Publication date: Available online 29 July 2017
Source:Allergology International
Author(s): Motoyasu Iikura, Masayuki Hojo, Naoko Nagano, Keita Sakamoto, Konomi Kobayashi, Shota Yamamoto, Masao Hashimoto, Satoru Ishii, Shinyu Izumi, Haruhito Sugiyama
http://ift.tt/2uK8Sk1
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Σάββατο 29 Ιουλίου 2017
Bronchial thermoplasty for severe uncontrolled asthma in Japan
Occupational allergy to Triticum spelta flour
Publication date: Available online 29 July 2017
Source:Allergology International
Author(s): Gemma Mencia, David El-Qutob, Fernando Pineda, Miriam Castillo
http://ift.tt/2vUxEfQ
An analysis of factors related to the effect of sublingual immunotherapy on Japanese cedar pollen induced allergic rhinitis
Publication date: Available online 29 July 2017
Source:Allergology International
Author(s): Syuji Yonekura, Yoshitaka Okamoto, Daiju Sakurai, Kimihiro Okubo, Minoru Gotoh, Shinya Kaneko, Akiyoshi Konno
BackgroundSublingual immunotherapy (SLIT) can improve the symptoms of allergic rhinitis and modify its natural history; however, its efficacy varies among patients. This study aimed to determine which factors modify the effect of SLIT through post hoc analysis of a previous phase 3 trial of standardized Japanese cedar (JC) pollen extract (CEDARTOLEN®).MethodsThe study included 482 patients who had previously completed a phase 3 trial during two seasons. The SLIT and placebo groups each contained 241 subjects. Because pollen dispersal differed in the two seasons, we identified good and poor responders from the SLIT group in the 2nd season. We compared patient baseline characteristics, changes in serum immunoglobulin, and severity of symptoms in the 1st season between good and poor responders, as well as between SLIT and placebo groups.ResultsWhen we compared the baseline characteristics of good and poor responders, a significant difference was observed in body mass index (BMI) such that the patients with BMI ≥25 presented with lower treatment efficacy. No significant difference was observed in correlation with any other factors or treatment-induced alterations of serum immunoglobulin levels. We found that 75.3% of the patients with moderate symptoms and 50.9% of the patients with severe or very severe symptoms in the 1st season met our criteria for good responders in the 2nd season.ConclusionsBMI might modify the effect of SLIT; however, other factors were not related clearly. The severity of symptoms in the 1st season of treatment does not predict that in the 2nd season.
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Effects of prostaglandin E2 on clonogenicity, proliferation and expression of pluripotent markers in human periodontal ligament cells
Source:Archives of Oral Biology, Volume 83
Author(s): Avirut Truntipakorn, Anupong Makeudom, Thanapat Sastraruji, Prasit Pavasant, Kassara Pattamapun, Suttichai Krisanaprakornkit
Background and objectiveBased on our earlier work on the response of periodontal ligament (PDL) cells to mechanical stress by induction of cyclooxygenase expression and production of prostaglandin PGE2 that could regulate mineralization of PDL cells, it was hypothesized that PGE2 had potential effects on PDL stemness. In this study, we aimed to investigate clonogenicity, proliferation and expression of certain pluripotent markers, considered to be characteristics of PDL stemness, in response to treatment with exogenously-added PGE2.Material and methodsHuman PDL cells were cultured and treated with various doses of PGE2, and the aforementioned characteristics of PDL stemness were analyzed.ResultsThe clonogenicity and proliferation were significantly enhanced by PGE2 at low concentrations (0.01, 0.1 and 1ng/ml; P<0.05), but only the proliferation was significantly diminished by PGE2 at a high concentration (100ng/ml; P<0.05). Expression of NANOG and OCT4 mRNA and protein was increased by PGE2 treatment at 0.1 and 1ng/ml. Consistently, expression of stage-specific embryonic antigen 4, a putative stem cell marker, was significantly augmented by PGE2 treatment at 1ng/ml (P<0.05).ConclusionOur findings suggest that although a high dose of PGE2 (100ng/ml) inhibits proliferation of PDL cells, PGE2 at low doses appears to play a role in the maintenance of PDL stemness.
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Evidence of surgical treatments for intractable Meniere’s disease
Source:Auris Nasus Larynx
Author(s): Tadashi Kitahara
Meniere's disease is an inner ear disease, characterized by recurrent rotatory vertigo, sensorineural hearing loss and tinnitus. There are some with frequent vertigo attacks, progressive hearing loss and persistent annoying tinnitus even through the continuous standard medical treatments. These cases are thought to account for 10%–20% of all cases of Meniere's disease. In this review article, we would like to demonstrate the evidences for surgical treatments according to the previous papers, and consider the next therapeutic strategies including surgical options according to the international guidelines.
