study with single-blind randomization. The population consisted of patients with chronic rhinosinusitis with eligible for endonasal surgery, over 18 years old. It took place between January 2010 and December 2014. A single preoperative dose of ciprofloxacin (oral or nasal topic- spray, gel or drops) was given and samples of plasma and nasal mucosa (inferior turbinate, middle turbinate, ethmoid and maxillary sinus) were collected prior to surgery. The plasma and mucosal ciprofloxacin concentrations were assayed with high performance liquid chromatography (HPLC) with fluorescence detection (FD).ResultsThe oral ciprofloxacin achieved better mucosal concentrations but had a significant plasmatic expression in all patients. None of the topical formulations achieved measurable ciprofloxacin plasmatic levels. Among the topical formulations, the gel had the best mucosal results, despite the existence of polyposis.
http://ift.tt/2wTlszP
Encuesta sobre el conocimiento en la indicación de implantes cocleares para el tratamiento de la hipoacusia en España
Source:Acta Otorrinolaringológica Española
Author(s): Manuel Manrique, Ángel Ramos, Beatriz Pradel, Carlos Cenjor, Diego Calavia, Constantino Morera
IntroducciónEste trabajo pretende analizar el conocimiento del especialista en Otorrinolaringología en España sobre los criterios de indicación de los implantes cocleares (IC) y, según los resultados, considerar si es necesario implementar medidas de formación dirigidas a mejorar el conocimiento en esta área.Material y métodosSe diseña un cuestionario dirigido a conocer el nivel de conocimiento sobre la indicación de IC en personas con hipoacusia. Este cuestionario recogía información demográfica de los encuestados y conocimientos sobre aspectos como indicaciones convencionales y emergentes de los IC, características técnicas de los IC y resultados en la población implantada.ResultadosUn total de 222 especialistas españoles en Otorrinolaringología respondieron el cuestionario (10,29% de la muestra encuestada).ConclusionesUn 50% de los encuestados mostraron unos conocimientos medios-altos sobre IC. Datos epidemiológicos sugieren que un alto porcentaje de adultos con sorderas poslocutivas candidatos a un IC no son referidos para tratamiento. El desconocimiento de los criterios para la indicación de IC por parte de los especialistas en Otorrinolaringología puede contribuir a una inadecuada orientación de los pacientes potencialmente candidatos a un IC. Las mayores deficiencias se encontraron en las indicaciones más emergentes de un IC. Dentro de los profesionales de la Otorrinolaringología los mayores conocimientos sobre IC se concentraron en aquellos que trabajaban en hospitales terciarios, especializados en Otología y Otoneurología, y desempeñaban su actividad laboral en el sector público y privado. Este estudio sugiere la conveniencia de incrementar acciones formativas sobre IC en los profesionales de la Otorrinolaringología, especialmente para otorrinolaringólogos generales.IntroductionThis study aims to analyse the knowledge of cochlear implant (CI) candidacy criteria of otorhinolaryngology specialists in Spain, and from the results, consider whether it is necessary to implement training measures aimed at improving knowledge in this area.Material and methodsA questionnaire was designed for measuring the level of knowledge of cochlear implant candidacy criteria (CI) in people with hearing loss. The questionnaire collected the demographic data of the respondents and their knowledge on the conventional and emergency indications for CI, technical characteristics of CI and results in the implanted population.ResultsA total of 222 Spanish specialists in otorhinolaryngology answered the questionnaire (10.29% of the sample surveyed).ConclusionsThe 50% of all respondents showed a medium-high knowledge about CI. Epidemiological data suggest that a high percentage of adults with postlocutive deafness and candidates for a CI are not referred for treatment. The lack of knowledge about the criteria for the indication of CI by otorhinolaryngology specialists may contribute to inadequate guidance of patients who are potential candidates for CI. The greatest shortcomings are found in the most emergency indications for a CI. Among otorhinolaryngology professionals, the greatest knowledge about CI is found in those who work in tertiary hospitals in the areas of otology and otoneurology, either in the public or private sector. This study suggests that training on CI should be increased for otorhinolaryngology professionals, especially for general otorhinolaryngologists.
