Risk of anaphylaxis in complementary and alternative medicine.

Purpose of review: Complementary and alternative medicine (CAM) use is widespread across the world. Patients with asthma and allergy regularly use CAM therapies. Allergic and anaphylactic reactions to CAM have been reported. Recent findings: Recent attempts to regulate and monitor adverse reaction to these therapies have given us further insight into potential causes of severe allergic reactions. Several culprits identified including Andrographis paniculata, Echinacea species, bee products, Ginkgo biloba and Ginseng are discussed here. Summary: Knowing the factors that increase the risk of anaphylaxis allows reactions to be recognized, reported and further investigated. Research to identify key causative allergens is necessary in the future. Collaboration between the allergy community and CAM practitioners can allow better understanding of allergy to these therapies. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2uScvWs

Risk of anaphylaxis in complementary and alternative medicine.

Purpose of review: Complementary and alternative medicine (CAM) use is widespread across the world. Patients with asthma and allergy regularly use CAM therapies. Allergic and anaphylactic reactions to CAM have been reported. Recent findings: Recent attempts to regulate and monitor adverse reaction to these therapies have given us further insight into potential causes of severe allergic reactions. Several culprits identified including Andrographis paniculata, Echinacea species, bee products, Ginkgo biloba and Ginseng are discussed here. Summary: Knowing the factors that increase the risk of anaphylaxis allows reactions to be recognized, reported and further investigated. Research to identify key causative allergens is necessary in the future. Collaboration between the allergy community and CAM practitioners can allow better understanding of allergy to these therapies. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2uScvWs

A Single 10 mg Oral Dose of Biotin Interferes with Thyroid Function Tests

Thyroid , Vol. 0, No. 0.


http://ift.tt/2uSaCZQ

Endoscopic transcanal myringoplasty for tympanic perforations: An outpatient minimally invasive procedure

Since the 1950s, microscopic myringoplasty has been the standard surgery for repairing a perforated tympanic membrane. In addition to conventional microscopic myringoplasty, endoscopic myringoplasty has been an emerging technique since the late 1990s. This study evaluated the efficacy of endoscopic transcanal myringoplasty for repairing tympanic perforations and examined the minimally invasive feature of this technique (no postauricular incision, no canalplasty).

http://ift.tt/2uS5pBl

The treatment and outcome analysis of primary squamous cell carcinoma of the thyroid

Primary squamous cell carcinoma (SCC) of the thyroid is a rare disease. It usually presents with locally advanced disease and has an overall poor prognosis. In this study, we investigated the characteristics and outcomes of patients with SCC of the thyroid, and reported our experience with chemotherapy with lenvatinib in the treatment of SCC of the thyroid.

http://ift.tt/2vKx6bE

MicroRNA-27b inhibits cell proliferation in oral squamous cell carcinoma by targeting FZD7 and Wnt signaling pathway

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Bingyao Liu, Wei Chen, Gang Cao, Zhen Dong, Jinke Xu, Tingyuan Luo, Senlin Zhang
This study intended to investigate the role of microRNA-27b (miR-27b) in proliferation of oral squamous cell carcinoma (OSCC) cells and to explore the potential molecular mechanism. Cell proliferation was detected by MTT assay. The expression levels of miR-27b, Frizzled7 (FZD7), cyclin D1 and c-myc were detected by quantitative real time polymerase chain reaction (qRT-PCR). The protein expression level of FZD7 was detected by western blot analysis. The relationship between miR-27b and FZD7, and the activity of Wnt signaling pathway were determined using luciferase reporter assay. The miR-27b expression in OSCC cell lines was significantly decreased compared with control. Overexpression of miR-27b remarkably inhibited OSCC cell proliferation. Additionally, miR-27b could target and inhibit FZD7 expression and decrease the activity of Wnt signaling pathway.miR-27b could inhibit OSCC cell proliferation through inhibiting FZD7 and FZD7-mediated Wnt signaling pathway.



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Determinants of Infection Outcome in HCV-Genotype 4

Viral Immunology , Vol. 0, No. 0.


http://ift.tt/2ukxmhV

Hepatitis transmission risk in kidney transplantation (the HINT study): a cross-sectional survey of transplant clinicians in Australian and New Zealand.

Background: Interpreting hepatitis serology and virus transmission risk in transplantation can be challenging. Decisions must balance opportunity to transplant against potential infection transmission. We aimed to survey understanding among the Australian and New Zealand medical transplant workforce of hepatitis risk in kidney donors and recipients. Methods: An anonymous, self-completed, cross-sectional survey was distributed via electronic mailing lists to Australian and New Zealand clinicians involved in kidney transplantation (2014-2015). We compared interpretation of clinical scenarios with paired donor and recipient hepatitis B and C (HBV, HBC) serology to recommendations in clinical practice guidelines. We used logistic regression modelling to investigate characteristics associated with decisions on transplant suitability in scenarios with poor (

http://ift.tt/2toFOeT

Monoclonal Gammopathy of Undetermined Significance after Kidney Transplantation: single-center experience.

Background: Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic premalignant plasma cell disorder. Prevalence and clinical outcomes of MGUS in kidney transplant (KT) recipients have been previously reported in few studies with conflicting results. Methods: We conducted a retrospective study in a population of 548 KT recipients transplanted between 1998 and 2015. Results: Thirty-nine subjects (8.1%) developed MGUS after KT. At diagnosis of MGUS, the average age was 52+/-9.2 years and 23% of patients were younger than 50 years. Occurrence of MGUS was not influenced by age and sex. After a mean follow-up of 7.8 years, only 1 patient (2.5%) progressed to multiple myeloma. We found no differences in the incidence of solid and hematological malignancies, serious infections, graft failure and mortality between KT patients with MGUS and a matched cohort of KT recipients without MGUS. The MGUS group had a significantly higher prevalence of Monoclonal B cell Lymphocytosis (MBL), premalignant condition poorly described in KT recipients. Prior history of glomerulonephritis or interstitial nephritis, as cause of renal failure, represented the only predictive factor for MGUS development. Conclusions: MGUS is a premalignant disorder frequently encountered in KT recipients; we found no differences in clinical outcomes between MGUS patients and KT controls. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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C1-inhibitor Treatment Decreases Renal Injury in an Established Brain-dead Rat Model.

Background: Kidneys derived from brain-dead (BD) donors have lower graft survival rates compared to kidneys from living donors. Complement activation plays an important role in brain death. The aim of our study was therefore to investigate the effect of C1-inhibitor (C1-INH) on BD-induced renal injury. Methods: Brain death was induced in rats by inflating a subdurally placed balloon catheter. Thirty minutes after BD, rats were treated with saline, low-dose or high-dose C1-INH. Sham-operated rats served as controls. After 4 hours of brain death, renal function, injury, inflammation and complement activation was assessed. Results: High-dose C1-INH treatment of BD donors resulted in significantly lower renal gene expression and serum levels of IL-6. Treatment with C1-INH also improved renal function and reduced renal injury, reflected by the significantly lower KIM-1 gene expression and lower serum levels of LDH and creatinine. Furthermore, C1-INH effectively reduced complement activation by brain death and significantly increased functional levels. However, C1-INH treatment did not prevent renal cellular influx. Conclusions: Targeting complement activation after the induction of brain death reduced renal inflammation and improved renal function, before transplantation. Therefore, strategies targeting complement activation in human BD donors might clinically improve donor organ viability and renal allograft survival. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Oral nucleos(t)ide Analogs Alone After Liver Transplantation in Chronic Hepatitis B with Preexisting rt204 Mutation.

Background: There is currently limited data regarding the use of oral antiviral therapy alone without HBIG for CHB patients with preexisting LAM-resistance (LAM-R) undergoing liver transplantation. Methods: This is a cohort study determining the effectiveness and long-term outcome in this group of patients. Results: Fifty-seven consecutive CHB patients with preexisting rt204 LAM-R mutations or virological load refractory to LAM undergoing liver transplantation were included, with a median follow-up of 73 months. Fifty-five (96.5%) patients received a regimen that included the use of nucleotide analogs. The cumulative rate of HBsAg seroclearance at 1, 5, and 10 years was 82%, 88%, and 91% respectively. At the time of transplantation, 39 (72%) patients had detectable HBV DNA, with a median of 4.5 log copies/mL. The cumulative rate of HBV undetectability was 91% at 1 year, increasing to 100% by 5 years. After 1 year of liver transplantation, over 90% of patients had undetectable HBV DNA, and from 8 years onwards, 100% had undetectable HBV DNA. The overall long-term survival was excellent, with a 12-year survival of 87%. There was no HBV-related graft loss, and no retransplantation or deaths due to HBV reactivation. Conclusion: Oral antiviral therapy alone without HBIG is highly effective in preventing HBV reactivation and graft loss from recurrent hepatitis B after liver transplantation in patients with preexisting lamivudine resistance HBV. The long-term outcome was excellent, with survival of 87% at 12 years after transplantation, without any mortality related to HBV reactivation. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Trichodysplasia Spinulosa.

No abstract available

http://ift.tt/2toaJIh

New answers to old conundrums: what antibodies, exosomes and inflammasomes bring to the conversation. Canadian National Transplant Research Program international summit report.

Antibody-mediated injury is a major cause of allograft dysfunction and loss. Antibodies to ABH(O) blood group antigens are classical mediators of ABO-incompatible (ABOi) graft rejection, while donor-specific anti-HLA antibodies and, more recently, autoantibodies are appreciated as important contributors to allograft inflammation and dysfunction. In August 2016, the International Summit of the Canadian National Transplant Research Program focused on recent advances in the field of antibody-mediated rejection. Here, we describe work presented and discussed at the meeting, with a focus on 3 major themes: the importance of 1- Natural antibodies and autoantibodies, 2- tissue injury derived exosomes and autoimmunity, 3- inflammasome activation and innate immune responses in regulating allograft inflammation and dysfunction. Finally, we explore novel areas of therapeutic intervention that have recently emerged from these 3 major and overlapping fields of transplantation research. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2uKiv2y

Seasonal variability precipitating hand transplant rejection?.

No abstract available

http://ift.tt/2tosdE4

Expanding the Toolkit for the Study of Allo-specific B and T Cell Responses.

No abstract available

http://ift.tt/2uK74ba

Terasaki epitope mismatch burden predicts the development of de novo DQ donor specific antibodies and are associated with adverse allograft outcomes.