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The applicability of new TNM classification for humanpapilloma virus-related oropharyngeal cancer in the 8th edition of the AJCC/UICC TNM staging system in Japan: A single-centre study
Source:Auris Nasus Larynx
Author(s): Daisuke Sano, Kenichiro Yabuki, Yasuhiro Arai, Teruhiko Tanabe, Yoshihiro Chiba, Goshi Nishimura, Hideaki Takahashi, Shoji Yamanaka, Nobuhiko Oridate
ObjectiveThe purpose of this study is to validate the applicability of new TNM classification for human papillomavirus (HPV)-related oropharyngeal cancer (OPC) in the 8th edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) TNM staging system in Japan.MethodsA total of 91 OPC patients treated with radiation-based therapy between January 2011 and December 2016 were analyzed retrospectively in this study. HPV infection status was evaluated using tumor p16 expression.Results40 OPC patients (44.0%) had HPV-positive disease in this study. The distribution of disease stage of HPV-positive OPC patients dramatically changed from the 7th edition to the 8th edition of AJCC/UICC TNM classification. However, neither the 8th edition nor the 7th edition of the AJCC/UICC TNM staging system could adequately predict outcomes of HPV-positive OPC patients in our patient series. On the other hand, our multivariate analysis indicated that matted nodes and age ≥63 were independent prognostic factors for progression-free survival. In addition, HPV-positive OPC patients with stage I without matted nodes showed significantly better OS and PFS compared with those with stage I with matted nodes and stages II and III in the 8th edition of the AJCC/UICC TNM staging system (P=0.008, and P=0.043, respectively).ConclusionOur results suggested that matted nodes of HPV-positive OPC patients might be additionally examined to apply the 8th edition of AJCC/UICC TNM classification for more adequate predicting outcomes of HPV-positive OPC patients.
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Editorial Board
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 134, Issue 4
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Contents
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases, Volume 134, Issue 4
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Control of vertigo in Ménière's disease by intratympanic dexamethasone
Publication date: Available online 29 July 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A. Weckel, M. Marx, M.-J. Esteve-Fraysse
ObjectiveThe main objective was to assess the efficacy of intratympanic dexamethasone injection in controlling vertigo in unilateral Ménière's disease refractory to medical treatment.Materials and methodsA retrospective study included 25 patients with disabling unilateral Ménière's disease, defined according to the American Academy of Otorhinolaryngology-Head and Neck Surgery (AAO-HNS) criteria. Patients received intratympanic dexamethasone during the monitoring period. Control of vertigo was classified according to AAO-HNS vertigo control index, at 6 months, 1 year, and 2 years after treatment initiation. Complications and progression of hearing were also assessed.ResultsSatisfactory control (class A or B) was obtained in 92% of patients (n=23/25) at 6 months, 68% (n=17/25) at 1 year, and 70% (n=16/23) at 2 years. There was no worsening of hearing in those patients who were well-controlled by this therapeutic strategy. No local or systemic complications were observed during follow-up.ConclusionDexamethasone is part of the management strategy for patients with Ménière's disease refractory to conventional treatment, implemented before destructive treatment. It achieves control of vertigo in 70% of patients at 2 years.
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Well-differentiated, pedunculated liposarcoma of the hypopharynx
Publication date: Available online 29 July 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): C. Eyermann, T. Raguin, P. Hemar, C. Debry
IntroductionLiposarcoma of the hypopharynx is extremely rare, as only 28 cases have been reported in the literature. The cardinal symptom of liposarcoma is progressively worsening dysphagia.Case reportThe authors report the case of a 71-year-old man who presented with dysphagia, marked weight loss over several weeks and an episode of exteriorization of a solid mass from the mouth during an episode of vomiting. Imaging revealed a fat density intra-oesophageal mass. Panendoscopy and upper gastrointestinal endoscopy visualized the pedunculated tumour in the left piriform sinus, which was able to be exteriorized via the mouth. The tumour was then resected endoscopically at its hypopharyngeal insertion pedicle. Histological examination of the operative specimen concluded on well-differentiated benign liposarcoma.DiscussionWell-differentiated liposarcoma is the most common form of liposarcoma, but is only exceptionally reported in the hypopharynx. The main symptoms are related to compression of adjacent structures. Imaging findings are nonspecific. Only histological examination can distinguish liposarcoma from other benign oesophageal tumours. Standard treatment consists of wide, complete resection, which is not always possible in the neck. Long-term follow-up of these patients is essential in order to rapidly detect recurrence.
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Blood and Nasal Epigenetics Correlate to Allergic Rhinitis Symptom Development in the Environmental Exposure Unit
Abstract
Background
Epigenetic alterations may represent new therapeutic targets and/or biomarkers of allergic rhinitis (AR). Our aim was to examine genome-wide epigenetic changes induced by controlled pollen exposure in the Environmental Exposure Unit (EEU).