http://ift.tt/2xO27fw
Maxillary hydatid cyst
Source:Acta Otorrinolaringológica Española
Author(s): Satvinder Singh Bakshi, Roopa Urs
http://ift.tt/2wTIvdG
Toll-like receptor 5 and 7 expression may impact prognosis of HPV-positive oropharyngeal squamous cell carcinoma patients
Abstract
A large subset of oropharyngeal squamous cell carcinomas (OPSCCs) is associated with HPV infection and has better outcome than non-viral-related tumors. Various malignancies also carry a role for TLRs, key activators of inflammation and innate immunity. We examined the expression of TLRs in OPSCC, and their association with HPV status and treatment outcome. TLR 5, 7, 9, and p16 were studied by immunohistochemistry and HPV status was detected with in situ hybridization in 202 tumors of consecutively treated OPSCC patients using tissue microarray method. The relations between TLR expression and HPV status, p16 expression, clinicopathological factors, and survival were analyzed. TLR 5, 7, and 9 expression patterns differed between HPV-positive and -negative tumors, and they were statistically significantly associated with history of smoking, heavy drinking, tumor site, grade, size (T), metastasis (N), and stage. Moreover, in HPV-positive tumors the expression of TLR 5 and 7 correlated with tumor recurrence. After adjustment, among HPV-positive OPSCC patients, high TLR 5 and low TLR 7 expression were associated with poor disease-specific survival. Our results indicate that TLR 5 and 7 may have a role in the prognostication of HPV-positive OPSCC, however, further studies are needed to clarify the comprehensive role of these TLRs in OPSCC.
http://ift.tt/2xynBOs
Demographic and clinicopathological characteristics of nasopharyngeal carcinoma and survival outcomes according to age at diagnosis: A population-based analysis
Source:Oral Oncology, Volume 73
Author(s): San-Gang Wu, Xu-Lin Liao, Zhen-Yu He, Li-Ying Tang, Xue-Ting Chen, Yan Wang, Qin Lin
ObjectiveTo investigate the demographic features, clinicopathological characteristics and treatment outcomes of patients with nasopharyngeal carcinoma (NPC) according to age at diagnosis.MethodsWe assessed demographic and clinicopathological variables extracted from the Surveillance, Epidemiology, and End Results database (2004–2014). The Cox proportional hazards regression model was used to perform univariate and multivariate analyses of NPC-related mortality (cause-specific survival).ResultsA total of 3880 patients were analyzed. Median age was 55-years-old; 108 (2.8%), 508 (13.1%), 1876 (48.4%), 1240 (32.0%), and 148 (3.8%) patients were aged 1–19, 20–39, 40–59, 60–79, and 80–99-years-old, respectively. Younger patients tended to be black and present with poorly/undifferentiated disease and advanced tumor and nodal category compared to older patients. Younger patients were more likely to receive chemotherapy than older patients. In multivariate analyses, age at diagnosis was an independent prognostic factor for cause-specific survival. Increasing age at diagnosis was associated with a significantly higher risk of NPC-related mortality. Compared to patients aged 1–19-years-old, the hazard ratios for patients aged 20–39, 40–59, 60–79, and 80–99-years-old were 2.030 (95% confidence interval 1.004–4.104), 2.871 (1.474–5.590), 4.443 (2.273–8.683), and 12.024 (5.855–24.695), respectively. With the exception of black patients (P=0.100), older age was associated with poor survival in all demographic and clinical subgroups.ConclusionAlthough younger patients tended to have advanced disease at diagnosis, older age at diagnosis was associated with a higher risk of NPC-related mortality.
