Surgical treatment associated with improved survival in patients with cutaneous angiosarcoma

Abstract

Cutaneous angiosarcoma is a rare aggressive vasoformative neoplasm of the skin with a poor prognosis.¹ The neoplasm preferentially involves areas of head and neck and usually diagnosed in advanced stage.^{1, 2} The neoplasm accounts for only 2% of soft-tissue sarcomas in the U.S. and most often affects elderly white males, patients treated with radiation, and individuals with certain chronic lymphatic disorders.³ Surgery with or without adjuvant or neoadjuvant radiation therapy (RT) is considered the mainstay of therapy.^{1, 3} Due to low incidence rates, the clinical outcomes data has been limited to case reports and single institution studies, with a lack of direct comparison between various treatment modalities: surgery, RT, and chemotherapy (CT).^{4, 5} In this study, we aimed to investigate the impact of undergoing different therapeutic approaches on long-term overall survival (OS) using cross-institutional data.

This article is protected by copyright. All rights reserved.

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Severe sequelae of erythema multiforme: three cases

Abstract

Erythema multiforme (EM) is a skin condition for which main causes are infectious factors (Herpes simplex virus, Mycoplasma pneumoniae). Anti-plakin auto-antibodies are found in some patients ¹. EM must be distinguished from Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), which are drug-induced in most cases ^2-5.

This article is protected by copyright. All rights reserved.

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A theory of the global demographic process

Abstract

Throughout human history, the human population has grown with blow-up; however, in recent decades population growth has slowed, tending toward stabilization of the size of the population (demographic transition). The notion of life-saving technologies is introduced in this work; their development is treated as the driver of history; the principle of the technological imperative is formulated, according to which the number of living people is correlated with the level of technological development. A model of global demographic growth is built on this basis, and the growth limits are determined. The demographic transition is explained as the effect of approximation to these limits. A corresponding phenomenological model is proposed, which agrees well with the data.

http://ift.tt/2utpNZ0

Evolutionary commonality of nonliving nature and living organisms

Abstract

Unification of knowledge and scientific disciplines is the leading trend in forming the current idea of living and nonliving things, as well as their evolution, which is considered as the formation of a hierarchical system, where subsequent forms are determined by previous ones. This approach to the understanding of evolution implies the unity of matter based on the commonality of conceptual laws of physics and chemistry for living and nonliving things. This universalistic understanding of matter and its development, in the opinion of the author, opens the possibility of a fundamental generalization of evolutionary processes, which makes it possible to identify common properties of seemingly unrelated phenomena, processes, and behavioral features of complex systems and offers hope for obtaining a cohesive explanation of evolution.

http://ift.tt/2v25wHe

Analysis of variations in the ice regime in individual regions of the Sea of Okhotsk during the warming period

Abstract

Research results of interannual variations in iciness anomalies in the Sea of Okhotsk from 1979 to 2015 are presented. This temporal interval is called the warming period, or the warm period in the modern literature. Variations in the ice regime for hierarchical regions of the first level with spatial scales larger than 400 000 km² are analyzed for the first time. A comparative analysis of repeatability of various winter types, as well as periods with positive and negative trends in iciness variations, is made for each ice-covered region chosen and for the entire Sea of Okhotsk. It is shown that ice formation processes and the ice regime in individual regions of the sea have significant differences, which should be considered in developing prognostic models, as well as in field work.

http://ift.tt/2utkFUY

Do additive technologies have a future?

Abstract

Having appeared on the planet, Homo sapiens became a geological force and began to act out of tune with the laws of nature. As a result, an antagonistic contradiction appeared between the technosphere, which was created by man, and the biosphere, which evolved according to its laws, and both are unable to coexist harmoniously. V.I. Vernadsky saw a way out of this situation in transferring scientific thought to the planetary, noospheric, level, which would ensure the triumph of Reason. This transfer cannot occur by itself; it requires the joint efforts of all mankind. M.V. Koval'chuk sees the perspective of overcoming the systems crisis in converging sciences and technologies; forming a new noosphere, in which the development of the technosphere will continue the evolution of the biosphere; and replacing traditional technologies with additive or naturelike ones. This requires restructuring of the entire basis of contemporary civilization: science, education, culture, production, technologies, and thinking. What hinders the development of this inspiring road to the shining summits of the new civilization? In the author's opinion, first comes misunderstanding of the deep mechanisms of global civilization; namely, science does not recognize the evolution of inert matter and the leading role of water in the development of geological and biological processes.

http://ift.tt/2v1RhSF

Generalized regularities of deformation and fracture processes

Abstract

On February 9, 2016, the meeting of the RAS Presidium heard and discussed a paper by RAS Corresponding Member N.A. Makhutov on priority basic interdisciplinary research and applied developments in coupled resource substantiation and strength and safety of unique objects using generalized regularities of deformation and fracture processes. It is shown that the solution to the above objectives in relation to unique facilities used in traditional, atomic, and thermonuclear power engineering; the rocket and space complex; aviation; high-speed and heavy haul rail transport; as part of petrochemical equipment; and in shelf developments is associated with the necessity, in addition to traditional approaches, to consider the possibility of initiation and development of accidental and emergency situations. Therefore, modern calculations use simultaneously traditional (strength, service life, wear resistance, cold resistance, and seismic resistance) and new criteria (survivability, safety, and immunity using risk criteria). Through this, new fields of limit states associated with extreme external impacts and internal factors are analyzed.

http://ift.tt/2utoj1a

A way to new rationality (On the Centenary of the Birth of I.R. Prigogine, A Foreign Member of the USSR/Russian Academy of Sciences)

Abstract

We are in the habit of living in a deterministic world, in which knowledge of the state of the system at a point in time allows us to describe the future unambiguously. Ilya Prigogine and his students were able to shake this idea, which had been formulated long ago by Isaac Newton. They were able to show that everything is much more complicated, that instability generates ambiguity, and that the future state of a system can at best be described only probabilistically.

http://ift.tt/2v1SUjl

Applied scientific research on the international space station and new flight-control technologies

Abstract

Some significant applied scientific research results obtained on the modules of the Russian Orbital Segment (ROS) of the International Space Station (ISS) and new flight-control technologies are considered. Plans to construct and resupply new modules to the ROS on the ISS in the next decade are covered. This article is based on a paper by RAS Corresponding Member V.A. Solov'ev heard at a session of the RAS Presidium.

http://ift.tt/2utsDNV

Environmental supramolecular physics: Climatic and biophysical effects

Abstract

The results of studies on channels of influence of major manifestations of solar–geomagnetic activity, such as solar flares and magnetic storms, on weather, the climate, and humans are presented. The accompanying energy fluxes are completely absorbed by the Earth's ionosphere, causing emissive radiation in the microwave (UHF, SHF, and EHF) range. It is shown that this microwave radiation can control the origination of optically thin cloudiness by creating a condensation–cluster haze in the troposphere. A similar approach is proposed for the mechanism of forming water associates in the human organism. Processes from atomic physics and the physics of atomic collisions are used, implying that the effect of cluster formation is determined by the fact that the orbital angular momentum of Rydberg electrons (participating in the neutralization of the associates' charge) grows in the microwave field. Quantitative estimations of the effects of clusterization during a global magnetic storm agree well with the available experiments.

http://ift.tt/2v24QS1

The rock-forming role of biota

Abstract

Stromatolites and other microbiolites formed in early epochs as a result of the life activity of primitive communities of microorganisms. It has become possible to prove that communities of higher organisms can form more powerful layers of sedimentary rocks. Back at the beginning of the 20th century, some geologists and soil scientists proposed a soil-related theory of the origin of loess and other sedimentary rocks, but this idea did not gain recognition. Functional ecology describes the metabolism of ecosystems with the utilization of waste in the form of sediments, which geologists jointly with ecologists can verify in model experiment. Then it will be possible to read freely the calendar of nature coded in stratigraphic columns of geological cross sections.

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Second Primary Cancer in Patients with Differentiated Thyroid Cancer: Does Radioiodine Play a Role?

Thyroid , Vol. 0, No. 0.


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Resveratrol inhibits IgE binding and down-regulates intracellular phosphorylation of Syk following IgE aggregation on human basophils

Publication date: Available online 14 July 2017
Source:Allergology International
Author(s): Sayaka Arakawa, Maho Suzukawa, Sayaka Igarashi, Hirotoshi Matsui, Masao Yamaguchi, Takahide Nagase, Ken Ohta




http://ift.tt/2utsUjU

Quality of Life, Anxiety Prevalence, Depression Symptomatology and Suicidal Ideation among Acne Patients in Lithuania

Abstract

Background/Objective

We aimed to determine the prevalence of anxiety, depression symptomatology and suicidal ideation among patients with acne and the impact of this skin condition on the quality of life in Lithuania.

Methods

The mental health of patients with acne was assessed using an adapted Hospital Anxiety and Depression Scale, the Dermatology Quality of Life Index, questions about characteristics of acne. The study was authorized by the Regional Biomedical Research Ethics Committee.

Results

A total of 255 responders out of 324 patients with acne included (84.4%) were assessed. 56.1% of the responders had comorbid anxiety, depression symptomatology or suicidal ideation related to acne; Among them 38.4% had anxiety symptoms, 23.1% had depression symptoms and 12.9% had suicidal thoughts due to acne. 96.5% of the responders had a reduced quality of life due to acne.

Conclusion

More than a half of the patients with acne who participated at the study had comorbid emotional disorders. Anxiety was the most prevalent sign, 1.7-fold more prevalent than depression and 3-fold more prevalent than suicidal ideation. Depression was prevalent in more than every fourth responder and suicidal ideation afflicted every eighth acne patient. More than 90% of the patients had impaired life quality.

This article is protected by copyright. All rights reserved.

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In Response.

No abstract available

http://ift.tt/2tcATl8

Hyperbaric Versus Isobaric Bupivacaine for Spinal Anesthesia: Systematic Review and Meta-analysis for Adult Patients Undergoing Noncesarean Delivery Surgery.

BACKGROUND: It is widely believed that the choice between isobaric bupivacaine and hyperbaric bupivacaine formulations alters the block characteristics for the conduct of surgery under spinal anesthesia. The aim of this study was to systematically review the comparative evidence regarding the effectiveness and safety of the 2 formulations when used for spinal anesthesia for adult noncesarean delivery surgery. METHODS: Key electronic databases were searched for randomized controlled trials, excluding cesarean delivery surgeries under spinal anesthesia, without any language or date restrictions. The primary outcome measure for this review was the failure of spinal anesthesia. Two independent reviewers selected the studies and extracted the data. Results were expressed as relative risk (RR) or mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: Seven hundred fifty-one studies were identified between 1946 and 2016. After screening, there were 16 randomized controlled clinical trials, including 724 participants, that provided data for the meta-analysis. The methodological reporting of most studies was poor, and appropriate judgment of their individual risk of bias elements was not possible. There was no difference between the 2 drugs regarding the need for conversion to general anesthesia (RR, 0.60; 95% CI, 0.08-4.41; P = .62; I2 = 0%), incidence of hypotension (RR, 1.15; 95% CI, 0.69-1.92; P = .58; I2 = 0%), nausea/vomiting (RR, 0.29; 95% CI, 0.06-1.32; P = .11; I2 = 7%), or onset of sensory block (MD = 1.7 minutes; 95% CI, -3.5 to 0.1; P = .07; I2 = 0%). The onset of motor block (MD = 4.6 minutes; 95% CI, 7.5-1.7; P = .002; I2 = 78%) was significantly faster with hyperbaric bupivacaine. Conversely, the duration of motor (MD = 45.2 minutes; 95% CI, 66.3-24.2; P

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Socioeconomic Deprivation and Utilization of Anesthetic Care During Pregnancy and Delivery: A French Retrospective, Multicenter, Cohort Study.

