Medicine by Sfakianakis Alexandros: 06/12/17

Δευτέρα 12 Ιουνίου 2017

High accumulation and in vivo recycling of the new antimalarial albitiazolium rapidly condemn the parasite to death [PublishAheadOfPrint]

Albitiazolium is the lead compound of bis-thiazolium choline analogues and exerts powerful in vitro and in vivo antimalarial activities. Here we provide new insight into the fate of albitiazolium in vivo in mice and how it exerts its pharmacological activity. We show that the drug exhibits a rapid and potent activity and has very favorable pharmacokinetic and pharmacodynamic properties. Pharmacokinetic studies in Plasmodium vinckei-infected mice indicated that albitiazolium rapidly and specifically accumulates to a great extent (cellular accumulation ratio > 150) in infected erythrocytes. Unexpectedly, plasma concentrations and the area under concentration-time curves increased by 15% and 69% when mice were infected at 0.9% and 8.9% parasitemia, respectively. Albitiazolium that had accumulated in infected erythrocytes and in the spleen was released into the plasma, where it was then available for another round of pharmacological activity. This recycling of the accumulated drug, after the rupture of the infected erythrocytes, likely extends its pharmacological effect.

We also established a new viability assay in the P. vinckei-infected mouse model to discriminate between fast- and slow-acting antimalarials. We found that albitiazolium impaired parasite viability in less than 6 and 3 hours at the ring and late stages, respectively, while parasite morphology was affected more belatedly. This highlights that viability and morphology are two parameters that can be differentially affected by a drug treatment, an element that should be taken into account when screening new antimalarial drugs.

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Efficacy of a Paromomycin plus Chloroquine Combination Therapy in Experimental Cutaneous Leishmaniasis [PublishAheadOfPrint]

The 4-aminoquinoline chloroquine (CQ) is clinically used in combination with doxycycline to cure chronic Q-fever, as it enhances the activity of the antibiotic against the causative Coxiella burnetii bacteria residing within macrophage phagolysosomes. As there is a similar cellular host-pathogen biology for Leishmania parasites, this study aimed to determine whether such an approach could be also the basis for a new, improved treatment for cutaneous leishmaniasis (CL). We have evaluated the in vitro and in vivo activity of combinations of CQ with standard drugs paromomycin (PM), miltefosine and amphotericin B against Leishmania major and Leishmania mexicana. In 72-hour intracellular anti-leishmanial assays, outcomes were variable for different drugs. Significantly, the addition of 10 μM CQ to PM reduced EC₅₀ values by over 5-fold against L. major and against the normally insensitive L. mexicana. In murine models of L. major and L. mexicana CL, daily co-administration of 50 mg/kg PM and 25 mg/kg CQ for 10 days resulted in significant reduction in lesion size but not in parasite load compared to mice given the same doses of PM alone. Overall, our data indicates that a PM plus CQ combination therapy is unlikely to be a potential candidate for further preclinical development.

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Potent In Vitro Synergism of Fluconazole and Osthole against Fluconazole-Resistant Candida albicans [PublishAheadOfPrint]

Osthole is a natural coumarin that exhibits wide biological and pharmacological activities such as neuroprotective, osteogenic, immunomodulation, anti-tumor and anti-inflammatory effects. In this study, we investigated the antifungal effects of osthole in vitro. Checkerboard microdilution assay showed that osthole has significant synergistic effect with fluconazole against fluconazole-resistant Candida albicans. Similar results was obtained from growth curve assay. Meanwhile, XTT reduction assay demonstrated the synergism of fluconazole and osthole against C. albicans biofilm formation. Microarray results showed that the expression of genes involved in oxidation-reduction process, energy metabolism and transportation changed significantly after the combined treatment with fluconazole and osthole, and further results showed that endogenous reactive oxygen species (ROS) was significantly increased in the combination group. In conclusion, these results demonstrated the synergism of fluconazole and osthole against fluconazole-resistant C. albicans and indicated that endogenous ROS augmentation might contribute to the synergism of fluconazole and osthole.

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Chemoenzymatic synthesis, nanotization and anti-Aspergillus activity of optically enriched fluconazole analogues [PublishAheadOfPrint]

Despite recent advances in diagnostic and therapeutic advances in antifungal research, aspergillosis still remains a leading cause of morbidity and mortality. One strategy to address this problem is to enhance the activity spectrum of known antifungals, and we now report the first successful application of Candida antarctica lipase (CAL) for the preparation of optically enriched fluconazole analogs. Anti-Aspergillus activity was observed for an optically enriched derivative, (-)-S-2-(2' ,4' -difluorophenyl)-1-hexyl-amino-3-(1''',2''',4''') triazol-1'''-yl-propan-2-ol, which exhibits MIC values of 15.6 μg/mL and 7.8 μg/disc in microbroth dilution and disc diffusion assays, respectively. This compound is tolerated by mammalian erythrocytes and cell lines (A549 and U87) at concentrations of up to 1000 μg/mL. When incorporated into dextran nanoparticles, the novel, optically enriched fluconazole analog exhibited improved antifungal activity against Aspergillus fumigatus (MIC = 1.63 μg/mL). These results not only demonstrate the ability of biocatalytic approaches to yield novel, optically enriched fluconazole derivatives but also suggest that enantiomerically pure fluconazole derivatives, and their nanotised counterparts, exhibiting anti-Aspergillus activity may have reduced toxicity.

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Liposomal Amphotericin B Nephrotoxicity in Patients with Hematological Malignancies: A Retrospective Cohort Analysis [PublishAheadOfPrint]

We retrospectively examined the incidence, onset, risk factors, and outcomes of renal injury during 103 treatment courses of liposomal amphotericin B (L-AMB) in 97 adult patients with hematological malignancies. All patients were analyzed before, during and after the administration of L-AMB, and renal injury was graded per the RIFLE criteria. Most patients (87.3%) received L-AMB at 3 mg/kg/day. Nearly two-thirds (61.7%) of treatment courses did not meet any RIFLE category for renal injury, while 19.4% of patients were classified at risk, 13.6% met an injury classification, and 5.8% were categorized as developing renal failure. However,15% of patients developed renal injury within 48 hours of the onset of multiorgan failure associated with sepsis, bleeding or progressing malignancy. When these patients were analyzed as a competing risk for L-AMB associated renal injury (RIFLE category "I" or above) in a multivariate Cox regression model, receipt of cyclosporine (subhazard ratio 2.62, 95% CI 1.10-6.27; P=0.03), cyclosporine plus furoseminde ≥ 40 mg/day (SHR 5.46,1.89-15.74;P=0.002) or cyclosporine plus foscarnet (SHR 9.03, 3.68-22.14; P<0.0001) were the only comedications significantly associated with increased rates of renal injury. The cumulative incidence of L-AMB renal injury during the first 10 days of therapy was 7% overall, but only 3% in patients who were not receiving cyclosporine. Hence, the renal risks of L-AMB therapy may be lessened if patients are switched to alternative agents after 7-10 days, or aggressive diuresis and/or foscarnet are avoided, especially among patients receiving calcineurin inhibitors.

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Pharmacokinetics of Pyrazinamide: optimising dosing regimens for drug-sensitive and -resistant tuberculosis [PublishAheadOfPrint]

Pyrazinamide is used in the treatment of tuberculosis(TB) because its sterilising effect against tubercle bacilli allows treatment shortening. It is part of standard treatment for drug-susceptible and drug-resistant TB, and it is being considered as a companion drug in novel regimens. The aim of this analysis was to characterize factors contributing to the variability in exposure and to evaluate drug exposures using alternative doses, thus providing evidence to support revised dosing recommendations for drug-susceptible and multi-drug resistant tuberculosis(MDR-TB). Pyrazinamide pharmacokinetic(PK) data from 61 HIV/TB co-infected patients in South Africa was used in the analysis. They were administered weight adjusted doses of pyrazinamide, rifampicin, isoniazid, and ethambutol in fixed-dose combination tablets according to WHO guidelines and underwent intensive PK sampling on day 1, 8, 15, and 29. The data was interpreted using nonlinear mixed-effects modelling. PK profiles were best described using a one-compartment model with first-order elimination. Allometric scaling was applied to disposition parameters using fat-free mass. Clearance increased by 14% from the 1st day to the 29th day of treatment. More than 50% of patients with weight less than 55 kg achieved lower pyrazinamide exposures at steady state than the targeted AUC0-24 of 363 mg⋅h/L. Among patients with drug susceptible TB, adding 400 mg to the dose for those weighing 30-54 kg improved exposure. Average pyrazinamide exposure in different weight bands among patients with MDR-TB could be matched by administering 1500 mg, 1750 mg and 2000 mg to patients in the 33-50 kg, 51-70 kg and greater than 70 kg weight-bands respectively.