Methods
38 AR-sufferers and 8 non-allergic controls were exposed to grass pollen for 3h on two consecutive days. We interrogated DNA methylation at baseline and 3h in peripheral blood mononuclear cells (PBMCs) using the Infinium Methylation 450K array. We corrected for demographics, cell composition, and multiple testing (Benjamini-Hochberg), and verified hits using bisulfite PCR-pyrosequencing and qPCR. To extend these findings to a clinically relevant tissue, we investigated DNA methylation and gene expression of mucin 4 (MUC4), in nasal brushings from a separate validation cohort exposed to birch pollen.
Results
In PBMCs of allergic rhinitis participants, 42 sites showed significant DNA methylation changes of 2% or greater. DNA methylation changes in tryptase gamma 1 (TPSG1), schlafen 12 (SLFN12) and MUC4 in response to exposure were validated by pyrosequencing. SLFN12 DNA methylation significantly correlated with symptoms (p<0.05), and baseline DNA methylation pattern was found to be predictive of symptom severity upon grass allergen exposure (p<0.05). Changes in MUC4 DNA methylation in nasal brushings in the validation cohort correlated with drop in peak nasal inspiratory flow (Spearman r = 0.314, p = 0.034), and MUC4 gene expression was significantly increased (p<0.0001).
Conclusion
This study revealed novel and rapid epigenetic changes upon exposure in a controlled allergen challenge facility, identified baseline epigenetic status as a predictor of symptom severity.
This article is protected by copyright. All rights reserved.
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Stab injury to the preauricular region with laceration of the external carotid artery without involvement of the facial nerve: a case report
Open injuries to the face involving the external carotid artery are uncommon. These injuries are normally associated with laceration of the facial nerve because this nerve is more superficial than the external...
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Hamartome conjonctif étendu de l’enfant
Publication date: Available online 29 July 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): O. Lafargue, S. Fraitag, O. Boccara, F. Comoz, J. Rod, C. Turgis Mezerette, A. Dompmartin
IntroductionL'hamartome conjonctif (HC) est une anomalie rare des composants de la matrice extracellulaire qui se présente habituellement sous la forme de papules couleur de peau normale. Cette atteinte peut être syndromique ou sporadique.ObservationsNous rapportons deux cas d'HC isolés de l'enfant, très étendus et infiltrants, qui entraînaient un risque d'enraidissement articulaire. Il s'agissait d'un hamartome mixte et d'un collagénome.DiscussionIl est difficile de dater l'apparition de ces lésions qui passent souvent inaperçues au début. Devant un HC étendu, les principaux diagnostics différentiels à éliminer grâce à la biopsie cutanée sont la fasciite à éosinophiles et la morphée. L'HC peut être associé à des lésions d'osteopœcilie dans le syndrome de Buschke-Ollendorf, à rechercher par un bilan radiologique itératif. La prise en charge est symptomatique.BackgroundConnective tissue nevus (CTN) is a rare condition of the extracellular matrix components that generally presents as papulae of normal skin colour. This condition may be syndromic or sporadic.Patients and methodsWe report herein two isolated cases of extensive and infiltrative CTN in children at risk for subsequent joint stiffening. The pathology samples displayed respectively mixed hamartoma and a collagenoma.DiscussionThe onset of these lesions is often difficult to establish, since they are usually unnoticeable at first. When confronted with extensive CTN, the main differential diagnoses are eosinophilic fasciitis and morphea, and these must be ruled out by skin biopsy. CTN is associated with osteopoikilosis in Buschke-Ollendorf syndrome. Skeletal lesions are asymptomatic and are detected by means of iterative X-ray. Their management comprises symptomatic care.