BACKGROUND: Socioeconomic deprivation is associated with reduced use of antenatal resources and poor maternal outcomes with pregnancy. Research examining the association between socioeconomic deprivation and use of obstetric anesthesia care in a country providing universal health coverage is scarce. We hypothesized that in a country providing universal health coverage, France, socioeconomic deprivation is not associated with reduced use of anesthetic care during pregnancy and delivery. This study aimed to examine the association between socioeconomic deprivation and (1) completion of a mandatory preanesthetic evaluation during pregnancy and (2) use of neuraxial analgesia during labor. METHODS: Data were from a cohort of 10,419 women who delivered between 2010 and 2011 in 4 public teaching hospitals in Paris. We used a deprivation index that included 4 criteria: social isolation, poor housing condition, no work-related household income, and state-funded health care insurance. Socioeconomic deprivation was defined as a deprivation index greater than 1. Preanesthetic evaluation was considered completed if performed more than 48 hours before delivery. The association between socioeconomic deprivation and completion of the preanesthetic evaluation and use of neuraxial labor analgesia was assessed by multivariable logistic regression adjusting for education level, country of birth, and maternal and pregnancy characteristics. RESULTS: Preanesthetic evaluation was completed for 8142 of the 8624 women (94.4%) analyzed and neuraxial labor analgesia was used by 6258 of the 6834 women analyzed (91.6%). After adjustment, socioeconomic deprivation was associated with reduced probability of completed preanesthetic evaluation (adjusted odds ratio 0.88 [95% confidence interval, 0.79-0.98]; P = .027) but not use of neuraxial labor analgesia (adjusted odds ratio 0.97 [95% confidence interval, 0.87-1.07]; P = .540). CONCLUSIONS: In a country providing universal health care coverage, women who were socioeconomically deprived showed reduced completion of preanesthetic evaluation during pregnancy but not reduced use of neuraxial labor analgesia. Interventions should be targeted to socioeconomically deprived women to increase the completion of the preanesthetic evaluation. (C) 2017 International Anesthesia Research Society

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Replication of Data Makes Statistical Analysis Difficult.

No abstract available

http://ift.tt/2uthbBH

Improving the Success Rate of Chest Compression-Only CPR by Untrained Bystanders in Adult Out-of-Hospital Cardiac Arrest: Maintaining Airway Patency May Be the Way Forward.

No abstract available

http://ift.tt/2v1L88U

Fixing Medical Prices.

No abstract available

http://ift.tt/2usHiZB

The impact of hearing loss on society in general: an underappreciated problem.

No abstract available

http://ift.tt/2usPcCb

The management of pediatric hearing loss caused by auditory neuropathy spectrum disorder.

Purpose of review: Auditory neuropathy spectrum disorder (ANSD) is a condition in which auditory testing reveals normal otoacoustic emissions, but auditory brainstem testing is abnormal or absent and speech discrimination is poor. This constellation of findings ostensibly suggests that the cochlea is healthy and an abnormality of conduction or processing of sound occurs along the nerve fibers. As more is learned about this condition, it is becoming clear that ANSD describes heterogeneous, distinct clinical entities that must be taken into account when devising treatment modalities. Recent findings: Modern auditory testing, genetic testing, and neuroimaging can allow for an accurate understanding of the location of the lesion causing ANSD in the auditory pathway. Contributing causes can include genetic mutations, absent or deficient cochlear nerve, hypoxia and jaundice among others. Hearing aids can be successful in the management of ANSD. Several studies suggest that cochlear implantation can lead to successful hearing outcomes in a subset of this patient population. Summary: Auditory neuropathy spectrum disorder represents a relatively rare but important diagnosis for clinicians. Treatment for this condition includes hearing aids and FM systems in more mild cases, and cochlear implants in severe cases. Cochlear implantation for many patients can lead to a good hearing outcomes but the outcome can vary greatly depending on the underlying etiology of ANSD. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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The impact of hearing loss on society in general: an underappreciated problem.

No abstract available

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Chemotherapy-induced peripheral neuropathy: a review of recent findings.

Purpose of review: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, frequently chronic condition characterized by pain and decreased function. Given the growing number of cancer survivors and an increasing recognition of opioid therapy limitations, there is a need for critical analysis of the literature in directing an informed and thoughtful approach for the management of painful CIPN. Recent findings: A PubMed search for 'chemotherapy-induced peripheral neuropathy AND pain' identifies 259 publications between 1 January 2016 and 31 March 2017. Based on review of this literature, we aim to present a clinically relevant update of painful CIPN. Notably, the use of duloxetine as a first-line agent in treatment of CIPN is confirmed. Moreover, clinical trials focus on nonpharmacologic strategies for managing painful CIPN. Summary: Despite the volume of recent publications, there are limited preventive or therapeutic strategies for CIPN supported by high-level evidence. Duloxetine remains the only pharmacologic agent with demonstrated benefit; its clinical use should be routinely considered. Moving forward, nonopioid analgesic therapies will likely play an increasing role in CIPN treatment, but further research is necessary to confirm their utility. Promising therapies include vitamin B12 supplementation, physical therapy, and various forms of neuromodulation. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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The courage to fail.

No abstract available

http://ift.tt/2uj6UHO

FDA OKs Biologic Guselkumab (Tremfya) for Plaque Psoriasis

Guselkumab is the first and only approved biologic agent that selectively blocks interleukin-23, a key player in plaque psoriasis.
FDA Approvals

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Enhanced Pru p 3 IgE binding activity by selective free fatty acid-interaction

Publication date: Available online 14 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Pawel Dubiela, Roberta Aina, Dominika Polak, Sabine Geiselhart, Piotr Humeniuk, Barbara Bohle, Stefano Alessandri, Rebecca Del Conte, Francesca Cantini, Tomasz Borowski, Merima Bublin, Karin Hoffmann-Sommergruber

Teaser

Upon binding to certain lipids, the major peach allergen, Pru p 3, undergoes conformational changes thus exposing one dominant IgE epitope. This conformational change enhances the allergenicity of Pru p 3.


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A rare case of gastric mixed adenoneuroendocrine carcinoma (MANEC) with gastric Helicobacter pylori-negative mucosa-associated lymphoid tissue (MALT) lymphoma

Description

A 47-year-old African-American man presented to the emergency department with upper abdominal pain, nausea and vomiting. His symptoms were aggravated by eating. He reported 32 kg unintentional weight loss over 2 months' period. Abdominal examination revealed tenderness in the epigastric region. Abdominal CT scan showed mural wall thickening involving the gastric antrum and pylorus (figure 1). Subsequent oesophagogastroduodenoscopy (EGD) revealed a large mass occupying the gastric antrum (figure 2). Initial biopsy from the gastric mass showed poorly differentiated adenocarcinoma.

Figure 1

(A) Coronal section of the CT abdomen with intravenous and oral contrast showing wall thickening at the level of the gastric antrum. (B) Axial section of the CT abdomen with intravenous and oral contrast showing wall thickening at the level of the gastric antrum and pylorus.

Figure 2

Upper gastrointestinal endoscopy showing a mass in...

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Takotsubo cardiomyopathy and transient global amnesia: a shared aetiology

Takotsubo cardiomyopathy (TTC) is associated with acute, reversible left ventricular (LV) dysfunction, while transient global amnesia (TGA) is a reversible disorder of the brain characterised by anterograde amnesia. We report an unusual case of TTC occurring concurrently in a patient with TGA, and propose that catecholamine surge induced cerebral venous congestion and cardiotoxicity is the shared aetiology that leads to the concurrent manifestation of these conditions. TTC and TGA are reversible disorders that can occur concurrently in a subset of patients due to a unifying aetiology, catecholamine excess, leading to pathophysiological changes within the brain and the myocardium.

http://ift.tt/2us2A9z

Lupus miliaris disseminatus faciei: a distinctive facial granulomatous eruption

Facial granulomatous papules are important to recognise, as some of them are associated with significant systemic association, particularly sarcoidosis and certain infectious conditions. Lupus miliaris disseminatus faciei (LMDF) is a benign granulomatous disorder of unknown aetiology characterised by symmetrical, monomorphic, reddish-brown papules on the face. It is not associated with any underlying systemic involvement. We report a case of LMDF in a middle-aged man who presented to us with multiple asymptomatic and monomorphic reddish papules on the face for 3 months. Skin biopsy showed well-formed perifollicular epithelioid cell granulomas with focus of necrosis suggestive of LMDF. The lesions significantly responded to oral steroids.

http://ift.tt/2v0LQ6o

Renal fistulae: different aetiologies, similar management

Iatrogenic renocolic fistulae, although have been described in literature, is a rare clinical complication. Recently its incidence is on rise due to advent of minimally invasive surgery and percutaneous surgery of kidney. It has been reported after percutaneous nephrolithotomy but its incidence after percutaneous nephrostomy is quite uncommon and rarely reported. Though spontaneous renocutaneous fistula has been reported, acquired renocutaneous fistula is very uncommon and fistula after gun shot injury has not been reported to the best of our knowledge. Herein, we present two different varieties of renal fistula with completely different history and presentation. But the interesting point is that both were managed conservatively in a similar fashion and both of them responded well

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Pseudomonas aeruginosa as an unusual cause of cavitating lung lesion

A 31-year-old woman with systemic lupus erythematosus presented to the emergency department with cough for 1âweek. Chest radiograph demonstrated cavitating lesion in the right upper zone with surrounding ground-glass change. Blood culture results from the day of hospital presentation grew Pseudomonas aeruginosa. Sputum sample and pleural fluid grew P. aeruginosa and were negative for acid-fast bacilli. P. aeruginosa is a rare cause of cavitating lung lesion and has been associated with immunocompromised hosts. Most reports of cavitating P. aeruginosa lesions have been identified in patients who are immunocompromised secondary to HIV.The current case highlights the potential for infection in patients who are immunosuppressed therapeutically and appropriate investigations are necessary to rule out common causes of cavitating lung lesions.

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Complement factor B mutation-associated aHUS and myocardial infarction

A 6-month-old female infant was referred with a 3-day history of low-grade fever, slight nasal congestion and rhinorrhoea. On admission, the clinical findings were unremarkable and she was discharged home. However, she became progressively more listless with a decreased urine output and was once again seen in the emergency department. Analytically she was found to have metabolic acidosis, hyperkalaemia, thrombocytopaenia, anaemia and schistocytes in the peripheral blood smear. Based on these findings, the diagnosis of haemolyticâ-uremic syndrome was made. A few hours postadmission, there was an abrupt clinical deterioration. She went into cardiorespiratory arrest and she was successfully resuscitated. An ST-segment elevation was noted on the ECG monitor and the troponin I levels were raised, suggesting myocardial infarction. Despite intensive supportive therapy, she went into refractory shock and died within 30 hours.

http://ift.tt/2us0pCX

Anaphylaxis secondary to Parietaria judaica (wall pellitory)

Aeroallergens are an unusual cause of anaphylaxis with sparse reports in the literature. We describe a case of suspected anaphylaxis to Parietaria judaica pollen and the difficulties encountered in confirming this diagnosis.

http://ift.tt/2v102MS

Focal neurological presentation in Hashimoto's encephalopathy mimicking a vascular occlusion of the middle cerebral artery

Hashimoto's encephalopathy is a rare form of autoimmune encephalopathy. It is likely an underdiagnosed entity especially in the setting of focal neurological defects. We report a case of a 49-year-old man who presented with "strange behavior"of a day's duration. Examination was significant only for lethargy, poor attention span and agitation. Routine labs revealed leucocytosis. Head CT scan was unremarkable. Lumbar puncture showed high white blood cells with lymphocytosis and elevated protein level. The patient was empirically treated for meningitis without improvement. His symptoms progressed to sudden right-sided weakness, ataxia and right facial droop. The MRI and magnetic resonance angiogram (MRA)were normal. The patientâ™s focal neurological signs improved spontaneously. Encephalopathy work-up was negative except for positive anti-Thyroid Peroxidaseand antithyroglobulin. The patient was treated as Hashimoto encephalopathy with steroids and azathioprine with marked improvement. Our case highlights how focal neurological findings can potentially mislead the provider to consider vascular aetiologies in Hashimoto's encephalopathy.

http://ift.tt/2usdjRJ

Peritoneal tuberculosis as a cause of ascites in a patient with cirrhosis

A 59-year-old Portuguese Caucasian man with a history of heavy alcohol intake and no significant medical history presented with ascites, weight loss and general malaise. The ascitic fluid analysis showed 921 cells/mm³ with mononuclear predominance (93.6%), elevated total proteins and a slightly elevated serum-ascites albumin gradient. The abdominal ultrasound confirmed the presence of chronic liver disease with ascites, and additionally on CT there was evidence of peritoneal thickening. On repeat paracentesis, the ascitic fluid analysis showed elevated adenosine deaminase but it was negative for the presence of mycobacteria by Ziehl-Neelsen stain, Löwenstein-Jensen culture and PCR amplification. Due to the persistent suspicion of tuberculosis, a laparoscopy was performed showing multiple small white tubercles scattered over the peritoneum. Peritoneal biopsies showed the presence of necrotising granulomas and cultures were positive for Mycobacterium tuberculosis complex. After a 6-month course of tuberculostatics, the ascites resolved completely. The patient remained asymptomatic.