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In Vitro - In Vivo Discordance with Humanized Piperacillin-Tazobactam Exposures against Piperacillin-Tazobactam-Resistant/Pan-{beta}-Lactam-Susceptible Klebsiella pneumoniae [PublishAheadOfPrint]

Recent findings have identified K. pneumoniae strains that are pan-β-lactam-susceptible (PBL-S), but piperacillin-tazobactam-resistant (TZP-R) in vitro. We assessed the efficacy of a humanized exposure of TZP against 12 TZP-R/PBL-S K. pneumoniae isolates in an immunocompromised murine lung infection model. Discordance between the in vitro resistance profile and the in vivo efficacy of human simulated TZP exposures against this phenotypic profile was observed. Additional studies are required to define the clinical implications these TZP-R/PBL-S strains.

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Pharmacokinetic Assessment of Vancomycin Loading Dose in Critically Ill Patients [PublishAheadOfPrint]

Background: The vancomycin loading dose (LD) of 25-30 mg/kg is a frequently practiced strategy to achieve effective concentrations from the first-treatment dose. However, considering only the body weight for dosing might be inadequate in critically ill patients due to pharmacokinetics changes.

Objective: Assess achieving optimal trough serum levels of vancomycin and AUC_0–24/MIC in the first 24-hours of treatment, by using a LD based on population pharmacokinetic parameters of critically ill patients.

Methods: We performed a concurrent cohort study over 22 months of patients with severe sepsis who received intravenous vancomycin. The patients were treated with three different strategies to initiate vancomycin: without LD (Group A), with LD of 25-30 mg/kg (Group B), and with LD based on population pharmacokinetic parameters of the critically ill patient (Group C).

Results: An optimal trough serum concentration was achieved in 5%, 9% and 83% of patients in Group A, B and C, respectively. The number of patients that reached optimal AUC_0–24, was 2 out of 18 (11%), 5 out of 11 (46%), and 11 out of 12 (92%) on Groups A, B and C, respectively. The statistical analysis for both parameters revealed significant differences in Group C, with respect to other groups.

Conclusions: The administration of LD calculated from population pharmacokinetic parameters from the beginning of therapy is a more efficient strategy to obtain adequate trough serum concentrations and AUC_0–24/MIC in critical patients.

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Selective Killing Of Dormant Mycobacterium tuberculosis By Marine Natural Products [PublishAheadOfPrint]

The dormant phenotype acquired by Mycobacterium tuberculosis (Mtb) during infection poses a major challenge in disease treatment since these bacilli are tolerant to front-line drugs. Therefore, it is imperative to find novel compounds that effectively kill dormant bacteria. By screening 4,400 marine natural product samples against dual-fluorescent Mtb under both replicating and non-replicating conditions we have identified compounds that are selectively active against dormant Mtb. This validates our strategy of screening all compounds in both assays as opposed to using the dormancy model as a secondary screen. Bioassay guided deconvolution enabled the identification of unique pharmacophores active in each screening model. To confirm the activity of samples against dormant Mtb we used a luciferase reporter assay and CFU enumeration. The structures of five purified active compounds were defined by NMR and mass spectrometry. We identified two lipid compounds with potent activity towards dormant and actively growing Mtb. One of these was commercially obtained and showed similar activity against Mtb in both screening models. Furthermore, puupehenone-like molecules were purified with potent and selective activity against dormant Mtb. In conclusion, we have identified and characterized antimycobacterial compounds from marine organisms with novel activity profiles which appear to target Mtb pathways conditionally essential for dormancy survival.

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Targeting quorum sensing signal biosynthesis to fight antibiotic resistant infections: Ambuic acid as a model inhibitor [PublishAheadOfPrint]

There has been major interest by the scientific community in anti-virulence approaches against bacterial infections. However, partly due to a lack of viable lead compounds, anti-virulence therapeutics have yet to reach the clinic. Here we investigate the development of an anti-virulence lead targeting quorum sensing signal-biosynthesis, a process that is conserved in Gram positive bacterial pathogens. Some preliminary studies suggest that the small molecule ambuic acid is a signal biosynthesis inhibitor. To confirm this, we construct a methicillin-resistant Staphylococcus aureus (MRSA) strain that decouples AIP production from regulation, and demonstrate that AIP production is inhibited in this mutant. Quantitative mass spectrometric measurements show that ambuic acid inhibits signal biosynthesis (IC₅₀ of 2.5 ± 0.1 μM) against a clinically relevant USA 300 MRSA strain. Quantitative real-time PCR confirms that this compound selectively targets the quorum sensing regulon. We show that a 5 μg dose of ambuic acid reduces MRSA-induced abscess formation in a mouse model, and verify its quorum sensing inhibitory activity in vivo. Finally, we employ mass spectrometry to identify or confirm the structure of quorum sensing signaling peptides in three strains of S. aureus, three strains of Staphylococcus epidermidis, Enterococcus faecalis, Listeria monocytogenes, Staphylococcus saphrophyticus, and Staphylococcus lugdunensis. By measuring AIP production by these strains, we show that ambuic acid possesses broad-spectrum efficacy against multiple Gram positive bacterial pathogens, but does not inhibit quorum sensing in some commensal bacteria. Collectively, these findings demonstrate the promise of ambuic acid as a lead for the development of anti-virulence therapeutics.

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Population pharmacokinetics of tigecycline in critically ill patients with severe infections [PublishAheadOfPrint]

Objectives: We sought to describe the population pharmacokinetics of tigecycline in critically ill patients and describe optimized dosing regimens of tigecycline for different bacterial infections.

Methods: This prospective study included ten critically ill patients given a standard dose of tigecycline. Blood samples were collected during one dosing interval and analyzed using validated chromatography. Population pharmacokinetics and Monte Carlo dosing simulations were undertaken using Pmetrics. Three target exposures, ratios of 24h area under the curve to minimum inhibitory concentrations (AUC_0-24/MIC), were evaluated (≥17.9 for skin infections, ≥6.96 for intraabdominal infections, ≥4.5 for hospital-acquired pneumonia).

Results: The median age, total body weight and body mass index (BMI) were 67 years, 69.1 kg and 24.7 kg/m², respectively. A two-compartment linear model best described the time course of tigecycline concentrations. The mean±SD parameter estimates from the final model were clearance 7.50±1.11 L/h, volume of central compartment 72.50±21.18 L, rate constant for tigecycline distribution from the central to peripheral compartment 0.31±0.16 h^-1 and from the peripheral to central compartment 0.29±0.30 h^-1. A larger BMI was associated with increased CL of tigecycline. Licensed doses were found to be sufficient for Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, and Methicillin-resistant Staphylococcus aureus for an AUC_0-24/MIC target of 4.5 or 6.96. For a therapeutic target of 17.9, an increase tigecycline dose is required, especially for patients with higher BMI.

Conclusion: Dosing requirements of tigecycline differ with indication, pathogen susceptibility and potentially with patient BMI.

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Erratum

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Issue Information - Contents

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Cover Image

The cover image, by Andrew J. Rosko et al., is based on the Case Report Dorsal scapular artery as a recipient vessel in the vessel-depleted neck during free tissue transfer in head and neck reconstruction, DOI: 10.1002/hed.24785.