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Hypersensibilité aux sels de platine et aux taxanes : intérêt des tests cutanés et des inductions de tolérance
Publication date: Available online 29 July 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): F. Brault, J. Waton, C. Poreaux, J.-L. Schmutz, A. Barbaud
ButLes réactions d'hypersensibilité (HS) aux sels de platine (SP) et aux taxanes (TX) sont fréquentes. L'objectif de notre étude était d'évaluer l'intérêt des tests cutanés et des inductions de tolérance aux SP et TX.MéthodesIl s'agit d'une étude rétrospective réalisée entre janvier 2007 et février 2016, incluant les patients adressés pour suspicion d'HS immédiate ou retardée. Les tests cutanés, prick tests (pT) et intradermoréaction (IDR), étaient réalisés selon les recommandations de l'ENDA/EAACI et les inductions de tolérance (IT) selon un protocole en 12 paliers.RésultatsChez les 99 patients inclus (30 hommes, 69 femmes, âge moyen 60,4 ans), les SP étaient suspectés chez 86 et les TX chez 13. Les tests cutanés étaient positifs chez 25 patients (7 pT et 18 IDR), 23 avec les SP et 2 avec les TX. Une IT était proposée chez 50 patients, réalisée chez 33 (30 avec SP et 3 avec TX), bien supportée chez 29, nécessitant une adaptation chez 7 mais échouait chez 4 patients. Chez ces 4 derniers, les tests cutanés étaient positifs. Parmi les patients ayant des tests positifs à l'oxaliplatine, 75 % avaient une réaction d'HS lors de l'IT, soit une proportion deux fois plus grande que parmi les patients ayant des tests cutanés négatifs. Des réactions croisées survenaient dans 2 % des cas avec les SP et 7 % avec les TX.ConclusionCette expérience française confirme l'intérêt des IT en 12 étapes, permettant dans la plupart des cas de poursuivre une chimiothérapie chez un patient avec HS. Les tests cutanés sont utiles pour l'étude des réactions croisées, cependant leur réalisation doit être considérée au cas par cas.AimThe rate of hypersensitivity reactions to platinum salts (PS) and taxanes (TX) is on the increase. The aim of our study was to show the value of skin testing and efficacy of rapid drug desensitization.Patients and methodsThis was a retrospective study conducted between January 2007 and February 2016 in patients consulting for immediate or delayed hypersensitivity to PS and TX. Skin prick tests (pT) and intradermal reaction tests (IDR) were performed according to the ENDA/EAACI recommendations. We used a 12-step desensitization protocol for rapid drug desensitization.ResultsAmong the 99 patients included (30 men, 69 women, age 60.4) PS were suspected in 86 cases and taxanes in 13 cases. Skin tests were positive in 25 patients (7 pT, 18 IDR), 23 for platinum salts and 2 for taxanes. Rapid drug desensitization was proposed in 50 patients and performed in 33 (30 PS and 3 TX), proved effective in 29 patients, with protocol adaptation being necessary in 7 cases, and was ineffective in 4 patients. The skin tests for the latter 4 patients were positive. Seventy-five percent of patients with positive skin tests to oxaliplatin presented hypersensitivity reactions during desensitization, i.e. twice as many as patients having negative skin tests. Two percent of patient for PS and 7% for TX had cross reactivity.ConclusionThis French study confirms the efficacy of the 12-step protocol that allows patients to receive chemotherapy after hypersensitivity reaction. Skin test permits the detection of cross-reactions but their practice must be considered based on the patient's history.
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Is there a best side for cochlear implants in post-lingual patients?
Publication date: Available online 29 July 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Maria Stella Arantes Amaral, Thiago A. Damico, Alina S. Gonçales, Ana C.M.B. Reis, Myriam de Lima Isaac, Eduardo T. Massuda, Miguel Angelo Hyppolito
IntroductionCochlear Implant (CI) is a sensory hearing aid capable of restoring hearing in patients with severe or profound bilateral sensorineural hearing loss.ObjectiveTo evaluate if there is a better side to be implanted in post-lingual patients.MethodsRetrospective longitudinal study. Participants were 40 subjects, of both sex, mean age of 47 years, with post-lingual hearing loss, users of unilateral CI for more than 12 months and less than 24 months, with asymmetric auditory reserve between the ears (difference of 10dBNA, In at least one of the frequencies with a response, between the ears), divided into two groups. Group A was composed of individuals with CI in the ear with better auditory reserve and Group B with auditory reserve lower in relation to the contralateral side.ResultsThere was no statistical difference for the tonal auditory threshold before and after IC. A better speech perception in pre-IC tests was present in B (20%), but the final results are similar in both groups.ConclusionThe CI in the ear with the worst auditory residue favors a bimodal hearing, which would allow the binaural summation, without compromising the improvement of the audiometric threshold and the speech perception.
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Familial misophonia or Selective Sound Sensitivity Syndrome: evidence for autosomal dominant inheritance?
