Perioperative management of rare coagulation factor deficiency states in cardiac surgery

Abstract

Rare bleeding disorders (RBDs) include the hereditary deficiency of fibrinogen, factor (F)II, FV, FV + FVIII, FVII, FX, FXI or FXIII. RBDs do not confer a protective effect against atheromatous plaque formation, and thus the need for cardiovascular (CV) surgery in RBD patients is expected to increase with improved healthcare access (diagnosis and management) and longevity of the population. Clinical data regarding the management of RBDs in this setting are sparse, but the perioperative care team is obliged to gain a better understanding on available biological and pharmacological hemostatic agents. Perioperative management of RBDs in CV surgery is further complicated by heparin anticoagulation, haemodilution, and consumption of procoagulant and anticoagulant proteins associated with cardiopulmonary bypass (CPB). The aims of this review are to summarize pathophysiology of RBDs and laboratory monitoring pertinent to CV surgery, available factor replacement agents, and to provide the framework for perioperative coagulation management of RBD patients.

http://ift.tt/2wAxtK5

Association Between Obesity and Chronic Kidney Disease, Defined by Both Glomerular Filtration Rate and Albuminuria, in Korean Adults

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


http://ift.tt/2xeHGc7

Urticaria by thiamine (vitamin B1)

Publication date: Available online 23 August 2017
Source:Allergology International
Author(s): Ana Rodríguez-Fernández, Marcos Sánchez-Domínguez, Blanca Noguerado-Mellado, Patricia Rojas-Pérez-Ezquerra




http://ift.tt/2irURTZ

High quality of evidence is uncommon in Cochrane systematic reviews in Anaesthesia, Critical Care and Emergency Medicine.

BACKGROUND: The association between the quality of evidence in systematic reviews and authors' conclusions regarding the effectiveness of interventions relevant to anaesthesia has not been examined. OBJECTIVE: The objectives of this study were: to determine the proportion of systematic reviews in which the authors made a conclusive statement about the effect of an intervention; to describe the quality of evidence derived from outcomes in reviews that used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) working group system for grading the quality of evidence; and to identify review characteristics associated with conclusiveness. DESIGN: Cross-sectional analysis of Cochrane systematic reviews from the Anaesthesia, Critical Care and Emergency Review Group was undertaken. DATA SOURCES: The Cochrane webpage was used to identify reviews for inclusion ( http://.ace.cochrane.org/). ELIGIBILITY CRITERIA: New and updated versions of systematic reviews published up to 17 September 2015 were eligible. Protocols for systematic reviews were excluded. RESULTS: A total of 159 reviews were included. GRADE was used in 103 reviews (65%). Of these, high-level evidence for the primary outcome was identified in 11 reviews (10%). The main reasons that quality of evidence for the primary outcome was downgraded were risk of bias (n = 44; 43%) and imprecision (n = 36; 35%). Authors of 47% (n = 75) of the total number of reviews made conclusive statements about the effects of interventions. Independent predictors of conclusiveness in the subgroup of reviews with GRADE assessments were quality of evidence for the primary outcome (odds ratio 2.03; 95% confidence interval: [1.18 to 3.52] and an increasing number of studies included in reviews (OR 1.05; 95% CI: [1.01 to 1.09]). CONCLUSION: It was common for conclusive statements to be made about the effects of interventions despite evidence for the primary outcome being rated less than high quality. Improving methodological quality of trials would have the greatest impact on improving the quality of evidence. 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. http://ift.tt/OBJ4xP (C) 2017 European Society of Anaesthesiology

http://ift.tt/2w6n0TO

Relatively low invasive capacity of Porphyromonas gingivalis strains into human gingival fibroblasts in vitro

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Ju Young Jang, Keum Jin Baek, Youngnim Choi, Suk Ji
ObjectiveBacterial invasion into host cells is a common strategy to escape the host immune system. Gingival fibroblasts (GFs) are the most predominant non-phagocytic cell type in gingival connective tissue. Therefore, invasion into GFs was thought to be the first strategy for the survival of Porphyromonas gingivalis. The present study compared the invasive ability of P. gingivalis into GFs with those of other red-complex and relatively less pathogenic bacterial strains, especially Fusobacterium nucleatum.Materials and methodsInvasive ability of bacterial strains into GFs was measured using a flow cytometric invasion assay at a multiplicity of infection of 1000. The effect of dual infection with F. nucleatum CCUG 37843T on P. gingivalis ATCC 49417 invasion was investigated. The invasive ability of F. nucleatum and P. gingivalis was confirmed using confocal microscopy.ResultsThe invasive ability of red-complex bacteria was markedly lower than that of F. nucleatum or Campylobacter gracilis. The invasive ability of 4 types and 10 clinical strains of P. gingivalis was less than 6%, and that of F. nucleatum strains was greater than 45%. Confocal analysis revealed that the percentage of bacteria invading GFs in the cell-treated P. gingivalis and F. nucleatum were 0.0068% and 1.22%, respectively. Dual infection with F. nucleatum increased the invasive ability of P. gingivalis.ConclusionThe invasive capacities of P. gingivalis into GFs were comparatively lower than those of relatively less pathogenic bacteria. Invasion into GFs cannot be the first strategy for survival of P. gingivalis in gingival connective tissue.