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Is FCH PET able to identify foci of infection superiorly to FDG PET?

We report a case of a brain abscess identified on fluorine-18 choline (FCH) positron emission tomography (PET) scan, which was not identified on fluorodeoxyglucose (FDG) PET scan. To our knowledge, there are no previous case reports of incidental brain abscess identified by FCH PET imaging. A 51-year-old man, with liver cirrhosis complicated by hepatocellular carcinoma (HCC) was enrolled in a research trial comparing HCC detection in FCH PET versus FDG PET. During the course of the trial, he underwent radiofrequency ablation (RFA) for HCC. A repeat FCH PET scan post-RFA incidentally revealed a 2.5âcm lesion with avid uptake in the left occipital area of the brain. The patient was asymptomatic. MRI suggested this was an abscess. A craniotomy and drainage was performed, with culture of Streptococcus intermedius (S. milleri group) from the thick-walled collection, a causative organism for previous episode of pneumonia. He successfully completed a 6 week course of antibiotics.

http://ift.tt/2uscPL0

External revascularisation for pseudochronic total occlusion of the dorsal pedis artery due to foot drop with severe diabetes mellitus

Description

A 45-year-old woman with end-stage renal disease and severe diabetes mellitus (haemoglobin A1c (HbA1c) 9.5%) suffered from critical limb ischaemia (CLI). Her right ankle brachial pressure index (ABPI) was 0.77; however, her left ABPI was immeasurable with flat waveform. Additionally, skin perfusion pressure was 34 mm Hg on the left dorsal and 22 mm Hg on the left planter. The angiography showed chronic total occlusion (CTO) of the dorsal pedis artery (DPA) (figure 1, left panel). We electively performed endovascular therapy. The soft wire smoothly passed the CTO of the DPA. We dilated the CTO with a 2.0 mm balloon several times; however, blood flow could not be restored. This discrepancy suggested an unusual CTO. Intravascular ultrasound showed an intact DPA. She also had foot drop due to diabetic neuropathy. Since the entry of CTO was at the dorsal ankle joint, this joint abnormality was considered the cause of the CTO....

http://ift.tt/2v0WxFY

Abciximab-induced acute profound thrombocytopenia postpercutaneous coronary intervention

Abciximab (c7E3 Fab) is one of the three potent intravenous glycoprotein IIb/IIIa receptor inhibitors (along with eptifibatide and tirofiban) that have shown significant positive outcomes when used in patients with intracoronary thrombus. However, major side effects have been reported with its use including hypotension, major bleeding and thrombocytopenia. This case is a 53-year-old man presenting with acute chest pain diagnosed with non-ST-elevation myocardial infarction, who underwent percutaneous coronary intervention with abciximab and heparin infusion and developed acute profound thrombocytopenia (platelet count <20,000/L) within 9 hours of infusion. This case demonstrates the importance of routinely monitoring the platelet count prior to and 2–4 hours following abciximab infusion and differentiating other causes of acute profound thrombocytopenia, particularly pseudothrombocytopenia and heparin-induced thrombocytopenia.

http://ift.tt/2urIFrr

Venobiliary fistula with haemobilia: a rare complication of percutaneous liver biopsy

We describe a case of a 36-year-old man with a history of chronic hepatitis C who presented with abdominal pain 3 days after undergoing a percutaneous ultrasound-guided liver biopsy. Initial investigations revealed a venobiliary fistula with haemobilia and obstructive jaundice with direct bilirubin peaking at 9.2 mg/dL. He underwent an endoscopic retrograde cholangiopancreatography with sphincterotomy and stent placement, bilirubin decreased to 3.7 mg/dL, and the patient was discharged. The patient returned with recurrent abdominal pain and upper gastrointestinal bleeding with haemoglobin of 8.6 g/dL, requiring multiple transfusions. He underwent transcatheter arterial embolisation but continued bleeding. Radiofrequency ablation was pursued and was able to achieve haemostasis. The patient was discharged. The patient returned again with a fever of 39.2 °C and was found to have a large right hepatic lobe abscess. The patient underwent abscess drainage with drain placement and was treated with antibiotics for 6 weeks. He followed up in the clinic with resolution of symptoms and infection.

http://ift.tt/2v1jWHp

Prognostic significance of central venous-to-arterial carbon dioxide difference during the first 24 hours of septic shock in patients with and without impaired cardiac function

Abstract

Objective: To investigate the prognostic significance of central venous-to-arterial carbon dioxide difference (cv-art CO₂ gap) during septic shock in patients with and without impaired cardiac function.Methods: We performed a prospective cohort study in 10 French intensive care units. Patients suffering from septic shock were assigned to the impaired cardiac function group ('cardiac group', n=123) if they had atrial fibrillation (AF) and/or left ventricular ejection fraction (LVEF) <50% at study entry and to the non-cardiac group (n=240) otherwise.Results: Central venous and arterial blood gases were sampled every 6 h during the first 24 h to calculate cv-art CO₂ gap. Patients in the cardiac group had a higher cv-art CO₂ gap [at study entry and 6 and 12 h (all P<0.02)] than the non-cardiac group. Patients in the cardiac group with a cv-art CO₂ gap >0.9 kPa at 12 h had a higher risk of day 28 mortality (hazard ratio=3.18; P=0.0049). Among the 59 patients in the cardiac group with mean arterial pressure (MAP) ≥65 mm Hg, central venous pressure (CVP) ≥8 mm Hg and central venous oxygen saturation (ScvO₂) ≥70% at 12 h, those with a high cv-art CO₂ gap (>0.9 kPa; n=19) had a higher day 28 mortality (37% vs. 13%; P=0.042). In the non-cardiac group, a high cv-art CO₂ gap was not linked to a higher risk of day 28 death, whatever the threshold value of the cv-art CO₂ gap.Conclusion: Patients with septic shock and with AF and/or low LVEF were more prone to a persistent high cv-art CO₂ gap, even when initial resuscitation succeeded in normalizing MAP, CVP, and ScvO₂. In these patients, a persistent high cv-art CO₂ gap at 12 h was significantly associated with higher day 28 mortality.

http://ift.tt/2uZAYWl

The ACTA PORT-score for predicting perioperative risk of blood transfusion for adult cardiac surgery

Abstract

Background. A simple and accurate scoring system to predict risk of transfusion for patients undergoing cardiac surgery is lacking.We conducted a retrospective analysis of data collected from the ACTA National Audit. For the derivation dataset, we included data from 20 036 patients, which we then externally validated using a further group of 1047 patients.Methods. We identified independent risk factors associated with transfusion by performing univariate analysis, followed by logistic regression. We then simplified the score to an integer-based system and tested it using the area under the receiver operator characteristic (AUC) statistic with a Hosmer-Lemeshow goodness-of-fit test. Finally, the scoring system was applied to the external validation dataset and the same statistical methods applied to test the accuracy of the ACTA-PORT score.Results. Several factors were independently associated with risk of transfusion, including age, sex, body surface area, logistic EuroSCORE, preoperative haemoglobin and creatinine, and type of surgery. In our primary dataset, the score accurately predicted risk of perioperative transfusion in cardiac surgery patients with an AUC of 0.76. The external validation confirmed accuracy of the scoring method with an AUC of 0.84 and good agreement across all scores, with a minor tendency to under-estimate transfusion risk in very high-risk patients.Conclusions. The ACTA-PORT score is a reliable, validated tool for predicting risk of transfusion for patients undergoing cardiac surgery. This and other scores can be used in research studies for risk adjustment when assessing outcomes, and might also be incorporated into a Patient Blood Management programme.

http://ift.tt/2v0nKIX

Reproducibility of science and developmental anaesthesia neurotoxicity: a tale of two cities

Editor—Reproducing scientific observations is the foundation of trusted discoveries. In clinical sciences, specific questions are repeatedly asked by a multitude of observational studies or trials, and the rigorous meta-analysis of these multicentre datasets leads us closer toward the application of evidence-based medicine in our patients. A similar approach is less frequently applied to basic and even translational research, where differences in experimental protocols used, species studied, and outcome measures reported make direct comparison of laboratory studies at best very difficult.¹ The seeming lack of interest in thoroughly replicating experiments produced by other laboratories can be explained by a multitude of factors, amongst which the difficulties to obtain funding and dedicated researchers to conduct highly time- and money-consuming "non-innovative" projects are probably the most important. It is increasingly acknowledged that many preclinical studies are statistically underpowered and cannot be reproduced.²³ The absence of confirmation of an experimental finding by other independent laboratories can greatly weaken the confidence in any particular observation. Importantly, many clinical trials are fuelled by translational experimental datasets, and these preclinical works should be reliable and of the highest quality to provide a solid base for human studies.

http://ift.tt/2urjMMG

Fading whispers down the lane: signal propagation in anaesthetized cortical networks

An active area of enquiry in the neuroscientific investigation of general anaesthesia is the question of whether anaesthetic-induced unconsciousness is mediated by bottom-up or top-down mechanisms in the brain. Candidates for the bottom-up approach include suppression of arousal centres in the brainstem and diencephalon,¹² activation of sleep-promoting neurones or nuclei in similar locations,¹³ blockade of sensory information en route from the thalamus to the cortex,⁴ and a disabled thalamic conductor for the neuronal orchestra of the cortex.⁵ Candidates for the top-down approach include direct effects on long-latency activity in cortical networks,⁶ with a consequent disruption of higher-order information synthesis that occurs beyond the level of the primary sensory cortex.^7–9 This bottom-up vs top-down distinction is almost surely artificial given the integrated circuits required for the normal function of neural systems and the widespread effects of general anaesthetics on the brain. We recently proposed that anaesthetics alter the level of consciousness (e.g. awake vs somnolent) through bottom-up mechanisms while degrading the contents of consciousness (e.g. the particular qualities of experience) through top-down mechanisms.¹⁰ Developing a clearer understanding of these processes is important because it can inform (i) the neurobiology of consciousness, a fundamental question in science, and (ii) our approach to brain monitoring, a fundamental and unmet challenge in clinical anaesthesia. However, it is difficult to address this question by investigating individual brain areas or molecular targets in the laboratory and also difficult to distinguish cortical and subcortical mechanisms through human neuroimaging and neurophysiology. In this issue of the British Journal of Anaesthesia, Hentschke and colleagues¹¹ examine an intermediate level of neuroanatomy and neurophysiology in a cortical slice model, finding more profound effects of isoflurane on signal propagation through the cortex than to the cortex.

