Efficacy of combining pulse corticotherapy and methotrexate in alopecia areata: Real-life evaluation

http://ift.tt/2wKGzzA

Lichen Planus triggered by infliximab biosimilar CT-P13 and recurred during secukinumab treatment

Abstract

we read with interest the manuscript published by Gonzales et al,¹ highlighting lichenoid reactions as an emerging side effect of biologics, with special regard to infliximab-biosimilar. We recently observed a 50-year-old male patient with a long-standing history of moderate-to-severe psoriasis, who developed oral lichen planus (LP) triggered by infliximab biosimilar CT-P13. Interestingly the same patient experienced cutaneous and oral LP when treated with IL-17A blocker, secukinumab. The patient suffered for hypertension, in treatment with valsartan, and anxiety. He previously failed to respond to phototherapy, methotrexate, etanercept and adalimumab.

This article is protected by copyright. All rights reserved.

http://ift.tt/2jOKeLz

Irradiance, as well as body site and timing of readings, is important in determining ultraviolet A minimal erythemal dose

Abstract

Irradiance, as well as body site and timing of readings, is important in determining ultraviolet A minimal erythemal dose. (Response to Gambichler et al. July BJD)

Gambichler et al. demonstrated that, in their population, using a 25 mWcm⁻² ultraviolet A-1 (UVA-1) source the median 24-hour delayed minimal erythema dose (MED) on the inner forearm was > 130 Jcm⁻².¹ This differs from the 20 Jcm⁻² to 28 Jcm⁻² median MED reported from our centre.²

This article is protected by copyright. All rights reserved.

http://ift.tt/2xXrY8U

Risk of malignancies associated with ustekinumab

Abstract

A recently published report by Florek et al.¹ associates malignancies with ustekinumab (STELARA^®) treatment. Janssen emphasizes patient safety and welcomes rigorous safety analyses from other parties. However, it is unclear how this report adds to the understanding of ustekinumab's safety profile.

This article is protected by copyright. All rights reserved.

http://ift.tt/2jOKaLP

Chronic Poststernotomy Pain: Incidence, Risk Factors, Treatment, Prevention, and the Anesthesiologist's Role.

Chronic pain following median sternotomy is common after cardiac surgery. If left untreated, chronic sternal pain can reduce quality of life, affecting sleep, mood, activity level, and overall satisfaction. This has a significant societal effect given the large number of cardiac surgeries annually. Although a number of pathophysiologic processes and risk factors are assumed to contribute, the exact cause and major risk factors remain unknown. Moreover, the treatment of chronic poststernotomy pain is often inadequate, relying on opioids and other medications that provide minimal benefit to the patient and have significant adverse effects. Indeed, little is known regarding the prevention of chronic pain development following sternotomy. This review aims to present the current, limited data regarding the incidence, risk factors, treatment, and prevention of chronic poststernotomy pain and to identify areas of future research to improve management of this common complaint following cardiac surgery. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

http://ift.tt/2xVYkkD

The Spread of Ultrasound-Guided Injectate From the Adductor Canal to the Genicular Branch of the Posterior Obturator Nerve and the Popliteal Plexus: A Cadaveric Study.

Background and Objectives: The popliteal nerve plexus contributes to afferent knee-pain conduction. It is mainly formed by genicular branches from the posterior obturator and the tibial nerves, innervating the intra-articular and posterior knee region. A subinguinal obturator nerve block alleviates pain after total knee arthroplasty. Reduced hip adductor motor function could be avoided by a posterior obturator nerve block inside the popliteal fossa. The aim of this study was to evaluate the spread of dye after a distal adductor canal (AC) injection to the popliteal fossa and coloring of the popliteal plexus and the genicular branch of the posterior obturator nerve by dissection. We also assessed the spread of dye into the popliteal fossa after a distal femoral triangle injection. Methods: Ten milliliters of dye was injected into the distal part of the AC in 10 cadaver sides and into the distal part of the femoral triangle in 3 sides. Dissection was used to assess the spread of the injectate and coloring of the popliteal plexus and the genicular branch of the posterior obturator nerve, as well as the saphenous and medial vastus nerves. Results: The popliteal plexus and the genicular branch of the posterior obturator nerve were dyed in all 10 dissections after AC injections. No dye spread into the popliteal fossa after femoral triangle injections. Conclusions: Injection of 10 mL of dye into the distal part of the AC spreads into the popliteal fossa and colors the popliteal plexus and the genicular branch of the posterior obturator nerve. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

http://ift.tt/2yuWmof

Murine typhus masquerading as retiform purpura-like rashes

http://ift.tt/2hnDi3N

Inherited palmoplantar keratodermas: the heart of the matter

http://ift.tt/2hl6Lig

Sex hormone status in premenopausal women with frontal fibrosing alopecia: a multicentre review of 43 patients

http://ift.tt/2hmvFdO

Improvement of wound healing by regulated oxygen-enriched negative pressure-assisted wound therapy in a rabbit model

Summary

Background

Development of drug therapies and other techniques for wound care have resulted in significant improvement of the cure rate and shortening of the healing time for wounds. A modified technique of regulated oxygen-enriched negative pressure-assisted wound therapy (RO-NPT) has been reported.

Aim

To evaluate the efficacy and impact of RO-NPT on wound recovery and inflammation.

Methods

Infected wounds were established on 40 adult female white rabbits, which were then randomized to one of four groups: O₂ group, regulated negative pressure-assisted wound therapy (RNPT) group, regulated oxygen-enriched negative pressure-assisted wound therapy (RO-NPT) group and healthy control (HC) group. Each day, the O₂ group was treated with a constant oxygen supply (1 L/min) to the wound, while the RNPT group was treated with continuous regulated negative pressure (70 ± 5 mmHg) and the RNPT + O₂ group was treated with both. The HC group was treated with gauze dressing alone, which was changed every day. Leucocyte count, colony count and wound-healing rate were calculated. Levels of tumour necrosis factor (TNF)-α, interleukin (IL)-1β and IL-8 were evaluated by ELISA.