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“Metabolism of Odontoblast-like cells submitted to transdentinal irradiation with blue and red LED”

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Leopoldina de Fátima Dantas de Almeida, Fernanda Gonçalves Basso, Ana Paula Silveira Turrioni, Carlos Alberto de-Souza-Costa, Josimeri Hebling
ObjectivesThe present study evaluated the trans-dentinal effect of light emitting diodes (LEDs) irradiation on the metabolism of odontoblast-like cells.MethodsSeventy-two dentin discs (0.2mm thick) were obtained from human molar teeth. MDPC-23 cells (20,000 cells/disc) were seeded on the pulpal side of the discs using DMEM, supplemented with 10% fetal bovine serum (FBS). After 12h, the culture medium was replaced with DMEM containing 0.5% FBS. After additional 12h, blue (455±10nm) or red (630±10nm) LEDs were used at irradiances of 80 and 40mW/cm², respectively, to irradiate the occlusal side of the discs. The energy doses were fixed at 2 or 4J/cm². Cell viability, alkaline phosphatase activity (ALP), total protein production and collagen synthesis were evaluated 72h after irradiation. Data were submitted to Kruskal-Wallis and Mann-Whitney tests (α=0.05).ResultsRed light promoted proliferative effects at the energy dose of 4J/cm². Conversely, cell cultures irradiated with 2J/cm² emitted by the blue light showed reduced viability. ALP production was stimulated by red light in comparison with blue light at 4J/cm². Total protein production was reduced after exposure to blue light at 4J/cm², while no effect was observed on collagen production.ConclusionsIrradiation with red LED at 4J/cm² bio-stimulated the viability of odontoblast-like cells, whilst blue light had unfavorable effects on the cellular metabolism.



http://ift.tt/2wAaG1c

Liver Transplantation for the Treatment of Complicated Iatrogenic Biliary Injuries: A National Review from the UNOS Dataset.

Background: Liver transplantation (LT) is rarely indicated in the management of iatrogenic bile duct injuries (IBDI), but occasionally it becomes the only remaining therapy. The purpose of this study is to evaluate potential complications of IBDI and their impact on perioperative mortality, graft and patient survival after LT. Methods: The UNOS database was queried for all LT performed in the United States between 1994 and 2014. Of the 101 238 liver transplants performed, 61 were related to IBDI. We performed a case matched analysis in a 5:1 ratio. Results: The median age for patients with IBDI was 50.16+11.7 years with a mean MELD score of 22.6 + 9.8. Patients receiving liver transplantation for IBDI were more likely women (54.1%, p 0.001), had lower incidence of hepatitis C virus infection (4.9%, p 0.001) and longer cold ischemic time (p 0.001). The mean BMI was 25.5+ 5.2) in patients transplanted for IBDI. IBDI was recognized as the strongest independent predictor associated with 8-fold increased risk of early graft loss (p 0.001, OR 8.4) and a 2.9-fold increased risk of 30-day mortality after LT in a case matched analysis (p 0.03). Conclusions: IBDI is an uncommon but challenging indication for liver transplantation. These patients have significantly increased rates of early graft loss. IBDI is an independent factor related to increased risk of perioperative death after LT. Further studies are needed to determine the causes of perioperative complications and identify potential modifiable factors to improve outcomes in patients undergoing transplantation for IBDI. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2vZVRU8

Transtympanic pseudoaneurysm of the internal carotid artery complicating a myringotomy in a four-year old child: Case report and literature review

We report the first case of a transtympanic iatrogenic internal carotid artery (ICA) pseudoaneurysm diagnosed in a 4-year-old child following a myringotomy. An endovascular treatment with a covered-stent was decided; spontaneous thrombosis was found during the therapeutic arteriography, and the procedure was aborted. Otoscopy and computed tomography (CT) scan monitoring showed a prolonged thrombosis and the disappearance of the pseudoaneurysm 18months after the diagnostic arteriography. Based on literature review, endovascular techniques seem to be preferred to the surgical approach for treatment of intrapetrous ICA pseudoaneurysm, however clinical and CT scan monitoring may also be a valid option.

http://ift.tt/2isimw4

Die Begutachtung der Facialisparese in der österreichischen privaten Unfallversicherung

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-115733

In Westeuropa ist die periphere Facialisparese die häufigste Hirnnervenaffektion. Traumatisch bedingte Paresen weisen im Gegensatz zu nichttraumatischen Paresen eine höhere Defektheilungsrate auf. Die anlagebedingte Form tritt als Bell'sche Lähmung oder in Kombination mit anderen Pathologien, vor allem in Verbindung mit der Lyme'schen Erkrankung oder dem Zoster oticus, in Erscheinung. Die traumatische Parese ist überwiegend unfallbedingt und fast immer vergesellschaftet mit multiplen anderen Verletzungsmustern. Anlagebedingte Formen haben im Vergleich zur traumatischen Form eine niedrige Defektheilungsrate. Der Gutachter hat diese Defekte, so wie sie sich ihm aktuell bieten, zu beurteilen, wobei auch prognostische Überlegungen einfließen sollten. Die österreichische private Unfallversicherung deckt das Risiko einer unfallbedingten Verletzung. Dieser versicherungsrechtliche Unfallbegriff umfasst ein breites Spektrum von Verletzungsmustern sowie auch eine durch Zeckenbiss verursachte Facialisparese. Primär stellt die österreichische private Unfallversicherung auf die erlittene unfallbedingte Funktionsstörung ab. Trotzdem bietet sie auch eingeschränkt Deckung für ästhetische aus dem Unfall resultierende Folgen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Hypoglossus-Stimulation bei OSAS auch außerhalb von Studien sicher und effektiv