Background: De novo DQ DSA are associated with antibody-mediated rejection and allograft loss. Given the lack of effective treatment of de novo DQ DSA, their prevention is vital if there is to be an improvement of long term allograft survival. Using the HLA Matchmaker programme, DQ epitope matching has been shown to be superior to HLA antigen mismatching in predicting de novo DQ DSA development. Whether DQ epitopes determined by Terasaki may more accurately predict de novo DQ development over HLA antigen matching is not known. Methods: We retrospectively analysed the immunogenicity of the different HLA antigens, DQB1 alleles and DQB1 Teraskai epitopes (TerEp) in a large cohort of renal transplant recipients, by comparing patient mismatches with de novo DSA development. Results: Patients mismatched at a DQB1 allele were at significantly higher risk of developing de novo DSA compared with other mismatched HLA antigens. Patients mismatched at the DQ7 allele appear to be at specific risk. For patients mismatched at a single DQB1 allele, the risk of de novo DQ DSA development increases with the number of TerEp mismatches. However, the immunogenicity of the different DQ TerEps, do not appear to be equal. Patients who develop antibodies against TerEps are at increased risk of adverse allograft outcomes, specifically antibody-mediated rejection. Conclusion: Epitope mismatch burden, determined by TerEps, helps predict risk of de novo DQ DSA development, and offers an alternative approach to predict an alloimmune response. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2tobxN4

Endoscopic transcanal myringoplasty for tympanic perforations: An outpatient minimally invasive procedure

Publication date: Available online 21 July 2017
Source:Auris Nasus Larynx
Author(s): Chih-Chieh Tseng, Ming-Tang Lai, Chia-Che Wu, Sheng-Po Yuan, Yi-Fang Ding
ObjectiveSince the 1950s, microscopic myringoplasty has been the standard surgery for repairing a perforated tympanic membrane. In addition to conventional microscopic myringoplasty, endoscopic myringoplasty has been an emerging technique since the late 1990s. This study evaluated the efficacy of endoscopic transcanal myringoplasty for repairing tympanic perforations and examined the minimally invasive feature of this technique (no postauricular incision, no canalplasty).MethodsWe retrospectively reviewed the medical records of patients who underwent endoscopic transcanal myringoplasty for perforations of the tympanic membrane. The main outcome was the overall rate of graft success of endoscopic transcanal myringoplasty.ResultsA total of 181 patients were included in the analysis. The overall graft success was determined in 163 of 181 patients (92.8%). The mean preoperative and postoperative air-bone gaps were 19.3dB and 7.8dB, respectively, revealing a significant improvement of 11.5dB (Cohen's d, 1.27; 95% CI, 1.03–1.50; P<0.05; paired t test) in the air-bone gap. The rate of graft success with partial visualization of the perforation margin was comparable to that with complete visualization of the perforation margin. Larger sizes of perforations were significantly associated with lower rates of graft success (P<0.01).ConclusionOur study revealed that the rate of graft success and hearing results of endoscopic transcanal myringoplasty and microscopic myringoplasty are comparable for repairing perforations of the tympanic membrane. Visualization of the perforation margin by otoscopy did not affect the rate of graft success. However, endoscopic transcanal myringoplasty is less invasive because this technique does not require postauricular incision, canalplasty, and general anesthesia.



http://ift.tt/2toGhO2

Neuraxial drug delivery for the management of cancer pain: cost, updates, and society guidelines.

Purpose of review: The present study discusses the utilization of neuraxial drug delivery (NDD) for the management of cancer pain, based on recent trials, reviews, and guidelines with a focus on cost analysis. Recent findings: Almost all recent publications suggest that more stringent research is needed to improve evidence on NDD, particularly as conflicting reports exist regarding cost effectiveness of drug delivery systems. The combination of local anesthetics and opioids, with or without clonidine, continues to be reported as beneficial with the utilization of patient controlled systems providing an advantage over continuous ones. Interestingly, the use of opioids as an adjunct to local anesthetics may not enhance analgesia but the addition of dexamethasone is useful for incident cancer-related bone pain. Ziconitide remains supported as first-line therapy in districts where it is available - United States and Europe. Although new targeted drugs are being designed for cancer pain management, none have seen human clinical trials in the last year. Summary: The ability to demonstrate cost effectiveness of NDD is variable from region to region. Less expensive externalized systems may pose a viable alternative. With the exception of dexamethasone, no new drugs have been shown to provide any benefit to conventional medications. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2ujgEky

Management of complex spine surgery.

Purpose of review: The main objective of this article is to present the updated data regarding the perioperative management of patients undergoing major spine surgery in an era where the surgical techniques are changing and there is a high demand for these surgeries in older and high-risk patients. Recent findings: Preoperative assessment and stabilization is now more structured protocol and it is based on a multidisciplinary approach to the patient. The Enhanced Recovery After Surgery (ERAS) programs and the Perioperative Surgical Home on major spine surgery are not yet fully evidence based but it seems that the use of a perioperative optimization of patients and use of a drugs' bundle is more effective than using single drugs or interventions on the postoperative pain reduction and faster recovery from surgery. Fluid and pain-control protocols combined with an accurate blood management represent the key to success. Summary: A tailored approach to patients undergoing major spine surgeries seems to be effective improving the outcome and quality of life of patients. Future studies should aim to understand which elements of the ERAS can be improved to allow the patient to have a long-term good outcome. Video abstract: http://ift.tt/2vtcsgP Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2ujeGRp

Promising approaches for treatment and prevention of viral respiratory illnesses

Publication date: Available online 21 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Nikolaos G. Papadopoulos, Spyridon Megremis, Nikolaos A. Kitsioulis, Olympia Vangelatou, Peter West, Paraskevi Xepapadaki
Viral respiratory infections are the most common human ailments, leading to enormous health and economic burden. Hundreds of virus species and subtypes have been associated with these conditions, with influenza viruses (IFV), respiratory syncytial virus (RSV) and the rhinoviruses (RV) being the most frequent and with the highest burden. When considering prevention or treatment of viral respiratory infections, potential targets include the causative pathogens themselves but also the immune response, disease transmission or even just the symptoms. Strategies targeting all these aspects are concurrently developing and several novel and promising approaches are emerging. In this perspective, we overview the entire range of options and highlight some of the most promising approaches, including new antivirals, symptomatic or immunomodulatory drugs, the re-emergence of natural remedies, as well as vaccines and public health policies towards prevention. Wide scale prevention through immunisation appears to be within reach for RSV and promising for IFV, while additional effort is needed in regard to RV, as well as other respiratory viruses.



http://ift.tt/2txD4jf

Effect of home exposure to Staphylococcus aureus on asthma in adolescents

Publication date: Available online 21 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Meghan F. Davis
This is the first study to find that environmental Staphylococcus aureus and staphylococcal enterotoxins in a national population of inner-city adolescents with asthma are common and have the potential to drive asthma symptoms.



http://ift.tt/2vtUPNU

Genetic and epigenetic regulation of YKL-40 in childhood

Publication date: Available online 21 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Stefano Guerra, Erik Melén, Jordi Sunyer, Cheng-Jian Xu, Iris Lavi, Marta Benet, Mariona Bustamante, Anne-Elie Carsin, Carlota Dobaño, Mònica Guxens, Christina Tischer, Martine Vrijheid, Inger Kull, Anna Bergström, Ashish Kumar, Cilla Söderhäll, Ulrike Gehring, Dorieke J. Dijkstra, Pieter van der Vlies, Magnus Wickman, Jean Bousquet, Dirkje S. Postma, Josep M. Anto, Gerard H. Koppelman
BackgroundCirculating levels of the chitinase-like protein YKL-40 are influenced by genetic variation in its encoding gene (CHI3L1) and are increased in several diseases, including asthma. Epigenetic regulation of circulating YKL-40 early in life is unknown.ObjectiveTo determine (1) whether methylation levels at CHI3L1 CpG sites mediate the association of CHI3L1 single nucleotide polymorphisms (SNPs) with YKL-40 levels in the blood; and (2) whether these biomarkers (CHI3L1 SNPs, methylation profiles, and YKL-40 levels) are associated with asthma in early childhood.MethodsWe used data from up to 2405 participants from the INMA, BAMSE, and PIAMA birth cohorts. Associations between 68 CHI3L1 SNPs, methylation levels at 14 CHI3L1 CpG sites in whole blood DNA, and circulating YKL-40 levels at 4 years of age were tested using correlation analysis, multivariable regression, and mediation analysis. Each of these biomarkers was also tested for association with asthma at 4 years of age using multivariable logistic regression.ResultsYKL-40 levels were significantly associated with seven SNPs and with methylation at five CpG sites. Consistent associations between these seven SNPs (particularly rs10399931 and rs4950928) and five CpG sites were observed. Alleles linked to lower YKL-40 levels were associated with higher methylation levels. Participants with high YKL-40 levels (defined as the highest YKL-40 tertile) had increased odds for asthma as compared with subjects with low YKL-40 levels [meta-analyzed adjusted odds ratio (adjOR): 1.90, 1.08-3.36]. In contrast, neither SNPs nor methylation levels at CpG sites in CHI3L1 were associated with asthma.ConclusionsThe effects of CHI3L1 genetic variation on circulating YKL-40 are partly mediated by methylation profiles. In our study, YKL-40 levels, but not CHI3L1 SNPs or methylation levels, were associated with childhood asthma.

Teaser

Circulating YKL-40 and variation in its encoding gene CHI3L1 have been associated with asthma. We found that methylation levels at CHI3L1 CpG sites partly mediated CHI3L1 genetic effects on circulating YKL-40, although they were not associated with childhood asthma.


http://ift.tt/2txHmqJ

Thoracic paravertebral block for postoperative pain management after renal surgery: A randomised controlled trial.

BACKGROUND: Thoracic paravertebral block (ThPVB) combined with general anaesthesia is used in thoracic and general surgery. It provides effective analgesia, reduces surgical stress response and the incidence of chronic postoperative pain. OBJECTIVE: To assess the efficacy of ThPVB in reducing opioid requirements and decreasing the intensity of pain after renal surgery. DESIGN: A prospective, randomised, open label study. SETTING: A single university hospital. Study conducted from August 2013 to February 2014. PARTICIPANTS: In total, 68 patients scheduled for elective renal surgery (open nephrectomy or open nephron-sparing surgery). INTERVENTIONS: Preoperative ThPVB with 0.5% bupivacaine combined with general anaesthesia, followed by postoperative oxycodone combined with nonopioid analgesics as rescue drugs. Follow-up period: 48 h. MAIN OUTCOME MEASURES: Total dose of postoperative oxycodone required, pain intensity, occurrence of opioid related adverse events, ThPVB-related adverse events and patient satisfaction. RESULTS: A total of 68 patients were randomised into two groups and, of these, 10 were subsequently excluded from analysis. Patients in group paravertebral block (PVB; n = 27) had general anaesthesia and ThPVB, and those in group general (anaesthesia) (GEN) (n = 31) formed a control group receiving general anaesthesia only. Compared with patients in group GEN, patients who received ThPVB required 39% less i.v. oxycodone over the first 48 h and had less pain at rest (P

http://ift.tt/2toexsG

Clinical trial registry use in anaesthesiology systematic reviews: A cross-sectional study of systematic reviews published in anaesthesiology journals and the Cochrane Library.