Results

RO-RNPT significantly decreased bacterial count and TNF-α level, and increased the wound-healing rate. IL-1β, IL-8 and leucocyte count had a tendency to increase in the early phase of inflammation and a tendency to decrease in the later phase of inflammation in the RO-RNPT group.

Conclusions

RO-NPT therapy assisted wound recovery and inflammation control compared with the RNPT and oxygen-enriched therapies. RO-NPT therapy also increased levels of IL-1β and IL-8 and attenuated expression of TNF-α in the early phase of inflammation.

http://ift.tt/2hl6JqE

A case of severe drug reaction secondary to alemtuzumab with successful re-exposure

http://ift.tt/2hmvDCI

Oral food challenge outcomes in a pediatric tertiary care center

Oral food challenges are the clinical standard for diagnosis of food allergy. Little data exist on predictors of oral challenge failure and reaction severity.

http://ift.tt/2yhlYnT

Posteriorly dislocated capsular tension ring leading to rhegmatogenous retinal detachment

Description

A 54-year-old woman presented with sudden diminution of vision in her left eye 4 months before. Medical history revealed that she underwent a phacoemulsification 1 year before in the left eye and 4 years before in the right eye. Snellen visual acuity in the right eye was 20/20 while she was just able to count fingers at 1 m in the left eye. She had a divergent squint of 30 prism dioptres in the left eye. The right eye had a well-centred foldable posterior chamber intraocular lens (PCIOL) in the capsular bag, while the left eye had a rigid polymethyl methacrylate (PMMA) PCIOL in the sulcus with a large posterior capsular defect (figure 1A). On fundus examination of the left eye, we found a total rhegmatogenous retinal detachment with a large punched-out toxoplasma scar at the macula, three retinal horseshoe tears superonasally at the equator (figure 2B) and a...

http://ift.tt/2xVYSGX

Splenic calcification in systemic lupus erythematosus

Description

A 39-year-old woman with known systemic lupus erythematosus (SLE) nephropathy, antiphospholipid syndrome and chronic renal failure was evaluated for renal transplant. She was asymptomatic; nevertheless, the abdominal ultrasonogram showed splenic calcification (figure 1). The chest radiograph showed faint lesions suggestive of (L) hypochondrial calcification (figure 2). The tuberculin skin test result revealed induration of 3 mm. She had no history of treatment for tuberculosis or brucellosis. The angiotensin-converting enzyme was normal at 19 U/L (normal range 29–112 U/L). A CT scan of the abdomen and pelvis showed a bulky spleen that contained numerous small and differently sized smooth calcific foci probably related to granulomatous disease. No calcification was seen in the liver (figure 3A, B). There were no definite or suspicious pulmonary nodules seen on a whole body fluorodeoxyglucose positron-emission tomography (PET) scan. Similarly, numerous tiny splenic calcifications with no abnormal metabolic activity were detected...

http://ift.tt/2jQH61F

Diaphyseal tuberculosis - a rare manifestation

DESCRIPTION

A 2 year old child presented with low-grade fever, progressive pain and swelling of right leg for the past 3 months. There was no history of injury, chronic cough, respiratory symptoms, weight loss or arthritis. Child's father had been treated for pulmonary tuberculosis 1 year back. On examination, there was a firm, diffuse, tender swelling over the medial aspect of middle one-third of right tibia and matted inguinal lymphadenopathy. Rest of the systemic examination was not contributory. A clinical diagnosis of diaphyseal bone tumour or chronic infective osteomyelitis was considered.

Investigations showed erythrocyte sedimentation rate 46 mm in first hour, haemoglobin 96 g/L and 20 mm induration after Mantoux test and normal chest radiograph. Radiograph of the right tibia showed a lytic intramedullary bone lesion (Figure 1A–B). MRI confirmed an intramedullary lytic lesion with cortical breach and thickening (figure 1C). Histopathology showed caseous necrosis, granuloma formation, Langhans giant cells...

http://ift.tt/2xVhg2O

Cholesterol embolism: its always a good idea to look into the eye

Description

Atheroembolism is a rare but feared complication of arteriography, causing a myriad of signs and symptoms including livedo reticularis, abdominal pain, cyanosis of the toes and renal injury. The main cause is a rupture of atherosclerotic plaque in vessel walls and its embolisation to small diameter vessels affecting more frequently skin and kidneys.1 Here, we present a 69-year-old Hispanic male with medical history of hypertension, type 2 diabetes mellitus and unstable angina status post drug-eluting stent in the left anterior descending coronary artery placement 10 days prior to admission, who arrived to the emergency department with intense diffuse sharp abdominal pain, nausea, vomiting, oliguria and lower extremity pain. Physical examination disclosed livedo reticularis in lower extremities (figure 1), tender abdomen with decreased bowel sounds and funduscopy positive for a Hollenhorst crystal observed in right inferotemporal quadrant (figure 2) and increased creatinine and...

http://ift.tt/2jOfRVv

Infected enteric duplication cyst

Description

An 8-month-old female infant presented with a 2-day history of vomiting, diarrhoea and fever. Physical examination revealed a painful right abdomen. Laboratory tests showed a C-reactive protein of 140 mg/L (normal: <6 mg/L) and a white blood cell count of 12.8x10⁹/L (normal: 4–15x10⁹/L). Ultrasound of the abdomen revealed a paracolic cystic mass of 1.4x5 cm with septations from the lower part of the liver into the right fossa with no signs of volvulus or intussusception (figure 1). Abdominal CT confirmed the cystic mass and revealed signs of infection. MRI of the abdomen suggested an enteric duplication cyst as the most likely diagnosis (figure 2).

