Tuberculous meningitis is globally highly prevalent and is commoner in resource-limited countries and in patients with immunosuppression. Central nervous system tuberculosis is one of the severest forms of ext...
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- Tuberculous meningoencephalitis associated with br...
- Fluorescein sodium-guided surgery of parotid gland...
- Partenij Pavlovich revisited
- Rivals and Collaborators. The Image of the West in...
- Rapid response to clinical symptoms in early psori...
- Dermatological learning needs among aboriginal hea...
- Lepromatous leprosy with Lucio's phenomenon
- Maculopapular type drug eruption caused by garenox...
- Necrobiosis lipoidica following Q-switched laser t...
- Pyoderma gangrenosum arising during treatment of p...
- Febrile headache and leg weakness as the initial s...
- Critical Ischemia Times and The Effect of Novel Pr...
- Targeted Next-generation Sequencing in Brazilian C...
- Pharmacokinetics and Clinical Outcomes of Generic ...
- Tacrolimus Trough Concentration Variability and Di...
- Necrotising coronaritis with fatal outcome
- Pattern of skin diseases among patients attending ...
- Infundibulocystic basal cell carcinoma of the eyelid
- Clinical and dermoscopic features of targetoid hae...
- Bilateral inner ear damage after electrical injury...
- Ultrasound Risk Categories for Thyroid Nodules and...
- Retrospective study of intranasal dexmedetomidine ...
- Comparison of home sleep apnea testing versus labo...
- Autoinflammatory keratinization diseases
- A clustering approach to identify and characterize...
- Novel Somatic RET Mutation Questioning the Causali...
- Double chin: Causes and how to get rid of one
- Whitish Papules and Scars on a Patient With Bowel ...
- Isotretinoin and Timing of Cutaneous Surgery Proce...
- Human Papillomavirus Vaccination and Keratinocyte ...
- Human Papillomavirus Vaccination and Keratinocyte ...
- Misspelling of Coauthor Surname
- Correlation Among Cancer Mortality Rates and Inter...
- Immediate moxifloxacin hypersensitivity: is there ...
- Delayed type hypersensitivity reactions induced by...
- The in vitro mucolytic effect of xylitol and dorna...
- Assessment of acquired mucociliary clearance defec...
- Platelet activation by crushed and uncrushed muscl...
- A call for critical examination of endoscopically ...
- Expression of Metabolic Syndrome in Women with Sev...
- Association between preoperative pulse pressure an...
- Some light in the grey zone?
- Hypotension during induction of anaesthesia is nei...
- The spectrum of spontaneous coronary artery dissec...
- Cohort study of preoperative blood pressure and ri...
- Quality metrics: hard to develop, hard to validate
- Predictor of fluid responsiveness in the ‘grey zon...
- Predicting postoperative morbidity in adult electi...
- Sleep deprived and unprepared
- Supplemental oxygen and surgical site infection: g...
- Continuous monitoring and feedback of quality of r...
- Hypotension during induction of anaesthesia is nei...
- Association between preoperative pulse pressure an...
- Prolonged concurrent hypotension and low bispectra...
- Intraoperative fraction of inspired oxygen: bringi...
- Supraglottic jet oxygenation and ventilation enhan...
- Methodology in systematic reviews of goal-directed...
- Some light in the grey zone?
- The Goldilocks principle as it applies to perioper...
- Impact of sleep deprivation on anaesthesia residen...
- Rising sudden death among anaesthesiologists in China
- Premedication with salbutamol prior to surgery doe...
- ISO (Infraclavicular–SubOmohyoid) block: a single-...
- Lip, tooth, and pharyngeal injuries during trachea...
- Reports of Adverse Reactions With Cosmetics Increa...
- Large Study Finds No Link Between Eczema, Cardiova...
- An Unusually Large Carbuncle of the Temporofacial ...
- Fluorescein sodium-guided surgery of parotid gland...
- Silver(I)-Induced Higher-Ordered Structure Based o...
- Understanding atypical sepsis
- School Gender Composition, Laddish School Culture ...
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Ετικέτες
Τετάρτη 28 Ιουνίου 2017
Tuberculous meningoencephalitis associated with brain tuberculomas during pregnancy: a case report
Fluorescein sodium-guided surgery of parotid gland tumors as a technical advance
Complete tumor removal and preservation of the facial nerve are essential in parotid gland surgery. A technical adjunct that potentially enhances the contrast between the facial nerve and the adherent tumor ti...
http://ift.tt/2tnbUKU
Rapid response to clinical symptoms in early psoriatic onycho-pachydermo-periostitis treated with infliximab
http://ift.tt/2soCr64
Dermatological learning needs among aboriginal health workers in rural and remote Australia: A cross-sectional survey
http://ift.tt/2sTxLsm
Maculopapular type drug eruption caused by garenoxacin mesilate hydrate: A case report and literature review
http://ift.tt/2sTRiJl
Pyoderma gangrenosum arising during treatment of psoriasis with adalimumab: Effectiveness of ustekinumab
http://ift.tt/2sTzDSf
Febrile headache and leg weakness as the initial symptoms of tickborne encephalitis
Description
A 61-year-old woman presented to the emergency department (ED) with a 1-week fever associated with progressive headache. She also reported weakness and paraesthesias in both legs. In the ED, the patient had normal vital parameters and reported no other medical history. Clinical examination showed a slight neck stiffness; the rest of the examination was normal. Laboratory findings showed a mild inflammatory syndrome. The patient had a lumbar punction; the cerebrospinal fluid (CSF) showed moderate pleocytosis (140 leucocytes/μL with a mononuclear cell dominance). After a normal CT scan, an MRI examination was performed (figures 1and 2). Several days later, intrathecal IgM and IgG antibodies came back positive.
Figure 1
T2-weighted transverse MRI. Localised hyperintense band involving the tegmentum pontis (arrow heads) and the cerebellar vermis (arrow).
Figure 2
Coronal MRI, fluid attenuation inversion recovery...
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Critical Ischemia Times and The Effect of Novel Preservation Solutions HTK-N and TiPROTEC on Tissues of a Vascularized Tissue Isograft.
http://ift.tt/2sTkCQ1
Targeted Next-generation Sequencing in Brazilian Children With Nephrotic Syndrome Submitted to Renal Transplant.
http://ift.tt/2soWiCl
Pharmacokinetics and Clinical Outcomes of Generic Tacrolimus (Hexal) Versus Branded Tacrolimus in De Novo Kidney Transplant Patients: A Multicenter, Randomized Trial.
http://ift.tt/2sTvnSv
Tacrolimus Trough Concentration Variability and Disparities in African American Kidney Transplantation.
http://ift.tt/2sToh0l
Necrotising coronaritis with fatal outcome
A 56-year-old woman presented with acute onset of typical chest pain. She was diagnosed with acute coronary syndrome with ST-segment elevation myocardial infarction. Although significant obstructive coronary artery disease was ruled out by coronary angiography, cardiac MRI showed transmural necrosis of the lateral free wall with extensive microvascular obstruction consistent with ischaemic heart disease. Within 48 hours after initial presentation, the patient suddenly arrested due to pulseless electrical activity with futile resuscitation efforts. Autopsy revealed myocardial perforation with extensive haematothorax due to pericardial laceration, caused by the mechanical chest compressions. Eventually, histology identified diffuse necrotising coronary vasculitis as a rare cause of ischaemic heart disease.