BACKGROUND: Publication bias within systematic reviews may result in incorrect conclusions leading to inappropriate clinical decisions and a decreased quality of patient care. Searching clinical trial registries for unpublished studies is one possible solution to minimise publication bias. OBJECTIVES: To examine rates of clinical trial registry searches in systematic reviews published in respected anaesthesiology journals and whether these searches found trials (or data) eligible for inclusion; to compare rates of registry searches between published reviews and similar reviews within the Cochrane Anaesthesia, Critical and Emergency Care Group; to conduct trial registry searches for a subset of reviews, determining whether eligible studies were overlooked; to investigate whether reporting of results in completed anaesthesia trials on ClinicalTrials.gov followed guidelines. DESIGN: A cross-sectional study of systematic reviews published in 10 anaesthesiology journals and the Cochrane Library. SETTING AND PARTICIPANTS: PubMed and the Cochrane Library were searched for systematic reviews or meta-analyses. MAIN OUTCOME MEASURES: The primary outcome was the number of systematic reviews that searched clinical trial registries for unpublished trials. Secondary outcomes included the number of registered trials in the ClinicalTrial.gov registry and the number of trials reporting trial results which were available on the ClinicalTrials.gov database and which should have been considered in a systematic review. RESULTS: The PubMed search yielded 507 records, and 415 remained after exclusions. Of these, 49 (11.8%) included a search of clinical trial registries. In total, 12 systematic reviews reported finding unpublished data but only five incorporated the data into their analyses. Of the Cochrane reviews, 58.9% (43/73) reported registry searches. Among a sample of 30 systematic reviews that omitted registry searches, we found many studies within the registries that were probably eligible to be included in the systematic reviews. For completed trials within the ClinicalTrials.gov database, only 15.4% reported results. CONCLUSION: The majority of systematic reviews in anaesthesiology did not include data from clinical trial registries. Exclusion of statistically nonsignificant data may lead to a biased interpretation of the data and hence inappropriate clinical interventions. TRIAL REGISTRATION: Registered in University hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000021932). (C) 2017 European Society of Anaesthesiology

http://ift.tt/2uJYdX2

History of anaesthesia: the ketamine story - past, present and future.

: Ketamine's history begins in the 1950s in Detroit, Michigan, at Parke-Davis Laboratories. On 26 March 1956, Harold V. Maddox synthesised phencyclidine or PCP. Domino studied PCP effects in animals and in 1958, Greifenstein made the first trials of PCP in humans under the name of Sernyl. Sernyl did not cause depression of cardiovascular and respiratory functions, but elicited severe excitation with a very prolonged postoperative recovery. Because of its psychedelic effects, it became a street drug under the name of 'angel dust' and was placed on schedule II of Federal Controlled Substance Act (CSA) in 1978. Eticyclidine or PCE had no medical career. The chemist Calvin Stevens, consultant to Parke-Davis, synthesised ketamine in 1962. The drug was studied in humans in 1964, by Domino and Corssen. These authors described the so-called 'dissociative anaesthesia'. Ketamine was patented in 1966 under the name of Ketalar for human use and was administered to soldiers during the Vietnam war. Because of abuse, ketamine was placed among the class III substances of CSA in 1999. The psychedelic effects and the arrival of propofol prompted the shelving of ketamine. However, the discovery of the NMDA-receptor and its noncompetitive inhibition by ketamine revolutionized the pathophysiology of hyperalgesia and mental functioning. In early 1990s, the arrival of remifentanil preceded the discovery of opioid-induced hyperalgesia, eliciting a paradigm shift in the management of pain, and a comeback of ketamine, as and antihyperalgesic drug. Ketamine is nowadays under the spotlight in the field of treatment-resistant depression and has been proposed as a potential fast antidepressant in patients with high suicidal risk. In a near future, we may observe new practices like increased S-(+)-ketamine availability, new ultra-short-acting ketamine analogues or the development antagonists. (C) 2017 European Society of Anaesthesiology

http://ift.tt/2toeHAs

Injectate spread following anterior sub-costal and posterior approaches to the quadratus lumborum block: A comparative cadaveric study.

BACKGROUND: The dermatomal level of analgesia achieved with quadratus lumborum blocks varies according to the location of injection. The most commonly used approaches are either at the postero-lateral aspect or anterior to the quadratus lumborum muscle. The aim of the study was to determine whether the site of injection of contrast dye around the quadratus lumborum muscle of cadavers affects the extent and mechanism of dye spread. METHODS: Six fresh human cadavers received either a posterior quadratus lumborum block or an anterior sub-costal quadratus lumborum block on each side. Cadavers were then dissected to determine the extent of dye spread. RESULTS: The posterior quadratus lumborum block approach revealed consistently deep staining of the iliohypogastric, ilioinguinal, subcostal nerve, T11 to 12 and L1 nerve roots. In addition, staining of the middle thoracolumbar fascia was seen in all specimens but only variable staining of T10 nerve roots. The anterior subcostal quadratus lumborum block approach in all specimens demonstrated predictable deep staining of the iliohypogastric and ilioinguinal nerves, subcostal nerves, T11 to 12 and L1 nerve roots, and in addition traversing the arcuate ligaments to involve T9 to 12 nerve roots with variable staining of higher thoracic nerve roots. CONCLUSION: Our cadaveric study demonstrates that injection of dye on the posterior aspect of quadratus lumborum muscle led to injectate spread through the lateral and posterior abdominal wall but with limited cranial spread, whereas the anterior approach produced broader coverage of the lower to mid-thoracic region. Clinical translation of these findings to determine the practical significance is warranted. (C) 2017 European Society of Anaesthesiology

http://ift.tt/2uJT5lD

Serious game versus online course for pretraining medical students before a simulation-based mastery learning course on cardiopulmonary resuscitation: A randomised controlled study.

BACKGROUND: Although both recorded lectures and serious games have been used to pretrain health professionals before simulation training on cardiopulmonary resuscitation, they have never been compared. OBJECTIVE: The aim of this study was to compare an online course and a serious game for pretraining medical students before simulation-based mastery learning on the management of sudden cardiac arrest. DESIGN: A randomised controlled trial. Participants were pretrained using the online course or the serious game on day 1 and day 7. On day 8, each participant was evaluated repeatedly on a scenario of cardiac arrest until reaching a minimum passing score. SETTING: Department of Simulation in Healthcare in a French medical faculty. PARTICIPANTS: Eighty-two volunteer second-year medical students participated between June and October 2016 and 79 were assessed for primary outcome. INTERVENTIONS: The serious game used was Staying Alive, which involved a 3D realistic environment, and the online course involved a PowerPoint lecture. MAIN OUTCOME MEASURES: The median total training time needed for students to reach the minimum passing score on day 8. This same outcome was also assessed 4 months later. RESULTS: The median training time (interquartile range) necessary for students to reach the minimum passing score was similar between the two groups: 20.5 (15.8 to 30.3) minutes in the serious game group versus 23 (15 to 32) minutes in the online course group, P = 0.51. Achieving an appropriate degree of chest compression was the most difficult requirement to fulfil for students in both groups. Four months later, the median training time decreased significantly in both groups, but no correlation was found at an individual level with the training times observed on day 8. CONCLUSION: The serious game used in this study was not superior to an online course to pretrain medical students in the management of a cardiac arrest. The absence of any correlation between the performances of students evaluated during two training sessions separated by 4 months suggests that elements such as chest compression can only be learned by simulation-based training. TRIAL REGISTRATION: ClinicalTrials.gov-NCT02758119. (C) 2017 European Society of Anaesthesiology

http://ift.tt/2toexca

EU Panel Recommends Dupilumab (Dupixent) for Eczema

A committee of the European Medicines Agency has recommended marketing authorization for dupilumab (Dupixent) for the treatment of moderate to severe atopic dermatitis in adults who are candidates for systemic therapy.
International Approvals

http://ift.tt/2uiCg0q

6 Active Immunization

Publication date: 2018
Source:Principles and Practice of Pediatric Infectious Diseases
Author(s): Raymond A. Strikas, Alison C. Mawle, Larry K. Pickering, Walter A. Orenstein




http://ift.tt/2vsVijj

Rhinoorbitocerebral Mucormycosis with Maggots in a Neglected Diabetic Patient

Abstract

Mucormycosis is a rare opportunistic fungal infection in immunocompromised patients, Rhizopus species are most common, sometimes mucormycosis can be life threatening we report a case of rhinoorbitocerebral mucormycosis a patient with diabetic ketoacidosis secondarily infected by maggots with altered consciousness and metabolic decompensation.

http://ift.tt/2uj973K

Vocoder Simulations Explain Complex Pitch Perception Limitations Experienced by Cochlear Implant Users

Abstract

Pitch plays a crucial role in speech and music, but is highly degraded for people with cochlear implants, leading to severe communication challenges in noisy environments. Pitch is determined primarily by the first few spectrally resolved harmonics of a tone. In implants, access to this pitch is limited by poor spectral resolution, due to the limited number of channels and interactions between adjacent channels. Here we used noise-vocoder simulations to explore how many channels, and how little channel interaction, are required to elicit pitch. Results suggest that two to four times the number of channels are needed, along with interactions reduced by an order of magnitude, than available in current devices. These new constraints not only provide insights into the basic mechanisms of pitch coding in normal hearing but also suggest that spectrally based complex pitch is unlikely to be generated in implant users without significant changes in the method or site of stimulation.

http://ift.tt/2gQtMJ8

Rhinoorbitocerebral Mucormycosis with Maggots in a Neglected Diabetic Patient

Abstract

Mucormycosis is a rare opportunistic fungal infection in immunocompromised patients, Rhizopus species are most common, sometimes mucormycosis can be life threatening we report a case of rhinoorbitocerebral mucormycosis a patient with diabetic ketoacidosis secondarily infected by maggots with altered consciousness and metabolic decompensation.

http://ift.tt/2uj973K

Why the World Needs an International Cyberwar Convention

Abstract

States' capacity for using modern information and communication technology to inflict grave harm on enemies has been amply demonstrated in recent years, with many countries reporting large-scale cyberattacks against their military defense systems, water supply, and other critical infrastructure. Currently, no agreed-upon international rules or norms exist to govern international conflict in cyberspace. Many governments prefer to keep it that way. They argue that difficulties of verifiability and challenges posed by rapid technological change rule out agreement on an international cyber convention. Instead, they prefer to rely on informal cooperation and strategic deterrence to limit direct conflict. In this article, I seek to rebut some of the main objections to seeking an international convention on the use of cyber weapons. While there are significant obstacles to achieving effective arms control in the cyber domain, historical experience from other areas of international arms control suggests that none of these obstacles are insurmountable. Furthermore, while most critics of cyberarms control assume that cyberspace favors offensive strategies, closer inspection reveals the dominance of cyber-defensive strategies. This in turn improves prospects for striking an effective international agreement on cyberarms control.

http://ift.tt/2vsRm1R

Expression of Concern

This Expression of Concern alerts readers to potential questions about research results published in a report of a trial in this journal in 2015 and announces the beginning of deeper investigation into the quality of this research.

http://ift.tt/2vspnzw

An Australian Mohs external quality assurance program

http://ift.tt/2uHjHEc

Biomarkers as a treatment guide in rheumatoid arthritis

Publication date: Available online 20 July 2017
Source:Clinical Immunology
Author(s): Tsutomu Takeuchi
It is anticipated that biomarkers support rheumatologists to judge a group of patients that can improve the diagnosis and prognosis, and further facilitate appropriate and precise treatment with targeted therapy. In particular, biomarkers for predicting and monitoring response to biological disease modifying anti-rheumatic drugs (DMARDs) are demanding. Given the mechanism action of biological DMARDs is much more simple than the conventional synthetic DMARDs, a variety of approaches to find such biomarkers has been taken recent years. In this article, I will summarize the background for biomarker research and introduce recent topics in the research and the possible clinical applications of biomarkers to guide treatment in rheumatoid arthritis (RA).



http://ift.tt/2uQtNmy

B-cells as therapeutic targets in neuro-inflammatory diseases

Publication date: Available online 21 July 2017
Source:Clinical Immunology
Author(s): Reinhard Hohlfeld
B cells are an emerging therapeutic target in neuroinflammatory diseases. The anti-CD20 monoclonal antibody ocrelizumab was recently approved in the US as the first B-cell targeting immunomodulatory treatment for relapsing-remitting MS and primary progressive MS. In autoantibody-associated demyelinating syndromes such as neuromyelitis optica (NMO) and in myelin-oligodendrocyte-glycoprotein-(MOG)-autoantibody-associated encephalomyelitis, B-cells are a logical target based on the pathogenesis of these antibody-mediated disorders. Furthermore, B cells and autoantibodies are promising targets in a variety of autoantibody-associated encephalitis syndromes such as N-methyl-d-aspartate receptor (NMDAR)-antibody encephalitis.