Laryngo-Rhino-Otol 2017; 96: 437-438
DOI: 10.1055/s-0043-105199

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Schmerzhafte Raumforderung der Ohrmuschel

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-116666

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Unklarer Tumor des Oropharynx beim Kind

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-116665

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Ulzerierende Laryngitis bei einer 34-jährigen Patientin

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-116664

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Hörtestergebnisse bei 18- bis 20-jährigen Männern aus Kreiswehrersatzämtern von 2008–2010

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-115732

Hintergrund Während eine mit dem Alter zunehmende Schwerhörigkeit im Hochtonbereich hinreichend belegt ist, sind das Ausmaß und die Zunahme möglicher Schwerhörigkeiten bei jungen Menschen weiterhin unklar. Da in diesem Altersbereich ein hoher Anteil an Normalhörigkeit zu erwarten ist, sind die Anforderungen an Screening-Methoden besonders hoch und die Motivation zur Teilnahme eher niedrig. Die verpflichtende Musterung umfasst u. a. eine audiologische Hörprüfung (Tonaudiogramm) und bietet daher die Möglichkeit das Hörvermögen junger männlicher Erwachsener zu analysieren. Material und Methoden Die Prävalenz für Hörbeeinträchtigungen wurde anhand der Luftleitungshörschwellen 18- bis 20-jähriger Männer von 54 deutschen Kreiswehrersatzämtern (KWEA) der Jahre 2008–2010 bestimmt. Als Kriterium wurde die Überschreitung einer Hörschwelle von 20 dB HL bei mindestens einer der Frequenzen 3, 4 oder 6 kHz auf mindestens einem Ohr verwendet. Diesem sehr strengen Kriterium wurden andere Definitionen für Hörschäden vergleichend gegenübergestellt. Ergebnisse Die Prävalenz von relevanten Hörschäden beträgt im Mittel 15,3 % und liegt damit im Bereich anderer Untersuchungen. Die Ergebnisse einzelner KWEA unterscheiden sich jedoch um bis zu einem Faktor 10. Schlussfolgerung Aufgrund stark schwankender Messqualität in den KWEA lässt sich nicht klären, ob regionale Unterschiede im Hörvermögen junger Männer bestehen und ob sich dieses im Vergleich zu früheren Untersuchungen verschlechtert hat. Die hohe Variabilität bei Messungen nahe der Hörschwelle erfordert eine ständige Qualitätskontrolle. Dabei können die Hörergebnisse im Screening nicht nach den strengen Kriterien bewertet werden, die für Hörprüfungen in audiologischen Zentren oder Studien anzusetzen sind.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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

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Orbital complications of acute sinusitis

Publication date: Available online 23 August 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Adam P. Campbell, Regan W. Bergmark, Ralph Metson
In the pre-antibiotic era, orbital complications of acute sinusitis were not infrequent, often leading to severe patient morbidity, including blindness. Today, treatment of orbital complications consists primarily of systemic antibiotic therapy with surgical intervention reserved for large or medically unresponsive orbital or subperiosteal abscesses. Staging systems have been created to assist physicians in management and prognosis of such complications, but do not replace clinical acumen. While powerful antibiotics have decreased the morbidity associated with orbital complications of acute sinusitis, the physician should remain aware of potential complications and ready to escalate treatment when necessary.



http://ift.tt/2vh0ohU

Cervical and craniofacial necrotizing fasciitis

Publication date: Available online 23 August 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Laura J. Vandelaar, Ibrahim Alava
Cervical and craniofacial necrotizing fasciitis is an aggressive disease process that at times has subtle etiologies and physical findings. Involvement in the head and neck is rare; however, when present it can have extensive morbidity and mortality. High index of suspicion is paramount for early treatment and survival. We describe the presentation, diagnosis and treatment of cervical and craniofacial necrotizing fasciitis. We detail the typical physical exam findings as well as diagnosis based on imaging. We then describe in-depth the operative techniques needed to properly treat these patients allowing for their best chance at survival from this deadly disease.



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Selected Literature Watch

Violence and Gender , Vol. 0, No. 0.


http://ift.tt/2vp6AUE

Development of the Endoscopic Endonasal Sinus and Skull Base Surgery Questionnaire

Background

The patients' perspective of health outcomes has become important input for assessing treatment effects. However, existing endoscopic endonasal surgery (EES) instruments are not fully aligned with the concept of health-related quality of life (HRQoL). A prospective cohort study was therefore conducted to develop a suitable quality-of-life tool to assess nasal morbidity after EES: the Endoscopic Endonasal Sinus and Skull Base Surgery Questionnaire (EES-Q).