http://ift.tt/2uqY0IK

21st Annual Scientific Meeting of the Difficult Airway Society: lessons learned and glimpses of the future

The 21st Annual Scientific Meeting of the Difficult Airway Society (DAS) took place in Torquay (Devon, UK) on November 16–18, 2016. The workshop day included traditional workshops, a tracheostomy workshop, and a 'can't intubate, can't oxygenate' (CICO) workshop. The next 2 days encompassed a variety of stimulating sessions, presentations, lunchtime symposia, a pro–con debate, free paper presentations, and poster presentations.

http://ift.tt/2uqYEpL

Brugada syndrome in a patient with amyotrophic lateral sclerosis: a case report

Amyotrophic lateral sclerosis is a fatal neuromuscular disorder characterized by progressive death of the upper and lower motor neurons in the central nervous system. Patients with this disease die mostly as a...

http://ift.tt/2tR66sF

Streptococcal toxic-shock syndrome due to Streptococcus dysgalactiae subspecies equisimilis in breast cancer-related lymphedema: a case report

Breast cancer-related lymphedema often causes cellulitis and is one of the most common complications after breast cancer surgery. Streptococci are the major pathogens underlying such cellulitis. Among the stre...

http://ift.tt/2tnaFYh

Extensive colorectal lymphomatous polyposis complicated by acute intestinal obstruction: a case report

Multiple lymphomatous polyposis is a rare type of gastrointestinal lymphoma that extensively infiltrates the intestine. Multiple lymphomatous polyposis originates from the mantle zone of the lymphoma follicle ...

http://ift.tt/2tRiVDs

Healthcare teams as complex adaptive systems: Focus on interpersonal interaction

http://ift.tt/2urnjuo

ECtHR finds Russia’s gay propaganda law discriminatory in strong-worded judgment

http://ift.tt/2v047Rj

Cerebellar degeneration-related proteins 2 and 2-like are present in ovarian cancer in patients with and without Yo antibodies

Abstract

Background

Cerebellar degeneration-related protein 2 (CDR2) has been presumed to be the main antigen for the onconeural antibody Yo, which is strongly associated with ovarian cancer and paraneoplastic cerebellar degeneration (PCD). Recent data show that Yo antibodies also target the CDR2-like protein (CDR2L). We, therefore, examined the expression of CDR2 and CDR2L in ovarian cancer tissue from patients with and without Yo antibodies and from various other cancerous and normal human tissues.

Methods

Ovarian cancer tissue and serum samples from 16 patients were included in the study (four with anti-Yo and PCD, two with anti-Yo without PCD, five with only CDR2L antibodies, and five without onconeural antibodies). Clinical data were available for all patients. The human tissues were examined by western blot and immunohistochemistry using rabbit CDR2 and CDR2L antibodies.

Results

Ovarian cancers from all 16 patients expressed CDR2 and CDR2L proteins. Both proteins were also present in normal and cancer tissue from mammary tissue, kidney, ovary, prostate, and testis.

Conclusion

CDR2L is present in ovarian cancers from patients with and without Yo antibodies as was shown previously for CDR2. In addition, both CDR2 and CDR2L proteins are more widely expressed than previously thought, both in normal and cancerous tissues.

http://ift.tt/2umEAE9

Macrophage rich myositis with calpain-3 mutation

Schutz, PW; Scalco, RS; Barresi, R; Houlden, H; Parton, M; Holton, JL; (2017) Macrophage rich myositis with calpain-3 mutation. Neuromuscular Disorders (In press).

http://ift.tt/2umzNCP

Anomalous experiences, trauma and social support

Prescott, A; (2007) Anomalous experiences, trauma and social support. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2vkD7LB

Increased connectivity of hub networks and cognitive impairment in multiple sclerosis

Meijer, KA; Eijlers, AJC; Douw, L; Uitdehaag, BMJ; Barkhof, F; Geurts, JJG; Schoonheim, MM; (2017) Increased connectivity of hub networks and cognitive impairment in multiple sclerosis. Neurology , 88 (22) pp. 2107-2114. 10.1212/WNL.0000000000003982 .

http://ift.tt/2umAlZn

Analysis of repeated measurements from medical research when observations are missing

Walker, K; (2007) Analysis of repeated measurements from medical research when observations are missing. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2vkJ7nM

The power of bioluminescence imaging in understanding host-pathogen interactions

Suff, N; Waddington, SN; (2017) The power of bioluminescence imaging in understanding host-pathogen interactions. Methods 10.1016/j.ymeth.2017.07.001 . (In press).

http://ift.tt/2umABHI

Early, Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis

Rowan, KM; Angus, DC; Bailey, M; Barnato, AE; Bellomo, R; Canter, RR; Coats, TJ; Rowan, KM; Angus, DC; Bailey, M; Barnato, AE; Bellomo, R; Canter, RR; Coats, TJ; Delaney, A; Gimbel, E; Grieve, RD; Harrison, DA; Higgins, AM; Howe, B; Huang, DT; Kellum, JA; Mouncey, PR; Music, E; Peake, SL; Pike, F; Reade, MC; Sadique, MZ; Singer, M; Yealy, DM; - view fewer (2017) Early, Goal-Directed Therapy for Septic Shock - A Patient-Level Meta-Analysis. New England Journal of Medicine , 376 (23) pp. 2223-2234. 10.1056/NEJMoa1701380 .

http://ift.tt/2vkqpwr

Analysis of interval-censored failure time data with application to studies of HIV infection

Goodall, RL; (2007) Analysis of interval-censored failure time data with application to studies of HIV infection. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2vkMISF

A note on properties of the restriction operator on Sobolev spaces

Hewett, DP; Moiola, A; (2017) A note on properties of the restriction operator on Sobolev spaces. Journal of Applied Analysis , 23 (1) pp. 1-8. 10.1515/jaa-2017-0001 .

http://ift.tt/2umAz2y

Analysis of ErbB2- and growth factor dependent gene expression in breast cells

Bertani, MF; (2006) Analysis of ErbB2- and growth factor dependent gene expression in breast cells. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2vkDvtV

An investigation into the biochemistry of glycoprotein I and the interaction of the fibrinolytic system with antiphospholipid antibodies

Nash, MJ; (2007) An investigation into the biochemistry of glycoprotein I and the interaction of the fibrinolytic system with antiphospholipid antibodies. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2umB90b

Community management indicators can conflate divergent phenomena: two challenges and a decomposition-based solution

Adams, GL; Jennings, S; Reuman, DC; (2017) Community management indicators can conflate divergent phenomena: two challenges and a decomposition-based solution. Journal of Applied Ecology , 54 (3) pp. 883-893. 10.1111/1365-2664.12787 . Green open access

http://ift.tt/2vkJXRv

Intentions and experiences of effective practice in mental health specific supported accommodation services: a qualitative interview study

Sandhu, S; Priebe, S; Leavey, G; Harrison, I; Krotofil, J; McPherson, P; Dowling, S; Sandhu, S; Priebe, S; Leavey, G; Harrison, I; Krotofil, J; McPherson, P; Dowling, S; Arbuthnott, M; Curtis, S; King, M; Shepherd, G; Killaspy, H; - view fewer (2017) Intentions and experiences of effective practice in mental health specific supported accommodation services: a qualitative interview study. BMC Health Services Research , 17 , Article 471. 10.1186/s12913-017-2411-0 . Green open access

http://ift.tt/2umgWaQ

Conceptualising forensic science and forensic reconstruction. Part II: The critical interaction between research, policy/law and practice

Morgan, RM; (2017) Conceptualising forensic science and forensic reconstruction. Part II: The critical interaction between research, policy/law and practice. Science and Justice 10.1016/j.scijus.2017.06.003 . (In press). Green open access

http://ift.tt/2vkS5kV

Conceptualising forensic science and forensic reconstruction. Part I: A conceptual model

Morgan, RM; (2017) Conceptualising forensic science and forensic reconstruction. Part I: A conceptual model. Science and Justice 10.1016/j.scijus.2017.06.002 . (In press). Green open access

http://ift.tt/2umGHHV

Can the organisation of commercial space in cities encourage creativity and ‘self-generating’ economic growth? A return to Jane Jacobs’ ideas

Froy, F; Davis, H; Dhanani, A; (2017) Can the organisation of commercial space in cities encourage creativity and 'self-generating' economic growth? A return to Jane Jacobs' ideas. In: Proceedings of the 11th Space Syntax Symposium. Instituto Superior Técnico, Portugal: Lisbon, Portugal. (In press).

http://ift.tt/2vkZlx0

An assessment of the utility of nerve- and vessel-related cranial characters for reconstructing primate phylogeny

Serdoz, D; (2006) An assessment of the utility of nerve- and vessel-related cranial characters for reconstructing primate phylogeny. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2umG3dK

Frutapin, a lectin from Artocarpus incisa (breadfruit): cloning, expression and molecular insights.

Sousa, FD; da Silva, BB; Furtado, GP; Carneiro, IDS; Lobo, MDP; Guan, Y; Guo, J; Sousa, FD; da Silva, BB; Furtado, GP; Carneiro, IDS; Lobo, MDP; Guan, Y; Guo, J; Coker, AR; Lourenzoni, MR; Guedes, MIF; Owen, JS; Abraham, DJ; Monteiro-Moreira, ACDO; Moreira, RDA; - view fewer (2017) Frutapin, a lectin from Artocarpus incisa (breadfruit): cloning, expression and molecular insights. Biosci Rep 10.1042/BSR20170969 .

http://ift.tt/2vkJOO5

Cranial bone structure in children with sagittal craniosynostosis: relationship with surgical outcomes

Rodriguez-Florez, N; Ibrahim, A; Hutchinson, JC; Borghi, A; James, G; Arthurs, O; Ferretti, P; Rodriguez-Florez, N; Ibrahim, A; Hutchinson, JC; Borghi, A; James, G; Arthurs, O; Ferretti, P; Dunaway, D; Schievano, S; Jeelani, NUO; - view fewer (2017) Cranial bone structure in children with sagittal craniosynostosis: relationship with surgical outcomes. Journal of Plastic, Reconstructive & Aesthetic Surgery 10.1016/j.bjps.2017.06.017 . (In press). Green open access

http://ift.tt/2umxakn

Agency and the sense of body-ownership psychophysical and neuroscientific investigations

Tsakiris, E; (2006) Agency and the sense of body-ownership psychophysical and neuroscientific investigations. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2vkMDhP

Link between healthy lifestyle and psychological well-being in Lithuanian adults aged 45-72: a cross-sectional study

Sapranaviciute-Zabazlajeva, L; Luksiene, D; Virviciute, D; Bobak, M; Tamosiunas, A; (2017) Link between healthy lifestyle and psychological well-being in Lithuanian adults aged 45-72: a cross-sectional study. BMJ OPEN , 7 (4) , Article e014240.. 10.1136/bmjopen-2016-014240 . Green open access

http://ift.tt/2umCLH6

Population-based reference values for the European Organization for Research and Treatment of Cancer Head and Neck module

Abstract

Background

The purpose of this study was to establish population-based norms for the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35 (EORTC QLQ-HN35) to be used as references to facilitate the interpretation of results from health-related quality of life (HRQOL) studies of patients with head and neck cancer.

Methods

The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and QLQ-HN35 were sent to a random sample representing the Swedish general population.

Results

The response rate was 69% (1504 participants of 2200 invited). The scores for the QLQ-C30 were comparable to previously published reference values. The reference values for the QLQ-HN35 were low, indicating few head and neck-specific problems in the population. For illustrative purposes, we also compared these reference values to our previously published HRQOL results obtained from patients with head and neck cancer at diagnosis and from 3-year survivors.