Publication date: Available online 29 July 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Tanit Ganz Sanchez, Fúlvia Eduarda da Silva
IntroductionMisophonia is a recently described, poorly understood and neglected condition. It is characterized by strong negative reactions of hatred, anger or fear when subjects have to face some selective and low level repetitive sounds. The most common ones that trigger such aversive reactions are those elicited by the mouth (chewing gum or food, popping lips) or the nose (breathing, sniffing, and blowing) or by the fingers (typing, kneading paper, clicking pen, drumming on the table). Previous articles have cited that such individuals usually know at least one close relative with similar symptoms, suggesting a possible hereditary component.Objectivewe found and described a family with 15 members having misophonia, detailing their common characteristics and the pattern of sounds that trigger such strong discomfort.MethodsAll 15 members agreed to give us their epidemiological data, and 12 agreed to answer a specific questionnaire which investigated the symptoms, specific trigger sounds, main feelings evoked and attitudes adopted by each participant.ResultsThe 15 members belong to three generations of the family. Their age ranged from 9 to 73 years (mean 38.3 years; median 41 years) and 10 were females. Analysis of the 12 questionnaires showed that 10 subjects (83.3%) developed the first symptoms during childhood or adolescence. The mean annoyance score on the Visual Analog Scale from 0 to 10 was 7.3 (median 7.5). Individuals reported hatred/anger, irritability and anxiety in response to sounds, and faced the situation asking to stop the sound, leaving/avoiding the place and even fighting. The self-reported associated symptoms were anxiety (91.3%), tinnitus (50%), obsessive-compulsive disorder (41.6%), depression (33.3%), and hypersensitivity to sounds (25%).ConclusionThe high incidence of misophonia in this particular familial distribution suggests that it might be more common than expected and raises the possibility of having a hereditary etiology.
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A case of otitis media with effusion due to leiomyoma of the Eustachian tube
Publication date: Available online 29 July 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Woo Sub Shim, Young Su Kim, Dong Keun Shin, Hahn Jin Jung
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Rebamipide gargle in preventive management of chemo-radiotherapy induced oral mucositis
Publication date: September 2017
Source:Oral Oncology, Volume 72
Author(s): B. Chaitanya, Keerthilatha M. Pai, Prahlad H. Yathiraj, Donald Fernandes, Yogesh Chhaparwal
Background & objectivesOral mucositis is inflammation of mucosa of oral cavity which is an inevitable and acute side effect in patients undergoing chemoradiotherapy for head & neck cancer. Though many agents have been tried in prevention & treatment of oral mucositis, until date no single agent exists that is universally established to be effective.Methods60 Patients diagnosed with Head & Neck cancer recruited for concurrent chemo-radiotherapy were assigned in a double blind fashion into 2 groups using computer based 1:1 ratio randomization. Subjects in Group 1 were given Rebamipide gargle while subjects in Group 2 were given Placebo gargle in similar colour coded bottles to gargle 6 times/day. Subjective assessment of oral mucositis was done by Numeric Rating Scale (NRS) and objective scoring according to RTOG system.ResultsAll subjects in the Group 1 reported good treatment compliance but 4 subjects in Group 2 developed burning sensation to gargle and were excluded. Onset of oral mucositis was 3.5days earlier in Group 2 (mean=11.17) as compared to Group 1 (mean=14.63). At the end of chemo-radiotherapy, severity of oral mucositis was significantly lower in Group 1 (mean=1.97) than in Group 2 (mean=2.81).Interpretation & conclusionFindings of this study revealed that Rebamipide gargle may be an effective means to prolong the onset of oral mucositis and may reduce the severity of oral mucositis in undergoing chemo-radiotherapy.
Graphical abstract
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Cervical spine anomalies: children in one of the oldest churches in Poland.
Abstract
This paper presents pathological changes indicative of type II Klippel-Feil syndrome identified in the skeleton of a child uncovered in one of the oldest Christian churches in Poland (first half of the 11th century) with the archaeological layer containing the burial dated to the 13th–15th centuries.
The age at death of the child was estimated at 9 to 10 years. The third and fourth cervical vertebrae of this individual were fused asymmetrically, leading to torticollis. The apex of the dens axis (odontoid process) was V-shaped, which is consistent with clinical descriptions of ossiculum terminale. The laminae of the second sacral vertebra were found to be fused, but positioned asymmetrically with respect to one another, while the laminae of the third and fourth vertebrae were hypoplastic, suggesting spina bifida of the sacrum. This configuration of anomalies is symptomatic of type II Klippel-Feil syndrome. In addition, the studied individual revealed heterotopic ossification on the supinator crest of the ulna, which may have arisen as a result of dislocation of the elbow joint.