Figure 1

Ultrasound: encapsulated tubular mass with predominant hypoechoic heterogeneous echogenicity under the right lobe of the liver.

Figure 2

MRI coronal T1-weighted image with intravenous contrast: tubular cystic mass with thick wall ventral and lateral...

http://ift.tt/2xVh97o

An airway traffic jam: a plastic traffic cone masquerading as bronchial carcinoma

Tracheobronchial foreign body (TFB) aspiration is a common occurrence in children compared with adults. Long-standing cases of TFB aspiration during childhood presenting in an adult have rarely been reported. We report the unique case of an endobronchial Playmobil traffic cone that went undetected for 40 years and presented as a suspected bronchogenic carcinoma. This was subsequently removed successfully with flexible bronchoscopy. To our knowledge this is the first case of a TFB that was overlooked this length of time.

http://ift.tt/2jQGMzZ

Perianal pseudoverrucous papules and nodules in Hirschsprung's disease: Rapid resolution with oral loperamide

Abstract

We report the case of a 2-year-old boy with Hirschsprung's disease who developed perianal pseudoverrucous papules and nodules subsequent to persistent diarrhea and stool leakage after Giardia infection. Bleeding from the papules resulted in iron deficiency anaemia requiring blood transfusion and iron infusion. Topical therapies used over 6 months were of limited benefit and colostomy was considered, but the condition completely resolved after commencement of oral loperamide. This demonstrates that perianal pseudoverrucous papules and nodules can be severe but are entirely reversible upon removal of the source of skin irritation.

http://ift.tt/2wKVbiu

Eruptive milia during isotretinoin therapy

Abstract

Isotretinoin (13-cis-retinoic acid) is a synthetic vitamin A derivative that is effective in the treatment of recalcitrant, nodulocystic acne. To our knowledge, there are no reports in the medical literature of milia as a side effect of isotretinoin. We report a case of eruptive facial milia in the setting of isotretinoin treatment for acne.

http://ift.tt/2xrF39h

X-linked ichthyosis associated with psychosis and behavioral abnormalities: a case report

X-linked ichthyosis is a dermatological condition caused by deficiency for the enzyme steroid sulfatase. Previously, X-linked ichthyosis/steroid sulfatase deficiency has been associated with developmental and ...

http://ift.tt/2fESsS9

Breast cancer metastases to the thyroid gland – an uncommon sentinel for diffuse metastatic disease: a case report and review of the literature

Metastases to the thyroid are rare. The most common primary cancer to metastasize to the thyroid is renal cell carcinoma, followed by malignancies of the gastrointestinal tract, lungs, and skin, with breast ca...

http://ift.tt/2xjW469

Thyroid High-Impact Articles

FREE ACCESS through October 5, 2017.
Read now:

Latest Impact Factor: 5.515
The Official Journal of: American Thyroid Association

Management of Recurrent/Persistent Nodal Disease in Patients with Differentiated Thyroid Cancer: A Critical Review of the Risks and Benefits of Surgical Intervention Versus Active Surveillance
Ralph P. Tufano, Gary Clayman, Keith S. Heller, William B. Inabnet, Electron Kebebew, Ashok Shaha, David L. Steward, R. Michael Tuttle, for the American Thyroid Association Surgical Affairs Committee Writing Task Force

Impact of the Multi-Gene ThyroSeq Next-Generation Sequencing Assay on Cancer Diagnosis in Thyroid Nodules with Atypia of Undetermined Significance/Follicular Lesion of Undetermined Significance Cytology
Yuri E. Nikiforov, Sally E. Carty, Simon I. Chiosea, Christopher Coyne, Umamaheswar Duvvuri, Robert L. Ferris, William E. Gooding, Shane O. LeBeau, N. Paul Ohori, Raja R. Seethala, Mitchell E. Tublin, Linwah Yip, Marina N. Nikiforova

Thyroid Ultrasound Features and Risk of Carcinoma: A Systematic Review and Meta-Analysis of Observational Studies
Luciana Reck Remonti, Caroline Kaercher Kramer, Cristiane Bauermann Leitão, Lana Catani F. Pinto, Jorge Luiz Gross

Incidences of Unfavorable Events in the Management of Low-Risk Papillary Microcarcinoma of the Thyroid by Active Surveillance Versus Immediate Surgery
Hitomi Oda, Akira Miyauchi, Yasuhiro Ito, Kana Yoshioka, Ayako Naka

Subclinical Hypothyroidism in Pregnancy: A Systematic Review and Meta-Analysis
Spyridoula Maraka, Naykky M. Singh Ospina, Derek T. O'Keeffe, Ana E. Espinosa De Ycaza, Michael R. Gionfriddo, Patricia J. Erwin, Charles C. Coddington III, Marius N. Stan, M. Hassan Murad, Victor M. Montori

 

The post Thyroid High-Impact Articles appeared first on American Thyroid Association.

http://ift.tt/2xj0l9S

Immunomodulation in multiple sclerosis: promises and pitfalls

Calliope A Dendrou | Lars Fugger

http://ift.tt/2jPi9DW

A case of adult congenital laryngeal cleft asymptomatic until hypopharynx cancer treatment

Laryngeal cleft is an anomaly of failed posterior closure of the larynx. Most cases are diagnosed and need treatment early in life due to respiratory and swallowing problems. We report an unusual case of a 66-year-old man with an asymptomatic laryngeal cleft until treatment for hypopharyngeal cancer. During concurrent chemoradiotherapy (CCRT), despite reduced tumor volume, he presented severe dysphagia and dyspnea, followed by severe pneumonia twice. Because CCRT had to be discontinued, a pharyngolaryngectomy was performed for the cancer treatment.