Conclusion

These new reference values for EORTC QLQ-HN35 may be useful in future HRQOL studies.

http://ift.tt/2uqJ4KW

Exercise therapy for trismus secondary to head and neck cancer: A systematic review

Abstract

Background

Effects of exercise therapy for trismus secondary to head and neck cancer have not been reviewed systematically since 2004.

Methods

Four databases were searched. The quality of observational studies and randomized controlled trials was assessed.

Results

Two hundred eleven articles were found, 20 studies were included. A large variation in research methodology, stretching techniques, duration of stretch, and repetition of exercises was found. The overall quality was moderate. Five of the 8 preventive studies found that exercises during (chemo)radiotherapy could not prevent a reduction in mouth opening. In 4 therapeutic case studies, mouth opening increased between 17 and 24 mm. In 8 other therapeutic studies, mouth opening increased between −1.9 and 13.6 mm. No exercise therapy was clearly superior to the others.

Conclusion

Changes in mouth opening ranged considerably and no stretching technique was superior to others regarding either prevention or treatment of trismus. Clinical guidelines cannot be given based on this systematic review. © 2016 Wiley Periodicals, Inc. Head Neck 39: 160–169, 2017

http://ift.tt/2uZrURm

Radioprotective effect of thymoquinone on salivary gland of rats exposed to total cranial irradiation

Abstract

Background

The purpose of this study was to investigate the radioprotective effects of thymoquinone against radiation-induced damage in the salivary glands of rats exposed to total cranial gamma irradiation.

Methods

Thirty-two Sprague-Dawley rats were divided into 4 groups to test the radioprotective effectiveness of thymoquinone by intraperitoneal injection. An appropriate control group was also studied. Biochemical parameters in liver tissue of rats were determined by spectrophotometer.

Results

Glutathione peroxidase (GSH-Px), glutathione-S-transferase (GST), total (enzymatic plus nonenzymatic) superoxide scavenger activity (TSSA), nonenzymatic superoxide scavenger activity (NSSA), and superoxide dismutase (SOD) activities were significantly decreased, whereas xanthine oxidase, nitric oxide synthase activities, malondialdehyde, nitric oxide, and peroxynitrite levels were significantly increased in the irradiation group when compared to the control and sham control groups.

Conclusion

Results showed that thymoquinone reduces oxidative and nitrosative stress parameters and has antioxidant effects and a free radical scavenging activity.

http://ift.tt/2ur0erN

Rosettes in actinic keratosis and squamous cell carcinoma: distribution, association to other dermoscopic signs and description of the rosette pattern

Abstract

Background

Rosettes, a dermoscopic structure characterized by four white points arranged as a 4-leaf clover, supports the dermoscopic diagnosis of actinic keratosis (AK) or squamous cell carcinoma (SCC).

Objective

The association of rosettes with other dermoscopic structures in AK or SCC and their distribution has not been analysed yet.

Methods

We conducted a prospective study of patients with histologically proven AK or SCC who presented dermoscopic rosettes at initial evaluation.

Results

A total of 56 tumors were collected (94,6% AK and 5,4% SCC). Thirty-seven (66.1%) lesions were non-pigmented and 19 (33.9%) pigmented. The most common dermoscopic findings were erythema (53; 94.6%) and scale (42; 75%). White circles were present in 21 lesions (37.5%); pigmented pseudonetwork in 18 (32.1%) and multiple gray-to-brown dots and globules in 14 (25%). Rosettes were distributed focally in 9 (16.1%) and generalized in 47 (83.9%). The rosette pattern (rosettes as the main structure) was observed only in AK (19; 35.8%).

Limitations

The analysis was not blinded. The distinction between focal distribution (up to 3 rosettes) or generalized could be considered arbitrary.

Conclusion

The rosette pattern identified in AK may be a specific pattern for AK.

This article is protected by copyright. All rights reserved.

http://ift.tt/2tmQgmk

Paraneoplastic systemic lupus erythematosus in association with oat cell tumour of the lung

A 63-year-old man presented in the emergency department with general malaise, asthenia, an erythematosquamous rash on face and forearms and severe hyponatremia. The rash appeared after working in his garden on a sunny afternoon without sunscreen protection (Figure 1A/B/C). Furosemide was stopped and once daily mometason furoate cream was prescribed. Hyponatremia was corrected by IV hypertonic fluids. Five days later, the rash spread to the upper legs, chest and back. Histopathology revealed damage of the basal layer with necrotic keratinocytes and dermal perivascular and adnexal infiltrates (Figure 2).

This article is protected by copyright. All rights reserved.

http://ift.tt/2tQN3ig

Psoriasis and migraine

Abstract

Background

Psoriasis and migraine share several pathogenetic mechanisms due to systemic inflammation, which increase the risk of developing cardiovascular disease.

Objective

Our aim is to investigate the prevalence of migraine with (MA) and without aura (MO) in the psoriatic population, investigating a possible new comorbidity of the psoriatic disease.

Methods

We referred 68 psoriatic patients to a 9 questions survey formulated on the basis of the International Headache Society (IHS) diagnostic criteria for migraine. Than, in the case of MA, the mean monthly number of migraine crises was assessed. Data of psoriatic patients were than compared with those of a psoriasis free control group composed of 235 migraine patients (with and without aura).

Results

A clinical diagnosis of migraine was performed in 32 psoriasis patients with a great prevalence in women (F: 87.50% - M: 12.5%). Moreover we found a much higher prevalence (62.5%) of MA, with the remaining 37.5% diagnosed with MO. Comparing the prevalence of MA between psoriasis + migraine patients and the control group we observed a statistical significative difference (p<0.0001); furthermore the number of MA crises was significantly higher (p<0.0001) in patients with psoriasis with respect to the MA control group.

Conclusions

We showed a significant association between psoriasis and migraine, especially MA, probably due to common pathogenetic mechanisms, but further studies are needed to assess their interplay in developing cardiovascular diseases.

This article is protected by copyright. All rights reserved.

http://ift.tt/2tmSt0N

Study to Evaluate the Safety and Tolerability of Avelumab in Combination With Other Anti-Cancer Therapies in Patients With Advanced Malignancies

Conditions:   Malignant Neoplasm of Breast;   Malignant Neoplasms of Bone and Articular Cartilage;   Malignant Neoplasms of Digestive Organs;   Malignant Neoplasms of Eye Brain and Other Parts of Central Nervous System;   Malignant Neoplasms of Female Genital Organs;   Malignant Neoplasms of Ill-defined Secondary and Unspecified Sites;   Malignant Neoplasms of Independent (Primary) Multiple Sites;   Malignant Neoplasms of Lip Oral Cavity and Pharynx;   Malignant Neoplasms of Male Genital Organs;   Malignant Neoplasms of Mesothelial and Soft Tissue;   Malignant Neoplasms of Respiratory and Intrathoracic Organs;   Malignant Neoplasms of Thyroid and Other Endocrine Glands;   Malignant Neoplasms of Urinary Tract;   Neoplasms of Uncertain or Unknown Behavior
Interventions:   Drug: Avelumab;   Drug: Utomilumab;   Drug: PF-04518600;   Radiation: Radiation;   Drug: Cisplatin
Sponsors:   M.D. Anderson Cancer Center;   Pfizer
Not yet recruiting - verified July 2017

http://ift.tt/2uhC9TM

Proton Re-Irradiation for Recurrent Head and Neck Cancer

Condition:   Head and Neck Cancer
Interventions:   Radiation: conventionally fractionated full dose re-irradiation;   Radiation: hypofractionated palliative re-irradiation
Sponsor:   Memorial Sloan Kettering Cancer Center
Recruiting - verified July 2017

http://ift.tt/2tahUYx

Effectiveness of Proprioceptive Exercise in Neck Pain

Condition:   Neck Pain
Interventions:   Other: Mobility exercises;   Other: Proprioception exercises
Sponsor:   University of Valencia
Recruiting - verified July 2017

http://ift.tt/2tTdx16

MRG HIFU With Radiotherapy for Palliation of H&N Cancer

Condition:   Head and Neck Cancer
Intervention:   Other: MR Guided HIFU
Sponsors:   Sunnybrook Health Sciences Centre;   Focused Ultrasound Foundation
Recruiting - verified July 2017

http://ift.tt/2taO4mB

De relatie tussen socio-economische omgeving en psychische problemen bij kinderen: de rol van executief functioneren onder de loep

http://ift.tt/2urbBjf

From quality control to structural reliability: where Bayesian statistics meets risk analysis

Quality inspection plays an important role in the production processes of structural material as well as in design and construction activities, inherently stimulating a higher performance with respect to the investigated activities or properties. In case of the conformity assessment of concrete compressive strength, the concrete strength distribution is filtered due to the rejection or acceptance of certain lots and this filter effect can be qualified using Bayesian updating techniques. A methodology based on numerical integration and Markov Chain Monte Carlo simulations is applied to update prior knowledge with respect to the hyperparameters of concrete strength distributions, considering the conformity criteria for concrete strength according to EN206-1. Further, as a consequence of this filter effect, conformity control has a positive influence on the reliability of concrete structures and this effect is quantified here by classical FORM calculations. Finally, also the variance reduction effect of conformity control with respect to structural reliability calculations is quantified, illustrating the reducing vulnerability to parameter uncertainties when performing structural reliability calculations.

http://ift.tt/2tQF5Wh

Behandlungsergebnisse bei rezidivierender respiratorischer Papillomatose

Zusammenfassung

Hintergrund

Die rezidivierende respiratorische Papillomatose (RRP) ist eine seltene chronische Erkrankung viraler Ätiologie, die durch das multiple, rezidivierende Auftreten von Plattenepithelpapillomen charakterisiert ist.

Material und Methoden

Retrospektiv wurden die Behandlungsergebnisse und Rezidivraten von 106 Patienten mit RRP des Larynx ausgewertet. Sie wurden zwischen 1983 und 2014 wegen RRP an der Uniklinik Magdeburg behandelt. Verglichen wurden die konventionelle und Laserchirurgie bezüglich der Rezidivintervalle und der Komplikationen sowie der Effekt der Gardasil®-Impfung bei 10 Patienten.

Ergebnisse

Bei Kindern mit RRP erfolgten signifikant mehr Eingriffe lebenslang als bei erwachsenen Patienten. Es gab keine signifikanten Unterschiede in der Zeit bis zum Rezidiv oder in der Anzahl der Eingriffe/Jahr bei der adulten (n = 79) und bei der juvenilen (n = 27) RRP. Die verschiedenen chirurgischen Methoden hatten keinen Einfluss auf die Zeit bis zum Rezidiv oder die Anzahl der Eingriffe/Jahr. Komplikationen traten ohne signifikanten Unterschied sowohl nach konventioneller Chirurgie als auch nach Laserchirurgie auf. Ernste Komplikationen und die Notwendigkeit einer Tracheotomie wurden nur selten beobachtet. Durch die Gardasil®-Impfung wurde bei den 10 Patienten eine signifikante Reduktion der Eingriffe/Jahr nach der Impfung erreicht.