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Auslagen

Die im Rahmen von Eingriffen und Operationen anfallenden Material- und Sachkosten werden in der Gebührenordnung für Ärzte (GOÄ) unterschiedlich behandelt. Der Beitrag klärt auf, welche Auslagen in welcher Form abrechenbar sind.

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Wischen statt blättern!

Was Sie gerade auf Papier gedruckt in den Händen halten, könnten Sie auch online auf Ihrem Tablet lesen, denn ab sofort gibt es Ihre „ästhetische dermatologie & kosmetologie" auch als ePaper: Es steht auf SpringerMedizin.de, dem Fachportal für Ärzte, kostenlos zum Download bereit. Dort finden Sie auch das Archiv der Zeitschrift und noch vieles mehr ...

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Molekulare Diagnostik entzündlicher Dermatosen

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Die neue Medizinprodukteverordnung EU

Spürbare Veränderungen gibt es derzeit im Medizinprodukterecht. Die Europäische Union hat mit der EU-Medizinprodukteverordnung 2017 (MDR) das Rechtsgebiet in wesentlichen Teilen novelliert. Betroffen von den Neuerungen sind in erster Linie die Hersteller von Medizinprodukten. Aber auch Anwender von Medizinprodukten, so auch niedergelassene Ärzte, die in ihrer Praxis Medizinprodukte zum Einsatz bringen, sollten über die neuen Regelungen Bescheid wissen.

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Zwischendurch bemerkt

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Narben wirksam behandeln

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Hautberuhigendes Reinigungserlebnis für Gesicht und Körper

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Ekzemen und Pickeln die Stirn bieten

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Dermatologen trafen sich zum zweiten Mal im CityCube in Berlin

Ende April 2017 fand die 49. Tagung der Deutschen Dermatologischen Gesellschaft (DDG) in Berlin statt. Die Vielzahl der vorgetragenen Themen und die Beteiligung zahlreicher Arbeitsgemeinschaften spiegelt die im Fachbereich vorhandene Innovationskraft wider. Eine Zusammenfassung über neue Ansätze bei der Behandlung der Psoriasis, die Lasertherapie beim malignen Melanom, die Fortschritte in der molekularen Diagnostik entzündlicher Erkrankungen sowie die Möglichkeiten und Grenzen der Off-Label-Medikation lesen Sie im folgenden Kongressbericht.

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Ästhetik-Konzept zur Verbesserung der Hautqualität

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Inhaltsverzeichnis

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Verbesserung in der Therapie von Krampfaderleiden

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Schutz vor UV-Strahlung lässt sich offenbar schlucken

Schlucken statt cremen: Karotinoide, wie sie in Tomaten und Grünkohl enthalten sind, schützen die Haut laut Ergebnissen einer Studie womöglich vor Schäden durch Sonnenlicht.

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Photodermatologie

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Ungleichgewicht im Mikrobiom

Mikrobiome sind beste Beispiele für gelungene Symbiosen — solang sich kein einzelnes Mitglied der Gemeinschaft in den Vordergrund drängt. Denn dann können sich bis dahin harmlose Kommensalen der Haut zu pathogenen Keimen aufschaukeln und Krankheiten wie Akne oder atopische Dermatitis begünstigen.

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Therapien jenseits der Zulassung

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Hyaluronidase unterstützt die Lokalanästhesie

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Supermodels verkörpern Typwandel

Der Modefotograf Peter Lindbergh richtete als Erster den Fokus auf die Persönlichkeit seiner Modelle: Statt menschlicher „Kleiderständer" zeigte er selbstbewusste, ausdrucksstarke Frauen und begründete damit das Supermodels-Phänomen der 1990er-Jahre. Sein ikonisches Werk in Bild und Film ist bis 27. August 2017 in der Kunsthalle München zu sehen.

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„Treat-to-target“ bei Psoriasis?

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Fraktioniertes Radiofrequenz-Microneedling

Die anspruchsvolle ästhetische Klientel von heute wünscht sich zur Hautverschönerung weitgehend schmerzfreie Behandlungen ohne große Nebenwirkungen oder lange Downtime, aber mit deutlich sichtbarem Ergebnis. Entsprechend steht der ästhetisch tätige Dermatologe heute vor der Qual der Wahl aus mehreren hunderten Laser-, IPL- und Radiofrequenz-Geräten, die am Markt zur nicht invasiven Hautverbesserung angeboten werden.

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Papillary Thyroid Cancer: The Good and Bad of the “Good Cancer”

Thyroid , Vol. 0, No. 0.

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Does the Risk of Metabolic Syndrome Increase in Thyroid Cancer Survivors?

Thyroid , Vol. 0, No. 0.

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Tinnitus alters resting state functional connectivity (RSFC) in human auditory and non-auditory brain regions as measured by functional near-infrared spectroscopy (fNIRS)

by Juan San Juan, Xiao-Su Hu, Mohamad Issa, Silvia Bisconti, Ioulia Kovelman, Paul Kileny, Gregory Basura

Tinnitus, or phantom sound perception, leads to increased spontaneous neural firing rates and enhanced synchrony in central auditory circuits in animal models. These putative physiologic correlates of tinnitus to date have not been well translated in the brain of the human tinnitus sufferer. Using functional near-infrared spectroscopy (fNIRS) we recently showed that tinnitus in humans leads to maintained hemodynamic activity in auditory and adjacent, non-auditory cortices. Here we used fNIRS technology to investigate changes in resting state functional connectivity between human auditory and non-auditory brain regions in normal-hearing, bilateral subjective tinnitus and controls before and after auditory stimulation. Hemodynamic activity was monitored over the region of interest (primary auditory cortex) and non-region of interest (adjacent non-auditory cortices) and functional brain connectivity was measured during a 60-second baseline/period of silence before and after a passive auditory challenge consisting of alternating pure tones (750 and 8000Hz), broadband noise and silence. Functional connectivity was measured between all channel-pairs. Prior to stimulation, connectivity of the region of interest to the temporal and fronto-temporal region was decreased in tinnitus participants compared to controls. Overall, connectivity in tinnitus was differentially altered as compared to controls following sound stimulation. Enhanced connectivity was seen in both auditory and non-auditory regions in the tinnitus brain, while controls showed a decrease in connectivity following sound stimulation. In tinnitus, the strength of connectivity was increased between auditory cortex and fronto-temporal, fronto-parietal, temporal, occipito-temporal and occipital cortices. Together these data suggest that central auditory and non-auditory brain regions are modified in tinnitus and that resting functional connectivity measured by fNIRS technology may contribute to conscious phantom sound perception and potentially serve as an objective measure of central neural pathology.

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Umgang und Aufbereitung semikritischer Medizinprodukte in der HNO – eine prospektive Studie

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-110858

Zahlreiche Gesetze, Vorgaben, Richtlinien und Empfehlungen regeln und beeinflussen den Umgang und die Aufbereitung semikritischer Medizinprodukte in der HNO. Obwohl als vorrangig zu verwenden charakterisiert, wird nach wie vor in den meisten HNO-Kliniken und Praxen aus Kosten- und Praktikabilitätsgründen die manuelle der maschinellen Aufbereitung vorgezogen. In der vorliegenden Studie wurde ein optimiertes Hygienekonzept erstellt. Es fand eine Bedarfsanalyse starrer Endoskope und des HNO-Instrumentariums bei ausschließlich maschineller Aufbereitung statt. Erstmals wurden zudem patientenferne Tätigkeiten im Rahmen der Patientenuntersuchung zeitlich untersucht. Im Ergebnis zeigt sich, dass patientenferne Tätigkeiten im Umgang mit dem HNO-Instrumentarium einen erheblichen Zeit- und damit auch Kostenfaktor in der Patientenversorgung darstellen. Die nötigen Investitionen für eine rein maschinelle Aufbereitung des Instrumentariums und ins Besondere starrer Endoskope sind erheblich, da die Durchlaufzeit und damit die Anzahl an vorzuhaltenden Endoskopen sehr hoch ist.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Phonochirurgie – eine retrospektive Analyse von 400 Eingriffen