http://ift.tt/2wIICsc
Epigenetic therapy regulates the expression of ALDH1 and immunologic response: Relevance to the prognosis of oral cancer
Source:Oral Oncology, Volume 73
Author(s): Ming-Shao Tsai, Wen-Cheng Chen, Chia-Hsuan Lai, Yu-Yen Chen, Miao-Fen Chen
ObjectivesAldehyde dehydrogenase 1 (ALDH1) is associated with tumorigenesis, and shown to identify cancer stem cells (CSC)-like cells. We aimed to investigate the significance of ALDH1 in oral squamous cell carcinoma (OSCC) and its correlation with DNMT3b and immune evasion in the present study.MethodsWe retrospectively analyzed the clinical outcomes of OSCC patients and examined its correlation with the levels of ALDH1 in tumors and circulating myeloid-derived suppressor cells (MDSCs) in the peripheral blood. Furthermore, the relationships between the DNMT3b, ALDH1 expression, and immune response were examined via clinical specimens and cellular and animal experiments. We also investigated the therapeutic potential of DNA hypomethylating agents in OSCC.ResultsOur data revealed that the levels of ALDH1 expression were linked to treatment resistance, CSC-like properties, higher circulating MDSC and poor prognosis for OSCC. The radiation resistance noted in ALDH1-positive tumors was associated with augmented radiation-induced increases in the expression of programmed death ligand (PD-L1) and the activation of MDSCs. Furthermore, there was a positive link between ALDH1 and DNMT3b expression shown by clinical specimens and cellular experiments. DNA hypomethylating agents attenuated the radioresistance of ALDH1-positive cancer cells associated with the decreased ALDH1 and the increased DNA damages. In addition, the activation of MDSCs and the expression of PD-L1 were significantly attenuated by epigenetic therapy.ConclusionsOur findings suggested that ALDH1 played an important role in treatment response and the tumor-promoting microenvironment in OSCC. Moreover, epigenetic therapy could be a promising strategy for the treatment of OSCC.
http://ift.tt/2wo21Mh
Incidence and dosimetric parameters for brainstem necrosis following intensity modulated radiation therapy in nasopharyngeal carcinoma
Source:Oral Oncology, Volume 73
Author(s): Yang-Chan Li, Fo-Ping Chen, Guan-Qun Zhou, Jin-Han Zhu, Jiang Hu, De-Hua Kang, Chen-Fei Wu, Li Lin, Xiao-Ju Wang, Jun Ma, Ying Sun
ObjectivesTo clarify the incidence of brainstem toxicity and perform a dose-volume analysis for the brainstem after long-term follow-up of a large cohort of nasopharyngeal carcinoma (NPC) patients who underwent intensity-modulated radiation therapy (IMRT).Materials and methodsAll patients with NPC treated with IMRT at Sun Yat-sen University Cancer Center between April 2009 and March 2012 were retrospectively reviewed. A total of 1544 patients with follow-up >12months and detailed treatment plan data were included. Radiotherapy was administered using the simultaneous integrated boost technique in 2.0–2.48Gy per fractions/28–33 fractions. Brainstem necrosis was defined as lesions with high signal intensity on T2-weighted images and low signal intensity on T1-weighted images, with or without enhancement after administration of contrast in follow-up MRI.ResultsAfter median follow-up of 79.7months (range, 12.2–85.6months), 2/1544 (0.13%) patients developed brainstem necrosis after intervals of 12.3 and 18.5months. Actuarial incidence of brainstem necrosis was 0.07%, 0.13%, 0.13% and 0.13% after 1, 2, 3 and 5years, respectively. Overall, 384 (24.9%), 153 (9.9%), 67 (4.3%), 39 (2.5%), 78 (5.1%), and 114 (7.4%) patients had excessive doses of Dmax≥64Gy, D1cc>59Gy, D2cc>59Gy, aV50>5.9cc, aV55>2.7cc and aV60>0.9cc respectively, of whom only two developed brainstem necrosis.ConclusionsBrainstem necrosis is rare in NPC. The definitive criteria based on conventional radiotherapy cannot accurately predict the occurrence of brainstem necrosis after IMRT, thus more flexible definitive criteria with strict restrictions need to be defined.