Methods

The study included 300 patients: 207 with sinus pathology and 93 with anterior skull base pathology. The EES-Q was administered prior to surgery and postoperatively (2 weeks, 3 months, and 1 year). Psychometric instrument properties were tested and relevant health domains were formulated. Seventy-two items were generated by the conventional psychometric approach. An exploratory factor analysis was used to test construct validity. The optimal number of factors to retain was determined by using the eigenvalues-greater-than-1 rule and scree plot. Orthogonal varimax rotation was used to enhance interpretability. Internal consistency was assessed using the Cronbach α.

Results

The factor analysis yielded a 3-factor solution, representing physical, psychological, and social functioning. The final version of the instrument consisted of 30 items with a high internal consistency (>0.80) for all 3 HRQoL domains.

Conclusions

The EES-Q is a comprehensive, multidimensional, disease-specific instrument. A distinguishing characteristic is that, apart from the physical and psychological domains, the EES-Q also encompasses a social domain. Understanding different HRQoL aspects in patients undergoing EES may help caregivers restore, improve, or preserve the patient's health through individualized care, which depends on identifying their specific needs.

http://ift.tt/2xd4WqY

Paradoxical worsening of hypoxemia in a patient treated by noninvasive positive pressure ventilation for obesity hypoventilation syndrome with concomitant obstructive sleep apnea: a case report

Noninvasive positive pressure ventilation is frequently prescribed to obese patients with obstructive sleep apnea syndrome and obesity hypoventilation syndrome. However, mechanical ventilation with a positive ...

http://ift.tt/2wFTINQ

A Re-examination of the Effect of Masker Phase Curvature on Non-simultaneous Masking

Abstract

Forward masking of a sinusoidal signal is determined not only by the masker's power spectrum but also by its phase spectrum. Specifically, when the phase spectrum is such that the output of an auditory filter centred on the signal has a highly modulated ("peaked") envelope, there is less masking than when that envelope is flat. This finding has been attributed to non-linearities, such as compression, reducing the average neural response to maskers that produce more peaked auditory filter outputs (Carlyon and Datta, J Acoust Soc Am 101:3636–3647, 1997). Here we evaluate an alternative explanation proposed by Wotcjzak and Oxenham (Wojtczak and Oxenham, J Assoc Res Otolaryngol 10:595–607, 2009). They reported a masker phase effect for 6-kHz signals when the masker components were at least an octave below the signal frequency. Wotcjzak and Oxenham argued that this effect was inconsistent with cochlear compression, and, because it did not occur at lower signal frequencies, was also inconsistent with more central compression. It was instead attributed to activation of the efferent system reducing the response to the subsequent probe. Here, experiment 1 replicated their main findings. Experiment 2 showed that the phase effect on off-frequency forward masking is similar at signal frequencies of 2 and 6 kHz, provided that one equates the number of components likely to interact within an auditory filter centred on the signal, thereby roughly equating the effect of masker phase on the peakiness of that filter output. Experiment 3 showed that for some subjects, masker phase also had a strong influence on off-frequency backward masking of the signal, and that the size of this effect correlated across subjects with that observed in forward masking. We conclude that the masker phase effect is mediated mainly by cochlear non-linearities, with a possible additional effect of more central compression. The data are not consistent with a role for the efferent system.

http://ift.tt/2vZgkbD

Cutaneous Pseudolymphoma Arising as Wolf’s Post-Herpetic Isotopic Response

This case report describes a patient with cutaneous pseudolymphoma arising as Wolf's post-herpetic isotopic response.

http://ift.tt/2g6gRCT

Progressive Annular Plaques in a Toddlers

A toddler presented with annular, indurated, dusky red plaques with central clearing and trailing scale ranging from 1 to 6 cm in diameter on his trunk. What is your diagnosis?

http://ift.tt/2irwzcu

USMLE Step 2 Clinical Knowledge Score in Dermatology Resident Selection

This survey analysis assesses the use of USMLE Step 2 CK scores in resident selection in US dermatology residency programs.

http://ift.tt/2g5nCoJ

Association of Vitamin D Receptor Polymorphisms With Nonmelanoma Skin Cancer Risk

This case-control study analyzes the contributions of known risk factors and polymorphisms to the development of nonmelanoma skin cancer.

http://ift.tt/2iqfjof

Noninvasive Test for NASH and Hepatic Fibrosis in Patients With Psoriasis

This cohort study evaluates if a noninvasive test for nonalcoholic steatohepatitis and hepatic fibrosis can be used in patients with psoriasis to aid in determining eligibility for methotrexate therapy, monitor for development of methotrexate-induced hepatotoxic effects, and monitor for worsening of hepatic fibrosis scores during methotrexate therapy.

http://ift.tt/2g5dJHm

Better recognition, diagnosis and management of non-IgE-mediated cow’s milk allergy in infancy: iMAP—an international interpretation of the MAP (Milk Allergy in Primary Care) guideline

Cow's milk allergy (CMA) is one of the most common presentations of food allergy seen in early childhood. It is also one of the most complex food allergies, being implicated in IgE-mediated food allergy as we...

http://ift.tt/2vooc2K

Abstracts from the 11th Symposium on Experimental Rhinology and Immunology of the Nose (SERIN 2017)

http://ift.tt/2v6992l

A Re-examination of the Effect of Masker Phase Curvature on Non-simultaneous Masking