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Efficacy paradox and proportional contextual effect (PCE)

Publication date: Available online 20 July 2017
Source:Clinical Immunology
Author(s): Weiya Zhang, Michael Doherty
The "efficacy paradox" is when the effect of a treatment tested in an RCT, or evidence-based guideline advice, differs markedly from treatment benefits observed in clinical practice. This arises because in RCT reporting and guideline development treatment efficacy is judged by the separation of the treatment group from the placebo group (the specific treatment effect) whereas in clinical practice it is the overall treatment effect, which includes both specific and contextual responses, that patients experience. This paradox causes a disconnect between guidelines and clinical practice and ignores the importance of contextual response in clinical care. This article fully explains and discusses these issues and presents a possible way to reduce the paradox through an alteration in RCT reporting that shifts the focus to overall treatment benefit and the proportion ("proportional contextual effect") that is explained by placebo and contextual effects.



http://ift.tt/2uQocNj

Oral treatment with foralumab, a fully human anti-CD3 monoclonal antibody, prevents skin xenograft rejection in humanized mice

Publication date: Available online 21 July 2017
Source:Clinical Immunology
Author(s): Mineko Ogura, Songyan Deng, Paula Preston-Hurlburt, Hideki Ogura, Kunwar Shailubhai, Chantal Kuhn, Howard L. Weiner, Kevan C. Herold
Oral administration of biologics may be a feasible approach for immune therapy that improves drug safety and potentiates mechanisms of tolerance at mucosal barriers. We tested the ability of a fully human non-FcR binding anti-CD3 mAb, foralumab, to prevent skin xenograft rejection in mice with human immune systems. At an intragastric dose of 15μg, the drug could transit through the small bowel. Serum absorption and binding of lymphoid cells was seen and proliferative responses of splenic CD8+ T cells to mitogen were reduced. Five consecutive daily doses, then weekly dosing led to indefinite graft acceptance without depletion of peripheral T cells. Proliferative and cytokine responses to activation of splenocytes with PHA were reduced. The serum levels of IL-10 but not TNF were increased 6days after application of the skin graft. Oral treatment with anti-CD3 mAb may represent a feasible approach for immune modulation.



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Solving the pathogenesis of ankylosing spondylitis

Publication date: Available online 20 July 2017
Source:Clinical Immunology
Author(s): Matthew A. Brown




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Dendritic cells activation is associated with sustained virological response to telaprevir treatment of HCV-infected patients

Publication date: Available online 20 July 2017
Source:Clinical Immunology
Author(s): Sacchi Alessandra, Tumino Nicola, Turchi Federica, Refolo Giulia, Fimia GianMaria, Ciccosanti Fabiola, Montalbano Marzia, Lionetti Raffaella, Taibi Chiara, D'Offizi Gianpiero, Casetti Rita, Bordoni Veronica, Cimini Eleonora, Martini Federico, Agrati Chiara
First anti-HCV treatments, that include protease inhibitors in conjunction with IFN-α and Ribavirin, increase the sustained virological response (SVR) up to 80% in patients infected with HCV genotype 1. The effects of triple therapies on dendritic cell (DC) compartment have not been investigated. In this study we evaluated the effect of telaprevir-based triple therapy on DC phenotype and function, and their possible association with treatment outcome.HCV+ patients eligible for telaprevir-based therapy were enrolled, and circulating DC frequency, phenotype, and function were evaluated by flow-cytometry. The antiviral activity of plasmacytoid DC was also tested.In SVR patients, myeloid DC frequency transiently decreased, and returned to baseline level when telaprevir was stopped. Moreover, an up-regulation of CD80 and CD86 on mDC was observed in SVR patients as well as an improvement of IFN-α production by plasmacytoid DC, able to inhibit in vitro HCV replication.



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Rheumatic paraneoplastic syndromes – A clinical link between malignancy and autoimmunity

Publication date: Available online 21 July 2017
Source:Clinical Immunology
Author(s): Bernhard Manger, Georg Schett
Paraneoplastic syndromes are rare but can have enormous clinical impact on diagnosis and outcome of neoplastic diseases. The rheumatologist should be familiar with a few typical musculoskeletal manifestations of malignancies to be able to diagnose them early for a timely initiation of anti-tumour therapies. This review describes the characteristic features of various paraneoplastic arthritides and vasculitides, cancer-associated myositis, hypertrophic osteoarthropathy, and tumour-induced osteomalacia. In addition, the current knowledge about underlying pathomechanisms of these syndromes is discussed.



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miRNA meets plasma cells “How tiny RNAs control antibody responses”

Publication date: Available online 21 July 2017
Source:Clinical Immunology
Author(s): Julia Meinzinger, Hans-Martin Jäck, Katharina Pracht
We review the importance of small non-coding microRNAs for the generation of germinal center B cells and their differentiation in antibody-secreting plasma cells. In the last part, we briefly elucidate the role of microRNAs in some plasma cell disorders.



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B cells and their cytokine activities implications in human diseases

Publication date: Available online 21 July 2017
Source:Clinical Immunology
Author(s): Simon Fillatreau
B cells are the only cell type that can give rise to antibody-producing cells, and the only cell type whose selective depletion can, today, lead to an improvement of a wide range of immune-mediated inflammatory diseases, including disorders not primarily driven by autoantibodies. Here, I discuss this paradoxical observation, and propose that the capacity of B cells to act as cytokine-producing cells explains how they can control monocyte activity and subsequently disease pathogenesis. Together with current data on the effect of anti-CD20 B cell-depleting reagents in the clinic, this novel knowledge on B cell heterogeneity opens the way for novel safer and more efficient strategies to target B cells. The forthcoming identification of disease-relevant B cell subsets is awaited to permit their monitoring and specific targeting in a personalized medicine approach.



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Novel insights into the pathogenesis of psoriasis

Publication date: Available online 21 July 2017
Source:Clinical Immunology
Author(s): T.A. Luger, K. Loser

Graphical abstract

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The serine/threonine protein phosphatase 2A controls autoimmunity

Publication date: Available online 21 July 2017
Source:Clinical Immunology
Author(s): Amir Sharabi, Isaac R. Kasper, George C. Tsokos
Protein phosphatase 2A (PP2A) is the first Ser/Thr phosphatase recognized to contribute to human and murine lupus immunopathology. PP2A expression in SLE is controlled both epigenetically and genetically, and it is increased in patients with SLE, which contributes to decreased IL-2 production, decreased CD3ζ and increased FcRγ expression on the surface of T cells, increased CREMα expression, hypomethylation of genes associated with SLE pathogenesis, and increased IL-17 production. B regulatory subunit of PP2A regulates IL-2 deprivation-induced T cell death and is decreased in SLE patients. A mouse overexpressing PP2Ac in T cells displays peripheral granulocytosis, elevated IL-17 production, and develops glomerulonephritis when challenged. A mouse which lacks PP2Ac only in regulatory T cells develops severe autoimmunity and multiorgan inflammation because of loss of restraint on mTORC1 and inability of Foxp3+ cells to regulate conventional T cells. Targeting PP2A in T cell subsets may be therapeutic for SLE and other autoimmune diseases.



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Paediatric hepatocellular carcinoma in tight junction protein 2 (TJP2) deficiency

http://ift.tt/2gQjYim

Crescentic glomerular nephritis associated with rheumatoid arthritis: a case report

Rheumatoid arthritis is a systemic disorder where clinically significant renal involvement is relatively common. However, crescentic glomerular nephritis is a rarely described entity among the rheumatoid nephr...

http://ift.tt/2tmWoLS

Vocoder Simulations Explain Complex Pitch Perception Limitations Experienced by Cochlear Implant Users

Abstract

Pitch plays a crucial role in speech and music, but is highly degraded for people with cochlear implants, leading to severe communication challenges in noisy environments. Pitch is determined primarily by the first few spectrally resolved harmonics of a tone. In implants, access to this pitch is limited by poor spectral resolution, due to the limited number of channels and interactions between adjacent channels. Here we used noise-vocoder simulations to explore how many channels, and how little channel interaction, are required to elicit pitch. Results suggest that two to four times the number of channels are needed, along with interactions reduced by an order of magnitude, than available in current devices. These new constraints not only provide insights into the basic mechanisms of pitch coding in normal hearing but also suggest that spectrally based complex pitch is unlikely to be generated in implant users without significant changes in the method or site of stimulation.

http://ift.tt/2gQtMJ8

Hearing Loss and the Effects of Statin Drugs in People With Head and Neck Squamous Cell Carcinoma Treated With Cisplatin Chemoradiation

Conditions:   Head and Neck Cancer;   Hearing Disorder;   Hyperlipidemia
Intervention:  
Sponsor:   National Institute on Deafness and Other Communication Disorders (NIDCD)
Recruiting - verified July 18, 2017

http://ift.tt/2uQ3NYC

Metabolomic and BH3 Profiling of Esophageal Cancers: Identification of Novel Assessment Methods of Treatment Response for Precision Therapy

Conditions:   Esophageal Cancer;   Esophageal Adenocarcinoma;   Esophageal Squamous Cell Cancer;   Esophageal Neoplasms;   Squamous Cell Carcinoma
Interventions:   Other: Chemoradiotherapy;   Procedure: Esophagectomy
Sponsor:   National Cancer Institute (NCI)
Not yet recruiting - verified July 17, 2017

http://ift.tt/2vIpw10

M3541 in Combination With Radiotherapy in Subjects With Solid Tumors

Condition:   Solid Tumors
Interventions:   Drug: M3541;   Radiation: Palliative Radiotherapy (RT)
Sponsors:   EMD Serono Research & Development Institute, Inc.;   Merck KGaA
Not yet recruiting - verified July 2017

http://ift.tt/2uQjmj9

PET-Directed Therapy With Pembrolizumab and Combination Chemotherapy in Treating Patients With Previously Untreated Classical Hodgkin Lymphoma