http://ift.tt/2xlD5Wi

Our experience with 500 patients with benign paroxysmal positional vertigo: Reexploring aetiology and reevaluating MRI investigation

To explore the aetiology of and to evaluate the importance of MRI investigation on the posterior semicircular canal benign paroxysmal positional vertigo in an Irish population.

http://ift.tt/2ygQJJs

Management of tinnitus in children: Review of literature and effect of counseling

Tinnitus in children has not been studied sufficiently to date. And, there is no consensus regarding the management of tinnitus in children. Tinnitus counseling can be considered as the most basic tool among therapeutic options of tinnitus in children. In this article, the importance of management in children with tinnitus is highlighted through the review of the literature. Also, we present survey results regarding usefulness and necessity of tinnitus counseling provided from parents of children with tinnitus.

http://ift.tt/2xmemko

Control of Pain After Tonsillectomy in Children

This review examines the treatment of postoperative pain in children after tonsillectomy.

http://ift.tt/2ttUcpD

An Objective Drug-Induced Sedation Endoscopy Data Capture and Analysis System

To the Editor We read with great interest the article published by Gobbi et al. We would like to acknowledge 3 key points presented in the article. First, the authors presented a novel objective technique—a drug-induced sleep endoscopy technique implemented with simultaneous polygraphic monitoring of cardiorespiratory parameters (DISE-PG)—for capturing and visualizing anatomical and physiological data simultaneously in real time. Second, DISE-PG was shown to be better than standalone DISE in terms of feasibility, safety, and detecting obstructive breathing patterns. Third, DISE-PG provides accurate comprehension of upper airway obstructive dynamics and a nonobstructive breathing pattern. Our letter focuses on 4 questions.

http://ift.tt/2s098qq

Partial Resection in Microsurgical Management of Vestibular Schwannomas

This Viewpoint discusses selective use of partial tumor resection, in particular near total resection, over gross total resection when there is concern for imminent facial nerve compromise in the management of vestibular schwannomas.

http://ift.tt/2rYT6xl

Foreign Body in a Premature Infant

This case examines the unique challenges of treating airway obstruction in neonates and describes an innovative technique of foreign body removal.

http://ift.tt/2sDY72n

Otolaryngology Research Challenges in Patient Care and Outcomes

Eight years ago, Chalmers and Glasziou estimated that nearly 85% of the public and private monies spent on biomedical research were wasted because of inadequately produced and reported research, thereby slowing improvement in patient care. There have been significant efforts made to remedy these issues, yet they persist because the underlying problems have not been corrected.

http://ift.tt/2uOCU3f

September 2017 Issue Highlights

http://ift.tt/2jPZjg0

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

Nocturnal Dyspnea as a Result of a Hypopharyngeal Mass

A man had worsening nocturnal dyspnea, dysphagia, and dysphonia; distal chip laryngeal endoscopy revealed a large, well-mucosalized mass of the left pyriform sinus, and CT with contrast showed a nonenhancing, well-circumscribed mass. What is your diagnosis?

http://ift.tt/2vhklVF

Somatization and the Review of Systems

This cohort study examines the association between patient responses on a form used for review of systems and somatization.

http://ift.tt/2rkOLVk

The Reduction in the Age-Adjusted Prevalence of Hearing Impairment in the United States An Unexpected Dividend of Phasing Out Leaded Gasoline?

In their article, "Declining Prevalence of Hearing Loss in US Adults Aged 20 to 69 Years," Hoffman and colleagues concluded that there was a 25% reduction in high-frequency hearing impairment and a 30% reduction in speech frequency hearing impairment in respondents' worse ear between the 1999 to 2004 cycle of the National Health and Nutrition Examination Survey (NHANES) and the 2011 to 2012 NHANES cycle. I hypothesize that this beneficial trend may be partially owing to the phasing out of leaded gasoline which resulted in an 87% decline in the geometric mean blood lead levels (BLL) in American adults from 13.1 μg/dL in the late 1970s to 1.64 μg/dL by the year 2000.

http://ift.tt/2sfiMY7

Comprehensive Hearing Aid Intervention at a Free Subspecialty Clinic

This observational cohort study describes the structure, feasibility, and outcomes of a free subspecialty clinic providing hearing aids to develop a paradigm for other programs interested in implementing similar projects.

http://ift.tt/2sDMx7y

Typographical Data Error in Abstract

In the Original Investigation titled "Objective and Subjective Measures of Simultaneous vs Sequential Bilateral Cochlear Implants in Adults: A Randomized Clinical Trial," published online June 22, 2017, a typographical data error occurred in the Results section of the abstract. For the difference of 0.9 dB, the upper limit of the 95% CI should have been reported as 4.4 dB, not −4.4 dB (ie, difference, 0.9 dB [95% CI, –3.1 to 4.4 dB], not [95% CI, –3.1 to –4.4 dB]). This article was corrected online.

http://ift.tt/2iu7Ww9

Simultaneous vs Sequential Bilateral Cochlear Implants in Adults

This randomized clinical trial investigates the hearing capabilities and the self-reported benefits of simultaneous bilateral cochlear implants compared with sequential bilateral cochlear implants.