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Pattern of skin diseases among patients attending an outpatient dermatology clinic in a tertiary hospital in urban Malaysia
http://ift.tt/2ukigrp
Clinical and dermoscopic features of targetoid haemosiderotic naevus: A peculiar melanoma simulator
http://ift.tt/2tmKIeW
Bilateral inner ear damage after electrical injury: A case report
Source:Auris Nasus Larynx
Author(s): George Psillas, Marios Stavrakas, Ioanna Petrou, Dimitrios Rachovitsas, Konstantinos Markou
Electrical injury occurs as a result of direct contact with an electrical source. We present the case of a 62-year-old male patient, an electrician by profession, who was hit by a high-voltage electrical current while working with cables in proximity to a wet floor. The patient suffered from immediate loss of consciousness and five days later he started complaining of slight hearing loss, persistent vertigo, instability and bilateral tinnitus. A thorough audiological and vestibular examination revealed an extensive bilateral vestibulocochlear dysfunction. The exact pathogenetic mechanisms of inner ear dysfunction after electrical injury have not been fully elucidated, although it is believed that there is significant improvement with time. Long-term follow-up, medical assistance and psychological support are crucial factors for the patient management.
http://ift.tt/2sSR0m8
Ultrasound Risk Categories for Thyroid Nodules and Cytology Results: A Single Institution’s Experience after the Adoption of the 2016 Update of Medical Guidelines by the American Association of Clinical Endocrinologists and Associazione Medici Endocrinologi
Objectives. In 2016, the American Association of Clinical Endocrinologists (AACE) and Associazione Medici Endocrinologi (AME) released updated guidelines for the diagnosis and management of thyroid nodules. The aim of this study was to evaluate the AACE/AME recommendations for FNA in clinical practice, by comparing the (US) stratification risk and indications for FNA with cytologic results. Methods. From May to December 2016, we collected the cytologic results from FNAs of nodules that were classified using a three-tier US category system (low, intermediate, and high risk). Results. We obtained 859 FNAs from 598 patients: 341 (39.7%) from low, 489 (56.9%) from intermediate, and 29 (3.4%) from high risk nodules. Of these, 88.5% and 74.9% of low and intermediate risk nodules, respectively, were cytologically benign, whereas 84.6% of high risk nodules had a moderate-to-elevated risk of malignancy or were malignant. If FNAs had been limited to intermediate risk nodules >20 mm, we would have missed 13/17 (76.5%) nodules that had moderate-to-elevated risk of malignancy or were malignant (11/13 were malignant based on histology). Conclusions. A nonnegligible number of cytologically malignant nodules or nodules that were suspected to be malignant would be missed if intermediate US risk nodules
http://ift.tt/2tkmEtq
Retrospective study of intranasal dexmedetomidine as a prophylactic against emergence delirium in pediatric patients undergoing ear tube surgery
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Lisgelia Santana, Katherine Mills
ObjectivesThis study evaluated the effect of intranasal dexmedetomidine on emergence delirium (ED) in pediatric patients who underwent ear tube surgeries. Due to the brief nature of the surgery and low levels of pain experienced, an IV is rarely needed, limiting the medications available to anesthesiologists to manage postoperative delirium that may arise during recovery from inhalational anesthesia. Intravenous dexmedetomidine is an alpha-2 agonist anesthetic that is used in pediatric patients for the management of ED in various surgical procedures. However, intranasal medication has not been evaluated specifically in ear tube surgeries for ED prevention.MethodsWe conducted a retrospective chart review of pediatric patients at Nemours Children's Hospital who had undergone ear tube insertion or removal surgery between 2013 and 2015, controlling for confounding variables such as age, surgery duration, and anesthesiologist. We used the post anesthesia emergence delirium (PAED) tool, an instrument created to assess ED in the clinical setting. We analyzed the data for significant differences in PAED score and time in the post anesthesia care unit (PACU) between patients treated with intranasal dexmedetomidine and the control group that did not receive the medication.ResultsWe found no significant difference between the PAED scores of those patients treated with intranasal dexmedetomidine prior to ear tube surgeries and those who did not receive the medication, and no difference in the duration of PACU stay.ConclusionThese results conflict with other research on intranasal dexmedetomidine and its potential to prevent ED in pediatric patients. This information should prompt further prospective investigation into the most efficacious use of dexmedetomidine for ED prevention, both in terms of timing and dosage required.
http://ift.tt/2t2bC9V
Comparison of home sleep apnea testing versus laboratory polysomnography for the diagnosis of obstructive sleep apnea in children
Source:International Journal of Pediatric Otorhinolaryngology, Volume 100
Author(s): Nicholas Scalzitti, Shana Hansen, Stephen Maturo, Joshua Lospinoso, Peter O'Connor
IntroductionObstructive sleep apnea (OSA) affects 1–5% of pediatric patients. Laboratory polysomnography is expensive, not always available, and is inconvenient for patients. Our study investigates the diagnostic ability of an unattended ambulatory monitor for the diagnosis of pediatric OSA.MethodsA prospective study was conducted in children, ages 2–17. Subjects completed in-lab polysomnography simultaneously with ambulatory monitoring. Caregivers attempted home studies on two subsequent nights to compare the home monitor and the laboratory polysomnogram (PSG).ResultsThirty-three subjects completed simultaneous laboratory polysomnogram with portable monitoring. Twenty patients completed home studies, with 16 completing 2 nights of monitoring. The measurement of AHI by the portable monitor was different than that obtained by the PSG with statistical significance for the comparisons of PSG vs. In-Lab (p = 0.0026), PSG vs. Home 1 (p = 0.033), and PSG vs. Home 2 (p = 0.033). The sensitivity of the portable monitor for diagnosing OSA was best for the In-lab use at 81%, but only 69% and 70% for the uses at home on the 2 nights respectively. Interestingly, the comparison of AHI and lowest oxygen saturation measurements from the home sleep test in children age 6 and older did not differ significantly from the PSG.ConclusionsThis pilot study demonstrated differences between home sleep testing and in-lab polysomnography for the diagnosis of pediatric sleep apnea. These differences were predominantly found to exist in younger children. Larger prospective studies are needed prior to widespread use, but home studies may alleviate issues of access to care and higher costs of laboratory polysomnography.
http://ift.tt/2sjnHKB
Autoinflammatory keratinization diseases
Source:Journal of Allergy and Clinical Immunology
Author(s): Masashi Akiyama, Takuya Takeichi, John A. McGrath, Kazumitsu Sugiura
http://ift.tt/2sSvcqL
A clustering approach to identify and characterize the asthma and chronic obstructive pulmonary disease overlap phenotype
Abstract
Background
Asthma and chronic obstructive pulmonary disease (COPD) are heterogeneous diseases. The phenotypes that have clinical features of both asthma and COPD are still incompletely understood.