Conditions:   Classical Hodgkin Lymphoma;   Lymphocyte-Depleted Classical Hodgkin Lymphoma;   Lymphocyte-Rich Classical Hodgkin Lymphoma;   Mixed Cellularity Classical Hodgkin Lymphoma;   Nodular Sclerosis Classical Hodgkin Lymphoma
Interventions:   Procedure: Computed Tomography;   Drug: Dacarbazine;   Drug: Doxorubicin Hydrochloride;   Radiation: Fludeoxyglucose F-18;   Other: Laboratory Biomarker Analysis;   Biological: Pembrolizumab;   Procedure: Positron Emission Tomography;   Drug: Vinblastine Sulfate
Sponsors:   Northwestern University;   National Cancer Institute (NCI)
Not yet recruiting - verified July 2017

http://ift.tt/2vIBxU9

Apatinib Combined With Chemotherapy for Esophageal Squamous Cell Cancer After the Failure of Standard Treatment

Condition:   Esophageal Squamous Cell Carcinoma
Interventions:   Drug: Apatinib;   Drug: fluorouracil and platinum
Sponsor:   The First Affiliated Hospital of Anhui Medical University
Recruiting - verified June 2017

http://ift.tt/2uQci63

Study of Targeted Therapy Using Transcription Activator-like Effector Nucleases in Cervical Precancerous Lesions

Condition:   Human Papillomavirus-Related Malignant Neoplasm
Interventions:   Biological: T27;   Biological: T512
Sponsor:   Huazhong University of Science and Technology
Not yet recruiting - verified July 2017

http://ift.tt/2uQfGxA

Trial of Magnetic Resonance Imaging Guided Radiotherapy Dose Adaptation in Human Papilloma Virus Positive Oropharyngeal Cancer

Conditions:   Malignant Neoplasms of Lip Oral Cavity and Pharynx;   Oropharyngeal Cancer
Interventions:   Procedure: Modified Barium Swallow (MBS);   Behavioral: Swallowing Questionnaire;   Behavioral: Symptom Questionnaire;   Procedure: Video-Strobe Procedure;   Procedure: MRI Guided Intensity Modulated Radiotherapy (IMRT) Planning;   Procedure: Standard-of-Care Intensity Modulated Radiotherapy (IMRT) Planning;   Radiation: Intensity Modulated Radiotherapy (IMRT)
Sponsors:   M.D. Anderson Cancer Center;   National Cancer Institute (NCI)
Not yet recruiting - verified July 2017

http://ift.tt/2tNuRTg

Pancreatoduodenectomy With Mesopancreas Dissection.A Prospective Study Comparing Artery-first Approach Versus Standard Approach

Condition:   Periampullary Carcinoma Resectable
Interventions:   Procedure: Artery-first Approach;   Procedure: Standard Approach
Sponsor:   Assiut University
Not yet recruiting - verified May 2017

http://ift.tt/2uPUDLE

Laryngocele: A Rare Case Report and Review of Literature

Abstract

Laryngocele is an abnormal cystic dilatation of the saccule of the larynx. It communicates with the laryngeal lumen and contains air. Laryngocele can be classified as internal (within the larynx), external (outside the larynx) and mixed (both). It is a rare entity. Hereby, we are reporting a case of laryngocele, which presented to us with a diagnostic quandary. After confirming the diagnosis by radiology, patient was operated upon by external approach. In the following article, we also discuss the establishment of the diagnosis and review different surgical modalities for the management of various types of laryngocele.

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Lichenified papules: An unusual cutaneous presentation of metastatic breast cancer

http://ift.tt/2vIjEox

Chronic cheilitis: Faecal calprotectin test a way to diagnose oral Crohn's disease

http://ift.tt/2uhL6vr

Folliculotropic mycosis fungoides associated with atopic dermatitis

http://ift.tt/2vInbD7

Tinea corporis presenting as disseminated verrucous plaques caused by Arthroderma incurvatum in a young Indian boy

http://ift.tt/2ui2oIG

Adult morphea en coup de sabre with accompanying regional polymyositis: A separate entity?

http://ift.tt/2vIjttt

A case of disfiguring primary cutaneous squamous cell carcinoma of the nasal tip

http://ift.tt/2uhN1jJ

Laryngocele: A Rare Case Report and Review of Literature

Abstract

Laryngocele is an abnormal cystic dilatation of the saccule of the larynx. It communicates with the laryngeal lumen and contains air. Laryngocele can be classified as internal (within the larynx), external (outside the larynx) and mixed (both). It is a rare entity. Hereby, we are reporting a case of laryngocele, which presented to us with a diagnostic quandary. After confirming the diagnosis by radiology, patient was operated upon by external approach. In the following article, we also discuss the establishment of the diagnosis and review different surgical modalities for the management of various types of laryngocele.

http://ift.tt/2uhFsJF

Apparent and Intrinsic Evolution of Active Region Upflows

Baker, D; Janvier, M; Démoulin, P; Mandrini, CH; (2017) Apparent and Intrinsic Evolution of Active Region Upflows. Solar Physics , 292 (4) 10.1007/s11207-017-1072-9 . Green open access

http://ift.tt/2tNsO1q

Institutions in Transition: Is the EU Integration Process Relevant for Inward FDI in Transition European Economies?

Delevic, U; Heim, I; (2017) Institutions in Transition: Is the EU Integration Process Relevant for Inward FDI in Transition European Economies? Eurasian Journal of Economics and Finance , 5 (1) pp. 16-32. 10.15604/ejef.2017.05.01.002 . Green open access

http://ift.tt/2uIDqD0

Characterization of a novel HESX1 mutation in a pediatric case of septo-optic dysplasia

Pozzi, S; Tan, W-H; Martinez-Barbera, J; (2017) Characterization of a novel HESX1 mutation in a pediatric case of septo-optic dysplasia. Clinical Case Reports , 5 (4) pp. 463-470. 10.1002/ccr3.868 . Green open access

http://ift.tt/2tN3Xeu

Signals that control embryonic Schwann cell development and myelination

Woodhoo, A; (2007) Signals that control embryonic Schwann cell development and myelination. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2uIzlik

Signalling mechanisms contributing to integrin activation and immunological synapse formation in B cells

Vehlow, A; (2007) Signalling mechanisms contributing to integrin activation and immunological synapse formation in B cells. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2tNtNPy

Scientists' views of the philosophy of science

Riesch, H; (2008) Scientists' views of the philosophy of science. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2uIuhdA

Role of major histocompatibility complex class II molecules in the maintenance of CD4 memory T cell function

De Riva, A; (2007) Role of major histocompatibility complex class II molecules in the maintenance of CD4 memory T cell function. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2tNlGlM

Risk and protective factors for the development of meningococcal disease in adolescence: A biopsychosocial investigation

Tully, J; (2006) Risk and protective factors for the development of meningococcal disease in adolescence: A biopsychosocial investigation. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2uIubCK

The global green economy: a review of concepts, definitions, measurement methodologies and their interactions

Georgeson, L; Maslin, M; Poessinouw, M; (2017) The global green economy: a review of concepts, definitions, measurement methodologies and their interactions. Geo: Geography and Environment , 4 (1) , Article e00036. 10.1002/geo2.36 . Green open access

http://ift.tt/2tN3Yiy

The measurement of water scarcity: Defining a meaningful indicator

Damkjaer, S; Taylor, R; The measurement of water scarcity: Defining a meaningful indicator. Ambio 10.1007/s13280-017-0912-z . (In press). Green open access

http://ift.tt/2uIJqvz

Association between urinary biomarkers of total sugars intake and measures of obesity in a cross-sectional study

Campbell, R; Tasevska, N; Jackson, KG; Sagi-Kiss, V; di Paulo, N; Mindell, JS; Lister, SJ; Campbell, R; Tasevska, N; Jackson, KG; Sagi-Kiss, V; di Paulo, N; Mindell, JS; Lister, SJ; Khaw, K-T; Kuhnle, GGC; - view fewer (2017) Association between urinary biomarkers of total sugars intake and measures of obesity in a cross-sectional study. PLoS ONE , 12 (7) , Article e0179508. 10.1371/journal.pone.0179508 . Green open access

http://ift.tt/2uILjse

Regulatory T cells in rheumatoid arthritis: Clinical relevance and mechanisms in disease

Nadkarni, SA; (2008) Regulatory T cells in rheumatoid arthritis: Clinical relevance and mechanisms in disease. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2tNgUEZ

Regulation of MDM2 stability and function by signalling from mTOR/S6K pathway

Wang, M-L; (2008) Regulation of MDM2 stability and function by signalling from mTOR/S6K pathway. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2uIZVYF

Iatrogenic B12-deficient peripheral neuropathy following nitrous oxide administration for functional tonic leg spasm: A case report.

Kaski, D; Kumar, P; Murphy, E; Warner, TT; (2017) Iatrogenic B12-deficient peripheral neuropathy following nitrous oxide administration for functional tonic leg spasm: A case report. Clin Neurol Neurosurg , 160 pp. 108-110. 10.1016/j.clineuro.2017.07.006 .

http://ift.tt/2tNlL91

Quantum chaos in cold atoms and spin waves: The double kicked rotor

Stocklin, M; (2008) Quantum chaos in cold atoms and spin waves: The double kicked rotor. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2uIAOFg

What is best practice in sex and relationship education? A synthesis of evidence, including stakeholders' views

Pound, P; Denford, S; Shucksmith, J; Tanton, C; Johnson, AM; Owen, J; Hutten, R; Pound, P; Denford, S; Shucksmith, J; Tanton, C; Johnson, AM; Owen, J; Hutten, R; Mohan, L; Bonell, C; Abraham, C; Campbell, R; - view fewer (2017) What is best practice in sex and relationship education? A synthesis of evidence, including stakeholders' views. BMJ Open , 7 (5) , Article e014791. 10.1136/bmjopen-2016-014791 . Green open access

http://ift.tt/2tNpXWB

Principles of two-phase flow microreactors and their scale-out

Amador, ZC; (2007) Principles of two-phase flow microreactors and their scale-out. Doctoral thesis, UCL (University College London). Green open access

http://ift.tt/2uIDkeC

The mineralocorticoid receptor is involved in glucocorticoid resistance

http://ift.tt/2tNemqm

Erratum

Case Rep Ophthalmol 2017;8:389

http://ift.tt/2tmxUme

Meta-analysis of quality-of-life improvement after cochlear implantation and associations with speech recognition abilities

Objectives

Determine the impact of cochlear implantation on quality of life (QOL) and determine the correlation between QOL and speech recognition ability.

Study Design

Two authors independently searched PubMed, Medline, Scopus, and the Cumulative Index to Nursing and Allied Health Literature to identify studies reporting hearing-specific or cochlear implant (CI)–specific QOL outcomes before and after cochlear implantation, and studies reporting correlations between QOL and speech recognition after cochlear implantation. Data from the included articles were obtained independently by two authors. Standardized mean difference (SMD) for each measure and pooled effects were determined to assess improvement in QOL before and after cochlear implantation.