http://ift.tt/2suFtcy

Variations in the Prevalence of Hearing Loss in Children

Epidemiologic estimates of the prevalence of childhood hearing loss (HL) are important to public health and policy for a host of reasons. On the public health front, estimating the disease and disability burden of HL influences priorities in health care and research, determines whether prevention strategies are effective, and tracks longitudinal progression vs new onset of HL in the population. On a policy level, knowing the prevalence of HL in children helps policymakers allocate resources needed in the schools to rehabilitate and accommodate children and adolescents with HL, as mandated by the Individuals with Disability Education Act part C, and contributes to understanding the overall societal cost as children with HL grow into adulthood. However, epidemiological studies have reported large differences in the prevalence of childhood HL over time, from approximately 1 in 1000 to 19.5%.

http://ift.tt/2vMFCay

Evaluating Surgeon-Specific Performance for Endoscopic Sinus Surgery

This study evaluates differences in surgeon-specific performance for endoscopic sinus surgery using a risk-adjusted 5-year revision endoscopic sinus surgery rate as a quality metric.

http://ift.tt/2suLtC5

Addressing the Challenges in Tonsillectomy Research to Inform Health Care Policy

This review provides an overview of the key challenges for research to inform tonsillectomy policy and recommendations to help bridge the evidence-policy gap.

http://ift.tt/2tQLlOd

Insurance and Community-Level Socioeconomic Status in Pharyngeal Cancer

This study of National Cancer Database records assesses the association of insurance and community-level socioeconomic status with outcomes for patients with squamous cell carcinoma of the pharynx.

http://ift.tt/2ttGbZi

Parental Understanding of Educational Materials on Laryngotracheal Reconstruction

This study assesses the understandability and actionability of parental educational materials for laryngotracheal reconstruction in children.

http://ift.tt/2tQDYq6

Audiometric Measurement for Vocal-Fold Function Assessment

This study examines whether bedside measurement of infant cry volume using a smartphone application can be a screening tool for vocal-fold movement in flexible nasolaryngoscopy.

http://ift.tt/2u2OnNa

Exercise-Induced Vertigo in Vestibular Schwannoma

This case report describes a man in his 60s with a right intracanalicular vestibular schwannoma who presented with persistent motion-induced vertigo.

http://ift.tt/2uBG3WU

Browning of Abdominal Aorta Perivascular Adipose Tissue Inhibits Adipose Tissue Inflammation

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


http://ift.tt/2jNyvwP

Persistent impairment on spirometry in chronic eosinophilic pneumonia: a longitudinal observation study (Shizuoka-CEP study)

Chronic eosinophilic pneumonia (CEP) is characterized by the accumulation of eosinophils in the lung with unknown etiology. Although systemic corticosteroid administration leads to dramatic improvement, nearly half the patients with CEP experience relapse and some develop persistent impairment of pulmonary function. However, predictive factors for this persistent impairment have not been determined.

http://ift.tt/2w9ypBl

Otologic disorders in Turner syndrome

Publication date: Available online 21 September 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): E. Bois, M. Nassar, D. Zenaty, J. Léger, T. Van Den Abbeele, N. Teissier
IntroductionPatients with Turner syndrome (TS) have craniofacial malformations, such as Eustachian tube hypoplasia and dysfunction and velar dysfunction, which foster acute otitis media. The aim of this study was to inventory pediatric otologic disorders in patients with TS at their first ENT consultation in our center.Patients and methodsWe reviewed the ENT consultation data of pediatric TS patients followed in our center between 2005 and 2015: otoscopy, hearing threshold, and history of acute otitis media or ENT surgery. Data were compared according to karyotype: X monosomy (45,X), mosaic (45,X/46,XX), isochromosome (46,Xi [Xq]), X ring chromosome X (XrX), with Y material, and "other".ResultsNinety patients, with mean age 11.9years (±4.8years) at first ENT consultation, were included: 29% showed tympanic abnormality on otoscopy, 21% had hearing loss, 24% had history of recurrent acute otitis media; 18% had undergone adenoidectomy, 24% T-tube insertion, and 5.6% tympanoplasty. No particular karyotype was associated with higher risk of hearing loss or acute otitis media.ConclusionPatients with TS showed high prevalence of pediatric otologic disorders; they therefore require close and prolonged ENT follow-up.



http://ift.tt/2feqHiw

Effect of proanthocyanidin on ultrastructure and mineralization of dentine collagen

Publication date: December 2017
Source:Archives of Oral Biology, Volume 84
Author(s): D.J. Epasinghe, M.F. Burrow, C.K.Y. Yiu
ObjectiveProanthocyanidin (PA) is a natural collagen cross-linker that has been used in dentine matrix biomodification for reparative and preventive therapies. This study evaluated the ultrastructure of collagen after its interaction with PA. Furthermore, the mineralization of PA-biomodified collagen matrix was observed.MethodsTen freshly extracted sound human molars were sectioned into 0.5mm×1.7mm×7mm beams for ultrastructural evaluation of PA and dentine matrix under Field Emission Scanning Electron Microscopy (FESEM) and Transmission Electron Microscopy (TEM). Specimens for TEM were completely demineralized and divided into three groups according to PA treatments: deionized water, 2% PA and 6.5% PA. The specimens were fixed, dehydrated, sectioned and examined using TEM. Specimens for FESEM were lightly conditioned with EDTA and similarly divided into the three groups for observation using FESEM. Type I collagen from calf skin was used to analyse the mineral interaction after treatment with 6.5% PA. Formvar- and carbon-coated 400-mesh Ni grids (EMS, Hatfiels, PA, USA) were placed over a 2mg/mL collagen solution prepared from calf skin-derived Type I collagen to achieve self-assembly of collagen fibrils. Grids were treated with 6.5% PA and divided into two groups. One group was floated over a remineralization solution containing 20mM HEPES, 2.25mM CaCl2-2H2O, 1.35mM KH2PO4, 3.08mM NaN3 and 130mM KCl and the other group was over a CPP-ACP solution (Tooth mousse 1:100 dilution with deionized water). The floating samples were kept in a 37°C and 100% humidity chamber. Grids were taken out at selected time durations (24h, 48h and 72h for mineralization solution/24h for CPP-ACP) and observed under TEM without staining. Selected area electron diffractions (SAEDs) were performed at 110kV.ResultsFollowing treatment of demineralized dentine collagen matrix with PA, the size and number of interfibrillar spaces were reduced. The collagen fibrils aggregated together with a reduction in porosity. A characteristic banding pattern of collagen fibrils was observed under TEM. Treatment of PA-biomodified collagen fibrils with remineralization solution increased mineral aggregation along its long axis, when compared to the control group. Furthermore, treatment of PA-biomodified collagen fibrils with CPP-ACP solution enhanced mineral uptake and deposition as well as initiated apatite formation within 24h.ConclusionProanthocyanidin alters the ultrastructure of demineralized dentine collagen matrix. The PA-biomodified collagen matrix promotes remineralization.