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-110859

Einleitung Stimmstörungen sind u. a. durch Pseudotumore der Stimmlippen oder durch Stimmlippenparesen mit inkomplettem Glottisschluss bedingt und können eine phonochirurgische Therapie erfordern. Es sollten derartige Eingriffe hinsichtlich postoperativem Stimmergebnis und Sicherheit des Verfahrens analysiert werden. Methode Im Rahmen einer retrospektiven Analyse von 400 konsekutiven phonochirurgischen Eingriffen wurden folgende Parameter erfasst: Verteilung der Pathologien, Einschätzung der Stimmqualität 6 Wochen nach dem chirurgischen Eingriff im Vergleich zu präoperativ durch den Patienten und Untersucher (RBH-System), Videolaryngostroboskopie, Komplikationen und histologisches Ergebnis. Ergebnisse Im Kollektiv dominierten Stimmlippenpolypen (36 %), -zysten (12 %) und -paresen (10 %). Nach dem Eingriff verbesserte sich die Stimmqualität in 90 % der Fälle.Bei 14 % war aufgrund einer Fehlkompensation eine postoperative Stimmtherapie erforderlich. Nach einer Stimmlippenaugmentation entwickelten sich je in einem Fall ein Larynxödem und eine temporäre Stimmlippenparese der Gegenseite. Die histologische Aufarbeitung erbrachte als Zufallsbefund einen malignen osteoklastären Riesenzelltumor, einen Granularzelltumor und ein Carcinoma in situ der Stimmlippe, welche einer weiterführenden chirurgischen Behandlung und Kontrollen zugeführt werden musste. Diskussion Die mikrolaryngoskopische Phonochirurgie ist ein sicheres und effektives Therapieverfahren. Die histologische Aufarbeitung ist auch bei makroskopisch primär unsuspekten Tumoren sinnvoll, damit seltene Tumorentitäten oder Malignome nicht übersehen werden. Eine postoperative Observation ist zur frühzeitigen Erkennung und Behandlung von Komplikationen wie Larynxschwellung oder Stimmlippenparese anzuraten.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Prognostic value of programmed cell death ligand 1 expression in patients with head and neck cancer: A systematic review and meta-analysis

by Ji Li, Ping Wang, Youliang Xu

Background

Programmed cell death ligand 1 (PD-L1) expression was reported to be correlated with poor prognosis in various cancers. However, the relationship between PD-L1 expression and the survival of patients with head and neck cancer (HNC) remains inconclusive. In the present study, we aimed to clarify the prognostic value of PD-L1 in HNC patients using meta-analysis techniques.

Methods

A comprehensive database searching was conducted in the PubMed, EMBASE, Web of Science and Cochrane Library from inception to August 2016. Studies meeting the inclusion criteria were included. The methodological quality of included studies was assessed by the Newcastle-Ottawa quality assessment scale. Hazard ratios (HRs) with their corresponding 95% confidence intervals (CIs) were pooled by STATA 11.0 for the outcome of overall survival (OS) and disease-free survival (DFS).

Results

A total of 17 studies with 2,869 HNC patients were included in the meta-analysis. The results of meta-analysis showed that there was no significant correlation between PD-L1 expression and OS (HR, 1.23; 95% CI, 0.99–1.53; P = 0.065) or DFS (HR, 1.42; 95% CI, 1.00–2.03; P = 0.052) of HNC patients. However, the subgroup analysis suggested that positive expression of PD-L1 was associated with poor OS (HR, 1.38; 95% CI, 1.12, 1.70; P = 0.003) and DFS (HR, 1.99; 95% CI, 1.59, 2.48; P = 0.001) in HNC patients from Asian countries/regions. The subgroup analysis also showed that the correlations between PD-L1 and prognosis are variant among different subtypes of HNC. When performing sensitive analyses, we found that the results of meta-analyses were not robust.

Conclusion

The meta-analysis indicated that positive expression of PD-L1 could serve as a good predictor for poor prognosis of Asian patients with HNC. However, the findings still need to be confirmed by large-scale, prospective studies.

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Stanford Professor Peter Koltai to Speak at ORL Frontiers 2017

Peter J. Koltai, MD will be the guest speaker at Otorhinolaryngology Frontiers 2017, which highlights research endeavors and emerging technology... Read the full article...

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Laryngotracheal Reconstruction: A Long-awaited Resolution for Jayda Hector

Pediatric otolaryngologist Sancak Yuksel, MD has provided care for Jayda Hector since shortly after she was born in October 2010... Read the full article...

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Dr. Michael Byrd Named Chief of Surgery

Michael Byrd, MD has been elected chief of surgery at Memorial Hermann Southeast Hospital, a 274-bed facility serving families in... Read the full article...

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Dr. Ibrahim Alava Recognized as a Texas Super Doctors Rising Star

Ibrahim "Trey" Alava, MD, an assistant professor in the Department of Otorhinolaryngology-Head & Neck Surgery at McGovern Medical School at... Read the full article...

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Your help changes the future of thyroid disease – Make a spring donation to the ATA!

This spring, we would like to extend a note of thanks to all the Friends of the American Thyroid Association (ATA.) We are grateful that you have chosen to be part of the ATA community.

It is our mission and privilege to provide reliable thyroid education and awareness information, patient care resources, and research grants to help you and all those patients and families who seek answers, information, and guidance on thyroid conditions and treatments. Read more

The post Your help changes the future of thyroid disease – Make a spring donation to the ATA! appeared first on American Thyroid Association.

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Application of headspace and direct immersion solid-phase microextraction in the analysis of organothiophosphates related to the Chemical Weapons Convention from water and complex matrices

Publication date: 1 November 2017
Source:Talanta, Volume 174
Author(s): Marc André Althoff, Andreas Bertsch, Manfred Metzulat, Thomas M. Klapötke, Konstantin L. Karaghiosoff
The successful application of headspace (HS) and direct immersion (DI) solid phase microextraction (SPME) for the unambiguous identification and characterization of a series of toxic thiophosphate esters, such as Amiton (I), from aqueous phases and complex matrices (e.g. grass and foliage) has been demonstrated. A Thermo Scientific gas chromatograph (GC) – tandem mass spectrometer (MS/MS) system with a TriPlus RSH® autosampler and a SPME tool was used to investigate the effect of different parameters that influence the extraction efficiency: e.g. pH of the sample matrix and extraction temperature.The developed methods were employed for the detection of several Amiton derivatives (Schedule II of the CWC) that are structurally closely related to each other; some of which are new and have not been reported in literature previously. In addition, a novel DI SPME method from complex matrices for the analysis of organophosphates related to the CWC was developed. The studies clearly show that DI SPME for complex matrices is superior to HS extraction and can potentially be applied to other related compounds controlled under the CWC.

Graphical abstract

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The G-BHQ synergistic effect: Improved double quenching molecular beacons based on guanine and Black Hole Quencher for sensitive simultaneous detection of two DNAs

Publication date: 1 November 2017
Source:Talanta, Volume 174
Author(s): Dongshan Xiang, Fengquan Li, Chenyi Wu, Boan Shi, Kun Zhai
We designed two double quenching molecular beacons (MBs) with simple structure based on guanine (G base) and Black Hole Quencher (BHQ), and developed a new analytical method for sensitive simultaneous detection of two DNAs by synchronous fluorescence analysis. In this analytical method, carboxyl fluorescein (FAM) and tetramethyl-6-carboxyrhodamine (TAMRA) were respectively selected as fluorophore of two MBs, Black Hole Quencher 1 (BHQ-1) and Black Hole Quencher 2 (BHQ-2) were respectively selected as organic quencher, and three continuous nucleotides with G base were connected to organic quencher (BHQ-1 and BHQ-2). In the presence of target DNAs, the two MBs hybridize with the corresponding target DNAs, the fluorophores are separated from organic quenchers and G bases, leading to recovery of fluorescence of FAM and TAMRA. Under a certain conditions, the fluorescence intensities of FAM and TAMRA all exhibited good linear dependence on their concentration of target DNAs (T1 and T2) in the range from 4 × 10⁻¹⁰ to 4 × 10⁻⁸molL⁻¹ (M). The detection limit (3σ, n = 13) of T1 was 3 × 10⁻¹⁰M and that of T2 was 2×10⁻¹⁰M, respectively. Compared with the existing analysis methods for multiplex DNA with MBs, this proposed method based on double quenching MBs is not only low fluorescence background, short analytical time and low detection cost, but also easy synthesis and good stability of MB probes.