Objective
To clarify the best discriminators of the asthma-COPD overlap phenotype from asthma and COPD subgroups using a clustering approach.
Methods
This study assessed pathophysiological parameters, including mRNA expression levels of T helper cell-related transcription factors, namely, TBX21 (Th1), GATA3 (Th2), RORC (Th17), and FOXP3 (Treg), in peripheral blood mononuclear cells in asthma patients (n = 152) and in COPD patients (n = 50). Clusters were determined using k-means clustering. Exacerbations of asthma and COPD were recorded during the 1-year follow-up period.
Results
The cluster analysis revealed four biological clusters: cluster 1, predominantly patients with COPD; cluster 2, patients with an asthma-COPD overlap phenotype; cluster 3, patients with non-atopic and late-onset asthma; and cluster 4, patients with early-onset atopic asthma. Hazard ratios for exacerbation were 2.5 (95% confidence interval [CI], 1.1–5.6) in cluster 1 and 2.3 (95% CI, 1.0–5.0) in cluster 2 compared with patients in other clusters. Cluster 2 was discriminated from other clusters by total serum IgE level ≥ 310 IU/mL, blood eosinophil counts ≥ 280 cells/μL, a higher ratio of TBX21/GATA3, FEV1/FVC ratio < 0.67, and smoking ≥ 10 pack-years with an area under the curve of 0.94 (95% CI, 0.90–0.98) in the receiver operating characteristic analysis.
Conclusions & Clinical Relevance
The asthma-COPD overlap phenotype was characterized by peripheral blood eosinophilia and higher levels of IgE despite the Th2-low endotype.
This article is protected by copyright. All rights reserved.
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Novel Somatic RET Mutation Questioning the Causality of the RET I852M Germline Sequence Variant in Multiple Endocrine Neoplasia 2A
http://ift.tt/2sRMGnd
Double chin: Causes and how to get rid of one
Excess fat under the chin can be caused by a number of factors, including age, weight, and genetics. Learn how to reduce the appearance of a double chin.
http://ift.tt/2sn853P
Whitish Papules and Scars on a Patient With Bowel Perforation
http://ift.tt/2siiHWH
Isotretinoin and Timing of Cutaneous Surgery Procedural Interventions
http://ift.tt/2t1AoXF
Human Papillomavirus Vaccination and Keratinocyte Carcinomas—Reply
http://ift.tt/2t1ydUa
Human Papillomavirus Vaccination and Keratinocyte Carcinomas
http://ift.tt/2siohZ5
Misspelling of Coauthor Surname
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Correlation Among Cancer Mortality Rates and Internet Searches
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Immediate moxifloxacin hypersensitivity: is there more than currently meets the eye?
Abstract
Immediate drug hypersensitivity reactions (IDHR) to moxifloxacin constitute a pathomechanistic conundrum and a diagnostic challenge. Our objective was to study whether simultaneous phenotyping and quantification of histamine release might add to our knowledge about the basophil activation properties of moxifloxacin and constitute a reliable diagnostic aid. Fifteen patients with an IDHR to moxifloxacin and 9 moxifloxacin challenged controls were selected. All had a basophil activation test (BAT) with moxifloxacin. Flow cytometric analysis of basophil responses implied labeling for CD63, CD203c and intracellular histamine. Unlike tolerant challenged controls, basophilic upregulation of CD203c in response to moxifloxacin was observed in 7/15 patients. Only 2 of these 7 patients demonstrated appearance of CD63 and release of histamine. In the remainder 8 patients no basophil responses were demonstrable. In conclusion, immediate hypersensitivity to moxifloxacin might involve mechanisms difficult to capture by traditional CD63/CD203c-based BAT. Deciphering the complexity of quinolone IDHR seems mandatory.
This article is protected by copyright. All rights reserved.
http://ift.tt/2tlk32p
Delayed type hypersensitivity reactions induced by proton pump inhibitors: a clinical and in vitro T cell reactivity study
Abstract
Background
Proton pump inhibitors (PPI) has been known to induce type I hypersensitivity reactions. However, severe delayed type hypersensitivity reactions (DHR) induced by PPI, such as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), or drug rash with eosinophilia and systemic symptoms (DRESS), are rarely reported. We conducted a study of a large series of PPI-related DHR, followed up their tolerability to alternative anti-ulcer agents, and investigated the T cell reactivity to PPI in PPI-related DHR patients.
Methods
We retrospectively analyzed patients with PPI-related DHR from multiple medical centers in Taiwan during the study period January 2003 to April 2016. We analyzed the causative PPI, clinical manifestations, organ involvement, treatment, and complications. We also followed up the potential risk of cross-hypersensitivity or tolerability to other PPI after their hypersensitivity episodes. Drug lymphocyte activation test (LAT) was conducted by measuring granulysin and interferon-γ to confirm the causalities.
Results
There were 69 cases of PPI-related DHR, including SJS/TEN (n=27) and DRESS (n=10). The LAT by measuring granulysin showed a sensitivity of 59.3% and specificity of 96.4%. Esomeprazole was the most commonly involved in PPI-related DHR (51%). Thirteen patients allergic to one kind of PPI could tolerate other structurally different PPI without cross-hypersensitivity reactions, whereas three patients developed cross-hypersensitivity reactions to alternative structurally similar PPI. The cross-reactivity to structurally similar PPI was also observed in LAT assay.
Conclusions
PPIs have the potential to induce life-threatening DHR. In patients when PPI is necessary for treatment, switching to structurally different alternatives should be considered.
This article is protected by copyright. All rights reserved.
http://ift.tt/2uiYYmp
The in vitro mucolytic effect of xylitol and dornase alfa on chronic rhinosinusitis mucus
Background
The overproduction and stagnation of purulent mucus impair mucociliary clearance and exacerbate the symptoms of chronic rhinosinusitis (CRS). There is a clinical need for effective topical mucolytic agents to facilitate removal of mucus and improve postoperative outcomes.
Methods
The effects of xylitol (5%) and dornase alfa (1 mg/mL) on mucus and mucus crusts were investigated. Viscoelasticity and viscosity of wet mucus derived from 30 CRS patients was measured with a plate rheometer. Postoperative dried mucus crust dissolution was measured by examining peripheral transparency, central transparency, and border definition of treated crust samples from 17 CRS patients.
Results
Xylitol and dornase alfa reduced wet mucus viscoelasticity at a frequency of 0.1 Hz significantly more than the saline control. Treatments also produced significantly lower viscosities than saline at a shear rate of 10 and 100 seconds−1. Xylitol and dornase alfa significantly decreased mucus crust border definition relative to saline.