http://ift.tt/2xq4LuC

Effects of connective tissue growth factor on human periodontal ligament fibroblasts

Publication date: December 2017
Source:Archives of Oral Biology, Volume 84
Author(s): Xuejing Duan, Mei Ji, Fengying Deng, Zhe Sun, Zhiyong Lin
ObjectiveThe aim of this study was to evaluate the effects of different concentrations of connective tissue growth factor (CTGF) on human periodontal ligament fibroblasts(HPLFs).DesignHPLFs were cultured and identified. Then, different concentrations of CTGF (1, 5, 10, 50, 100ng/ml) were added to the HPLF culture. Next, CCK-8 assays, alkaline phosphatase (ALP) assays, hydroxyproline determination, alizarin red staining methods, Transwell chambers and real-time PCR methods were applied to observe the effects of CTGF on the proliferation, ALP activity, synthesis of collagen, formation of mineralized nodules and migration. We also studied expression of ALP, fiber link protein (FN), integrin-binding sialoprotein (IBSP), osteocalcin (OC), and integrin beta 1 (ITGB1) mRNA by HPLFs. Statistical significance was assumed if P<0.05 or P<0.01.ResultsThe addition of CTGF (1, 5, 10ng/ml) remarkably promoted the proliferation and collagen synthesis of HPLFs compared with controls. CTGF (1, 5, 10, 50ng/ml) improved ALP activity of HPLFs, and at all concentrations, CTGF (1, 5, 10, 50, 100ng/ml) improved the expression of ALP, FN, IBSP and ITGB1 mRNA. In addition, CTGF (1, 5, 10, 50, 100ng/ml) promoted the migration of HPLFs, which was dose-dependent, with maximal promotion in the 10ng/ml group (P<0.05 or P<0.01).ConclusionsThus, in a certain range of concentrations, CTGF can promote the biological effects, including proliferation, migration and collagen synthesis of HPLFs, to promote the differentiation of HPLFs in the process of osteogenesis.



http://ift.tt/2wJFyb3

Editorial board

Publication date: October 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 10





http://ift.tt/2fly2k7

Calendrier

Publication date: October 2017
Source:Annales de Dermatologie et de Vénéréologie, Volume 144, Issue 10





http://ift.tt/2xyB4rV

Do Tattoos Raise the Risk for Cancer?

Components of the ink in tattoos migrate from the skin to the lymph nodes, leading to chronic enlargement, but the health risk has yet to be determined.
Medscape Medical News

http://ift.tt/2xTAPIH

IL-23 Blocker for Psoriasis Successful in Extension Trials

For those with chronic plaque psoriasis, responses to tildrakizumab, an experimental interleukin-23 inhibitor, were upheld in two long-term extension studies, and FDA approval could be in the offing.
Medscape Medical News

http://ift.tt/2xOBWtk

Prognosis of 5-Year Survival of Chemoradiotherapy-Treated Patients With Nasopharyngeal Carcinoma

This cohort study evaluates outcomes data and the American Joint Committee on Cancer staging system to improve the accuracy of the 5-year survival prognosis for patients with nasopharyngeal carcinoma who underwent chemoradiotherapy.

http://ift.tt/2xkmnq3

Extracapsular Dissection vs Superficial Parotidectomy

This study reviews all parotidectomies at a single institution conducted by head and neck surgeons to compare extracapsular dissection with superficial parotidectomy for benign parotid tumors with respect to surgical outcomes and cost-effectiveness.

http://ift.tt/2yfZ7sJ

The End of the Road

http://ift.tt/2xkc857

Prevalence of dermatologic manifestations and metabolic biomarkers in women with polycystic ovary syndrome in north China

Summary

Background

Cutaneous features of hyperandrogenism in polycystic ovary syndrome (PCOS) include acne, hirsutism, seborrhea, androgenic alopecia (AGA), and acanthosis nigricans (AN). However, the relationships have not been well known broadly in terms of clinical hyperandrogenism and biochemical markers.

Objectives

The aim of this study was to investigate biochemical and metabolic parameters in relation to cutaneous characters women in with and without PCOS. Methods: This was a cross-sectional retrospective study including 186 women with PCOS and 113 age-matched without PCOS women. Acne grade, hirsutism, seborrhea, AGA, and AN were recorded. Hormonal and metabolic parameters were measured.

Results

The most common finding was acne, and AN was the least dermatological manifestations between PCOS and non-PCOS groups. The severity location and type of acne did not differ in PCOS women compared to non-PCOS women. Significant differences were found with respect to free androgen index (FAI) (P = .036), sex hormone-binding globulin (SHBG) (P = .023), and body mass index (BMI) (P = .001) between PCOS with acne and PCOS without acne groups. Overall, age (P = .005) was significantly decreased, while BMI (P = .004) was significantly higher in PCOS with hirsutism. The mean serum total testosterone (TT), dehydroepiandrosterone sulfate, and FAI were significantly elevated, but SHBG was decreased between PCOS with and without hirsutism groups. There were significantly different BMI (P = .018) and triglyceride (P = .024) except other hormonal parameter of without AGA group.