Graphical abstract

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New Analytical Framework for Verification of Biomarkers of Exposure to Chemicals Combining Human Biomonitoring and Water Fingerprinting

TOC Graphic

Analytical Chemistry

DOI: 10.1021/acs.analchem.7b01527

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The Gut: A Key to the Pathogenesis of Type 2 Diabetes?

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

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Re: “Plasminogen Activator Inhibitor-1 and Pericardial Fat in Individuals with Type 2 Diabetes Mellitus” by Bayomi et al. (Metab Syndr Relat Disord DOI:10:1089/met.2017.0031)

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

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The Gut: A Key to the Pathogenesis of Type 2 Diabetes?

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

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Re: “Plasminogen Activator Inhibitor-1 and Pericardial Fat in Individuals with Type 2 Diabetes Mellitus” by Bayomi et al. (Metab Syndr Relat Disord DOI:10:1089/met.2017.0031)

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

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FREE IN-HOME WATER TEST

Free water test available by a licensed local water expert. Water Contaminants tested for include: Chlorine Calcium Iron Magnesium pH TDS (total dissolved solids) Additional water contaminants that can be tested for include: Aluminum Arsenic Barium Chloramines Chlorides Cryptosporidium Mercury N...

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Limited nucleotide pools restrict Epstein–Barr virus-mediated B-cell immortalization

Limited nucleotide pools restrict Epstein–Barr virus-mediated B-cell immortalization

Oncogenesis 6, e349 (June 2017). doi:10.1038/oncsis.2017.46

Authors: A Y Hafez, J E Messinger, K McFadden, G Fenyofalvi, C N Shepard, G M Lenzi, B Kim & M A Luftig

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MLK3 regulates FRA-1 and MMPs to drive invasion and transendothelial migration in triple-negative breast cancer cells

MLK3 regulates FRA-1 and MMPs to drive invasion and transendothelial migration in triple-negative breast cancer cells

Oncogenesis 6, e345 (June 2017). doi:10.1038/oncsis.2017.44

Authors: C Rattanasinchai, B J Llewellyn, S E Conrad & K A Gallo

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The deubiquitinating enzymes USP4 and USP17 target hyaluronan synthase 2 and differentially affect its function

The deubiquitinating enzymes USP4 and USP17 target hyaluronan synthase 2 and differentially affect its function

Oncogenesis 6, e348 (June 2017). doi:10.1038/oncsis.2017.45

Authors: M Mehić, V K de Sa, S Hebestreit, C-H Heldin & P Heldin

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Proline-Rich Homeodomain protein (PRH/HHEX) is a suppressor of breast tumour growth

Proline-Rich Homeodomain protein (PRH/HHEX) is a suppressor of breast tumour growth

Oncogenesis 6, e346 (June 2017). doi:10.1038/oncsis.2017.42

Authors: R M Kershaw, D Roberts, J Wragg, A M Shaaban, E Humphreys, J Halsall, L Price, R Bicknell, K Gaston & P-S Jayaraman

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TIP30 regulates lipid metabolism in hepatocellular carcinoma by regulating SREBP1 through the Akt/mTOR signaling pathway

TIP30 regulates lipid metabolism in hepatocellular carcinoma by regulating SREBP1 through the Akt/mTOR signaling pathway

Oncogenesis 6, e347 (June 2017). doi:10.1038/oncsis.2017.49

Authors: F Yin, G Sharen, F Yuan, Y Peng, R Chen, X Zhou, H Wei, B Li, W Jing & J Zhao

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Serum lipoprotein-associated phospholipase A2 predicts the formation of carotid artery plaque and its vulnerability in anterior circulation cerebral infarction

Publication date: Available online 12 June 2017
Source:Clinical Neurology and Neurosurgery
Author(s): Yuping Yang, Tao Xue, Juehua Zhu, Jiayi Xu, Xiaowei Hu, Penghao Wang, Tao Kong, Yan Yan, Lihui Yang, Shouru Xue
ObjectiveCirculation inflammation markers such as high-sensitive C-reactive protein (hsCRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2) are considered as predictors of cerebral and cardiac vascular diseases. However, the role of hsCRP and Lp-PLA2 in the anterior circulation cerebral infarction (ACI) is to be elaborated.Patients and MethodsWe included 100 patients with acute anterior circulation cerebral infarction (AaCI group) and 50 non-infarction subjects (control group). Carotid artery was detected by color Doppler ultrasound. Subjects were grouped based on carotid intima-media thickness (IMT) and degree of stability of carotid atherosclerotic plaque. The levels of hsCRP and Lp-PLA2 were measured in corresponding groups and the association was analyzed.ResultshsCRP and Lp-PLA2 levels were the risk factors for AaCI. With the increment of carotid IMT and degree of plaque instability, the level of hsCRP and Lp-PLA2 showed an elevating tendency. hsCRP and Lp-PLA2 levels were significantly higher in plaque formation group than in IMT normal group (P=0.002 and P=0.001,respectively). hsCRP and Lp-PLA2 levels were significantly higher in vulnerable plaque group than in mixed plaque group and stable plaque group (P=0.003, P <0.001 for hsCRP and P <0.001, P <0.001 for Lp-PLA2). Lp-PLA2 were finally included in the atherosclerotic plaque model (OR=1.019, 95% confidence interval (CI): 1.003-1.035, P=0.020) and vulnerable plaque model (OR=1.041, 95%CI: 1.017-1.065, P=0.001) by performing multivariate logistic regression analysis. The area under the ROC curve (AUC) of Lp-PLA2 levels for atherosclerotic plaque was 0.746 (95% CI: 0.628–0.865, P<0.001). The optimal cut-off value for Lp-PLA2 level was 267.5ng/ml, and its sensitivity and specificity for diagnosis of atherosclerotic plaque were 70.8% and 67.1%, respectively.ConclusionsThe current study demonstrates that hsCRP and Lp-PLA2 are among the risk factors for AaCI. Elevated hsCRP and Lp-PLA2 are associated with carotid plaque formation. Univariate and multivariate logistic regression analysis suggests that elevated Lp-PLA2 is the independent risk factor for carotid plaque and its vulnerability.

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Diagnostic Value of Circulating microRNA-95 and -190 in the Differential Diagnosis of Thyroid Nodules: A Validation Study in 1000 Consecutive Patients

Thyroid , Vol. 0, No. 0.

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A Randomized Study Comparing Stem Cell Transplantation Versus Conventional Therapy for Low- and Intermediate-Risk Myelodysplastic Syndromes Patients

Stem Cells and Development , Vol. 0, No. 0.

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The Role of Integrin α6 (CD49f) in Stem Cells: More than a Conserved Biomarker

Stem Cells and Development , Vol. 0, No. 0.

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Diagnostic Value of Circulating microRNA-95 and -190 in the Differential Diagnosis of Thyroid Nodules: A Validation Study in 1000 Consecutive Patients

Thyroid , Vol. 0, No. 0.