Conclusion
Xylitol and dornase alfa may be efficacious mucolytics, encouraging the breakdown of postoperative mucus crusts and the reduction of viscoelasticity and viscosity of wet mucus. In vivo study is required to evaluate the potential of these agents in treating recalcitrant CRS.
http://ift.tt/2tYiZPz
Assessment of acquired mucociliary clearance defects using micro-optical coherence tomography
Background
Dehydration of airway surface liquid (ASL) disrupts normal mucociliary clearance (MCC) in sinonasal epithelium, which may lead to chronic rhinosinusitis (CRS). Abnormal chloride (Cl−) transport is one such mechanism that contributes to this disorder and can be acquired secondary to environmental perturbations, such as hypoxia at the tissue surface. The objective of this study was to assess the technological feasibility of the novel micro-optical coherence tomography (μOCT) imaging technique for investigating acquired MCC defects in cultured human sinonasal epithelial (HSNE) cells.
Methods
Primary HSNE cell cultures were subjected to a 1% oxygen environment for 12 hours to induce acquired cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction. Ion transport characteristics were assessed with pharmacologic manipulation in Ussing chambers. ASL, periciliary fluid (PCL), and ciliary beat frequency (CBF) were evaluated using μOCT.
Results
Amiloride-sensitive transport (ΔISC) was greater in cultures exposed to hypoxia (hypoxia: −13.2 ± 0.6 μA/cm2; control: −6.5 ± 0.1 μA/cm2; p < 0.01), whereas CFTR-mediated anion transport was significantly diminished (hypoxia: 28.6 ± 0.3 μA/cm2; control: 36.2 ± 1.6 μA/cm2; p < 0.01), consistent with acquired CFTR dysfunction and sodium hyperabsorption. Hypoxia diminished all markers of airway surface function microanatomy as observed with μOCT, including ASL (hypoxia: 5.0 ± 0.4 μm; control: 9.0 ± 0.9 μm; p < 0.01) and PCL depth (hypoxia: 2.5 ± 0.1 μm; control: 4.8 ± 0.3 μm; p < 0.01), and CBF (hypoxia: 8.7 ± 0.3 Hz; control: 10.2 ± 0.3 Hz; p < 0.01).
Conclusion
Hypoxia-induced defects in epithelial anion transport in HSNE led to predictable effects on markers of MCC measured with novel μOCT imaging. This imaging method represents a technological leap forward and is feasible for assessing acquired defects impacting the airway surface.
http://ift.tt/2tpAVFZ
Platelet activation by crushed and uncrushed muscle: a flow cytometry analysis
Background
Crushed autologous muscle is used in skull base surgery in the acute phase of major arterial hemorrhage to stop bleeding. The mechanism of this is not yet clear, but is thought to involve the formation of a platelet plug, which seals the vessel wall defect but still allows ongoing blood flow to the brain.
Methods
In this study we use flow cytometry to replicate the in-vivo actions of crushed muscle on platelets in whole blood. We compare the ratio of activation of platelets exposed to crushed and uncrushed muscle supernatant in control patients and in patients on antiplatelet agents.
Results
Crushed muscle activated platelets to a higher degree than uncrushed muscle: 5.18-fold greater in control blood (p = 0.002); 6.53-fold greater in aspirin-exposed blood (p < 0.0001); and 9.4-fold greater in clopidogrel-exposed blood (p < 0.0001).
Conclusion
Crushed muscle caused a consistently increased ratio of platelet activation when compared with uncrushed muscle across all groups, adding to the evidence that at least part of its clinical effect is the result of platelet activation.
http://ift.tt/2uj3nFM
Expression of Metabolic Syndrome in Women with Severe Obesity
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
http://ift.tt/2s2fOoS
Association between preoperative pulse pressure and perioperative myocardial injury: an international observational cohort study of patients undergoing non-cardiac surgery
from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2s27u8n
via IFTTT
Some light in the grey zone?
from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2tlbzIT
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Hypotension during induction of anaesthesia is neither a reliable nor a useful quality measure for comparison of anaesthetists’ performance
from #MedicinebyAlexandrosSfakianakis via xlomafota13 on Inoreader http://ift.tt/2s2gzhB
via IFTTT
The spectrum of spontaneous coronary artery dissection: illustrated review of the literature
http://ift.tt/2tkPMkt
Quality metrics: hard to develop, hard to validate
http://ift.tt/2s2r8kM
Predictor of fluid responsiveness in the ‘grey zone’: augmented pulse pressure variation through a temporary increase in tidal volume
http://ift.tt/2s2pxLR
Predicting postoperative morbidity in adult elective surgical patients using the Surgical Outcome Risk Tool (SORT)
http://ift.tt/2s27yF9
Sleep deprived and unprepared
http://ift.tt/2tlbULq
Supplemental oxygen and surgical site infection: getting to the truth
http://ift.tt/2tl2G1M
Continuous monitoring and feedback of quality of recovery indicators for anaesthetists: a qualitative investigation of reported effects on professional behaviour
http://ift.tt/2s2msex
Hypotension during induction of anaesthesia is neither a reliable nor a useful quality measure for comparison of anaesthetists’ performance
http://ift.tt/2s2gzhB
Association between preoperative pulse pressure and perioperative myocardial injury: an international observational cohort study of patients undergoing non-cardiac surgery
http://ift.tt/2s27u8n
Prolonged concurrent hypotension and low bispectral index (‘double low’) are associated with mortality, serious complications, and prolonged hospitalization after cardiac surgery
http://ift.tt/2s2qUKs
Intraoperative fraction of inspired oxygen: bringing back the focus on patient outcome
http://ift.tt/2tl8TLj
Supraglottic jet oxygenation and ventilation enhances oxygenation during upper gastrointestinal endoscopy in patients sedated with propofol: a randomized multicentre clinical trial
http://ift.tt/2s2BFMK
Methodology in systematic reviews of goal-directed therapy: improving but not perfect
http://ift.tt/2tlpvTj
Some light in the grey zone?
http://ift.tt/2tlbzIT
The Goldilocks principle as it applies to perioperative blood pressure: what is too high, too low, or just right?
http://ift.tt/2tkTsTb
Impact of sleep deprivation on anaesthesia residents’ non-technical skills: a pilot simulation-based prospective randomized trial
http://ift.tt/2tliNwC
Rising sudden death among anaesthesiologists in China
http://ift.tt/2s2qRhA
Premedication with salbutamol prior to surgery does not decrease the risk of perioperative respiratory adverse events in school-aged children
http://ift.tt/2s27mWy
ISO (Infraclavicular–SubOmohyoid) block: a single-puncture technique for diaphragm- and opioid-sparing shoulder anaesthesia
http://ift.tt/2s2wyfq
Lip, tooth, and pharyngeal injuries during tracheal intubation at a teaching hospital
http://ift.tt/2tlkGJp
Reports of Adverse Reactions With Cosmetics Increasing
Reuters Health Information
http://ift.tt/2tTUXFB
Large Study Finds No Link Between Eczema, Cardiovascular Disease
Atopic dermatitis (AD) is unlikely to be associated with cardiovascular disease, new research shows.