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Correlation between serum vitamin D status and immunological changes in children affected by gastrointestinal food allergy
Publication date: Available online 27 July 2017
Source:Allergologia et Immunopathologia
Author(s): H. Guo, Y. Zheng, X. Cai, H. Yang, Y. Zhang, L. Hao, Y. Jin, G. Yang
BackgroundLow vitamin D status is linked to increased incidence of food allergy and intestinal inflammation. Whether vitamin D status is associated with immunological changes in children with gastrointestinal food allergy (GFA) remains unclear.MethodsForty-nine GFA children (aged 2–11 years old) were enrolled in this study. Serum 25-hydroxyvitamin D (25OHD) level, total immunoglobulin E (IgE), specific IgE against allergens, circulating regulatory T lymphocytes (Tregs), and blood eosinophil numbers were measured.ResultsLevels of serum 25OHD in the GFA children ranged 35.5–156.4nmol/L, with a mean value similar to that of the healthy controls. Compared to those with normal 25OHD (≥75nmol/L), GFA children with low 25OHD (<75nmol/L) had increased total IgE (84% vs. 54%, P<0.05), persistent blood eosinophilia (56% vs. 25%, P<0.05), and delayed resolution of symptoms after food allergen elimination (odds ratio 3.51, 95% CI 1.00–12.36, P<0.05). Among the GFA children with elevated total IgE, those with low 25OHD had lower circulatory Tregs (8.79±2.4% vs. 10.21±1.37%, P<0.05), higher total IgE (1197.5±1209.8 vs. 418.5±304.6kU/L, P<0.05), and persistent eosinophilia (0.61±0.52 vs. 0.31±0.15×109cells/L, P<0.05) compared to those with normal 25OHD. In addition, serum 25OHD concentrations inversely correlated with total IgE (R=−0.434, P<0.05), and positively with Treg population (R=0.356, P<0.05).ConclusionLow serum vitamin D status correlates with stronger allergic immune response in GFA children.
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Air pollution and its relationship to lung function among adolescents from Taubate, São Paulo, Brazil
Publication date: Available online 27 July 2017
Source:Allergologia et Immunopathologia
Author(s): M. Froio Toledo, B. Mangueira Saraiva-Romanholo, R. Carvalho Oliveira, L. Ferraz da Silva, D. Solé
BackgroundThis paper sought to evaluate individual exposure to air pollution by quantifying the carbon in alveolar macrophages (AMs) and its relationship to lung function. We also examined the proximity of participants' residences to the Presidente Dutra highway (PDH) in adolescents with asthma from Taubaté, São Paulo, Brazil.MethodsThis descriptive study examined fifty 13- to 14-year-old adolescents with asthma identified by the International Study of Asthma and Allergies in Childhood (ISAAC) in Taubaté. These adolescents underwent spirometry and sputum induction via the inhalation of 3% hypertonic saline (HSS). Sputum was collected after each nebulisation, and forced expiratory flow in one second (FEV1) was measured. The collected sputum was stored and transported to the laboratory; it was then processed and analysed for ultrafine particles (≤100nm). This analysis was correlated with the residence location and FEV1 of each adolescent.ResultsA total of 39 adolescents completed the study. The comparison of the carbon fraction within macrophages (CA/MA) showed no differences according to residence in relation to the PDH (p=0.758). After adjustment, a mixed linear model with FEV1 as the dependent variable and CA/MA, location, and evaluation condition as the predictors found that the interactions among the variables were not significant.ConclusionsThe amount of carbon present within the AMs of adolescents with asthma was not correlated with either lung function or residence location. Evaluations of the topography and local climatic conditions in Taubaté should be considered in future studies.
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Clinical presentation and airway management of tracheal atresia: A systematic review
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Mariana M. Smith, Amy Huang, Mathilde Labbé, Joshua Lubov, Lily H.P. Nguyen
ObjectivesTracheal atresia (TA) is a rare congenital condition that typically requires an unexpected and emergent resuscitation in the delivery room. The mortality rate associated is very high, with only a few long-term survival cases reported. We describe the findings of a systematic review on the clinical presentation and airway management of TA.MethodsUsing the keywords "tracheal atresia", "tracheal agenesis" and "tracheal hypoplasia" a search through Embase and Pubmed databases was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Articles published from 1950 to 2015 in English, French, Italian, Portuguese and Spanish were included. Exclusion criteria were cases of stillborn, and unclear diagnosis or outcome.Results149 cases of TA were identified after reviewing 1125 initial references. There was a male preponderance (65%), and associated malformations were described in 94.2% of patients. Prenatal ultrasound was abnormal in 56.3% of cases, with polyhydramnios being the most common finding. The most frequent type of TA was Faro Type C. 94 (41.3%) patients did not survive beyond the first 24 h of life. Only 13 (8.4%) patients survived more than three months of life, after undergoing a variety of surgical approaches.ConclusionThis review, which to our knowledge is the largest one to date, confirms that TA is a rare malformation, occurs more frequently in males, and has a very high mortality rate. Depending on the presence and type of concomitant malformation, as well of the length of the remaining trachea, different surgical management options are described.