Results

From 14 articles with 679 CI patients who met the inclusion criteria, pooled analyses of all hearing-specific QOL measures revealed a very strong improvement in QOL after cochlear implantation (SMD = 1.77). Subset analysis of CI-specific QOL measures also showed very strong improvement (SMD = 1.69). Thirteen articles with 715 patients met the criteria to evaluate associations between QOL and speech recognition. Pooled analyses showed a low positive correlation between hearing-specific QOL and word recognition in quiet (r = 0.213), sentence recognition in quiet (r = 0.241), and sentence recognition in noise (r = 0.238). Subset analysis of CI-specific QOL showed similarly low positive correlations with word recognition in quiet (r = 0.213), word recognition in noise (r = 0.241), and sentence recognition in noise (r = 0.255).

Conclusions

Using hearing-specific and CI-specific measures of QOL, patients report significantly improved QOL after cochlear implantation. However, widely used clinical measures of speech recognition are poor predictors of patient-reported QOL with CIs. Laryngoscope, 2017

http://ift.tt/2uIBtGS

Diagnostic accuracy of nasal cannula versus microphone for detection of snoring

Objective

Snoring is a common reason for referral to a sleep unit. Although there are several instruments to measure snoring, there is no gold standard for this purpose. In this study, we determine the diagnostic accuracy of the cannula as compared with the microphone, which are the two most commonly used tools.

Study Design

We performed a cross-sectional study of 75 patients who underwent baseline home sleep apnea testing for any reason.

Methods

Snore intensity and percentage were assessed during Home sleep-apnea testing via nasal cannula and microphone in all patients. We performed a complete diagnostic accuracy analysis, assuming the microphone to be the reference instrument use in order to compare it with the cannula.

Results

The intra-class correlation coefficient between the cannula and microphone for the percentage of snoring was 0.25. The Bland Bland-Altman analysis to determine the agreement regarding the percentage of snoring showed a lower limit of −57.73 and an upper limit of 20.30. A linear regression analysis of the differences produced a negative slope of −0.86. The receiver operating characteristic curve for severe snoring using the cannula produced an area under the curve of 0.67 (P = 0.019). The cannula showed a sensitivity of 57.89 and a specificity of 73.21.

Conclusion

The nasal cannula showed poor reliability and accuracy for measuring snoring.

Level of Evidence

2b. Laryngoscope, 2017

http://ift.tt/2uhZwKx

The effect of frailty on short-term outcomes after head and neck cancer surgery

Objective

To determine the relationship between frailty and comorbidity, in-hospital mortality, postoperative complications, length of hospital stay (LOS), and costs in head and neck cancer (HNCA) surgery.

Study Design

Cross-sectional analysis.

Methods

Discharge data from the Nationwide Inpatient Sample for 159,301 patients who underwent ablative surgery for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2001 to 2010 was analyzed using cross-tabulations and multivariate regression modeling. Frailty was defined based on frailty-defining diagnosis clusters from the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator.

Results

Frailty was identified in 7.4% of patients and was significantly associated with advanced comorbidity (odds ratio [OR] = 1.5[1.3–1.8]), Medicaid (OR = 1.5[1.3–1.8]), major procedures (OR = 1.6[1.4–1.8]), flap reconstruction (OR = 1.7[1.3–2.1]), high-volume hospitals (OR = 0.7[0.5–1.0]), discharge to a short-term facility (OR = 4.4[2.9–6.7]), or other facility (OR = 5.4[4.5–6.6]). Frailty was a significant predictor of in-hospital death (OR = 1.6[1.1–2.4]), postoperative surgical complications (OR = 2.0[1.7–2.3]), acute medical complications (OR = 3.9[3.2–4.9]), increased LOS (mean, 4.9 days), and increased mean incremental costs ($11,839), and was associated with higher odds of surgical complications and increased costs than advanced comorbidity. There was a significant interaction between frailty and comorbidity for acute medical complications and length of hospitalization, with a synergistic effect on the odds of medical complications and LOS in patients with comorbidity who were also frail.

Conclusion

Frailty is an independent predictor of postoperative morbidity, mortality, LOS, and costs in HNCA surgery patients, and has a synergistic interaction with comorbidity that is associated with an increased likelihood of medical complications and greater LOS in patients with comorbidity who are also frail.

Level of Evidence

2c. Laryngoscope, 2017

http://ift.tt/2uIEpTX

Association between systemic antibiotic and corticosteroid use for chronic rhinosinusitis and quality of life

Objective

We sought to establish the significance of querying chronic rhinosinusitis (CRS) patients about their past CRS-related oral antibiotic and corticosteroid usage by determining the association between these metrics and patients' quality of life (QoL).

Study Design

Cross-sectional study.

Methods

A total of 157 patients with CRS were prospectively recruited. CRS-specific QoL was measured using the 22-item Sinonasal Outcome Test (SNOT-22). General health-related QoL was measured using the EuroQoL five-dimensional questionnaire visual analog scale. Associations were sought between these measures of QoL and frequency of CRS-related oral antibiotic and corticosteroid usage reported by the participants in the prior 3 and 12 months.

Results

More frequent antibiotic and corticosteroid use was significantly associated with worse CRS-specific and general health-related QoL, whether querying medication use over the prior 3 months or over the prior 12 months (P < 0.001 in all cases). The effect size of CRS-related antibiotic use during the prior 3 months on CRS-specific QoL (SNOT-22 score) was significantly greater than for use during the prior 12 months. However, there was no other statistically significant difference in effect size for association between QoL and CRS-related antibiotic or corticosteroid use in the prior 3 months versus prior 12 months. These results were independent of the presence or absence of polyps.

Conclusion

More frequent past CRS-related oral antibiotic and corticosteroid use, regardless of time period queried (3 months or 12 months) is associated with significant decrease in CRS-specific and general health-related QoL. CRS-related systemic medication use is an important indicator of CRS patients' QOL that easily can be queried and utilized in both clinical and research settings.

Level of Evidence

2c. Laryngoscope, 2017

http://ift.tt/2ui02b8

Editor's Choice

http://ift.tt/2uIJ0VX

Plain language summaries in Simplified Chinese

Linked Comment: Wu et al. Br J Dermatol 2017; 177:72–83

Linked Comment: Tashiro et al. Br J Dermatol 2017; 177:158–167

Linked Comment: Senet et al. Br J Dermatol 2017; 177:206–211

Linked Comment: Gambichler et al. Br J Dermatol 2017; 177:238–244

Linked Comment: Saunte et al. Br J Dermatol 2017; 177:47–62

Linked Comment: Andersen et al. Br J Dermatol 2017; 177:107–116

Linked Comment: Su et al. Br J Dermatol 2017; 177:125–133

Linked Comment: Cañueto et al. Br J Dermatol 2017; 177:168–178

Linked Comment: Gilbert et al. Br J Dermatol 2017; 177:117–124

Linked Comment: Chasset et al. Br J Dermatol 2017; 177:188–196

Linked Comment: Karimkhani et al. Br J Dermatol 2017; 177:134–140

Linked Comment: Hagforsen et al. Br J Dermatol 2017; 177:179–187

Linked Comment: Reich et al. Br J Dermatol 2017; 177:197–205

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Percutaneous absorption risks in atopic dermatitis

Linked Article: Halling-Overgaard et al. Br J Dermatol 2017; 177:84–106.

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Prognostic factors of patients with linear IgA bullous dermatosis

Linked Article: Gottlieb et al. Br J Dermatol 2017; 177:212–222.

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New technology discloses the tumour margin of extramammary Paget disease?

Linked Article: Murata et al. Br J Dermatol 2017; 177:229–237

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Biologics for psoriasis: more drugs, new patient categories, but fresh challenges for clinical dermatologists

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Antimalarials in cutaneous lupus erythematous subtypes

Linked Article: Chasset et al. Br J Dermatol 2017; 177:188–196.

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Cover image: Intralymphatic histiocytosis with giant blanching violaceous plaques

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Pathogenesis of morphoea: knowledge gaps in subtypes and comparisons to systemic sclerosis

Linked Article: Saracino et al. Br J Dermatol 2017; 177:34–46.

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Clinical significance of immunoglobulin E in bullous pemphigoid

Linked Article: Hashimoto et al. Br J Dermatol 2017; 177:141–151.

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Positive about negative: no need for a pink cloud of fluff and justifications

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Folliculotropic mycosis fungoides is a heterogenous group

Linked Article: van Santen et al. Br J Dermatol 2017; 177:223–228.

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Image Gallery: Congenital onychodysplasia of the toenails

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Plain language summaries

Linked Comment: Wu et al. Br J Dermatol 2017; 177:72–83

Linked Comment: Tashiro et al. Br J Dermatol 2017; 177:158–167

Linked Comment: Senet et al. Br J Dermatol 2017; 177:206–211

Linked Comment: Gambichler et al. Br J Dermatol 2017; 177:238–244

Linked Comment: Saunte et al. Br J Dermatol 2017; 177:47–62

Linked Comment: Andersen et al. Br J Dermatol 2017; 177:107–116

Linked Comment: Su et al. Br J Dermatol 2017; 177:125–133

Linked Comment: Cañueto et al. Br J Dermatol 2017; 177:168–178

Linked Comment: Gilbert et al. Br J Dermatol 2017; 177:117–124

Linked Comment: Chasset et al. Br J Dermatol 2017; 177:188–196

Linked Comment: Karimkhani et al. Br J Dermatol 2017; 177:134–140

Linked Comment: Hagforsen et al. Br J Dermatol 2017; 177:179–187

Linked Comment: Reich et al. Br J Dermatol 2017; 177:197–205

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What progress have we made in the treatment of atopic eczema? Putting the new biological therapies into a wider context

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Candida infections and interleukin-17 inhibitors used in dermatology

Linked Article: Saunte et al. Br J Dermatol 2017; 177:47–62.

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Image Gallery: Pink papules within a tattoo linked to Mycobacterium chelonae infection

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Lessons to be learned from type 1 segmental Gorlin syndrome

Linked Article: Reinders et al. Br J Dermatol 2017; 177:249–252.

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To learn more about sickle cell ulcers

Linked Article: Senet et al. Br J Dermatol 2017; 177:206–211.

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A practical approach to the initial dose and subsequent increments for ultraviolet A1 phototherapy

Linked Article: Gambichler et al. Br J Dermatol 2017; 177:238–244

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Award-Winning Research in 2017

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Nasalance Changes Following Various Endonasal Surgeries

Abstract Introduction There is change in nasalance post endonasal surgery which is not permanent. Objectives The objective of this study is to evaluate the long-term nasalance changes following different types of endonasal surgeries. Methods We included in this study patients who underwent sinonasal surgery at the Otorhinolaryngology Department in Zagazig University Hospitals from February 2015 until March 2016. We divided the patients into two groups according to the surgeries they underwent: Group (A) was the FESS group and group (B), the septoturbinoplasty group.We checked nasalance using a nasometer before and after the sinonasal surgery. Results Nasalance increased at one month after the operation in both groups. However, it returned to nearly original levels within three months postoperatively. Conclusion FESS, septoplasty, and turbinate surgery may lead to hypernasal speech. This hypernasal speech can be a result of change in the shape and diameter of the resonating vocal tract. Hypernasal speech in these circumstances may be a temporary finding that can decrease with time. Surgeons should inform their patients about the possibility of hypernasality after such types of surgery, especially if they are professional voice users.