Abstract

Forward masking of a sinusoidal signal is determined not only by the masker's power spectrum but also by its phase spectrum. Specifically, when the phase spectrum is such that the output of an auditory filter centred on the signal has a highly modulated ("peaked") envelope, there is less masking than when that envelope is flat. This finding has been attributed to non-linearities, such as compression, reducing the average neural response to maskers that produce more peaked auditory filter outputs (Carlyon and Datta, J Acoust Soc Am 101:3636–3647, 1997). Here we evaluate an alternative explanation proposed by Wotcjzak and Oxenham (Wojtczak and Oxenham, J Assoc Res Otolaryngol 10:595–607, 2009). They reported a masker phase effect for 6-kHz signals when the masker components were at least an octave below the signal frequency. Wotcjzak and Oxenham argued that this effect was inconsistent with cochlear compression, and, because it did not occur at lower signal frequencies, was also inconsistent with more central compression. It was instead attributed to activation of the efferent system reducing the response to the subsequent probe. Here, experiment 1 replicated their main findings. Experiment 2 showed that the phase effect on off-frequency forward masking is similar at signal frequencies of 2 and 6 kHz, provided that one equates the number of components likely to interact within an auditory filter centred on the signal, thereby roughly equating the effect of masker phase on the peakiness of that filter output. Experiment 3 showed that for some subjects, masker phase also had a strong influence on off-frequency backward masking of the signal, and that the size of this effect correlated across subjects with that observed in forward masking. We conclude that the masker phase effect is mediated mainly by cochlear non-linearities, with a possible additional effect of more central compression. The data are not consistent with a role for the efferent system.

http://ift.tt/2vZgkbD

Adipokines are dysregulated in patients with hidradenitis suppurativa

Abstract

Hidradenitis suppurativa (HS), is characterized by the appearance of painful subcutaneous nodules and dermal abscesses in the axillae, perineum and inframammary folds. The development of HS has been linked to factors such as cigarette smoking and obesity¹. Patients with HS are more likely to have metabolic syndrome than control populations and develop early cardiovascular diseases². Adipokines are signalling molecules secreted by adipose tissue and peripheral blood mononuclear cells. The expression of adipokines is dysregulated in obesity and cardiovascular diseases³.

This article is protected by copyright. All rights reserved.

http://ift.tt/2voCyAi

Thyrotoxicosis and Choledocholithiasis Masquerading as Thyroid Storm

A 26-year-old female, thirteen months postpartum, presented to the emergency department for four weeks of epigastric abdominal pain, pruritus, new onset jaundice, and 11.3 kgs (25 lbs) unintentional weight loss. On examination, she was afebrile, tachycardic, alert, and oriented and had jaundice with scleral icterus. Labs were significant for undetectable TSH, FT4 that was too high to measure, and elevated total bilirubin, direct bilirubin, alkaline phosphatase, and transaminases. Abdominal ultrasound revealed cholelithiasis without biliary ductal dilation. Treatment for presumed thyroid storm was initiated. Further work-up with magnetic resonance cholangiopancreatography (MRCP) revealed an obstructing cholelith within the distal common bile duct. With the presence of choledocholithiasis explaining the jaundice and abdominal pain, plus the absence of CNS alterations, the diagnosis of thyroid storm was revised to thyrotoxicosis complicated by choledocholithiasis. Endoscopic retrograde cholangiopancreatogram (ERCP) with sphincterotomy was performed to alleviate the biliary obstruction, with prompt symptomatic improvement. Thyroid storm is a rare manifestation of hyperthyroidism with a high rate of morbidity and mortality. The diagnosis of thyroid storm is based on clinical examination, and abnormal thyroid function tests do not correlate with disease severity. Knowledge of the many manifestations of thyroid storm will facilitate a quick and accurate diagnosis and treatment.

http://ift.tt/2vf28IC

Treatment of oral lichen planus using 308-nm excimer laser

Abstract

Oral lichen planus (OLP) is a chronic inflammatory disease, has prolonged courses, repeated attacks and resistance to treatment. The traditional narrow spectrum UVB treatment has an established efficacy on skin lichen planus, and high safety. However, most of ultraviolet phototherapy devices have a huge volume, thereby cannot be used in the treatment of OLP. Lymphocytic infiltration is evident in the lesions of lichen planus, and the direct irradiation of 308-nm excimer laser can induce apoptosis of the T lymphocytes in skin lesions, thereby has a unique therapeutic effect on the diseases involving T lymphocytes. This study aims to investigate the efficacy of 308-nm excimer laser in the treatment of OLP. A total of six OLP patients were enrolled into this study, and further pathological diagnosis was conducted, then 308-nm excimer laser was used in the treatment. The efficacy of 308-nm excimer laser in the treatment of OLP was satisfactory. The clinical symptoms of five patients were significantly improved. In two patients, the erosion surface based on congestion and the surrounding white spots completely disappeared, and clinical recovery was achieved. Three patients achieved partial remission, that is, the erosion surface healed, congestion and white spot area shrunk by more than 1/2 of the primary skin lesions. In the remaining one patient, the erosion surface had not completely healed after treatment, and congestion and white spot area shrunk by less than 1/2 of the primary skin lesions. Only one patients had developed mild pain during the treatment, and this symptom alleviated by itself. The 308-nm excimer laser therapy can serve as a safe and effective treatment for OLP.