Conclusion

This study indicated a strong correlation between hirsutism and metabolic abnormalities. Hirsutism is the most common cutaneous finding in PCOS women. Acne and AGA are associated with other manifestations of clinical hyperandrogenism, but not obvious markers of biochemical hyperandrogenemia and metabolic dysfunction.

http://ift.tt/2xUuHjz

National clinical practice guidelines for Allergen Immunotherapy: an international assessment applying AGREE-II

Abstract

Background

Since 1988 numerous allergen immunotherapy guidelines (AIT-GLs) have been developed by national and international organizations to guide physicians in AIT. Even so, AIT is still severely under-used.

Objective

to evaluate AIT-GLs with AGREE-II, developed in 2010 by McMaster University methodologists to comprehensively evaluate GL-quality.

Methods

Allergist, from different continents, knowledgeable in AIT and AGREE-II trained were selected into the project team. The project received methodologists' guidance. AIT-GLs in any language were sought from 1980-2016; AIT-GLs were AGREE II evaluated by at least 2 team-members, independently; discrepancies were resolved in a second round, by team-discussion or methodologists' consulting.

Results

We found 31 AIT-GLs (15 post-2010), ranging from local consensus reports to international position papers (EAACI, AAAAI-ACAAI, WAO). Pre-2010 GLs' scored 1.6-4.6 (23-67%); post-2010 GLs' 2.1-6 (30-86%), on a 7-point Likert-scale. Best evaluated were: German-Austrian-Swiss (6.0), Mexican (5.1) and the AAAAI/ACAAI AIT-GL (4.7). These were also the only 3 GLs that received 'yes' of both evaluators to the item: 'I would recommend this GL for use'. The domains of 'Stakeholder involvement' and 'Rigor of Development' only scored 3/7, and 'Applicability' scored the lowest. Strikingly, newer GLs only scored clearly better in 'Editorial independence' and 'Global evaluation'.

Conclusions

In AIT-GLs there is still a lot of room for improvement, especially in domains crucial for the dissemination. For some GLs, the 'Scientific rigor' domain flawed. When resources are limited, transculturizing a high-quality GL might be preferable over developing a GL from zero. Our study and AGREE-II could help to select the best candidate.

This article is protected by copyright. All rights reserved.

http://ift.tt/2hl3rQp

The Influence of Anxiety and Depression on Survival in Nasopharyngeal Carcinoma Patients

Condition:   Nasopharyngeal Carcinoma
Intervention:  
Sponsor:   Sun Yat-sen University
Recruiting - verified September 2017

http://ift.tt/2jMms2J

Haemoglobin concentrations in pregnancy and respiratory and allergic outcomes in childhood: birth cohort study

Abstract

Background Limited epidemiological evidence suggests that low maternal iron status and anaemia in pregnancy may increase the risk of childhood respiratory and allergic outcomes.

Objectives To investigate the relation between maternal haemoglobin concentrations in pregnancy and childhood respiratory and allergic outcomes.

Methods In the Avon Longitudinal Study of Parents and Children (ALSPAC) we examined associations of maternal haemoglobin concentrations (g/dL) in pregnancy with hayfever, eczema, wheezing, doctor-diagnosed asthma, allergic sensitisation and total IgE at 7 years, and with lung function at 8-9 years in the offspring, after controlling for potential confounders (N=3234-5335).

Results Maternal haemoglobin was not associated with offspring hayfever, eczema, wheezing or asthma. However, the first haemoglobin measurement in pregnancy (<18 weeks' gestation) and the last measurement (>28 weeks' gestation) were negatively associated with allergic sensitisation (adjusted odds ratio (95% CI) per g/dl 0.91 (0.83 to 0.99) and 0.90 (0.83 to 0.98), respectively). The last haemoglobin measurement was also negatively associated with total IgE (adjusted geometric mean ratio 0.94 (0.88 to 0.99)). Anaemia (haemoglobin <11g/dL) in late pregnancy was negatively associated with Forced Vital Capacity (difference in standard deviation score -0.07 (-0.13 to -0.01)).

Conclusions and clinical relevance Lower maternal haemoglobin in pregnancy may be a risk factor for allergic sensitisation, elevated IgE and lower FVC in childhood, which may reflect effects of lower prenatal iron status. However, maternal haemoglobin was not associated with risk of childhood asthma or other allergic disorders.

This article is protected by copyright. All rights reserved.

http://ift.tt/2jNE3rh

Salivary duct carcinoma: An aggressive salivary gland malignancy with opportunities for targeted therapy

Publication date: November 2017
Source:Oral Oncology, Volume 74
Author(s): Nicole C. Schmitt, Hyunseok Kang, Arun Sharma
Salivary duct carcinoma (SDC) is a rare, aggressive salivary malignancy that is often diagnosed at an advanced stage. Previously, little was known about outcomes of this disease due to its rarity. In the past several years, much has been learned about salivary duct carcinoma after publication of outcomes from several large single-institution series and national database searches. Recent studies of genomic alterations have helped elucidate the biology and pathogenesis of this aggressive disease. Here we review outcomes of the disease, effects of treatment, prognostic factors, and genomic alterations in SDC. Studies of targeted therapy and promising future directions are also discussed.



http://ift.tt/2yfHPMl

Advancing toward a molecular characterization of polymorphous low grade adenocarcinoma

Publication date: Available online 20 September 2017
Source:Oral Oncology
Author(s): Piotr T. Wysocki, William H. Westra, David Sidransky, Mariana Brait




http://ift.tt/2yfKsOa

Tailoring Diagnostic Studies in Hand, Foot, and Mouth Disease: Utility of PCR testing of Lesional Skin

Hand, Foot, Mouth Disease (HFMD) is a highly contagious enteroviral infection with the potential for significant morbidity. In recent years, there has been an increase in atypical cutaneous manifestations of HFMD. We present a pilot case series utilizing Polymerase Chain Reaction (PCR) testing of lesional skin to render a diagnosis of HFMD. These preliminary results suggest that lesional skin PCR testing could be an effective and minimally-invasive test for diagnosing HFMD.