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Impaired body perception in developmental prosopagnosia

Publication date: August 2017
Source:Cortex, Volume 93
Author(s): Federica Biotti, Katie L.H. Gray, Richard Cook
Developmental prosopagnosia (DP) is a lifelong neurodevelopmental disorder associated with difficulties recognising and discriminating faces. In some cases, the perceptual deficits seen in DP appear to be face-specific. However, DP is known to be a heterogeneous condition, and many cases undoubtedly exhibit impaired perception of other complex objects. There are several well-documented parallels between body and face perception; for example, faces and bodies are both thought to recruit holistic analysis and engage similar regions of visual cortex. In light of these similarities, individuals who exhibit face perception deficits, possibly due to impaired holistic processing or aberrant white matter connectivity, might also show co-occurring deficits of body perception. The present study therefore sought to investigate body perception in DP using a sensitive delayed match-to-sample task and a sizeable group of DPs. To determine whether body perception deficits, where observed, co-vary with wider object recognition deficits, observers' face and body matching ability was compared with performance in a car matching condition. Relative to age-matched controls, the DP sample exhibited impaired body matching accuracy at the group level, and several members of the sample were impaired at the single-case level. Consistent with previous reports of wider object recognition difficulties, a number of the DPs also showed evidence of impaired car recognition.

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Prognostic value of programmed cell death ligand 1 expression in patients with head and neck cancer: A systematic review and meta-analysis

by Ji Li, Ping Wang, Youliang Xu

Background

Methods

Results

Conclusion

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Prognostic value of programmed cell death ligand 1 expression in patients with head and neck cancer: A systematic review and meta-analysis

by Ji Li, Ping Wang, Youliang Xu

Background

Methods

Results

Conclusion

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Prognostic value of programmed cell death ligand 1 expression in patients with head and neck cancer: A systematic review and meta-analysis

by Ji Li, Ping Wang, Youliang Xu

Background

Methods

Results

Conclusion

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Thymic large cell neuroendocrine carcinoma – a rare and aggressive tumor: a case report

Neuroendocrine tumors are a large group of tumors with a wide spectrum of behavior, affecting mainly the digestive system and the lung. The thymus is very rarely affected.

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Thymic large cell neuroendocrine carcinoma – a rare and aggressive tumor: a case report

Neuroendocrine tumors are a large group of tumors with a wide spectrum of behavior, affecting mainly the digestive system and the lung. The thymus is very rarely affected.

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Can a Single Exercise Session Benefit Your Brain?

There is currently enormous interest in the beneficial effects of aerobic exercise on a wide range of brain functions including mood, memory, attention, motor/reaction times, and even creativity. Understanding the immediate effects of a single bout of exercise is the first step to understanding how the positive effects of exercise may accrue over time to cause long-lasting changes in select brain circuits.

According to principal investigator Wendy A. Suzuki, PhD, Professor of Neural Science and Psychology in the Center for Neural Science, New York University, "Exercise interventions are currently being used to help address everything from cognitive impairments in normal aging, minimal cognitive impairment (MCI), and Alzheimer's disease to motor deficits in Parkinson's disease and mood states in depression. Our review highlights the neural mechanisms and pathways by which exercise might produce these clinically relevant effects."

Caption: What is the relationship between the central neurochemical changes following acute exercise that have
mainly been described in rodents and the behavioral changes seen after acute exercise that have mainly been
described in humans? Credit: Henriette van Praag (photo on left); MarathonFoto (photo on right).

The investigators summarized a large and growing body of research examining the changes that occur at the cognitive/behavioral, neurophysiological, and neurochemical levels after a single bout of physical exercise in both humans and animals. They reviewed brain imaging and electrophysiological studies, including electroencephalography (EEG), functional magnetic resonance imaging (fMRI), functional near-infrared spectroscopy (fNIRS), and transcranial magnetic stimulation (TMS). They then turned to neurochemical studies, including lactate, glutamate and glutamine metabolism, effects on the hypothalamic-pituitary- adrenal (HPA) axis through cortisol secretion, and neurotrophins such as brain-derived neurotrophic factor (BDNF), insulin-like growth factor 1 (IGF-1), and vascular endothelial growth factor (VEGF). Neurotransmitter studies of monoamines (dopamine, serotonin, epinephrine and norepinephrine), acetylcholine, glutamate and gamma-aminobutyric acid (GABA) were reviewed, as well as neuromodulators such as endogenous opioids and endocannabinoids.

This extensive review resulted in three main observations. First, the most consistent behavioral effects of acute exercise are improved executive function, enhanced mood, and decreased stress levels. Second, neurophysiological and neurochemical changes that have been reported after acute exercise show that widespread brain areas and brain systems are activated. Third, one of the biggest open questions in this area is the relationship between the central neurochemical changes following acute exercise, that have mainly been described in rodents, and the behavioral changes seen after acute exercise reported in humans. Bridging this gap will be an important area of future study.

Co-author Julia C. Basso, PhD, post-doctoral research fellow, Center for Neural Science at New York University, commented, "The studies presented in this review clearly demonstrate that acute exercise has profound effects on brain chemistry and physiology, which has important implications for cognitive enhancements in healthy populations and symptom remediation in clinical populations."

# # #

NOTES FOR EDITORS
"The Effects of Acute Exercise on Mood, Cognition, Neurophysiology and Neurochemical Pathways: A Review," by Julia C. Basso and Wendy A. Suzuki (DOI: 10.3233/BPL-160040), openly available at http://ift.tt/2pCAiE8, Brain Plasticity, Volume 2, Issue 2 (2017). Contact Diana Murray, IOS Press, at +1 718-640-5678, d.murray@iospress.com for additional information. Journalists wishing to interview the authors should contact Wendy Suzuki, at +1 212-998-3734 or wendy@cns.nyu.edu.

ABOUT BRAIN PLASTICITY
Brain Plasticity publishes peer-reviewed original articles, reviews, and short communications on all aspects of neurogenesis, gliogenesis, and synaptic plasticity, from development to the adult. This includes research articles or reviews on modifications to neural circuits in the developing and adult brain, whether by learning or physical activity, spine formation, changes in neural structure, changes in neural networks, new cell division, as well as response of the CNS to experimental injuries, neurodevelopmental and neurodegenerative disorders. Papers adopting fresh conceptual approaches on specification and function at the molecular and cellular levels, neural circuits, systems and behavioral levels are encouraged. http://ift.tt/2sgKOnO.http://ift.tt/2sgKOnO

ABOUT IOS PRESS
Celebrating its 30 th anniversary, IOS Press (www.iospress.com) is headquartered in Amsterdam with satellite offices in the USA, Germany, India and China and serves the information needs of scientific and medical communities worldwide. IOS Press now publishes over 100 international journals and about 75 book titles each year on subjects ranging from computer sciences and mathematics to medicine and the natural sciences.
www.iospress.com

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Simplified split-bolus intravenous contrast injection technique for pediatric abdominal CT

Publication date: Available online 12 June 2017
Source:Clinical Imaging
Author(s): Yong Hee Kim, Myung-Joon Kim, Hyun Joo Shin, Haesung Yoon, Mi-Jung Lee
PurposeTo investigate pediatric abdominal CT using a simplified split-bolus (Split group) contrast injection compared with a single bolus (Control group).MethodsRadiation dose, image quality and diagnostic accuracy were compared.ResultsSplit group demonstrated lower effective dose (2.46 vs. 2.85mSv, p=0.002) and noise levels in aorta, liver and portal vein (p<0.001). There was one false-negative case of portal vein obliteration in the Split group.ConclusionsA simple method of split-bolus intravenous contrast injection technique can provide adequate and homogeneous enhancement in pediatric abdominal CT.

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Early recognition of methicillin-resistant Staphylococcus aureus surgical site infections using risk and protective factors identified by a group of Italian surgeons through Delphi method

Surgical site infections (SSIs) constitute a major clinical problem in terms of morbidity, mortality, duration of hospital stay, and overall costs. The bacterial pathogens implicated most frequently are Streptoco...

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Evaluation of fibular muscles and prevalence of accessory fibular muscles on fetal cadavers

Abstract

Purpose

The purpose of this study was to determine clinical importance and morphology of the fibularis longus, brevis, tertius muscles (presented as fibular muscles in this study), and prevalence of accessory fibular muscles (AFM) on fetal cadavers.