Reuters Health Information
http://ift.tt/2sn25rQ
An Unusually Large Carbuncle of the Temporofacial Region
How was this extensive carbuncle over the temporofacial region effectively managed?
Wounds
http://ift.tt/2thg737
Fluorescein sodium-guided surgery of parotid gland tumors as a technical advance
Abstract
Background
Complete tumor removal and preservation of the facial nerve are essential in parotid gland surgery. A technical adjunct that potentially enhances the contrast between the facial nerve and the adherent tumor tissue and allows to identify residual tumor tissue could be Fluorescein Sodium.
Methods
Retrospective chart analysis on 7 patients with benign parotid gland lesions that were operated using Fluorescein Sodium intravenously and the application of the YELLOW 560 nm filter of the operating microscope. Safety and feasibility were evaluated.
Results
All tumors showed fluorescence and the rating ´contrast-enhancing´ was assigned in all cases. In 2 patients, satellite nodules were identified and resected meaning that the fluorescence staining of the tumor margins was significantly better than under white light.
Conclusion
The use of Fluorescein Sodium in parotidectomy is promising. In two cases residual tumor was detected that would have been left behind under white light. Further research in parotid gland surgery and other head and neck tumor procedures is warranted.
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Silver(I)-Induced Higher-Ordered Structure Based on Planar Chiral Tetrasubstituted [2.2]Paracyclophane
DOI: 10.1039/C7CC03615A, Communication
Optically active phenylene-ethynylene dimers with pyridine groups based on a planar chiral 4,7,12,15-tetrasubstituted [2.2]paracyclophane were synthesized. The chiral conformation was controlled by pyridine-Ag(I) coordinations. After Ag(I) coordination, the resulting higher-ordered...
The content of this RSS Feed (c) The Royal Society of Chemistry
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Understanding atypical sepsis
Paramedics Australasia WA describe presentations of atypical sepsis.
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Next generation deep sequencing corrects diagnostic pitfalls of traditional molecular approach in a patient with prenatal onset of Pompe disease
Pompe disease is a rare inherited metabolic disorder of glycogen metabolism caused by mutations in the GAA gene, encoding the acid α-1,4 glucosidase. Successful diagnosis of Pompe disease is achieved by clinical and biochemical evaluation followed by confirmation with DNA testing. Here, we report a male infant with a prenatal onset of cardiac symptoms and enzyme testing consistent with Pompe disease, but DNA testing by Sanger sequencing revealed no pathogenic variants. Due to the strong indication from clinical, enzymatic, and histological studies (despite the absence of molecular confirmation by traditional Sanger sequencing), enzyme replacement therapy (ERT) for Pompe disease was initiated. Reanalysis of the patient's DNA sample using next generation sequencing (NGS) of a panel of target genes causing glycogen storage disorders demonstrated compound heterozygosity for a point mutation and an exonic deletion in the GAA gene. This case illustrates the value of astute clinical judgement in patient management as well as the power of target capture deep NGS in the simultaneous detection of both a point mutation and a heterozygous exonic deletion by correcting pitfalls of the traditional PCR based sequencing, namely; allele dropout and the inability to detect exonic deletions.
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Shared Care of Childhood Cancer Survivors: A Telemedicine Feasibility Study
Journal of Adolescent and Young Adult Oncology , Vol. 0, No. 0.
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FOXC1 haploinsufficiency due to 6p25 deletion in a patient with rapidly progressing aortic valve disease
6p25 deletion is a rare but well-known entity. The main clinical features include an abnormal facial appearance, developmental delay, and ocular anomalies. Cardiac anomalies are frequently seen but remain poorly delineated. We describe a 4-year-old girl with 6p25.3 deletion, which includes the FOXC1 gene, typical dysmorphic features associated with developmental delay and oculo-motor anomalies. Aortic valve dysplasia was diagnosed early in life. The cardiac lesion progressed very rapidly between the age of 3 and 4 years requiring aortic valve replacement. Genomic analysis of blood and excised valve tissue showed down-regulation of FOXC1 but also FOXC2 expression in the diseased aortic valve. This allows us to speculate on the potential role of FOXC1 in aortic valve anomalies.
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The Impact of Coverage Restrictions on Antipsychotic Utilization Among Low-Income Medicare Part D Enrollees
Abstract
Prior research demonstrates substantial access problems associated with utilization management and formulary exclusions for antipsychotics in Medicaid, but the use and impact of coverage restrictions for these medications in Medicare Part D remains unknown. We assess the effect of coverage restrictions on antipsychotic utilization in Part D by exploiting a unique natural experiment in which low-income beneficiaries are randomly assigned to prescription drug plans with varying levels of formulary generosity. Despite considerable variation in use of coverage restrictions across Part D plans, we find no evidence that these restrictions significantly deter utilization or reduce access to antipsychotics for low-income beneficiaries.
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Recommendations of the Fertility Preservation Working Group in Oncological, Hematological and Other Patients Treated With Gonadotoxic Therapies “ONCOFERTILITY” (GROF) of the Polish Society of Oncological Gynecology
Journal of Adolescent and Young Adult Oncology , Vol. 0, No. 0.
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Glucose uptake in human brown adipose tissue is impaired upon fasting-induced insulin resistance
Human brown adipose tissue (BAT) has recently emerged as a potential target in the treatment of type 2 diabetes, owing to its capacity to actively clear glucose from the circulation-at least upon cold exposure. The effects of insulin resistance on the capacity of human BAT to take up glucose are unknown. Prolonged fasting is known to induce insulin resistance in peripheral tissues in order to spare glucose for the brain. We studied the effect of fasting-induced insulin resistance on the capacity of BAT to take up glucose during cold exposure as well as on cold-stimulated thermogenesis. BAT glucose uptake was assessed by means of cold-stimulated dynamic 2-deoxy-2-[F-18]fluoro-d-glucose positron emission tomography/computed tomography ([F-18]FDG-PET/CT) imaging. We show that a 54 h fasting period markedly decreases both cold-induced BAT glucose uptake and nonshivering thermogenesis (NST) during cold stimulation. In vivo molecular imaging and modelling revealed that the reduction of glucose uptake in BAT was due to impaired cellular glucose uptake and not due to decreased supply. Interestingly, decreased BAT glucose uptake upon fasting was related to a decrease in core temperature during cold exposure, pointing towards a role for BAT in maintaining normothermia in humans. Cold-stimulated glucose uptake in BAT is strongly reduced upon prolonged fasting. When cold-stimulated glucose uptake in BAT is also reduced under other insulin-resistant states, such as diabetes, cold-induced activation of BAT may not be a valid way to improve glucose clearance by BAT under such conditions. Trial registration: www.trialregister.nl NTR3523 Funding: This work was supported by the EU FP7 project DIABAT (HEALTH-F2-2011-278373 to WDvML) and by the Netherlands Organization for Scientific Research (TOP 91209037 to WDvML).