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Evaluation of transient-evoked otoacoustic emissions in a healthy 1 to 10 year pediatric cohort in Sub-Saharan Africa
Source:International Journal of Pediatric Otorhinolaryngology, Volume 101
Author(s): Daniel Dejaco, Fabian C. Aregger, Helene V. Hurth, Josua Kegele, Veronika Muigg, Lukas Oberhammer, Sebastian Bunk, Natalie Fischer, Leyla Pinggera, David Riedl, Allan Otieno, Tsiri Agbenyega, Ayola A. Adegnika, Herbert Riechelmann, Peter Lackner, Patrick Zorowka, Peter Kremsner, Joachim Schmutzhard
ObjectiveTransient-evoked otoacoustic emissions (TEOAEs) monitor cochlear function. High pass rates have been reported for industrialized countries. Pass rates in low and middle income countries such as Sub-Saharan Africa are rare, essentially lower and available for children up to 4 years of age and frequently based on hospital recruitments.This study aims at providing additional TEOAE pass rates of a healthy Sub-Saharan cohort aged 1–10 years with data from Gabon, Ghana and Kenya. Potentially confounding factors (recruitment site, age) are taken into consideration.MethodsHealthy children were recruited in hospitals, schools and kindergartens. Inclusion criteria were age 1–10 years and normal otoscopic findings. Exclusion criteria were any sickness or physical ailment potentially impairing the hearing capacity. Five measurements per ear were performed with Capella Cochlear Emission Analyzer (MADSEN, Germany). An overall wave reproducibility of above 60% served as pass-criterion. Pass rates were compared between recruitment sites and age groups (1–5 and 6–10 years).ResultsOverall pass rate was 87.5% (n = 264; 231 passes vs. 33 fails). Of these 84.0% of hospital recruited children passed (n = 156; 131 passes vs. 25 fails), compared to 92.6% of community recruitments (n = 108; 100 passes vs. 8 fails), which was significantly different p = 0.039). If analyzed by age groups, this difference was only observed in children younger than 6 years (p = 0.007).ConclusionHospitals as recruitment sites for healthy controls seem to affect TEOAE pass rates. We advise for a cautious approach when recruiting healthy TEOAE control collectives under the age of 6 in a hospital setting. In children older than 6 years conventional pure-tone audiometry remains the standard method for hearing screening.
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Combination of a 2940 nm Er:YAG laser with recombinant bovine basic fibroblast growth factor (rb-bFGF) and light-emitting diode-red light (LED-RL) for the treatment of striae alba: A pilot study
Summary
Background
Striae distensae (SD) are a common dermatologic problem that plagues many people. Although there are many therapeutic modalities have been used to treat SD, effective method has been disappointing for striae Alba.
Aims
To evaluate the clinical and histopathologic efficacy and safety of the 2940-nm erbium yttrium aluminum garnet (Er:YAG) ablative fractional laser (AFL) with recombinant bovine basic fibroblast growth factor (rb-bFGF) and light-emitting diode-red light (LED-RL) for the treatment of striae alba.
Patients and methods
Thirty volunteers with striae distensae alba were enrolled. The subjects completed treatments with the 2940-nm Er:YAG AFL 6 times at 4-week intervals. Following this treatment, the subjects were required to spray rb-BFGF for 1 week at home. They then received LED-RL once every 7 days for three sessions between the two laser treatments. Two independent investigators evaluated clinical improvement at pretreatment and 1, 3, 6, and 12 months post-treatment, patients also provided self-assessments of clinical improvement. Two biopsies were obtained from two subjects, both of the same sites of striae alba, one before the first treatment and one 6 months after the last session.
Results
All 30 subjects demonstrated clinical improvement after treatment. Skin biopsies after treatment showed an increase in epidermal thickness, dermal thickness, and collagen and elastin density when compared to that at the baseline.
Conclusions
The combination of the 2940-nm Er:YAG laser with rb-bFGF and LED-RL for the treatment of striae alba was a safe and effective approach for improving the appearance of striae alba.
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Absolute Postoperative B-Type Natriuretic Peptide Concentrations, but Not Their General Trend, Are Associated With 12-Month, All-Cause Mortality After On-Pump Cardiac Surgery.