Materials and methods

In this study, 200 limbs from 100 embalmed fetuses (54 male and 46 female) were studied. Morphology of fibular muscles and the presence of AFM were observed through dissection on fetal legs bilaterally. The absence of fibularis tertius muscle (FT) and the presence of AFM were identified. Length and length of the tendon of AFM were measured. Insertion of AFM was also identified.

Results

Mean values and standard deviations of all parameters according to trimesters were calculated. All parameters were increased with age during the fetal period. We determined the absence of FT; no FT was observed in 40 legs of 200 extremities (20%). The AFM was present in 7 of 200 specimens (3.5%). AFM muscles were classified into two types according to their site of origin.

Conclusion

The present study has revealed the morphology of the fibular muscles and prevalence of the presence of AFM on fetal cadavers. In addition, it has revealed the morphometric development and prevalence of the absence of FT in a large series, and their clinical importance was discussed.

Analytical Chemistry

DOI: 10.1021/acs.analchem.7b01382

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Postural control in blind individuals: A systematic review

Publication date: Available online 12 June 2017
Source:Gait & Posture
Author(s): Rodolfo Borges Parreira, Luanda André Collange Grecco, Claudia Santos Oliveira
Postural control (PC) requires the interaction of the three sensory systems for a good maintenance of the balance, and in blind people, lack of visual input can harm your PC. Thus the objective is to perform a literature review concerning role of sight in the maintenance of PC and the adaptation of brain structures when vision is absent. Studies were searched from Pubmed, and EMBASE that included individuals with congenital blindness. Articles studying person with acquired blindness or low vision was excluded from this review. 26 out of 322 articles were selected for review, and we found that 1) blind individuals exhibit PC deficits and that is compensated by the intensification of the remaining systems; 2) Neuroplastic adaptation occurs throughout the entire cerebral cortex; and 3) Sensorimotor stimulation and transcranial direct current stimulation seem to be a rehabilitation strategy. According to this review, the findings suggest that improved remaining sensations in the presence of adaptations and neuroplasticity, does not translate into better postural control performance. Regarding rehabilitation strategies, more studies are needed to show which therapeutic modality best contributes to postural control.

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Peripheral neuropathy in a diabetic child treated with linezolid for multidrug-resistant tuberculosis: a case report and review of the literature

Extensively drug-resistant (XDR) tuberculosis (TB) and multidrug resistant (MDR)-TB with additional resistance to injectable agents or fluoroquinolones are challenging to treat due to lack of available, effect...

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Bacteremia due to Gordonia polyisoprenivorans: case report and review of literature

Gordonia polyisoprenivorans is a ubiquitous aerobic actinomycetes bacterium that rarely cause infections in humans. Here, we report a case of G. polyisoprenivorans catheter-related bac...

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Risk factors of lower limb cellulitis in a level-two healthcare facility in Cameroon: a case-control study

Cellulitis is a common infection of the skin and subcutaneous tissues. It is associated with significant morbidity from necrosectomies and amputations especially in sub-Saharan Africa. We aimed at identifying ...

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Intentional Segmentectomies for Stage I Lung Cancer: An Up-to-Date Systematic Review

Abstract

Purpose of Review

The role of this systematic review is to analyse and compare with a meta-analytic approach the outcomes of lobectomy versus intentional segmentectomy in the surgical treatment of stage I non-small cell lung cancer (NSCLC) as reported in the largest studies on the subject published to date.

Recent Findings

Regarding the results, most of these studies were based on the retrospective data. The size of the cohorts varied from 17 to 11,520 with a total number of 31,684 patients. The pooled hazard ratio was 1.08 (95% CI = 0.97–1.21; p = 0.16).

Summary

The survival in the lobectomy group was not superior to patients treated with intentional segmentectomy in stage I NSCLC. A large numbered, prospective, randomised trials are needed to assess the feasibility of intentional segmentectomy and its oncologic value in this group of patients, in order to dissolve the questions raised by retrospective data.

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In Situ Immunofluorescent Staining of Autophagy in Muscle Stem Cells

Active autophagy is associated with productive muscle regeneration, which is essential for Muscle Stem Cell (MuSC) activation. Here, we provide a protocol for the in situ detection of LC3, an autophagy marker in MyoD-positive MuSCs of muscle tissue sections from control and injured mice.

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A retrospective study: Can we differentiate between repeat self-inflicted burn patients and those who commit a self-inflicted burn as an individual occurrence?

Publication date: Available online 12 June 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Meelad Sayma, Simon Booth, Debbie Weller, Baljit Dheansa
Self-inflicted burns (SIB) are a significant cause of burns morbidity worldwide. A sub-group of SIB patients demonstrate recurrent SIB behaviour causing repeated morbidity and an increasing strain on hospital resources. The ability to predict which patients are likely to demonstrate repeat behaviour will allow for more targeted intervention in this group. The aim of this study was to identify the factors that differentiate patients who repeat SIB from those who commit SIB as an individual occurrence. A 3-step approach was adopted: (1) Initial data collection through the locally held records of the International Burns Injury Database (iBID), (2) Follow-up data of SIB patient information was extracted from patient notes, (3) Statistical data analysis. 75 records remained for analysis. 17 patients were identified as going on to commit SIB more than once and so classified as 'repeat SIB' patients (22.7%). Repeat SIB patients appeared to be more commonly female and Caucasian with a mean total body surface area of less than half the individual occurrence group. The repeat SIB group were also more likely to commit burns to their limbs and demonstrate previous non-burn deliberate self harm behaviour. 'Cold' burns were also committed more commonly in the repeat SIB group. This paper describes the largest sample of repeat SIB patients in the literature. It appears that repeat SIB patients have a set of differentiating factors that, when combined, allow for some element of prediction of these behaviours.

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Colo. paramedics receive 75 donated ballistic vests

The North Colorado Medical Center's volunteer services team raised $44,000 for the vests

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Dallas 911 system remains a gamble for callers

The 911 center is so severely understaffed that the city has spent more than $400,000 in overtime in recent months just to get the phones answered

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Survival of melanoma patients treated with novel drugs: retrospective analysis of real-world data

Abstract

Purpose

Recently, several new drugs have been licensed for advanced melanoma therapy, significantly changing the therapeutic landscape. Ipilimumab and vemurafenib were the first drugs that demonstrated a survival benefit over the long-standing standard therapy with dacarbazine. However, the comparative efficacy of these novel drugs has not been properly assessed yet.

Patients and methods

We conducted a retrospective analysis of all the Polish population treated between January 2012 and October 2016 with one of the following agents: ipilimumab (IPI), vemurafenib (VEM), dabrafenib (DAB), and classic chemotherapy (CTH). The main objective was to assess the overall survival of melanoma patients treated in real-world conditions, taking into account sequences of treatment.

Results

We identified 3397 patients with malignant melanoma treated for the first line and the second line. Patients receiving CTH were significantly older than those treated with the novel drugs. At the same time, the population treated with immunotherapy and targeted therapy was well balanced. Overall survival was significantly better for the novel drugs compared to classic chemotherapy in both lines (for the first line, VEM vs CTH HR = 0.72, 95% CI 0.65–0.81; p < .01, and for the second line, VEM vs CTH HR = 0.78, 95% CI 0.62–0.98; p = .03; IPI vs CTH HR = 0.72, 95% CI 0.62–0.86; p < .01). There was no statistically significant difference for IPI vs VEM; however, subgroup analysis revealed superior results in the case of the CTH–IPI over BRAFi–IPI sequence.

Conclusion

Novel drugs for melanoma provide a significant advantage in survival over classic chemotherapy. Comparative assessment of IPI and VEM indicated no difference, but only immunotherapy-treated patients achieved long-lasting results. Our data on sequential treatment indicate that immunotherapy might be a better option for the first line rather than targeted therapy, but that conclusion requires further studies of the best way to manage the treatment of melanoma patients.

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Johns Hopkins Health System President and Executive Vice President of Johns Hopkins Medicine Announces Retirement at Year’s End

After more than 44 years of unparalleled service to Johns Hopkins, Ronald R. Peterson has announced plans to retire as president of Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine at the end of 2017.