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Study of Anthropometric Measurements of the Anterior Ethmoidal Artery using Threedimensional Scanning on 300 Patients

Abstract Introduction The anterior ethmoidal artery (AEA) is one of the main arteries that supply both the nasal mucosa and the ethmoid sinuses. The AEA shows variability regarding its distance from adjacent structures. Several studies have developed techniques to identify the AEA. Objective This study aimed to compare the measurements from the AEA to the ethmoid bulla and to the frontal beak by using computed tomography of the face, while identifying their intraindividual and interindividual variations. Methods We analyzed 300 CT scans of the face performed at the CT scan Center at Hospital. The average age of subjects was 36 ± 15.1 years (range 4-84). Results We found that the average distance from the AEA to the ethmoid bulla was 17.2 ± 1.8 mm and the distance from the AEA to the frontal beak was 15.1± 2.2 mm. Regarding the average distance from the AEA to the frontal beak (AEA-frontal beak), there was a difference between the right and left sides, with the former being 0.4 mm higher on average than the latter. Among the age groups, there was a significant difference of distances between the AEA and the ethmoid bulla (AEA-ethmoid bulla), which were shorter in the ≤ 12 years group. There was a positive and significant correlation between both measurements analyzed, with low values (high) of AEAethmoid bulla distance corresponding to low values (high) of AEA-frontal beak distance. Conclusion Themeasurements obtained adds anatomical knowledge that can serve as a parameter in frontal and ethmoid sinus surgery.

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Fibrotic Tissue and Middle Turbinate Exhibit Similar Mechanical Properties. Is Fibrosis a Solution in Nasal Polyposis?

Abstract Introduction Nasal polyposis (NP) is a chronic inflammatory condition of the upper airway characterized by overgrowth of nasal mucosa. Recent studies have shown a mechanical dysfunction in the nasal polyp tissue. Objective This study aims to evaluate the mechanical properties of nasal fibrotic tissue. Method This study was an institutional review board approved translational study in 20 participants (8 patients with NP, 7 patients with nasal synechiae, and 5 subjects without sinus disease (control group). We used Controlled Disc Stimulation equipment to compare the curve Pressure/Volume created during the saline solution infusion. Results The increase of pressure in response to solution injection was lower in the nasal polyp group when compared with control middle turbinate group and fibrotic group. No significant difference was found in the pressure response during solution injection between fibrotic group and control middle turbinate group. Inferior turbinate group showed significant difference when compared with control middle turbinate group. Conclusion Themechanical dysfunction found in the nasal mucosa of patients with NP provides new insight into this condition. These data allow the belief that the fibrosis has a potential role in increasing interstitial hydrostatic pressure and, consequently, mitigating edema formation in NP.

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Evaluation of the Prevalence of Maxillary Sinuses Abnormalities through Spiral Computed Tomography (CT)

Abstract Introduction Maxillary sinus disease is common and numerous disorders can affect this anatomical area. Abnormalities can be classified as: non-neoplastic, neoplastic benign, and neoplastic malignant. Objective Evaluate through CT the prevalence of diseases in maxillary sinuses, using the Radiology Department's database of a hospital in São Paulo city. Methods The sample consisted of 762 facial CT scans that we divided into three groups: Group A (12-19 years old); Group B (20-49 years old); Group C (above 50 years old); and male or female. We considered the following pathological processes: I - Mucoperiosteal Thickening; II - Chronic Sinusitis; III - Chronic Odontogenic Sinusitis; IV - Rhinosinusitis; V - Polypoid Lesions; VI - Bone Lesions; VII - Neoplasms; VIII - Antrolith; IX - Foreign Bodies; X - Oroantral Fistula. Results Our study found that 305 exams (40.02%) were normal and 457 exams (59.97%) were abnormal. We found the following disease frequencies: focal mucoperiosteal thickening (21.25%); polypoid lesions (10.76%); chronic sinusitis (7.48%); chronic odontogenic sinusitis (2.29%); neoplasms (2.03%); rhinosinusitis (1.77%); bone lesions, foreign bodies and oroantral fistula in 0.65%; 0.13% and 0.06% respectively. There was no significant difference between male and female, and Groups A, B, or C when relating the frequencies of abnormalities found. There was no significant difference between male and female and the age group for the side of the altered maxillary sinus. Conclusion We observed a high prevalence of sinus maxillary diseases. Mucoperiosteal thickening; acute, chronic, and odontogenic sinusitis; polypoid lesions and neoplasms have high prevalence in maxillary sinuses. Thus, facial CT exam was effective for the evaluation of diseases in maxillary sinuses.

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Test-Retest of Long Latency Auditory Evoked Potentials (P300) with Pure Tone and Speech Stimuli

Abstract Introduction Long latency auditory evoked potentials, especially P300, have been used for clinical evaluation of mental processing. Many factors can interfere with Auditory Evoked Potential - P300 results, suggesting large intra and inter-subject variations. Objective The objective of the study was to identify the reliability of P3 components (latency and amplitude) over 4-6 weeks and the most stable auditory stimulus with the best test-retest agreement. Methods Ten normal-hearing women participated in the study. Only subjects without auditory processing problems were included. To determine the P3 components, we elicited long latency auditory evoked potential (P300) by pure tone and speech stimuli, and retested after 4-6 weeks using the same parameters. We identified P300 latency and amplitude by waveform subtraction. Results We found lower coefficient of variation values in latency than in amplitude, with less variability analysis when speech stimulus was used. There was no significant correlation in latency measures between pure tone and speech stimuli, and sessions. There was a significant intrasubject correlation between measures of latency and amplitude. Conclusion These findings show that amplitude responses are more robust for the speech stimulus when compared with its pure tone counterpart. The P300 indicated stability for latency and amplitudemeasures when the test-retest was applied. Reliability was higher for amplitude than for latency, with better agreement when the pure tone stimulus was used. However, further research with speech stimulus is needed to clarify how these stimuli are processed by the nervous system.

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Outcomes of Late Implantation in Usher Syndrome Patients

Abstract Introduction Usher syndrome (US) is an autosomal recessive disorder characterized by hearing loss and progressive visual impairment. Some deaf Usher syndrome patients learn to communicate using sign language. During adolescence, as they start losing vision, they are usually referred to cochlear implantation as a salvage for their new condition. Is a late implantation beneficial to these children? Objective The objective of this study is to describe the outcomes of US patients who received cochlear implants at a later age. Methods This is a retrospective study of ten patients diagnosed with US1. We collected pure-tone thresholds and speech perception tests from pre and one-year post implant. Results Average age at implantation was 18.9 years (5-49). Aided average thresholds were 103 dB HL and 35 dB HL pre and one-year post implant, respectively. Speech perception was only possible to bemeasured in four patients preoperatively, who scored 13.3; 26.67; 46% vowels and 56% 4-choice. All patients except one had some kind of communication. Two were bilingual. After one year of using the device, seven patients were able to perform the speech tests (from four-choice to close set sentences) and three patients abandoned the use of the implant. Conclusion We observed that detection of sounds can be achieved with late implantation, but speech recognition is only possible in patients with previous hearing stimulation, since it depends on the development of hearing skills and the maturation of the auditory pathways.

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Psychoacoustic Characteristics of Tinnitus versus Temporal Resolution in Subjects with Normal Hearing Sensitivity

Abstract Introduction Cochlear or neural mechanisms of tinnitus generation may affect auditory temporal resolution in tinnitus patients even with normal audiometry. Thus, studying the correlation between tinnitus characteristics and auditory temporal resolution in subjects with tinnitus may help in proper modification of tinnitus management strategy. Objective This study aims to examine the relationship between the psychoacoustic measures of tinnitus and the auditory temporal resolution in subjects with normal audiometry. Methods Two normal hearing groups with ages ranging from 20 to 45 years were involved: control group of 15 adults (30 ears) without tinnitus and study group of 15 adults (24 ears) with tinnitus. Subjective scaling of annoyance and sleep disturbance caused by tinnitus, basic audiological evaluation, tinnitus psychoacoustic measures and Gaps in Noise test were performed. Data from both groups were compared using independent sample t-test. Psychoacoustic measures of tinnitus and Gaps in Noise test parameters of the tinnitus group were correlated with Pearson's correlation coefficient. Results Significantly higher hearing threshold, higher approximate threshold and lower correct Gaps in Noise scores were observed in tinnitus ears. There was no significant correlation between psychoacoustic measures of tinnitus and Gaps in Noise test parameters of the tinnitus group. Conclusion Auditory temporal resolution impairment was found in tinnitus patients, which could be attributed to cochlear impairment or altered neural firing within the auditory pathway. It is recommended to include temporal resolution testing in the tinnitus evaluation battery to provide a proper management planning.

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Use of an Osteoplastic Flap for the Prevention of Mastoidectomy Retroauricular Defects

Abstract Introduction After mastoidectomy, patients usually complain of bone depressions in the retroauricular region in the surgical site, especially in procedures that require extensive cortical resections. This causes inconveniences such as difficulty wearing glasses, cleaning, and aesthetics complaints. Objective This study aims to describe a vascularized flap surgical technique that uses the mastoid cortical bone adhered to the periosteum, which is pedicled on the anterior portion and repositioned at the end of the surgery. This ensures the coverage of the mastoid cavity generated by surgery and prevents ear retraction into the cavity. This preliminary report describes the technique and intraoperative and immediate postoperative complications. Methods After retroauricular incision, periosteal exposure is performed. A U-shaped incision is required for the procedure and delimits a periosteum area appropriate to the size of the mastoidectomy. The cortical bone is opened using a 2.5 mm drill around the perimeter of the "U," at a 3 mmdepth. A chisel is introduced through the surface cells of the mastoid, and a hammer evolves into the anterior direction. The flap is lifted, leaving the periosteum adhered to it and forming a cap. The flap is anteriorly fixed to not hinder the surgery, and repositioned at the end. The periosteum is then sutured to the adjacent periosteum. Results The first 14 cases had no intraoperative complications and were firm and stable when digital pressure was applied during the intraoperative and immediate postoperative periods. Conclusion The osteoplastic flap pedicle is a safe and simple procedure, with good results in the immediate postoperative period.

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Parental Expectation from Children with Cochlear Implants in Indian Context: a Questionnaire Based Study

Abstract Introduction Parental support is important in the habilitation/rehabilitation of children using cochlear implant devices. Hence, it is important for families to know the realistic expectations regarding outcomes from CIs. Objective The objective of the present study is to know the parents' expectation from children using CIs. Methods For this study, we recruited 23 parents of children using CIs. We administered 15 questions translated in to Hindi related to communication abilities, social skills, academic achievement, change in future life, rehabilitation demand, and stress due to hearing impairment. Results The response of the questions (5-point rating scale) related to communication abilities showed that parents were expecting children using CIs to use the telephone (95%), to be able to detect soft sounds (99%), to listen in crowds (86%), to be able to easily understand others (76%), and to show improvement in communication skills (78%). Similarly, for questions related to social skills showed 90% of the parents expecting that their children with CIs should be able to easily make friends with normal hearing peers, and 80% of the parents were expecting the children to achieve high standards in their reading and writing skills. Questions related to change in future life showed 86% of the parents expecting their children with CIs to act like normal hearing children. Further, 78% parents showed positive response regarding importance of intensive training. However, 70% of the parents reported stress in the family due to the existence of the hearing impaired child. Conclusion Overall, the existing questionnaire-based study showed that parents have high expectations from their children with cochlear implant.