Schlussfolgerung

Die RRP ist eine seltene Krankheit. Die Behandlung benötigt Erfahrung und kann sehr schwierig sein. Nach Auswertung der Ergebnisse ist die Behandlung der Wahl die laserchirurgische Ablation der Papillomherde in Kombination mit der quadrivalenten bzw. polyvalenten Impfung. Möglicherweise kann durch eine konsequente Impfung sowohl von Mädchen als auch Jungen das Auftreten der RRP reduziert werden.

http://ift.tt/2umvxDi

De wijziging van de Europese en Vlaamse regelgeving inzake milieueffectrapportage voor projecten (2014-17)

http://ift.tt/2sY5nDh

A comprehensive study of smoking-specific microRNA alterations in head and neck squamous cell carcinoma

Publication date: September 2017
Source:Oral Oncology, Volume 72
Author(s): Aswini R. Krishnan, Hao Zheng, James G. Kwok, Yuanhao Qu, Angela E. Zou, Avinaash Korrapati, Pin Xue Li, Joseph A. Califano, Melbourne F. Hovell, Jessica Wang-Rodriguez, Weg M. Ongkeko
ObjectiveWhile tobacco smoking is a well-known risk factor for head and neck squamous cell carcinoma (HNSCC), the molecular mechanisms underlying tobacco-induced HNSCC remain unclear. This study sought to comprehensively identify microRNA (miRNA) alterations and evaluate their clinical relevance in smoking-induced HNSCC pathogenesis and progression.Materials and methodsUsing small RNA-sequencing data and clinical data from 145 HNSCC patients, we performed a series of differential expression and correlation analyses to identify a panel of tobacco-dysregulated miRNAs associated with key clinical characteristics in HNSCC. We then examined the expression patterns of these miRNAs in normal epithelial cell lines following exposure to cigarette smoke extract.ResultsOur analyses revealed distinct panels of miRNAs to be dysregulated with smoking status and associated with additional clinical features, including tumor stage, metastasis, anatomic site, and patient survival. The differential expression of key miRNAs, including miR-101, miR-181b, miR-486, and miR-1301, was verified in cigarette-treated epithelial cell lines, suggesting their potential roles in the early development of smoking-related HNSCCs.ConclusionSpecific alterations in miRNA expression may be traced to tobacco use and are associated with important HNSCC clinical characteristics. Future studies of these miRNAs may be valuable for furthering the understanding and targeted treatment of smoking-associated HNSCC.



http://ift.tt/2uqCTGw

Pica, constipation and cardiorespiratory arrest

Description

Pica is an eating disorder typically defined as the persistent ingestion of non-nutritive substances, for at least 1 month, at an age of which this behaviour is inappropriate. It may be benign or may have life-threatening consequences.1 2 The clinical presentation is highly variable and is associated with the specific nature of the resulting medical conditions and the ingested substances. The signs and symptoms can be from toxic, infectious, dental or gastrointestinal conditions.3

The authors present a clinical case of a 61-year-old man with clinical history of cognitive impairment and pica, admitted in an intensive care unit after cardiorespiratory arrest. The initial hospital admission was for constipation and abdominal pain. Abdominal and pelvic CT scan revealed 'significant colonic dilatation with a sigmoid size of 14.5 cm, with evidence of abundant intraluminal faecal content at this level—aspects suggestive of translating obstructive process by faecaloma,...

http://ift.tt/2tTruvJ

Marantic endocarditis and paraneoplastic pulmonary embolism

Cancer is frequently associated with a hypercoagulable state. Almost 15% of patients with cancer will suffer a thromboembolic event during their clinical course. The aetiology of this hypercoagulable state is multifactorial and includes procoagulant factors associated with malignancy as well as the host's inflammatory response. Cancer-associated thrombophilia can present as venous thromboembolism, migratory superficial thrombophlebitis, arterial thrombosis, disseminated intravascular coagulation, thrombotic microangiopathy and rarely non-bacterial thrombotic endocarditis (NBTE). In this paper, we will describe an uncommon presentation of lung cancer on a non-smoker middle-aged woman, with recent diagnosis of pulmonary embolism, who develops malignant recurrent pleural effusion, NBTE with cutaneous and neurological manifestations, with a rapid evolution into shock, culminating in death. Diagnosis of NBTE requires a high degree of clinical suspicion. The mainstay of treatment is systemic anticoagulation to prevent further embolisation and underlying cancer control whenever is possible.

http://ift.tt/2ta9xfk

Leucocytoclastic vasculitis following influenza vaccination

Background

Influenza vaccinations are commonly administered and effectively prevent influenza. Most vaccine reactions are mild and self-limiting with few reported cases of vasculitis. We present a case of vasculitis post-vaccination unique for its dramatic visual presentation and rapid response to treatment with the aim to emphasise possible causation and timely treatment.

Case presentation

This is a case of a 60-year-old man with chronic idiopathic pulmonary fibrosis, with fever, arthralgias and rash characterised by extensive erythematous plaques on his limbs and trunk 5âdays after influenza vaccination. Skin biopsy revealed leucocytoclastic vasculitis. Rash and symptoms resolved 10 days after initiating treatment with oral prednisone.

Conclusions

Influenza vaccines can potentially precipitate cutaneous vasculitis, and timely treatment reduces morbidity in the elderly.

http://ift.tt/2tThliF

Ciliated foregut cyst of the gall bladder: the largest ever described

A 78-year-old man presented to the accident and emergency department with acute abdominal pain. A CT scan done to investigate the pain showed an intra-abdominal abscess medial to the caecum and an incidental exophytic lesion in the gall bladder. This was excised during surgery and sent for histological examination. Histology showed a ciliated foregut cyst of the gall bladder. A literature review revealed that this was the 13th case worldwide, as ciliated foregut cysts are usually found either above the diaphragm or in the liver. It was also the largest cyst described, with 45âmm diameter. So far none of these cysts found in the gall bladder have shown malignant transformation, though those found in the liver have been known to become malignant. Due to histological similarity, excision of ciliated foregut cysts of the gall bladder should be considered as there is still a risk of malignant transformation.

http://ift.tt/2ta9wYO

Cervical shock: a complication of incomplete abortion

A case of a 37-year-old female primagravida who attended the emergency department (ED) via ambulance in hypotensive shock. She was 10 weeks pregnant, but had an inevitable miscarriage confirmed in the local Early Pregnancy Unit 3 weeks previously. She was hypotension (90/60âmm Hg), bradycardic (45 bpm) and was peripherally shut down. A provisional diagnosis of haemorrhagic shock was made, but despite intravenous fluid challenges, she appeared to be deteriorating, so a major haemorrhage protocol was activated. On examination, there was some vaginal bleeding and a protruding sac noted. The gynaecology registrar was informed and performed an Evacuation of the Retained Products of Conception in the ED. This gave instant relief to the patient and her blood pressure and heart rate became normal over a few minutes. She went on to make a full recovery. This case provides useful learning points for doctors working in the ED and other urgent care settings.

http://ift.tt/2tTrufd

Use of cabergoline for the management of persistent Cushings disease in pregnancy

Cushing's disease (CD) is rare during pregnancy and is associated with significant maternal and fetal complications. It is important to control hypercortisolism during pregnancy, either surgically or medically, for a successful maternal and fetal outcome. We report a patient with recurrent CD who was treated with low-dose cabergoline (CAB) for persistent hypercortisolism throughout pregnancy. A 36-year-old woman was diagnosed with CD at the age of 23. She underwent trans-sphenoidal surgery with initial complete remission. However, 4 years after surgery, CD recurred and she underwent Gamma Knife radiosurgery (GKRS). Following GKRS, her cortisol levels remained elevated despite no evidence of visible tumour on pituitary MRI. Medical treatment was commenced with ketoconazole and cyproheptadine. This was changed to CAB as she was keen for pregnancy. She conceived spontaneously and was on CAB throughout pregnancy. She delivered a healthy male neonate, weighing 3195 g at 40 weeks of gestation.

http://ift.tt/2taJODK

Stigma kills! The psychological effects of emotional abuse and discrimination towards a patient with HIV in Uganda

Our patient is a 58-year-old Ugandan woman. After her husband's death in 1994, the patient was forced to leave her home by her late husband's family and arrangements were made for her mother to provide care until her inevitable death. The patient suffered from multiple mental health disturbances as a result of discrimination. Socially isolated after years of self-neglect, she prepared to overdose. In 2007, she became open regarding her status after receiving psychosocial support from various sources. She opened her home as an HIV clinic with the help of a local doctor, and subsequently the majority of her psychological symptoms were resolved. This case illustrates the negative impact that stigma and discrimination can have on mental and consequently physical health, both acutely and chronically. It also highlights the importance of social and psychological support in maintaining the well-being of patients with HIV globally.

http://ift.tt/2tTxjti

Laparoscopic excision of an inflammatory myofibroblastic tumour of the bladder disguised as deep infiltrating endometriosis

Inflammatory myofibroblastic tumour (IMT) of the bladder is a rare tumour of indeterminate malignant potential with myofibroblastic differentiation, with a generally benign but rarely aggressive behaviour. Vesical IMT is usually treated by transurethral resection or partial cystectomy. Herein we describe a case of a woman who underwent laparoscopic excision of an IMT of the bladder, initially diagnosed as deep infiltrating endometriosis.

http://ift.tt/2taJk0f

Unusual sensory variant of Guillain-Barre syndrome

We describe a 52-year-old woman presenting with acute onset of severe burning paraesthesia in the hands and feet associated with allodynia and antalgic gait. At the time of admission to hospital no motor weakness was present. A diagnosis of Guillain-Barré syndrome (GBS) was considered when neurophysiological studies were completed showing convincing evidence of demyelination on motor conduction studies and sural sparing on sensory nerve studies.¹ We describe this case as a sensory variant of GBS. Clinical improvement followed treatment with a single course of intravenous immunoglobulin (IVIG). The patient made a complete clinical recovery within 6 months of onset and repeat neurophysiological studies showed marked improvement. We encourage clinicians to consider an atypical variant of GBS in patients presenting with acute sensory complaints.

http://ift.tt/2tTdz8S

Disseminated histoplasmosis presenting as multiple oral ulcers

A 61-year-old female with a history of advanced HIV disease and chronic hepatitis B was presented with an 8-week history of painful oral ulcers. She appeared systemically well but examination revealed multiple well-demarcated clean-based ulcers on the tongue and hard palate. Biopsy of one of the lesions showed numerous histiocytes containing intracellular yeast forms consistent with Histoplasma capsulatum var. capsulatum. Fungal blood cultures subsequently grew H. capsulatum var. capsulatum, confirming a diagnosis of disseminated histoplasmosis. She was treated with intravenous amphotericin B for 2 weeks followed by a prolonged course of oral itraconazole, with which her ulcers resolved completely and have not recurred. This case exemplifies how oral ulcers may be a manifestation of an underlying systemic disease and demonstrates the utility of biopsy in establishing a diagnosis.

http://ift.tt/2taN3L7

Organ-sparing surgery for large cell calcifying Sertoli cell tumour in a patient with Carney complex

Carney complex is a rare genetic disease characterised by a complex of myxomas, spotty pigmentation and endocrine overactivity. At diagnosis, about one-third of male patients presents with testicular tumours, namely large cell calcifying Sertoli cell tumours, which are often multicentric and/or bilateral and have a low malignant potential. Although radical orchiectomy is the gold standard for the treatment of testicular neoplasms, a conservative approach with partial orchiectomy or tumourectomy may be the best treatment option for these patients, allowing the preservation of endocrine function, fertility and body image. We present a case of a 19-year-old man with a known history of Carney complex with early identification of a small testicular tumour treated with organ-sparing surgery.

http://ift.tt/2tT3dpv

IVC tumoural thrombosis: an unusual complication of testicular tumour

Description

A 30-year-old man presented with right scrotal mass and bilateral leg oedema for the last 3 months. CT scan showed a heterogeneously enhancing lesion in the right testis with retroperitoneal and mediastinal lymph node (LN) mass with enhancing tumorous thrombus filling the common iliac veins and inferior vena cava (IVC) up to the infrahepatic region with pulmonary metastases (figure 1). The preoperative tumour markers including lactate dehydrogenase, alpha-fetoprotein and human chorionic gonadotropin were 2270 U/L, 28 214 ng/mL and 6253 mIU/mL, respectively. High inguinal orchidectomy was carried out which revealed mixed germ cell tumour (GCT) (pT3N3M1aS3, poor risk as per International Germ Cell Cancer Collaborative Group). Chemotherapy including four cycles of VIP (etoposide, ifosfamide and cisplatin) with anticoagulation was started in the immediate postoperative period. Standard BEP (bleomycin, etoposide and cisplatin) xfour regimen could not be given because of poor pulmonary function. Postchemotherapy CT scan after 4 weeks revealed complete resolution of IVC thrombus with small residual...

http://ift.tt/2ta9wrM

Chilaiditi syndrome mimicking congestive heart failure

Description

An 85-year-old man presented with orthopnoea and dyspnoea, symptoms of which were suspicious for heart failure. He was in respiratory distress and oxygen saturation was 85% on 4 L oxygen. On initial assessment, lungs were clear and heart sounds were normal. What was immediately evident was a distended abdomen. Digital rectal examination revealed hard faeces in rectum. He had a history of chronic constipation and last bowel movement was over 5 days ago.