http://ift.tt/2vfiy3K

Radiation Therapy With Durvalumab or Cetuximab in Treating Patients With Stage III-IVB Head and Neck Cancer Who Cannot Take Cisplatin

Conditions:   Head and Neck Squamous Cell Carcinoma;   Stage III Hypopharyngeal Squamous Cell Carcinoma AJCC v7;   Stage III Laryngeal Squamous Cell Carcinoma AJCC v6 and v7;   Stage III Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7;   Stage III Oropharyngeal Squamous Cell Carcinoma AJCC v7;   Stage IVA Hypopharyngeal Squamous Cell Carcinoma AJCC v7;   Stage IVA Laryngeal Squamous Cell Carcinoma AJCC v7;   Stage IVA Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7;   Stage IVA Oropharyngeal Squamous Cell Carcinoma AJCC v7;   Stage IVB Hypopharyngeal Squamous Cell Carcinoma AJCC v7;   Stage IVB Laryngeal Squamous Cell Carcinoma AJCC v7;   Stage IVB Oral Cavity Squamous Cell Carcinoma AJCC v6 and v7;   Stage IVB Oropharyngeal Squamous Cell Carcinoma AJCC v7
Interventions:   Biological: Cetuximab;   Biological: Durvalumab;   Radiation: Intensity-Modulated Radiation Therapy;   Other: Laboratory Biomarker Analysis;   Other: Quality-of-Life Assessment;   Other: Questionnaire Administration
Sponsor:   National Cancer Institute (NCI)
Not yet recruiting - verified August 2017

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HPV-47-Induced and Tattoo-associated Verrucae Planae: Report of a Case and Review of the Literature

Abstract

The human papillomavirus (HPV), of which more than 200 different types have so far been identified, is an infectious disease impacting skin and mucous membranes. Several genera exist with distinct clinical impact. However, with ornamental tattoos increasing in popularity, a number of mostly cutaneous side effects have also been reported, such as infections, allergic reactions, or even a rise of malignant tumours within the tattoo. We report the first case of a β1-HPV-type infection in cutaneous lesions in terms of verrucae vulgares near a tattoo in an immunocompetent adult without pre-existing conditions, and discuss possible relationships and etiologic concerns of this association.

http://ift.tt/2xsvDYc

Glutaredoxin 1 (GRX1) inhibits oxidative stress and apoptosis of chondrocytes by regulating CREB/HO-1 in osteoarthritis

Publication date: October 2017
Source:Molecular Immunology, Volume 90
Author(s): Jie Sun, Xuelei Wei, Yandong Lu, Meng Cui, Fangguo Li, Jie Lu, Yunjiao Liu, Xi Zhang
GRX1 (glutaredoxin1), a sulfhydryl disulfide oxidoreductase, is involved in many cellular processes, including anti-oxidation, anti-apoptosis, and regulation of cell differentiation. However, the role of GRX1 in the oxidative stress and apoptosis of osteoarthritis chondrocytes remains unclear, prompting the current study. Protein and mRNA expressions were measured by Western blot and RT-qPCR. Oxidative stress was detected by the measurement of MDA and SOD contents. Cells apoptosis were detected by Annexin V-FITC/PI and caspase-3 activity assays. We found that the mRNA and protein expressions of GRX1 were significantly down-regulated in osteoarthritis tissues and cells. GRX1 overexpression increased the mRNA and protein expression of CREB and HO-1. Meanwhile, GRX1 overexpression inhibited oxidative stress and apoptosis in osteoarthritis chondrocytes. Furthermore, we found that GRX1 overexpression regulated HO-1 by increasing CREB, and that HO-1 regulated oxidative stress and apoptosis in osteoarthritis chondrocytes. Thus, GRX1 overexpression constrains oxidative stress and apoptosis in osteoarthritis chondrocytes by regulating CREB/HO-1, providing a novel insight into the molecular mechanism and potential treatment of osteoarthritis.



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Vitamin D supplementation for vitiligo

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Crisaborole: A new and effective nonsteroidal topical drug for atopic dermatitis

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UVA-1 in the treatment of alopecia areata

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Minocycline: A strategy for unresponsive nerve function impairment

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Salmonella Thompson splenic abscess in a healthy female

A 26-year-old woman presented with a 5-day history of fever and 3-day history of left upper quadrant abdominal pain and cough associated with left shoulder tip pain. Initial blood cultures did not display growth. On CT imaging, there was a cyst measuring 7.2x8 cm originally interpreted to be haemorrhagic in nature. Repeat cultures during admission revealed Salmonella Thompson. Percutaneous drainage and antibiotic treatment, rather than splenectomy, was successfully pursued with the patient afebrile and in no pain at 6 weeks follow-up.

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Resolution of Periodic Breathing in a Child with Idiopathic Pulmonary Arterial Hypertension

Central sleep apnea (CSA) and periodic breathing are unusual findings described in pediatric patients with congestive heart failure. However, CSA has not been reported in children with pulmonary hypertension. We hereby report on a 10-year-old girl with idiopathic pulmonary arterial hypertension who had frequent central events in a periodic breathing fashion seen in her polysomnography, which was normalized following medical treatment leading to improvement of the pulmonary pressures.