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Frequency of Serous Otitis Media in Children without Otolaryngological Symptoms

Abstract Introduction Otitis media with effusion is the fluid in the middle ear with no signs or symptoms of acute ear infection. Objective This study aims to research the frequency of serous otitis media in patients referred to the pediatric clinic between 3-16 years of age without any active ear, nose, and throat complaints. Methods This study included 589 children patients (280 boys, 309 girls; mean age: 9.42; range 3-16) who were administered to the pediatric clinic without otolaryngologic complaints. Patients underwent examination with flexible nasopharyngoscopy for adenoid hypertrophy. An otorhinolaryngologist examined all children on both ears using an otoscope and tested with tympanometry. We used tympanometry results to diagnose SOM. Results The study included 589 patients that underwent fiber optic examination of the nasopharynx with an endoscope. Adenoid vegetation was present in 58 patients (9.8%) and was not detected in 531 patients (90.2%). We found serous otitis media in 94 (15.9%) patients. We obtained Type A tympanogram in 47 (81%) of 58 patients with adenoid vegetation, 6 (10.3%) Type B, and 5 (8.6%) Type C.When comparing 58 patients with adenoid vegetation with 538 patients without adenoid vegetation for serous otitis media, the frequency was not statistically significant (p > 0.05). Conclusion We believe that in children without any ear, nose, and throat complaints, it is possible to detect serous otitis media with adenoid vegetation. Thus, pediatric patients should undergo screening at regular intervals.

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The Impact of Tobacco Smoking Upon Chronic/ Recurrent Tonsillitis and Post Tonsillectomy Bleeding

Abstract Introduction Smoking has many adverse effects on the oral and pharyngeal mucosa. Outcomes may be developing tonsillar infections and predisposing for post tonsillectomy bleeding (PTB). Objective The objective of our study was to determine whether smokers have more chronic/recurrent tonsillitis indicating for tonsillectomy or develop more PTB episodes. Methods We conducted a retrospective study on two groups of adults (age ≥18 years). Cohort 1: Smoking among patients who underwent tonsillectomy for recurrent/ chronic tonsillitis. Cohort 2: Smoking among patients requiring control of PTB that were operated primarily for recurrent/chronic tonsillitis. Cohort 1 served as a populationreference for the second. We retrieved the data from medical records. Results Cohort 1: 206 adults aged 18-50 years (mean 26 ± 7.6). 28% (57 patients) were smokers, versus 24% and 20% in the general population (in the years 2000 and 2010; p = 0.5, p = 0.18, respectively). Cohort 2: 114 adults aged 18-73 years (mean 26 ± 7.6). 43% were smokers, double the incidence in the general population (p = 0.004, p = 0.0004, in 2000 and 2010, respectively), and 1.5 times cohort 1 (p = 0.02). Smoking rates among bleeders on post-operative days 8-10 and later than day 10 were 53% and 60% (p = 0.0005 and p < 0.0001, respectively). Five of ten patients presenting a second PTB were smokers. Timing of re-bleedings was similar to their first PTB and dated similarly as first PTB of the entire group, mean 5.6 days (SD ± 3.2). Conclusion Smokers may encounter more chronic/recurrent tonsillitis episodes, indicating tonsillectomy and significantly are more prone for PTB. Smoking cessation may perhaps diminish recurrent/chronic tonsillitis.Whether pre-operative abstinence or its length would reduce PTB incidence is yet to be determined.

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Primary Concurrent Chemoradiation in Head and Neck Cancers withWeekly Cisplatin Chemotherapy: Analysis of Compliance, Toxicity and Survival

Abstract Introduction Concurrent chemoradiation is the standard of care in inoperable locally advanced squamous cell head and neck cancers. The most widely accepted schedule of concomitant cisplatin is 100mg/m2 given on a 3 weekly basis but the optimal regime is unknown. Objective The objective of this study is to assess the tolerability, compliance, and clinical outcomes of weekly cisplatin (40mg/m2). Methods During the period of January 2007-December 2009, we analyzed retrospectively 122 patients with histologically proven squamous cell carcinoma of head and neck (nasopharynx, oropharynx, larynx, hypopharynx, and oral cavity) treated with definitive chemoradiation. All patients received 63 Gy in 30 daily fractions with concomitant weekly cisplatin 40mg/m2. We assessed treatment toxicities and patient compliance. We estimated overall survival using the Kaplan-Meier method. Results Sixty-eight percent of patients managed to complete all six cycles of chemotherapy while 87% of patients completed at least 5 cycles of weekly cisplatin. Incidence of grade 3/4 toxicity was as follows: mucositis 33%, dermatitis 41%, dysphagia 15%, mouth/neck pain 17%, neutropenia 2%, and renal impairment 3%. 53% patients required at least one hospital admission for symptom control. The 5-year overall survival rate was 60%. Conclusion Concurrent chemoradiotherapy using weekly cisplatin at 40mg/m2 per week is an effective, well tolerated regimen allowing most patients to receive at least 5 cycles of chemotherapy. However, a phase III randomized control trial comparing the standard dose of 100mg/m2 cisplatin tri-weekly with a weekly regimen is needed to establish the long term clinical outcome.

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The Surgical Treatment of Vertigo - A Historical Perspective

Abstract Introduction Concurrent chemoradiation is the standard of care in inoperable locally advanced squamous cell head and neck cancers. The most widely accepted schedule of concomitant cisplatin is 100mg/m2 given on a 3 weekly basis but the optimal regime is unknown. Objective The objective of this study is to assess the tolerability, compliance, and clinical outcomes of weekly cisplatin (40mg/m2). Methods During the period of January 2007-December 2009, we analyzed retrospectively 122 patients with histologically proven squamous cell carcinoma of head and neck (nasopharynx, oropharynx, larynx, hypopharynx, and oral cavity) treated with definitive chemoradiation. All patients received 63 Gy in 30 daily fractions with concomitant weekly cisplatin 40mg/m2. We assessed treatment toxicities and patient compliance. We estimated overall survival using the Kaplan-Meier method. Results Sixty-eight percent of patients managed to complete all six cycles of chemotherapy while 87% of patients completed at least 5 cycles of weekly cisplatin. Incidence of grade 3/4 toxicity was as follows: mucositis 33%, dermatitis 41%, dysphagia 15%, mouth/neck pain 17%, neutropenia 2%, and renal impairment 3%. 53% patients required at least one hospital admission for symptom control. The 5-year overall survival rate was 60%. Conclusion Concurrent chemoradiotherapy using weekly cisplatin at 40mg/m2 per week is an effective, well tolerated regimen allowing most patients to receive at least 5 cycles of chemotherapy. However, a phase III randomized control trial comparing the standard dose of 100mg/m2 cisplatin tri-weekly with a weekly regimen is needed to establish the long term clinical outcome.

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Endolymphatic Sac Surgery for Ménière’s Disease - Current Opinion and Literature Review

Abstract Introduction The endolymphatic sac is thought to maintain the hydrostatic pressure and endolymph homeostasis for the inner ear, and its dysfunction may contribute to the pathophysiology of Ménière's disease. Throughout the years, different surgical procedures for intractable vertigo secondary to Ménière's disease have been described, and though many authors consider these procedures as effective, there are some who question its long-term efficacy and even those who think that vertigo control is achieved more due to a placebo effect than because of the procedure itself. Objective To review the different surgical procedures performed in the endolymphatic sac for the treatment of Ménière's disease. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis We focus on describing the different surgical procedures performed in the endolymphatic sac, such as endolymphatic sac decompression, endolymphatic sac enhancement, endolymphatic sac shunting and endolymphatic duct blockage, their pitfalls and advantages, their results in vertigo control and the complication rates. The senior author also describes his experience after 30 years of performing endolymphatic sac surgery. Conclusions The endolymphatic sac surgery, with all its variants, is a good option for patients with incapacitating endolymphatic hydrops, providing a high percentage of vertigo control and hearing preservation.

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Labyrinthectomy and Vestibular Neurectomy for Intractable Vertiginous Symptoms

Abstract Introduction Labyrinthectomy and vestibular neurectomy are considered the surgical procedures with the highest possibility of controlling medically untreatable incapacitating vertigo. Ironically, after 100 years of the introduction of both transmastoid labyrinthectomy and vestibular neurectomy, the choice of which procedure to use rests primarily on the evaluation of the hearing and of the surgical morbidity. Objective To review surgical labyrinthectomy and vestibular neurectomy for the treatment of incapacitating vestibular disorders. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis In this review we describe and compare surgical labyrinthectomy and vestibular neurectomy. A contrast between surgical and chemical labyrinthectomy is also examined. Proper candidate selection, success in vertigo control and complication rates are discussed on the basis of a literature review. Conclusions Vestibular nerve section and labyrinthectomy achieve high and comparable rates of vertigo control. Even though vestibular neurectomy is considered a hearing sparing surgery, since it is an intradural procedure, it carries a greater risk of complications than transmastoid labyrinthectomy. Furthermore, since many patients whose hearing is preserved with vestibular nerve section may ultimately lose that hearing, the long-term value of hearing preservation is not well established. Although the combination of both procedures, in the form of a translabyrinthine vestibular nerve section, is themost certain way to ablate vestibular function for patients with no useful hearing and disabling vertigo, some advocate for transmastoid labyrinthectomy alone, considering that avoiding opening the subarachnoid space minimizes the possible intracranial complications. Chemical labyrinthectomy may be considered a safer alternative, but the risks of hearing loss when hearing preservation is desired are also high.

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Surgical Treatment for Recurrent Benign Paroxysmal Positional Vertigo

Abstract Introduction Benign paroxysmal positional vertigo is a generally benign condition that responds to repositioning maneuvers and frequently resolves spontaneously. However, for some patients it can become a disabling condition in which surgery must be considered. Two different surgical techniques exist, singular neurectomy and posterior semicircular canal occlusion. Objective The objective of this study is to review the current status of singular nerve section and posterior semicircular canal occlusion as treatments for intractable benign paroxysmal positional vertigo, and to determine if there are published data available that favors one over the other. Data Sources MEDLINE and OLDMEDLINE databases of the National Library of Medicine. Data Synthesis Four studies regarding singular neurectomy and 14 reports on semicircular canal occlusion were analyzed. Both techniques are reported to provide similar symptomatic benefit, with low risk of hearing loss and balance impairment. However, anatomical and clinical studies of singular neurectomy show it to be a more challenging technique, and considering that it is indicated in a very small number of cases, it may be difficult to master. Conclusions Both singular neurectomy and semicircular canal occlusion can be safe and effective in those few patients that require surgery for intractable positional vertigo. Although semicircular canal occlusion requires a postauricular transmastoid approach, it is ultimately easier to learn and perform adequately, and thus may be considered the best alternative.

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