Chest X-ray (figure 1) showed raised diaphragms with loops of large bowel interposed between the right hemidiaphragm and liver. An abdominal X-ray (figure 2) confirmed faecal impaction. Brain natriuretic peptide, d-dimer and echocardiogram were normal. He eventually underwent manual evacuation following failure of oral laxatives and enemas (figure 3 for follow-up chest X-ray).

Figure 1

Chest X-ray on presentation showing Chilaiditi sign and lungs compressed.

...

http://ift.tt/2tTsxvI

Thyrotoxicosis in patients with hypothyroidism is not just overtreatment

A 62-year-old Caucasian woman presented with hypothyroid symptoms and biochemical thyrotoxic picture. Previously, she underwent right-sided subtotal thyroidectomy and left partial thyroid lobectomy for thyroid lumps, and treated with thyroxine replacement for hypothyroidism. Although there were no significant findings on clinical examination, investigations confirmed thyrotoxicosis with positive autoimmunity against thyroid glandâ"all in line with a diagnosis of Gravesâ™ hyperthyroidism. We would like to highlight atypical presentations of thyroid dysfunction and conversion of underactive to overactive thyroid status with this case. Early recognition, diagnosis and intervention are essential to prevent and/or reduce associated morbidity and mortality. When encountered with such clinical conundrums, we recommend seeking opinion from an experienced endocrinologist while interpreting such situation.

http://ift.tt/2tayV4s

Utility of microscope-integrated optical coherence tomography (MIOCT) in the treatment of myopic macular hole retinal detachment

Macular hole-associated retinal detachment in high myopia is described as a final stage in progression of myopic traction maculopathy (MTM).^1â"3 Shimada et al⁴ described the progressive stages of MTM from macular retinoschisis to serous retinal detachment in high myopia. Stage 4 MTM is characterised as disappearance of retinoschisis with progression to retinal detachment due to macular hole formation. It is hypothesised that vitreoschisis and abnormal vitreo-retinal interface create the premacular tangential traction.^{5 6} Intraoperative triamcinolone acetonide is used to visualise the residual posterior vitreous cortex (PVC). We hereby describe the utility of microscope-integrated optical coherence tomography (MIOCT) in assisting complete removal of PVC and internal limiting membrane (ILM) peeling with multilayered inverted ILM flap in the treatment of myopic macular hole retinal detachment. MIOCT helped identify vitreoschisis and confirm the position of ILM flaps over the macular hole intraoperatively.

http://ift.tt/2tT255j

Gilliamella intestini sp. nov., Gilliamella bombicola sp. nov., Gilliamella bombi sp. nov. and Gilliamella mensalis sp. nov. : four novel Gilliamella species isolated from the bumblebee gut

http://ift.tt/2vkqP65

An assessment of resource conservation in WEEE management from a life cycle perspective: a case study of E-scrap recycling in Belgium

http://ift.tt/2ulJSj9

Accuracy of computer-assisted navigation: significant augmentation by facial recognition software

Background

Over the past 20 years, image guidance navigation has been used with increasing frequency as an adjunct during sinus and skull base surgery. These devices commonly utilize surface registration, where varying pressure of the registration probe and loss of contact with the face during the skin tracing process can lead to registration inaccuracies, and the number of registration points incorporated is necessarily limited. The aim of this study was to evaluate the use of novel facial recognition software for image guidance registration.

Methods

Consecutive adults undergoing endoscopic sinus surgery (ESS) were prospectively studied. Patients underwent image guidance registration via both conventional surface registration and facial recognition software. The accuracy of both registration processes were measured at the head of the middle turbinate (MTH), middle turbinate axilla (MTA), anterior wall of sphenoid sinus (SS), and nasal tip (NT).

Results

Forty-five patients were included in this investigation. Facial recognition was accurate to within a mean of 0.47 mm at the MTH, 0.33 mm at the MTA, 0.39 mm at the SS, and 0.36 mm at the NT. Facial recognition was more accurate than surface registration at the MTH by an average of 0.43 mm (p = 0.002), at the MTA by an average of 0.44 mm (p < 0.001), and at the SS by an average of 0.40 mm (p < 0.001). The integration of facial recognition software did not adversely affect registration time.

Conclusion

In this prospective study, automated facial recognition software significantly improved the accuracy of image guidance registration when compared to conventional surface registration.

http://ift.tt/2uqH5pE

Aggressive necrotizing pseudomonal sinonasal infections

Background

Pseudomonas aeruginosa is a gram-negative bacterium frequently implicated in recalcitrant sinonasal infections, especially in immunocompromised hosts. We report 6 cases of rapidly progressive pseudomonal acute rhinosinusitis producing tissue necrosis and, in certain cases, cranial nerve palsies.

Methods

Retrospective review of 6 patients with aggressive necrotizing sinonasal infections treated at 4 tertiary academic medical centers with sinonasal cultures growing P. aeruginosa in the absence of other pathology.

Results

A total of 6 patients were identified. In all cases, there was tissue necrosis that appeared to mimic an invasive process such as mucormycosis, prompting urgent surgical intervention. Pathologic analysis revealed fibropurulent exudates in backgrounds of positive P. aeruginosa cultures without evidence of invasive fungal organisms or malignancy. Four of the 6 patients presented with cranial nerve palsies, with 3 patients having vision changes and 3 complaining of trigeminal neuropathy. Four of 6 patients improved clinically over time after surgery and antibiotic therapy; 1 remains in follow-up without complete improvement and 1 has succumbed to other causes.

Conclusion

P. aeruginosa is a tenacious organism that is frequently associated with severe, recalcitrant sinonasal infections. We report the first case series of necrotizing sinonasal infections caused by this organism, and illustrate that, in rare cases, P. aeruginosa may mimic and behave like life-threatening conditions such as fulminant invasive fungal sinusitis or malignancy.

http://ift.tt/2uZfau2

Inhibition of fibroblast growth factor receptor with AZD4547 mitigates juvenile nasopharyngeal angiofibroma

Background

Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor that presents in adolescent males. Although surgical excision is the mainstay of treatment, recurrences complicate treatment. There is a need to develop less invasive approaches for management. JNA tumors are composed of fibroblasts and vascular endothelial cells. We identified fibroblast growth factor receptor (FGFR) and vascular endothelial growth factor (VEGF) expression in JNA-derived fibroblasts. FGFR influences fibroblast proliferation and VEGF is necessary for angiogenesis. We hypothesized that targeting FGFR would mitigate JNA fibroblast proliferation, invasion, and migration, and that targeting the VEGF receptor would attenuate endothelial tubule formation.

Methods

After informed consent, fibroblasts from JNA explants of 3 patients were isolated. Fibroblasts were treated with FGFR inhibitor AZD4547, 0 to 25 μg/mL for 72 hours and proliferation was quantified using CyQuant assay. Migration and invasion of JNA were assessed using 24-hour transwell assays with subsequent fixation and quantification. Mitigation of FGFR and downstream signaling was evaluated by immunoblotting. Tubule formation was assessed in human umbilical vein endothelial cells (HUVECs) treated with vehicle control (dimethylsulfoxide [DMSO]) or semaxanib (SU5416) as well as in serum-free media (SFM) or JNA conditioned media (CM). Tubule length was compared between treatment groups.

Results

Compared to control, AZD4547 inhibited JNA fibroblast proliferation, migration, and invasion through inhibition of FGFR and downstream signaling, specifically phosphorylation of - p44/42 mitogen activated protein kinase (p44/42 MAPK). JNA fibroblast CM significantly increased HUVEC tubule formation (p = 0.0039).

Conclusion

AZD4547 effectively mitigates FGFR signaling and decreases JNA fibroblast proliferation, migration, and invasion. SU5416 attenuated JNA fibroblast-induced tubule formation. AZD4547 may have therapeutic potential in the treatment of JNA.

http://ift.tt/2uqvrLr

Comparison of the Effect of Skin Preparation Pads on Transepidermal Water Loss in Ex Vivo Human Skin

Abstract

Introduction

Pre-treatment of the skin to remove scales and crusts prior to photodynamic therapy (PDT) is essential to enhance the uptake of topically applied methyl aminolevulinate (MAL) and to improve treatment efficacy. This study compared the effect of two different skin preparation pads on skin integrity in ex vivo human skin.

Methods

Ex vivo human skin samples from three donors were pre-treated in triplicates with PREPSTER™ (PR) skin preparation pad (6, 8, and 10 passages) or Ambu Unilect™ (A-UN) skin preparation pad (6, 8, and 10 passages). In addition, skin samples were pre-treated with tape strippings (10 adhesive tape strips) as a reference method for comparison. Transepidermal water loss (TEWL) was measured on intact skin and following skin barrier impairment using skin preparation pads and tape stripping. Histological analysis was performed to verify the impairment of the stratum corneum (SC) barrier function in samples from intact skin (control), 10 tape strippings (reference method), 10 passages of PR, and 10 passages of A-UN.

Results

TEWL increased with the increasing number of passages of skin preparation pads, with 2.4- and 3.3-fold increases following 10 passages of A-UN and PR, respectively, versus a 2.2-fold increase with 10 tape strippings (reference). Histological analysis showed only partial removal of the SC, with no damage observed on the epidermis, regardless of the procedure used.

Conclusion

Pre-treatment of skin using PR and A-UN skin preparation pads markedly increases TEWL, indicating slight impairment of the SC barrier function. Comparison of both skin preparation pads showed that PR pad consistently induced significantly higher TEWL than A-UN pad (p < 0.05), regardless of the number of passages. Both skin preparation pads are thought to increase the uptake of MAL and can therefore be used for the preparation of skin prior to PDT.