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Physiotherapy and Rehabilitation in a Child with Joubert Syndrome

Objective. Joubert syndrome (JS) is a rare autosomal recessive genetic disorder characterized by brain malformation, hypotonia, breathing abnormalities, ataxia, oculomotor apraxia, and developmental delay. The purpose of this study was to report the efficiency of the physiotherapy and rehabilitation program in a child with JS. Materials and Methods. Our case is a 19-month-old female child with mild clinical signs of JS. The pretreatment and posttreatment motor functioning level of the case was evaluated through the Gross Motor Function Measure (GMFM), whereas the independence level was evaluated through the Pediatric Functional Independence Measure (WeeFIM). The case was included in the rehabilitation program by the physiotherapist for one hour for five days a week throughout the period of 13 months in accordance with the neurodevelopmental treatment principles. Results. The case was able to turn around from the supine position to the reverse direction by oneself, and she was able to rise on her forearms facedown and was able to sit, crawl, and walk independently. The GMFM score was 210, whereas WeeFIM score was 65. Discussion. In the direction of those findings, in Joubert Syndrome, physiotherapy and rehabilitation can be effective in coping with the symptoms causing developmental delay.

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Contralateral cerebral hemoglobin oxygen saturation changes in patients undergoing thoracotomy with general anesthesia with or without paravertebral block: a randomized controlled trial

Abstract

Purpose

Perioperative analgesia during thoracotomy is often achieved by combining paravertebral block (PVB) with general anesthesia (GA). Functional near-infrared spectroscopy (NIRS) can detect changes in cerebral oxygenation resulting from nociceptive stimuli in the awake state or under sedation. We used NIRS to measure changes in cerebral blood flow provoked by thoracotomy incision made under GA and determine how these changes were influenced by supplementation of GA with PVB.

Methods

Thirty-four patients undergoing elective thoracotomy were enrolled. Patients were randomly assigned to a group receiving only GA, or GA combined with PVB (GA + PVB). Changes in cerebral oxygenated hemoglobin (ΔO₂Hb), deoxygenated-Hb (ΔHHb), and total-Hb (ΔtotalHb) were evaluated by NIRS as surgery began.

Results

In the GA group, ΔO₂Hb was significantly higher in the hemisphere contralateral to the side of surgery when the incision was made and 2 min after incision compared with the ipsilateral side (start of surgery, P < 0.01; 2 min, P < 0.05). In contrast, there were no significant changes in the ΔO₂Hb at any of the time points in the GA + PVB group. Comparable with ΔO₂Hb, the concentration of ΔtotalHb was significantly higher in the contralateral hemisphere in the GA group at the start of surgery (P < 0.05).

Conclusions

Changes in the cerebral O₂Hb concentration were detected by NIRS immediately after surgical incision under GA, but not in the presence of a PNB. NIRS could be used to monitor surgical pain. PVB inhibited changes in oxygenation induced by incision-provoked pain.

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Reliable and simple spectrophotometric determination of sun protection factor: A case study using organic UV filter-based sunscreen products

Summary

Background

Current in vitro SPF screening method for plant oil body (oleosome)-based SPF products possesses significant inconsistency and low reliability in the SPF rating.

Objectives

The primary objective of this study was to evaluate the reliability and reproducibility of spectrophotometrically determined sun protection factor (SPF) from oleosome-based SPF products. The secondary objective was the data comparison of the spectrophotometric measurements against in vivo SPF testing to establish a reliable in vitro test method as a screening assay.

Methods

Octyl methoxycinnamate (UVB filter) and avobenzone (UVA filter) were loaded into safflower oil bodies and formulated into oil-in-water emulsion-based finished products. To evaluate the reliability between in vivo and spectrophotometric test methods, samples were dispatched to a clinical laboratory, and the reported SPF values were compared with spectrophotometric test results.

Results

The observed SPF from the in vivo and spectrophotometric test results demonstrated a high correlation for SPF 30 products. Proportional correlation between the two evaluation methods was observed for SPF 15 and 50 products with slightly lesser accuracy with a smaller number of population tested in the clinical studies.

Conclusions

A reliable spectrophotometric screening method for oil body-based SPF formulas has been developed using two broadly used organic UV sunscreen actives as a case study. The results demonstrated a high level of reproducibility and reliability compared to the US FDA-guided in vivo SPF testing method.

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Polycystic ovary syndrome with asynchronous bilateral adnexal torsion in a natural cycle

Cases involving polycystic ovaries (PCOs) with adnexal torsion in a natural cycle without ovulation induction are rare, and no reports of such cases have described asynchronous bilateral adnexal torsion. Here, we report a case of PCO syndrome (PCOS) with asynchronous bilateral adnexal torsion in a natural cycle. The patient was a 37-year-old woman with a history of 2 gravidas 1 para. Her primary complaint was left lower abdominal pain. Ultrasonography and MRI identified multiple uterine myomas occupying the pelvis and the left ovary, with oedematous swelling that had moved ventrally to the uterus. She was diagnosed with adnexal torsion and underwent emergency laparoscopic adnexectomy. Nine months after surgery, she experienced right lower abdominal pain. Ultrasonography revealed suspected right adnexal torsion and she underwent emergency surgery. The right ovary was twisted 540° counterclockwise and swollen to 7 cm in size, with partial polycystic changes. She was histopathologically diagnosed with a PCO, and the final diagnosis, which also considered the endocrine test results, was PCOS. In PCOS, adnexal torsion may occur if the swollen ovary moves because of a hysteromyoma or other cause. Accordingly, torsion should be considered during the follow-up of patients with PCOS.