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Flow Cytometric Single-Cell Identification of Populations in Synthetic Bacterial Communities
Bacterial cells can be characterized in terms of their cell properties using flow cytometry. Flow cytometry is able to deliver multiparametric measurements of up to 50,000 cells per second. However, there has not yet been a thorough survey concerning the identification of the population to which bacterial single cells belong based on flow cytometry data. This paper not only aims to assess the quality of flow cytometry data when measuring bacterial populations, but also suggests an alternative approach for analyzing synthetic microbial communities. We created so-called in silico communities, which allow us to explore the possibilities of bacterial flow cytometry data using supervised machine learning techniques. We can identify single cells with an accuracy > 90% for more than half of the communities consisting out of two bacterial populations. In order to assess to what extent an in silico community is representative for its synthetic counterpart, we created so-called abundance gradients, a combination of synthetic ( i. e., in vitro) communities containing two bacterial populations in varying abundances. By showing that we are able to retrieve an abundance gradient using a combination of in silico communities and supervised machine learning tech-niques, we argue that in silico communities form a viable representation for synthetic bacte-rial communities, opening up new opportunities for the analysis of synthetic communities and bacterial flow cytometry data in general.
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Understanding atypical sepsis
Paramedics Australasia WA describe presentations of atypical sepsis.
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Helminth Products Potently Modulate Experimental Autoimmune Encephalomyelitis by Downregulating Neuroinflammation and Promoting a Suppressive Microenvironment
A negative correlation between the geographical distribution of autoimmune diseases and helminth infections has been largely associated in the last few years with a possible role for such type of parasites in the regulation of inflammatory diseases, suggesting new pathways for drug development. However, few helminth-derived immunomodulators have been tested in experimental autoimmune encephalomyelitis (EAE), an animal model of the human disease multiple sclerosis (MS). The immunomodulatory activities of Taenia crassiceps excreted/secreted products (TcES) that may suppress EAE development were sought for. Interestingly, it was discovered that TcES was able to suppress EAE development with more potency than dexamethasone; moreover, TcES treatment was still effective even when inoculated at later stages after the onset of EAE. Importantly, the TcES treatment was able to induce a range of Th2-type cytokines, while suppressing Th1 and Th17 responses. Both the polyclonal and the antigen-specific proliferative responses of lymphocytes were also inhibited in EAE-ill mice receiving TcES in association with a potent recruitment of suppressor cell populations. Peritoneal inoculation of TcES was able to direct the normal inflammatory cell traffic to the site of injection, thus modulating CNS infiltration, which may work along with Th2 immune polarization and lymphocyte activation impairment to downregulate EAE development.
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The novel compound PBT434 prevents iron mediated neurodegeneration and alpha-synuclein toxicity in multiple models of Parkinson’s disease
Abstract
Elevated iron in the SNpc may play a key role in Parkinson's disease (PD) neurodegeneration since drug candidates with high iron affinity rescue PD animal models, and one candidate, deferirpone, has shown efficacy recently in a phase two clinical trial. However, strong iron chelators may perturb essential iron metabolism, and it is not yet known whether the damage associated with iron is mediated by a tightly bound (eg ferritin) or lower-affinity, labile, iron pool. Here we report the preclinical characterization of PBT434, a novel quinazolinone compound bearing a moderate affinity metal-binding motif, which is in development for Parkinsonian conditions. In vitro, PBT434 was far less potent than deferiprone or deferoxamine at lowering cellular iron levels, yet was found to inhibit iron-mediated redox activity and iron-mediated aggregation of α-synuclein, a protein that aggregates in the neuropathology. In vivo, PBT434 did not deplete tissue iron stores in normal rodents, yet prevented loss of substantia nigra pars compacta neurons (SNpc), lowered nigral α-synuclein accumulation, and rescued motor performance in mice exposed to the Parkinsonian toxins 6-OHDA and MPTP, and in a transgenic animal model (hA53T α-synuclein) of PD. These improvements were associated with reduced markers of oxidative damage, and increased levels of ferroportin (an iron exporter) and DJ-1. We conclude that compounds designed to target a pool of pathological iron that is not held in high-affinity complexes in the tissue can maintain the survival of SNpc neurons and could be disease-modifying in PD.
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A finite element study of traditional Chinese cervical manipulation
Abstract
Purpose
Traditional Chinese cervical manipulation (TCCM) has been claimed as an effective treatment for diseases of the cervical spine, but its biomechanical effects on the vertebral body and intervertebral discs remain unclear. The aim of this study was to develop and validate a detailed finite element model of cervical spine, which was then used to investigate the biomechanical response of the cervical spine to TCCM.
Methods
The model of a C2–T1 cervical spine was constructed based on CT images of a healthy male volunteer and validated against published in vitro studies under different loading conditions. The detailed force–time data of TCCM were measured on the same volunteer through dynamometric diaphragms. The data were applied on the validated finite element model to simulate TCCM.
Results
The current model could offer potentials to effectively reflect the behavior of human cervical spine suitable for biomechanics studies of TCCM. Under simulated TCCM condition, the stress distributions in cervical spine and intervertebral discs could not be completely explained through the traditional theory.
Conclusion
Spinal manipulation, or TCCM, might play no role in reducing intradiscal pressure for treating cervical spondylosis. It could cause less stress concentration in intervertebral discs while operating spinal manipulation or TCCM when the adjustment points was chosen near the root of spinous process than the top of spinous process.