http://ift.tt/2wJnUIE
Pneumocystis Pneumonia in Patients With Autoimmune Blistering Diseases
This analysis assesses the incidence of Pneumocystis pneumonia in patients with autoimmune blistering diseases receiving no routine prophylaxis.
http://ift.tt/2wiQVJZ
http://ift.tt/2wiQVJZ
Canakinumab for Severe Hidradenitis Suppurativa
This case report describes the use of canakinumab to treat 2 patients with severe hidradenitis suppurativa.
http://ift.tt/2xxUVF3
http://ift.tt/2xxUVF3
Incorrectly Reported Request for Reply
In the Letter to the Editor titled "Types of Shade Vary in Protection Just Like Sunscreens," published online on June 21, 2017, and commenting on the Original Investigation titled "Sun Protection by Beach Umbrella vs Sunscreen With a High Sun Protection Factor: A Randomized Clinical Trial" by Ou-Yang et al, it was incorrectly reported that Dr Ou-Yang, corresponding author of the Original Investigation, had been shown a copy of the letter and offered an opportunity to reply. Dr Ou-Yang had not seen the letter at that time nor received the request for reply. The Letter to the Editor has been corrected online.
http://ift.tt/2wiVjZH
http://ift.tt/2wiVjZH
Utility of Microbiology in Suspected Dermatological Infections
This medical record review analyzes data from the Partners Healthcare registry to determine the value of microbiological studies in suspected skin tissue infections.
http://ift.tt/2xxZ385
http://ift.tt/2xxZ385
Uniform Nomenclature to Describe Clinical Features of Pigmented Lesions
This Editorial describes how uniform terminology to describe features of malignancy facilitates communication among physicians, trainees, and disciplines.
http://ift.tt/2wiz06d
http://ift.tt/2wiz06d
Laser Treatment of Café au Lait Macules Based on Morphologic Features
This case series compares the responses of café au lait lesions to laser treatment based on their morphologic characteristics, ie, ill-defined vs well-defined borders.
http://ift.tt/2xy3bow
http://ift.tt/2xy3bow
Types of Shade Vary in Protection Just Like Sunscreens—Reply
In Reply We read with interest the comments of Opene et al related to our study that evaluated the sunburn protection of beach umbrellas vs that of sunscreen with sun protection factor (SPF) 100. However, we must disagree with their interpretation of our findings. The clear message from our study remains that, although the SPF 100 sunscreen performed better, neither of these 2 measures alone completely blocked sunburn, so a combination of sun protection measures should be considered for extended outdoor exposures. We demonstrated in a typical-use setting that a beach umbrella was not as effective as sunscreen for sun protection, despite it being a widely used beach shade structure. We consider this an important public education point, since there may not be many practical shade structure choices at a beach.
http://ift.tt/2wiccUc
http://ift.tt/2wiccUc
12-OH-17,18-epoxyeicosatetraenoic acid alleviates eosinophilic airway inflammation in murine lungs
Abstract
Background
Asthma is characterized by airway inflammation and obstruction with eosinophil infiltration into the airway. Arachidonic acid, an omega-6 fatty acid, is metabolized into cysteinyl leukotriene with pro-inflammatory properties for allergic inflammation, whereas the omega-3 fatty acid eicosapentaenoic acid (EPA) and its downstream metabolites are known to have anti-inflammatory effects. In this study, we investigated the mechanism underlying the counter-regulatory roles of EPA in inflamed lungs.
Methods
Male C57BL6 mice were sensitized and challenged by OVA. After EPA treatment, we evaluated the cell count of BALF, mRNA expressions in the lungs by q-PCR, and the amounts of lipid mediators by Liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based lipidomics. We investigated the effect of the metabolite of EPA in vivo and vitro study.