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Staff Nurse – Vitalink - New Hanover Regional Medical Center

Staff Nurse – Vitalink Full-Time, Rotating Schedule New Hanover Regional Medical Center Wilmington, NC New Hanover Regional Medical Center's Emergency Transport Services (ETS) is a recognized leader at both state and national levels. Recent awards include: the 2016 American Heart Association Mission Lifeline Gold Award Recognition for EMS, AirLink, and VitaLink, the 2016 EMS National Association ...

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Critical Care Transport Paramedic – Vitalink - New Hanover Regional Medical Center

Critical Care Transport Paramedic – Vitalink Full-Time, Rotating Schedule New Hanover Regional Medical Center Wilmington, NC New Hanover Regional Medical Center's Emergency Transport Services (ETS) is a recognized leader at both state and national levels. Recent awards include: the 2016 American Heart Association Mission Lifeline Gold Award Recognition for EMS, AirLink, and VitaLink, the ...

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Bullous pemphigoid and chronic kidney graft rejection

Abstract

Bullous pemphigoid (BP) is a disease caused by antibodies against components of the basement membrane, mainly two proteins: BP180 and BP230. We present two cases of BP related to chronic renal rejection.

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Johns Hopkins Health System President and Executive Vice President of Johns Hopkins Medicine Announces Retirement at Year’s End

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Video Tracking Protocol to Screen Deterrent Chemistries for Honey Bees

The loss of honey bee colonies presents a challenge to crop pollination services. Current pollinator protection practices warrant an alternative approach to minimize the contact of honey bees to harmful pesticides using repellent chemistries. Here, we provide detailed methods for a visual tracking protocol to screen deterrents for bees.

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Data on analysis of coronary atherosclerosis on computed tomography and 18F-sodium fluoride positron emission tomography

Publication date: Available online 12 June 2017
Source:Data in Brief
Author(s): Toshiro Kitagawa, Hideya Yamamoto, Shinya Toshimitsu, Ko Sasaki, Atsuhiro Senoo, Yumiko Kubo, Fuminari Tatsugami, Kazuo Awai, Yutaka Hirokawa, Yasuki Kihara
This article contains the data showing illustrative examples of plaque classification on coronary computed tomography angiography (CCTA) and measurement of ¹⁸F-sodium fluoride (¹⁸F-NaF) uptake in coronary atherosclerotic lesions on positron emission tomography (PET). We divided the lesions into one of three plaque types on CCTA (calcified plaque, non-calcified plaque, partially calcified plaque). Focal ¹⁸F-NaF uptake of each lesion was quantified using maximum tissue-to-background ratio. This article also provides a representative case with a non-calcified coronary plaque detected on CCTA and identified on ¹⁸F-NaF PET/non-contrast computed tomography based on a location of a vessel branch as a landmark. These complement the data reported by Kitagawa et al. [1].

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Practical Tips for Working as an Expedition Doctor on High-Altitude Expeditions

High Altitude Medicine & Biology , Vol. 0, No. 0.

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Pulsatile Flow Leads to Intimal Flap Motion and Flow Reversal in an In Vitro Model of Type B Aortic Dissection

Abstract

Understanding of the hemodynamics of Type B aortic dissection may improve outcomes by informing upon patient selection, device design, and deployment strategies. This project characterized changes to aortic hemodynamics as the result of dissection. We hypothesized that dissection would lead to elevated flow reversal and disrupted pulsatile flow patterns in the aorta that can be detected and quantified by non-invasive magnetic resonance imaging. Flexible, anatomic models of both normal aorta and dissected aorta, with a mobile intimal flap containing entry and exit tears, were perfused with a physiologic pulsatile waveform. Four-dimensional phase contrast magnetic resonance (4D PCMR) imaging was used to measure the hemodynamics. These images were processed to quantify pulsatile fluid velocities, flow rate, and flow reversal. Four-dimensional flow imaging in the dissected aorta revealed pockets of reverse flow and vortices primarily in the false lumen. The dissected aorta exhibited significantly greater flow reversal in the proximal-to-mid dissection as compared to normal (21.1 ± 3.8 vs. 1.98 ± 0.4%, p < 0.001). Pulsatility induced unsteady vortices and a pumping motion of the distal intimal flap corresponding to flow reversal. Summed true and false lumen flow rates in dissected models (4.0 ± 2.0 L/min) equaled normal flow rates (3.8 ± 0.1 L/min, p > 0.05), validated against external flow measurement. Pulsatile aortic hemodynamics in the presence of an anatomic, elastic dissection differed significantly from those of both steady flow through a dissection and pulsatile flow through a normal aorta. New hemodynamic features including flow reversal, large exit tear vortices, and pumping action of the mobile intimal flap, were observed. False lumen flow reversal would possess a time-averaged velocity close to stagnation, which may induce future thrombosis. Focal vortices may identify the location of tears that could be covered with a stent-graft. Future correlation of hemodynamics with outcomes may indicate which patients require earlier intervention.

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Pseudocyst of Morel–Lavalle´e : Post Liposuction

Case Report: Patient is a post liposuction status with post procedural changes and signal alteration in the subcutaneous fat. There is an oblong lobulated lesion in left anterolateral gluteal region/thigh measuring 9.9 x 6.2cm in the axial section and 16cm in superoinferior direction with fluid fluid level and fat contents showing signal suppression on fat sat images. Few septae are noted within the lesion. These findings are consistent with pseudocyst of Morel-Lavallee. (post liposuction soft tissue injury can lead to the formation of a pseudocyst in the subcutaneous adipose tissue due to a haematoma, seroma, or fat necrosis.)

Pathogenesis: In response to excessive pressure, the fat compartments burst open, with rupture of the septa and shearing of the anchorage of the skin and the superficial fascia. Subsequently, a cavity arises where blood migrates with fat and lymph capillaries continuously draining, resulting in stasis and even encapsulation by fibrous tissue (granulation or connective tissue), followed by the formation of a pseudocyst, pseudolipoma, hematoma and/or seroma.

History : The French physician Morel–Lavalle´e first described these cysts in 1853. He observed the phenomenon in a woman's lower limb after tangential trauma with separation of the fatty layers.

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Health Effects of Overweight and Obesity in 195 Countries over 25 Years

The prevalence of overweight and obesity is increasing worldwide. Epidemiologic studies have identified high body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) as a risk factor for an expanding set of chronic diseases, including cardiovascular disease,…

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Global Health Effects of Overweight and Obesity

The Global Burden of Disease (GBD) study that is now reported in the Journal offers a discouraging reminder that the global obesity epidemic is worsening in most parts of the world and that its implications regarding both physical health and economic health remain ominous. The study, in which…

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Ebb Insomnia Therapy System Cools Front of Heat to Help Stop Racing Thoughts

A new sleep therapy system is coming to market that works by cooling the frontal lobe. The technology is rooted in some evidence that less activity in the front of the brain is linked to better sleep. It seems related to "racing thoughts" that people sometimes experience while trying to sleep, the slowing of which may be induced by slightly reducing the temperature where they originate.

The Ebb Insomnia Therapy from Ebb Therapeutics, a Pittsburgh, Penssylvania firm, consists of a headband through which cooled fluid is moved, and a control unit that does the pumping. The headband temperature can be set using a dial on the front of the controller, and the device can be programmed to stop cooling close to wake-up time.

It already has FDA clearance and is being made available to a number of sleep centers, with wider available expected next year.

From the announcement on a study of the system presented at the SLEEP 2017 conference this week:

The study included a randomized, placebo-controlled trial collecting polysomnographic sleep measurements in 106 adults with primary insomnia. Results of the study showed a statistically signifi cant reduction in latency to Stage 1 sleep, the time it takes to get into the fi rst stage of sleep, as well as latency to Stage 2 sleep, a deeper stage of sleep that typically represents over half the night.

Product page: Ebb Insomnia Therapy…

Via: Ebb Therapeutics…