Funding

Nestlé Skin Health – Galderma R&D.

http://ift.tt/2ulZJON

Zeitpunkt der Chemotherapie und Überleben beim Magenkarzinom

http://ift.tt/2ulNIJ0

Observation of Broadband Optical Gain in Quasi-2D CdSe Nanoplatelets

Solution processable nanomaterials for photonic applications, in particular light emission and lasing, have received much attention in the past decade(s). A demonstration of ultralow continuous wave optical gain and lasing using CdSe platelets, quasi-2D materials in a colloidal dispersion, was the most recent milestone in this field. Until now, the optical gain in these quasi-2D systems was though to originate from the biexciton-to-exciton transition, much as is the case for 0D colloidal QDs. The net gain should therefore occur at biexciton carrier densties and moreover only develop in a narrow region below the lowest energy exciton feature. Here, we show that quasi-2D colloidal CdSe platelets are instead able to deliver broadband optical gain and that this gain is caused by the formation of a high temperature, unbound electron-hole gas, a first demonstration for a solution processable material. Moreover, the control over the plasma temperature indicates that the material gain can be tuned and even enhanced in different spectral regions. These results shed a new light on the role of excitons in solution processable inorganic gain media and pave the way for the development of more efficient gain media.

http://ift.tt/2tmnems

Manifestationen von Autoimmunerkrankungen in der HNO-Heilkunde

Zusammenfassung

Manifestationen von Autoimmunerkrankungen stellen eine diagnostische Herausforderung dar. Es existieren jedoch verschiedene Erkrankungen dieser Genese, die sich mit typischen Symptomen im Hals-Nasen-Ohren-Bereich manifestieren und daher bei der Differenzialdiagnose berücksichtigt werden sollten. Das Sjögren-Syndrom, verschiedene Vaskulitiden und die Sarkoidose repräsentieren die häufigsten Autoimmunerkrankungen der Hals-Nasen-Ohren-Heilkunde, es werden jedoch auch IgG4-assoziierte Erkrankungen, die rezidivierende Polychondritis und autoimmune Erkrankungen der Schleimhäute beobachtet. Autoimmunerkrankungen können zu Schallempfindungsdefiziten führen. Im Bereich der Schilddrüse können sowohl Hypo- als auch Hyperthyreosen durch Autoimmunerkrankungen verursacht werden. Häufig orientiert sich die Diagnose an entsprechenden Klassifikationskriterien, deren korrekte Anwendung die Abklärung dieser Erkrankungen erleichtern kann.

http://ift.tt/2ta0TgY

Minimally invasive management of traumatic lung herniation

Abstract

Post-traumatic pulmonary hernia can occur immediately after thoracic trauma or it may also appear months or even years after the onset. We report a case of a seventeen year-old male patient with thoracic blunt trauma secondary to high energy bicycle accident. Chest CT shows moderate hemothorax and pneumothorax, displaced fracture of the fifth left rib, and protusion of pulmonary tissue through a chest wall defect. In the Emergency Room the patient presents with chest pain (7/10 in Visual Analog Scale) and respiratory distress. Video-assisted thoracic surgery approach was chosen. Hernia reduction, non-anatomic lingular resection and rib fracture external fixation using a titanium plate was performed. Traumatic pulmonary hernia is an uncommon complication of thoracic trauma which may constitute an emergency for the trauma or thoracic surgeon. The early management of this injury can be developed by minimally invasive approach with excellent results.

http://ift.tt/2tTowaR

Syndrome of inappropriate antidiuretic hormone associated with rectal small cell neuroendocrine carcinoma: a case report

Abstract

Neuroendocrine tumors can arise from any portion of the gastrointestinal tract including the colon and rectum. In the scope of all colon and rectal malignancies, they are a rare cause of colorectal carcinoma. Relating to their pluripotent neuroendocrine cellular origins these carcinomas can produce a variety of biologically active peptides with several resultant paraneoplastic syndromes. One of these paraneoplastic syndromes is the syndrome of inappropriate antidiuretic hormone (SIADH). In the SIADH, supraphysiologic levels of vasopressin (antidiuretic hormone, AVP) precipitates exorbitant free water retention and resultant electrolyte abnormalities, most notably hyponatremia. Herein we report a rare case of paraneoplastic SIADH from rectal small cell neuroendocrine carcinoma. To our knowledge, SIADH from rectal small cell neuroendocrine carcinoma has been reported only three times.

http://ift.tt/2tSV3xn

A rare diaphragmatic hernia with a delayed presentation of intestinal symptoms following spleno-distal pancreatectomy: a case report

ABSTRACT

Acquired diaphragmatic hernia, non-related to trauma, is a very rare condition. It can constitute a therapeutic problem and the surgical solution is not always immediately clear. We report the case of a 73-year-old woman with a history of spleno-distal pancreatectomy for a neuroendocrine tumour performed in 2009, who came back to Emergency Room 2 years later, complaining of abdominal pain. Chest radiography and computed tomography were performed; they showed a diaphragmatic hernia with visceral migration into the thorax. The diaphragmatic defect was surgically repaired and the patient had an uneventful post-operative recovery.

http://ift.tt/2tT5bpU

The use of geoscience methods for aquatic forensic searches

Ruffell, A; Pringle, JK; Cassella, JP; Morgan, RM; Ferguson, M; Heaton, VG; Hope, C; Ruffell, A; Pringle, JK; Cassella, JP; Morgan, RM; Ferguson, M; Heaton, VG; Hope, C; McKinley, JM; - view fewer (2017) The use of geoscience methods for aquatic forensic searches. [Review]. Earth-Science Reviews , 171 pp. 323-337. 10.1016/j.earscirev.2017.04.012 .

http://ift.tt/2tQ6zLB

Cerebral rituximab uptake in multiple sclerosis: A (89)Zr-immunoPET pilot study

Hagens, MH; Killestein, J; Yaqub, MM; van Dongen, GA; Lammertsma, AA; Barkhof, F; van Berckel, BN; (2017) Cerebral rituximab uptake in multiple sclerosis: A (89)Zr-immunoPET pilot study. Multiple Sclerosis 10.1177/1352458517704507 . (In press). Green open access

http://ift.tt/2tmK8KB

A study of Notch signalling in development angiogenesis

Phng, L-K; (2009) A study of Notch signalling in development angiogenesis. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2tQhGEF

Dislocation loop formation by swift heavy ion irradiation of metals

Khara, GS; Murphy, ST; Duffy, DM; (2017) Dislocation loop formation by swift heavy ion irradiation of metals. Journal of Physics: Condensed Matter , 29 (28) , Article 285303. 10.1088/1361-648X/aa74f8 . Green open access

http://ift.tt/2tmz7cg

Palliative care education in Latin America: A systematic review of training programs for healthcare professionals

Vindrola, C; Mertnoff, R; Lasmarias, C; Gomez-Batiste, X; (2017) Palliative care education in Latin America: A systematic review of training programs for healthcare professionals. Palliative and Supportive Care 10.1017/S147895151700061X . (In press).

http://ift.tt/2tQBZ4H

A spatio-temporal analysis of access to higher education

Singleton, AD; (2007) A spatio-temporal analysis of access to higher education. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2tm6goA

The Heterocellular Emergence of Colorectal Cancer.

Tape, CJ; (2017) The Heterocellular Emergence of Colorectal Cancer. Trends Cancer , 3 (2) pp. 79-88. 10.1016/j.trecan.2016.12.004 . Green open access

http://ift.tt/2tQcz7b

Editorial for special issue on Job Tasks and Labour Studies

Green, F; Handel, M; (2016) Editorial for special issue on Job Tasks and Labour Studies. Journal for Labour Market Research , 49 (2) pp. 97-98. 10.1007/s12651-016-0212-2 . Green open access

http://ift.tt/2tmK6SZ

Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease

Augustin, S; Pons, M; Maurice, JB; Bureau, C; Stefanescu, H; Ney, M; Blasco, H; Augustin, S; Pons, M; Maurice, JB; Bureau, C; Stefanescu, H; Ney, M; Blasco, H; Procopet, B; Tsochatzis, E; Westbrook, RH; Bosch, J; Berzigotti, A; Abraldes, JG; Genescà, J; - view fewer (2017) Expanding the Baveno VI criteria for the screening of varices in patients with compensated advanced chronic liver disease. Hepatology 10.1002/hep.29363 . (In press).

http://ift.tt/2tmNcXc

Clinical and patient-reported outcomes of SPARE - a randomised feasibility study of selective bladder preservation versus radical cystectomy

Huddart, RA; Birtle, A; Maynard, L; Beresford, M; Blazeby, J; Donovan, J; Kelly, JD; Huddart, RA; Birtle, A; Maynard, L; Beresford, M; Blazeby, J; Donovan, J; Kelly, JD; Kirkbank, T; Mclaren, DB; Mead, G; Moynihan, C; Persad, R; Scrase, C; Lewis, R; Hall, E; - view fewer (2017) Clinical and patient-reported outcomes of SPARE - a randomised feasibility study of selective bladder preservation versus radical cystectomy. BJU International 10.1111/bju.13900 . (In press). Green open access

http://ift.tt/2tQ8gsB

A scale-down evaluation of adsorptive process options for the recovery and initial purification of antibody fragments from crude E. coli feedstocks

Ujam, SB; (2007) A scale-down evaluation of adsorptive process options for the recovery and initial purification of antibody fragments from crude E. coli feedstocks. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2tmapJ9

Genome analysis of Diploscapter coronatus: insights into molecular peculiarities of a nematode with parthenogenetic reproduction

Hiraki, H; Kagoshima, H; Kraus, C; Schiffer, PH; Ueta, Y; Kroiher, M; Schierenberg, E; Hiraki, H; Kagoshima, H; Kraus, C; Schiffer, PH; Ueta, Y; Kroiher, M; Schierenberg, E; Kohara, Y; - view fewer (2017) Genome analysis of Diploscapter coronatus: insights into molecular peculiarities of a nematode with parthenogenetic reproduction. BMC Genomics , 18 (1) , Article 478. 10.1186/s12864-017-3860-x . Green open access

http://ift.tt/2tQvHlK

ESPGHAN- Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children with Neurological Impairment

Romano, C; van Wynckel, M; Hulst, J; Broekaert, I; Bronsky, J; Dall'Oglio, L; Mis, NF; Romano, C; van Wynckel, M; Hulst, J; Broekaert, I; Bronsky, J; Dall'Oglio, L; Mis, NF; Hojsak, I; Orel, R; Papadopoulou, A; Schaeppi, M; Thapar, N; Wilschanski, M; Sullivan, P; Gottrand, F; - view fewer (2017) ESPGHAN- Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children with Neurological Impairment. Journal of Pediatric Gastroenterology and Nutrition 10.1097/MPG.0000000000001646 . (In press).

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First Results from BISTRO: A SCUBA-2 Polarimeter Survey of the Gould Belt

Ward-Thompson, D; Pattle, K; Bastien, P; Furuya, RS; Kwon, W; Lai, S-P; Qiu, K; Ward-Thompson, D; Pattle, K; Bastien, P; Furuya, RS; Kwon, W; Lai, S-P; Qiu, K; Berry, D; Choi, M; Coude, S; Di Francesco, J; Hoang, T; Franzmann, E; Friberg, P; Graves, SF; Greaves, JS; Houde, M; Johnstone, D; Kirk, JM; Koch, PM; Kwon, J; Lee, CW; Li, D; Matthews, BC; Mottram, JC; Parsons, H; Pon, A; Rao, R; Rawlings, M; Shinnaga, H; Sadavoy, S; van Loo, S; Aso, Y; Byun, D-Y; Eswaraiah, C; Chen, H-R; Chen, MC-Y; Chen, WP; Ching, T-C; Cho, J; Chrysostomou, A; Chung, EJ; Doi, Y; Drabek-Maunder, E; Eyres, SPS; Fiege, J; Friesen, RK; Fuller, G; Gledhill, T; Griffin, MJ; Gu, Q; Hasegawa, T; Hatchell, J; Hayashi, SS; Holland, W; Inoue, T; Inutsuka, S-I; Iwasaki, K; Jeong, I-G; Kang, J-H; Kang, M; Kang, S-J; Kawabata, KS; Kemper, F; Kim, G; Kim, J; Kim, K-T; Kim, KH; Kim, M-R; Kim, S; Lacaille, KM; Lee, J-E; Lee, S-S; Li, D; Li, H-B; Liu, H-L; Liu, J; Liu, S-Y; Liu, T; Lyo, A-R; Mairs, S; Matsumura, M; Moriarty-Schieven, GH; Nakamura, F; Nakanishi, H; Ohashi, N; Onaka, T; Peretto, N; Pyo, T-S; Qian, L; Retter, B; Richer, J; Rigby, A; Robitaille, J-F; Savini, G; Scaife, AMM; Soam, A; Tamura, M; Tang, Y-W; Tomisaka, K; Wang, H; Wang, J-W; Whitworth, AP; Yen, H-W; Yoo, H; Yuan, J; Zhang, C-P; Zhang, G; Zhou, J; Zhu, L; Andre, P; Dowell, CD; Falle, S; Tsukamoto, Y; - view fewer (2017) First Results from BISTRO: A SCUBA-2 Polarimeter Survey of the Gould Belt. Astrophysical Journal , 842 (1) , Article 66. 10.3847/1538-4357/aa70a0 . Green open access

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