Results
EPA treatment reduced accumulation of eosinophils in the airway and decreased mRNA expression of selected inflammatory mediators in the lung. Lipidomics clarified the metabolomic profile in the lungs. Among EPA-derived metabolites, 12-hydroxy-17,18-epoxyeicosatetraenoic acid (12-OH-17,18-EpETE) was identified as one of the major biosynthesized molecules; the production of this molecule was amplified by EPA administration and allergic inflammation. Intravenous administration of 12-OH-17,18-EpETE attenuated airway eosinophilic inflammation through downregulation of C-C chemokine motif 11 (CCL11) mRNA expression in the lungs. In vitro, this molecule also inhibited the release of CCL11 from human airway epithelial cells stimulated with interleukin-4.
Conclusion
These results demonstrated that EPA alleviated airway eosinophilic inflammation through its conversion into bioactive metabolites. Additionally, our results suggest that 12-OH-17,18-EpETE is a potential therapeutic target for the management of asthma.
This article is protected by copyright. All rights reserved.
http://ift.tt/2wixL6Z
Altered miR-193a-5p expression in children with cow's milk allergy
Abstract
Background
Cow's milk allergy (CMA) is one of the most common food allergies in children. Epigenetic mechanisms have been suggested to play a role in CMA pathogenesis. We shown that DNA methylation of Th1/Th2 cytokine genes and FoxP3 affects CMA disease course. Preliminary evidence suggest that also the miRNome could be implicated in the pathogenesis of allergy. Main study outcome was to comparatively evaluate miRNome in children with CMA and in healthy controls.
Methods
Peripheral blood mononuclear cells were obtained from children aged 4-18 months: 10 CMA patients, 9 CMA patients who outgrew CMA, and 11 healthy controls. Small RNA libraries were sequenced using a next-generation sequencing-based approach. Functional assessment of IL-4 expression was also performed.
Results
Among the miRNAs differently expressed, 2 were up-regulated and 14 were down-regulated in children with active CMA compared to healthy controls. miR-193a-5p resulted the most down-regulated miRNA in children with active CMA compared to healthy controls. The predicted targets of miR-193a-5p resulted up-regulated in CMA patients compared to healthy controls. Peripheral blood CD4+ T cells transfected with a miR193a-5 inhibitor showed a significant up-regulation of IL-4 mRNA and its protein expression. Children who outgrew CMA showed miRNA-193a-5p level, and its related targets expression, similar to that observed in healthy controls.
Conclusions
Our results suggest that miR-193a-5p is a post-transcriptional regulator of IL-4 expression and could have a role in IgE-mediated CMA. This miRNA could be a novel diagnostic and therapeutic target for this common form of food allergy in childhood.
This article is protected by copyright. All rights reserved.
http://ift.tt/2xxLTb7
5-/12-lipoxygenase-linked cascade contributes to the IL-33-induced synthesis of IL-13 in mast cells, thus promoting asthma development
Abstract
Background
As asthma progresses, the levels of IL-33 in serum are markedly increased and contribute to asthmatic development and exacerbation. Mast cells, one of the principal effector cells in the pathogenesis of asthma, express high levels of the IL-33 receptor ST2 and have been shown to be activated by IL-33. Thus, IL-33 stimulates mast cells to produce Th2-type cytokines such as IL-13, thus contributing to asthmatic development. However, the signaling mechanism for IL-33-induced synthesis of Th2 cytokines, particularly IL-13, has not been fully elucidated in mast cells.
Methods
The role of 5- or 12-LO in the IL-33-induced synthesis of IL-13 was investigated using knockdown or pharmacological inhibitors in BMMCs and animal model.
Results
Blockade of 5- or 12-LO significantly suppressed IL-33-induced synthesis of IL-13 in BMMCs. The subsequent action of 5- and 12-LO metabolites through their specific receptor, BLT2, was also critical for IL-33-induced synthesis of IL-13. We also demonstrated that the MyD88-p38 kinase cascade lies upstream of 5-/12-LO and that NF-κB lies downstream of 5-/12-LO to mediate the IL-33-induced synthesis of IL-13 in mast cells. Consistent with these findings, we observed that in an IL-33-administered asthmatic airway inflammation model, IL-13 levels were markedly increased in bronchoalveolar lavage fluid, but its levels were markedly suppressed by treatment with inhibitors of 5-LO, 12-LO or BLT2, further suggesting roles of 5-/12-LO in IL-33-induced IL-13 production.