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Granulome annulaire élastolytique à cellules géantes : étude anatomoclinique
Publication date: Available online 27 June 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): F. Margerin, B. Cribier
IntroductionLe rare granulome annulaire élastolytique à cellules géantes (GAECG), décrit en 1979, est très proche du granulome actinique (GA) de O'Brien, décrit en 1975. Depuis, de nombreux cas ont été publiés sous l'un ou l'autre nom. Nous avons effectué une étude anatomoclinique monocentrique afin d'en préciser les caractéristiques et de déterminer s'il existait une différence entre GAECG et GA.Matériel et méthodesLes cas classés GAECG ou GA au laboratoire de dermatopathologie de Strasbourg ont été inclus et analysés avec les colorations hématoxyline-éosine, orcéine et bleu alcian. Le diagnostic était retenu lorsqu'il existait un granulome riche en cellules géantes multinucléées et une diminution ou une disparition du tissu élastique. Les renseignements cliniques ont été collectés à partir des demandes d'analyse et des dossiers cliniques.RésultatsNous avons retenu 73 cas : 12 classés GAECG et 61 GA. L'âge moyen était de 60,5 ans et le sex-ratio de 0,55. La durée d'évolution variait de 8jours à 17 ans. Il s'agissait d'une lésion unique dans 52 % des cas et de lésions multiples dans les autres cas. Leur taille variait de 0,3 à 10cm. Elles siégeaient avec prédilection dans les zones photo-exposées, majoritairement la tête, le cou et les membres supérieurs. Il s'agissait le plus souvent de lésions à bordure érythémateuse annulaire et à centre clair, de croissance centrifuge lente. Le diagnostic n'avait été proposé que dans 5,5 % des cas par le clinicien. Ces granulomes étaient de siège dermique superficiel et moyen, rarement profond, comportaient de nombreuses cellules géantes avec un contingent lymphocytaire constant, mais aussi plasmocytaire dans la moitié des cas. La coloration à l'orcéine montrait une diminution nette ou une disparition totale du tissu élastique au sein de la zone granulomateuse et presque toujours des images d'élastophagocytose. De manière plus rare, des images de nécrobiose, d'organisation palissadique de granulome, d'atteinte vasculaire ou encore de corps astéroïdes orcéinophiles étaient observées. Il n'y avait pas de différence clinique ou histologique notable entre les cas initialement classés comme GAECG ou GA.DiscussionLe GAECG est une entité unique distincte du granulome annulaire, qui doit être assimilée au granulome actinique d'O'Brien. Le rôle central des fibres élastiques semble clair mais celui des ultraviolets est plus débattu. Le terme de granulome annulaire élastolytique à cellules géantes apparaît plus approprié car plus descriptif et sans implication physiopathologique. Le lien avec une sarcoïdose ou un diabète semble significatif dans une minorité de cas, justifiant leur dépistage.BackgroundAnnular elastolytic giant cell granuloma (AEGCG), a rare entity first described in 1979, is very similar to O'Brien actinic granuloma (AG), first described in 1975. Since then, many cases have been published under one or other of the two names. We performed a single-centre histopathology study to identify the distinguishing features and determine whether there was any objective difference between AEGCG and AG.Patients and methodsCases classed as AEGCG or AG at the dermatopathology laboratory in Strasbourg were included and analysed using haematoxylin-eosin, orcein and Alcian blue staining. The diagnosis was made in the event of granuloma rich in multi-nucleated giant cells and reduction or disappearance of elastic tissue. Clinical data were collected from the analysis requests and clinical files.ResultsWe identified 73 cases: 12 classed as AEGCG and 61 classed as AG. Mean age was 60.5 years with a sex ratio of 0.55. The duration of the disease ranged from 8 days to 17 years. A single lesion was seen in 52% of cases with multiple lesions in the remaining cases. Lesions measured between 0.3 and 10cm and exhibited a predilection for photo-exposed areas, chiefly on the head, neck and upper limbs. In most cases, an annular erythematous edge was seen together with a light centre, and slow centrifugal spread. The diagnosis was made by a clinician in only 5.5% of cases. These granulomas were chiefly in the superficial and mid dermis and only rarely deep, and contained numerous giant cells with a constant contingent of lymphocytes, but plasma cells were also seen in half of the cases. Orcein staining revealed marked decrease or total disappearance of elastic tissue within the granulomatous area together with elastophagocytosis in practically all images. More rarely, there was evidence of necrobiosis, palisading granuloma, vascular involvement or orcein-stained asteroid bodies. There were no notable clinical or histological differences between the cases initially classed as AEGCG or AG.DiscussionAEGCG is a separate entity from annular granuloma that must be assimilated with O'Brien actinic granuloma. The central role of elastic fibres seems clear, but that of ultraviolet radiation remains more controversial. The term annular elastolytic giant cell granuloma seems more appropriate since it is more descriptive and carries no physiopathological implications. There appears to be a significant association with sarcoidosis and with diabetes in a minority of cases, thus warranting screening for these diseases.
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Germline genetic variants in men with prostate cancer and one or more additional cancers
BACKGROUND
Prostate cancer has a significant heritable component, and rare deleterious germline variants in certain genes can increase the risk of the disease. The aim of the current study was to describe the prevalence of pathogenic germline variants in cancer-predisposing genes in men with prostate cancer and at least 1 additional primary cancer.
METHODS
Using a multigene panel, the authors sequenced germline DNA from 102 men with prostate cancer and at least 1 additional primary cancer who also met ≥1 of the following criteria: 1) age ≤55 years at the time of diagnosis of the first malignancy; 2) rare tumor type or atypical presentation of a common tumor; and/or 3) ≥3 primary malignancies. Cancer family history and clinicopathologic data were independently reviewed by a clinical genetic counselor to determine whether the patient met established criteria for testing for a hereditary cancer syndrome.
RESULTS
Sequencing identified approximately 3500 variants. Nine protein-truncating deleterious mutations were found across 6 genes, including BRCA2, ataxia telangiectasia mutated (ATM), mutL homolog 1 (MLH1), BRCA1 interacting protein C-terminal helicase 1 (BRIP1), partner and localizer of BRCA2 (PALB2), and fibroblast growth factor receptor 3 (FGFR3). Likely pathogenic missense variants were identified in checkpoint kinase 2 (CHEK2) and homeobox protein Hox-B13 (HOXB13). In total, 11 of 102 patients (10.8%) were found to have pathogenic or likely pathogenic mutations in cancer-predisposing genes. The majority of these men (64%) did not meet current clinical criteria for germline testing.
CONCLUSIONS
Men with prostate cancer and at least 1 additional primary cancer are enriched for harboring a germline deleterious mutation in a cancer-predisposing gene that may impact cancer prognosis and treatment, but the majority do not meet current criteria for clinical genetic testing. Cancer 2017. © 2017 American Cancer Society.
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Efficacy of tyrosine kinase inhibitors in EGFR -mutant lung cancer women in a real-world setting: the WORLD07 database
Abstract
Background
The WORLD07 project is a female specific database to assess the characteristics of women with lung cancer.
Methods
WORLD07 database sets up in 2007, and prospectively stores clinical characteristics, treatment, outcome, and follow-up of lung cancer women. All women with epidermal growth factor receptor (EGFR) mutation non-small cell lung cancer (NSCLC) were selected for this analysis.
Results
From October 2007 to December 2012, a total of 1775 NSCLC women were recruited. EGFR mutation was identified in 34.4% of patients. Upfront EGFR tyrosine kinase inhibitor (TKI) reported a response rate of 60%, a median progression-free survival of 11.7 months, and median overall survival of 23.0 months. EGFR TKI, EGFR-mutation type, and smoking status did not impact in the outcome of treated women.
Conclusion
Prevalence of EGFR mutation in women with NSCLC is higher than overall population with NSCLC. Efficacy of EGFR TKI in this real-world setting is similar to that previously reported.
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School Gender Composition, Laddish School Culture and the Ethnic Prejudice of Flemish Pupils.
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Les Raisons du livre: du statut de l’œuvre écrite à la figuration du symbole (XIIe – XVIIe siècles). Études réunies par GÉRARD GROS
Spencer-Hall, A; (2016) Les Raisons du livre: du statut de l'œuvre écrite à la figuration du symbole (XIIe – XVIIe siècles). Études réunies par GÉRARD GROS. [Review]. French Studies , 70 (3) pp. 436-437. 10.1093/fs/knw138 .