BACKGROUND: B-type natriuretic peptide (BNP) is a predictor of mortality after on-pump cardiac surgery. However, previous limited and heterogeneous studies have focused on peak concentrations at 3 to 5 days after surgery and may not offer clinicians much help in early decision-making. After confirming the predictive value of first-postoperative-day BNP in a preliminary analysis, we explored the association between isolated second-postoperative-day BNP concentrations, second-day BNP concentrations in conjunction with first-day BNP concentrations, and the change in BNP (ie, [DELTA]BNP) from the first to the second postoperative day and 12-month, all-cause mortality. METHODS: We included consecutive patients undergoing on-pump cardiac surgery in this observational, secondary analysis of prospectively collected data. We analyzed biomarkers on the first and second postoperative day. [DELTA]BNP was defined as BNP on the second postoperative day minus BNP on the first postoperative day. The primary end point was 12-month, all-cause mortality. The secondary end point was a composite of major adverse cardiac events (MACEs) at 12 months and/or all-cause mortality at 12 months. MACE was defined as nonfatal cardiac arrest, myocardial infarction, and congestive heart failure. The association between BNP and outcomes was examined by receiver operating characteristic curves, as well as univariate and multivariable logistic regression, adjusting for the EuroSCORE II, cross-clamp time, and first-postoperative-day troponin T. RESULTS: We included 1199 patients in the preliminary analysis focused on BNP on postoperative day 1. In the analyses examining BNP variables requiring second-postoperative-day BNP measurement (n = 708), we observed 66 (9.3%) deaths, 48 (6.8%) MACE, and 104 (14.7%) deaths and/or MACE. Both first- and second-postoperative-day BNP were significant independent predictors of all-cause, 12-month mortality per 100 ng/L increase (adjusted odds ratio [aOR], 1.040 [95% confidence interval (CI), 1.019-1.065] and 1.064 [95% CI, 1.031-1.105], respectively). When used in conjunction with one another, first-day BNP was not significant (aOR, 1.021 [95% CI, 0.995-1.048]), while second-day BNP remained significant (aOR, 1.046 [95% CI, 1.008-1.091]). The [DELTA]BNP per 100 ng/L increase was not associated with 12-month, all-cause mortality in the univariable (OR, 0.977 [95% CI, 0.951-1.007]) or multivariable analysis (aOR, 0.989 [95% CI, 0.962-1.021]). CONCLUSIONS: Both absolute concentrations of first- and second-postoperative-day BNP are independent predictors of 12-month, all-cause mortality. When modeled together, second-postoperative-day BNP is more predictive of 12-month, all-cause mortality. Although intuitively appealing, the change in BNP from the first to the second postoperative day is a complex variable and should not routinely be used for prognostication. (C) 2017 International Anesthesia Research Society
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The WFSA Global Anesthesia Workforce Survey.
BACKGROUND: Safe anesthesia and surgical care are not available when needed for 5 billion of the world's 7 billion people. There are major deficiencies in the specialist surgical workforce in many parts of the world, and specific data on the anesthesia workforce are lacking. METHODS: The World Federation of Societies of Anaesthesiologists conducted a workforce survey during 2015 and 2016. The aim of the survey was to collect detailed information on physician anesthesia provider (PAP) and non-physician anesthesia provider (NPAP) numbers, distribution, and training. Data were categorized according to World Health Organization regional groups and World Bank income groups. RESULTS: We obtained information for 153 of 197 countries, representing 97.5% of the world's population. There were marked differences in the density of PAPs between World Health Organization regions and between World Bank income groups, ranging from 0 to over 20 PAP per 100,000 population. Seventy-seven countries reported a PAP density of
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http://ift.tt/2haQmfI
Comparison Between the Cobra Perilaryngeal Airway and Laryngeal Mask Airways Under General Anesthesia: A Systematic Review and Meta-analysis.
The complication rate and efficacy of the Cobra Perilaryngeal Airway (CobraPLA) and laryngeal mask airways (LMAs(R)) have been evaluated in the published literature, but the conclusions have been inconsistent. The aim of this systematic review and meta-analysis was thus to assess the performance of the CobraPLA and LMAs under general anesthesia. We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials comparing the CobraPLA with LMAs under general anesthesia. The LMAs used for comparison were the classic LMA (CLMA) and the unique LMA (ULMA). The random effect model was used if heterogeneity was observed, otherwise the fixed effect model was used. Seventeen randomized controlled trials were included; number of studies analyzed for each result are different and were up to 10. The current result suggests that no significant difference between the devices in the insertion success rate at the first attempt. The success rate of first insertion of the CobraPLA was not different from the rates for the CLMA and the ULMA (relative risk: 0.95, 95% confidence interval [CI], 0.91-1.00). CobraPLA insertion was not different from CLMA and ULMA insertion. The CobraPLA provided an oropharyngeal leak pressure higher than that provided by the CLMA (weight mean difference: 3.90, 95% CI, [1.59-6.21] cmH2O) and ULMA (weight mean difference: 6.57, 95% CI, [4.30-8.84] cmH2O). We also found a higher likelihood of blood staining in the airway with the CobraPLA than with the CLMA. In our research, the principal finding of our meta-analysis is that the success rate of first insertion of the CobraPLA was not different from the rate for each of the CLMA and the ULMA, which featured a short learning curve implying its ease of insertion. There was also no significant difference in the incidence of the best view (with a score of 4) obtained with the CobraPLA compared with the other 2 devices. The CobraPLA does seem to be superior to the CLMA and ULMA in providing a higher oropharyngeal leak pressure. The data were insufficient to establish differences in airway adverse events between the groups except for blood staining in the devices, although mucosal trauma occurred more frequently with the Cobra PLA device than with the CLMA and the ULMA. (C) 2017 International Anesthesia Research Society
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