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Suspected case of lipoedema in Japanese woman with a characteristic histology in skin biopsy

Description

A 42-year-old Japanese woman with a body mass index of 42, presented with a long history of bilateral swelling of buttocks and lower extremities. The upper trunk, upper extremities and feet were spared of excessive fat deposition without a complete loss of adipose tissues (figure 1), lowering the likelihood of partial lipodystrophy. Physical examination revealed that the edema was dry, hard and non-pitting. Stemmer's sign was negative, and five out of seven criteria for the diagnosis of lipoedema1 were met. A CT scan showed massive circumferential enlargement of subcutaneous tissues with the same CT value as fat, further suggesting the diagnosis of lipoedema (figure 1). Other conditions causing lower-extremity swelling or fat excess were excluded. We performed skin punch biopsy of the right hip (figure 2). Chief pathological findings were as follows: (1) the size of adipocytes was generally...

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Filarial breast lump

Lymphatic filariasis is one of the most debilitating and disfiguring scourges among all diseases. This report presents a case of a woman with recurrent breast nodularity after being previously operated for a suspected breast neoplasm. We would like to highlight the issue of similar clinical presentation of a filarial breast lump and other breast lesions leading to inappropriate therapy.

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Large pectoral haematoma post-transradial catheterisation: an unusual but avoidable complication

Large pectoral haematoma is an extremely rare complication of transradial catheterisation. Branch or main vessel injury due to luminal passage of guidewires and catheters may lead to bleeding and haematoma formation at adjacent sites along the vessel track. We present a 53-year-old post-transradial catheterisation patient, who complained of chest pain due to right axillary artery branch perforation causing haematoma, which was emergently managed by embolisation with autologous coagulated blood.

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A rare case of pulmonary toxoplasmosis in a patient with undifferentiated inflammatory arthritis on chronic methotrexate and corticosteroid therapy

Pulmonary toxoplasmosis is a serious pulmonary condition caused by the protozoan Toxoplasma gondii. It typically affects immunocompromised patients presenting acutely with cough, fever, myalgias, arthralgias and lymphadenopathy, and chronically with persistent cough and dyspnoea. Because of its protean features, it can mimic many more common lung conditions in the immunocompromised patient, including atypical pneumonia, Pneumocystis pneumonia and interstitial lung disease. In this article, we present the case of a 55-year-old woman who presented to our hospital with persistent dyspnoea and cough, initially suspected to have an arthritis-related interstitial lung disease. She received a final diagnosis of pulmonary toxoplasmosis after lung biopsy demonstrated Toxoplasma cysts, later confirmed by serology. Treatment with trimethoprim–sulfamethoxazole resulted in significant improvement of her respiratory symptoms after 3 months.

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Oral mucosal grafting combined with tenonplasty for ocular surface and lid margin reconstruction in an atypical sectorial chemical burn

A 46-year-old woman presented with chemical injury in both eyes after the instillation of undefined eye-drops prescribed by quack. She had an atypical presentation in the form of bilateral severe necrosis of both lids and whole palpebral conjunctiva. Extensive debridement with conjunctival epitheliectomy, tenonplasty and amniotic membrane transplantation (AMT) was performed. Characteristic differences from typical chemical injuries were a sectorial involvement of ocular surface and keratinisation over distorted lid margins. Lid margin needed replacement by labial mucous membrane for the restoration of ocular surface. Ocular surface reconstruction with AMT in acute phase and mucous membrane grafting for involved lid margins in late phase achieves vision salvage and avoids late complications in drug-induced chemical injury.

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Cheyne-Stokes respiration: poor prognostic sign in a patient with heart failure

Description

Patients with congestive heart failure (CHF) have high incidence of sleep-disordered breathing. Two distinct types are known: obstructive sleep apnoea (OSA) and Cheyne-Stokes respiration (CSR).1 Effective heart failure treatment improves CSR but not OSA, indicating that the development of CSR is secondary to heart failure. CSR is characterised by recurrent episodes of central apnoea/hypopnoea interposed with periods of hyperpnoea with waning and waxing pattern of tidal volume. A 5-month-old girl who presented with acute onset of poor appetite and tachypnoea had cardiomegaly on chest X-ray. Echocardiography showed severely depressed left ventricular (LV) function with ejection fraction of 10%. She was diagnosed with LV non-compaction cardiomyopathy and placed on heart transplant list. Her heart failure management included milrinone infusion, diuretics and digoxin. She subsequently worsened with increasing heart rate and tachypnoea. Her telemetry showed evidence of CSR with clinical and echocardiographic evidence of worsening LV function (

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