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Design out of complexity: A mathematical theory of design as an universal property of organization
Zamenopoulos, T; (2008) Design out of complexity: A mathematical theory of design as an universal property of organization. Doctoral thesis, UCL (University College London). Green open access
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Reducing systematic review workload using text mining: opportunities and pitfalls
Stansfield, CM; O'Mara-Eves, A; Thomas, J; (2015) Reducing systematic review workload using text mining: opportunities and pitfalls. Journal of the European Association for Health Information and Libraries , 11 (3) pp. 8-10. Green open access
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Development of a multi-location motion displacement test for detection of early glaucoma
Verdon-Roe, GM; (2006) Development of a multi-location motion displacement test for detection of early glaucoma. Doctoral thesis, UCL (University College London). Green open access
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Cost-Effectiveness Analysis Of Regorafenib In Gastrointestinal Stromal Tumours In England Using Crossover Adjustment Methods
Pitcher, A; Grabbi, E; Madin-Warburton, M; Vadgama, S; (2016) Cost-Effectiveness Analysis Of Regorafenib In Gastrointestinal Stromal Tumours In England Using Crossover Adjustment Methods. Presented at: ISPOR 19th Annual European Congress, Vienna, Austria.
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Surface Reactions of Ethanol over UO2(100) Thin Film
Senanayake, SD; Mudiyanselage, K; Burrell, AK; Sadowski, JT; Idriss, H; (2015) Surface Reactions of Ethanol over UO2(100) Thin Film. Journal of Physical Chemistry C , 119 (44) pp. 24895-24901. 10.1021/acs.jpcc.5b08577 .
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Granulome annulaire élastolytique à cellules géantes : étude anatomoclinique
Publication date: Available online 27 June 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): F. Margerin, B. Cribier
IntroductionLe rare granulome annulaire élastolytique à cellules géantes (GAECG), décrit en 1979, est très proche du granulome actinique (GA) de O'Brien, décrit en 1975. Depuis, de nombreux cas ont été publiés sous l'un ou l'autre nom. Nous avons effectué une étude anatomoclinique monocentrique afin d'en préciser les caractéristiques et de déterminer s'il existait une différence entre GAECG et GA.Matériel et méthodesLes cas classés GAECG ou GA au laboratoire de dermatopathologie de Strasbourg ont été inclus et analysés avec les colorations hématoxyline-éosine, orcéine et bleu alcian. Le diagnostic était retenu lorsqu'il existait un granulome riche en cellules géantes multinucléées et une diminution ou une disparition du tissu élastique. Les renseignements cliniques ont été collectés à partir des demandes d'analyse et des dossiers cliniques.RésultatsNous avons retenu 73 cas : 12 classés GAECG et 61 GA. L'âge moyen était de 60,5 ans et le sex-ratio de 0,55. La durée d'évolution variait de 8jours à 17 ans. Il s'agissait d'une lésion unique dans 52 % des cas et de lésions multiples dans les autres cas. Leur taille variait de 0,3 à 10cm. Elles siégeaient avec prédilection dans les zones photo-exposées, majoritairement la tête, le cou et les membres supérieurs. Il s'agissait le plus souvent de lésions à bordure érythémateuse annulaire et à centre clair, de croissance centrifuge lente. Le diagnostic n'avait été proposé que dans 5,5 % des cas par le clinicien. Ces granulomes étaient de siège dermique superficiel et moyen, rarement profond, comportaient de nombreuses cellules géantes avec un contingent lymphocytaire constant, mais aussi plasmocytaire dans la moitié des cas. La coloration à l'orcéine montrait une diminution nette ou une disparition totale du tissu élastique au sein de la zone granulomateuse et presque toujours des images d'élastophagocytose. De manière plus rare, des images de nécrobiose, d'organisation palissadique de granulome, d'atteinte vasculaire ou encore de corps astéroïdes orcéinophiles étaient observées. Il n'y avait pas de différence clinique ou histologique notable entre les cas initialement classés comme GAECG ou GA.DiscussionLe GAECG est une entité unique distincte du granulome annulaire, qui doit être assimilée au granulome actinique d'O'Brien. Le rôle central des fibres élastiques semble clair mais celui des ultraviolets est plus débattu. Le terme de granulome annulaire élastolytique à cellules géantes apparaît plus approprié car plus descriptif et sans implication physiopathologique. Le lien avec une sarcoïdose ou un diabète semble significatif dans une minorité de cas, justifiant leur dépistage.BackgroundAnnular elastolytic giant cell granuloma (AEGCG), a rare entity first described in 1979, is very similar to O'Brien actinic granuloma (AG), first described in 1975. Since then, many cases have been published under one or other of the two names. We performed a single-centre histopathology study to identify the distinguishing features and determine whether there was any objective difference between AEGCG and AG.Patients and methodsCases classed as AEGCG or AG at the dermatopathology laboratory in Strasbourg were included and analysed using haematoxylin-eosin, orcein and Alcian blue staining. The diagnosis was made in the event of granuloma rich in multi-nucleated giant cells and reduction or disappearance of elastic tissue. Clinical data were collected from the analysis requests and clinical files.ResultsWe identified 73 cases: 12 classed as AEGCG and 61 classed as AG. Mean age was 60.5 years with a sex ratio of 0.55. The duration of the disease ranged from 8 days to 17 years. A single lesion was seen in 52% of cases with multiple lesions in the remaining cases. Lesions measured between 0.3 and 10cm and exhibited a predilection for photo-exposed areas, chiefly on the head, neck and upper limbs. In most cases, an annular erythematous edge was seen together with a light centre, and slow centrifugal spread. The diagnosis was made by a clinician in only 5.5% of cases. These granulomas were chiefly in the superficial and mid dermis and only rarely deep, and contained numerous giant cells with a constant contingent of lymphocytes, but plasma cells were also seen in half of the cases. Orcein staining revealed marked decrease or total disappearance of elastic tissue within the granulomatous area together with elastophagocytosis in practically all images. More rarely, there was evidence of necrobiosis, palisading granuloma, vascular involvement or orcein-stained asteroid bodies. There were no notable clinical or histological differences between the cases initially classed as AEGCG or AG.DiscussionAEGCG is a separate entity from annular granuloma that must be assimilated with O'Brien actinic granuloma. The central role of elastic fibres seems clear, but that of ultraviolet radiation remains more controversial. The term annular elastolytic giant cell granuloma seems more appropriate since it is more descriptive and carries no physiopathological implications. There appears to be a significant association with sarcoidosis and with diabetes in a minority of cases, thus warranting screening for these diseases.
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Analysis and modelling of recurrent solar flares observed with Hinode/EIS on March 9, 2012
Polito, V; Del Zanna, G; Valori, G; Pariat, E; Mason, HE; Dudk, J; Janvier, M; (2017) Analysis and modelling of recurrent solar flares observed with Hinode/EIS on March 9, 2012. Astronomy & Astrophysics , 601 , Article A39. 10.1051/0004-6361/201629703 . Green open access
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