Conclusion
Our results suggest that 'MyD88-5-/12-LO-BLT2-NF-κB' cascade significantly contributes to the IL-33-induced synthesis of IL-13 in mast cells, thus potentially contributing to asthmatic development and exacerbation.
This article is protected by copyright. All rights reserved.
http://ift.tt/2xy73Wu
Pathogenicity of memory Th2 cells is linked to stage of allergic rhinitis
Abstract
Background
Allergic rhinitis (AR) consists of three developmental stages that are based on the presence/absence of antigen-specific IgE and symptoms. The pathogenic Th2 (Tpath2) cells constitute a population of Th2 cells with additional potentially pathogenic characteristics. We examined the relationship between Tpath2 cells and the stages of allergic rhinitis by focusing on ST2, which is an IL-33 receptor.
Methods
Patients with Japanese cedar pollen-induced AR (JCP-AR) and healthy volunteers were divided into "non-sensitized," "asymptomatic sensitized (AS)," and "JCP-AR" groups. We analyzed the ST2 expression and the Th2 function of cultured CD4+ T cells. Next, we observed the progress of patients in the AS stage around the time of seasonal pollen dispersal, with the characteristics of Th2 cells.
Results
The ST2 expression of T cells was only upregulated in the AR group. The production of IL-4 and IL-13 was found in CD4+ T cells obtained from AS by stimulation with JCP, but reactivity to IL-33 was not observed. Although IL-33 did not induce the elevation of IL-4 production in the JCP-AR group, IL-33 substantially increased the production of IL-5 and IL-13 in comparison to antigen stimulation alone. In newly afflicted patients, the increased expression of ST2 and elevated reactivity to IL-33 was observed, even before the pollen dispersal season.
Conclusions
Our study demonstrated that the pathogenicity of memory Th2 cells is linked to sensitization and the stage of allergic rhinitis. Therefore, Tpath2 cells may provide useful insights into the mechanism of the onset and progression of allergic rhinitis.
This article is protected by copyright. All rights reserved.
http://ift.tt/2wiNumQ
Simultaneous induction of HSP70 expression, and degranulation, in IgE/Ag-stimulated or extracellular HSP70-stimulated mast cells (129/200)
Abstract
Background
In mast cells, induction of HSP70 expression during antigen stimulation has not been reported.
Methods
Mouse bone marrow derived mast cells (BMMC) were stimulated with IgE/Ag or HSP70. Induction of HSP70 expression, and signaling protein phosphorylation, were evaluated by immunoblotting.
Results
HSP70 expression is induced in BMMC at an early stage of IgE/Ag-dependent stimulation, some of which is released from the cells in a granule-associated form. Induction of HSP70 expression was also observed with an IgE/Ag-stimulated human basophilic cell line, indicating that the phenomenon is not restricted to mouse BMMC. The induction of HSP70 expression, and its release, followed a similar time course to that of degranulation. Released HSP70 seems to be responsible for degranulation and production of eicosanoids, at least in part, since a neutralizing anti-HSP70 antibody mitigated these activities, and since exogenous HSP70 not only induced immediate degranulation followed by autocrine HSP70 expression but also enhanced degranulation in IgE/Ag stimulated BMMC. Extracellular HSP70 was found to induce phosphorylation of Linker for activation of T cells (LAT) and a series of downstream signaling molecules in BMMC. We further found that Fyn, Lyn and spleen tyrosine kinase (Syk), which are known to concern LAT phosphorylation in IgE/Ag stimulated BMMC, were not phosphorylated in HSP70-stimulated BMMC, whereas lymphocyte-specific-protein tyrosine kinase (Lck) was phosphorylated.
Conclusion
FcεRI stimulation in BMMC and basophils induces HSP70 expression and its release. Extracellular HSP70 induces degranulation and mediator release via phosphorylation of LAT.
This article is protected by copyright. All rights reserved.
http://ift.tt/2xy22NT
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