This article is protected by copyright. All rights reserved.

http://ift.tt/2fcQxDr

Evaluation of Serum Selenium and Erythrocyte Glutathione Peroxidase Levels in Patients with Recurrent Tonsillitis

Abstract

The aim of this study is to investigate serum selenium (Se) and glutathione peroxidase (GSH-Px) levels in patients with recurrent tonsillitis. The study included 53 patients with recurrent tonsillitis and 51 healthy children. The measurement of serum Se levels were done in graphite furnace atomic absorption spectrophotometer using Zeeman background correction. Erythrocyte GSH-Px levels were indirectly measured by using the spectrophotometry. The ages of children in both groups ranged between 3 and 13 years, with a mean age of 7.60 years for patient group and 7.22 years for control group. Mean serum Se levels in patient and control groups were 60.4 and 78.7 µg/dL respectively. Mean erythrocyte GSH-Px levels in patient and control groups were 7.0 and 23.1 U/g hb, respectively. The mean blood Se and GSH-Px levels in patients with recurrent tonsillitis were significantly (P < 0.001) lower than control group. In our study, we found that serum Se and erythrocyte GSH-Px levels of cases with recurrent tonsillitis were significantly lower than healthy controls. The decline in serum Se and erythrocyte GSH-Px enzyme levels may predispose a chronic disease state but this issue needs further investigation.

http://ift.tt/2w9Q3EU

Helicobacter pylori eradication rates of concomitant and sequential therapies in Korea

Abstract

Background

The efficacy of the standard triple therapy for Helicobacter pylori eradication has decreased to an unacceptable level. We aimed to compare the efficacy of sequential and concomitant therapies as for the first-line treatments for H. pylori eradication and analyzed the effect of clarithromycin resistance on the eradication rates.

Materials and Methods

Four hundred and seventy-eight patients with H. pylori infection were randomly assigned to either concomitant therapy (amoxicillin 1000 mg with clarithromycin 500 mg, metronidazole 500 mg, and pantoprazole 40 mg twice daily for 10 days) or sequential therapy (amoxicillin 1000 mg with pantoprazole 40 mg twice daily for 5 days, followed by clarithromycin 500 mg with metronidazole 500 mg and pantoprazole 40 mg twice daily for 5 days). The success of the eradication was evaluated 4-5 weeks after treatment completion. To evaluate the efficacy of the two regimens according to clarithromycin sensitivity, dual-priming oligonucleotide-based multiplex-polymerase chain reaction was also performed in the final third of the enrolled study populations.

Results

The eradication rates with concomitant or sequential therapy were 81.9% and 76.6% (P = .153) in intention-to-treat analysis, and 93.4% and 84.8% (P = .004) in per-protocol analysis, respectively. Among the 156 patients for whom dual-priming oligonucleotide-based multiplex-polymerase chain reaction was performed, 17.9% were clarithromycin resistant, and the efficacy of concomitant therapy was better than sequential therapy in the clarithromycin-resistant strains (100% vs 58.3%, P = .010).

Conclusion

Concomitant therapy was superior to sequential therapy as the first-line treatment for H. pylori eradication, especially in clarithromycin-resistant strains in Korea.

http://ift.tt/2ysloEq

Doppler ultrasonography can be useful to determine the etiology of idiopathic sudden sensorineural hearing loss

Publication date: Available online 21 September 2017
Source:Auris Nasus Larynx
Author(s): Ahmet Mutlu, Isa Cam, Sinem Dasli, Murat Topdag
ObjectiveThis study aims to evaluate clinical features of both carotid and vertebral arteries in the idiopathic sudden sensorineural hearing loss (ISSNHL) patients and healthy individuals to contribute additional knowledge on vascular compromise theory.MethodsThis study was designed as a retrospective case control study in a tertiary referral center. 55 patients for ISSNHL and 35 healthy participants (70 ears) are involved to the study. All of the patients were evaluated for the systemic disorders and excluded other possible causes (autoimmune diseases, acoustic schwannoma, drug toxicity, etc) of ISSNHL. The carotid and vertebral arteries were assessed with Doppler USG; in fact, the vascular diameter (VD), intima media thickness (IMT), peak systolic velocity (PSV), blood flow (BF) and resistive index (RI) were evaluated. Related parameters were compared with the control groups.ResultsIn carotid artery system; common carotid artery intima-media thickness (CC-IMT) (p<0.001), and internal carotid artery intima-media thickness (IC-IMT) (p<0.001) were found significantly increased. Otherwise; PSV, VD and BF were not differed significantly. In vertebral artery system; VD (<0.001), PSV (<0.002) and BF (<0.001) were decreased significantly but vertebral artery RI was statistically increased (<0.001).ConclusionIn our study, we found the carotid artery thickening on vascular wall. We also demonstrate the vascular compromise on vertebral arteries. The Doppler USG may lead to determine the etiology of ISSNHL and further investigations are needed to define the exact results.Level of evidence: III b



http://ift.tt/2fl24o4

Lamina papyracea position in patients with nasal polypi: A computed tomography analysis

Publication date: Available online 21 September 2017
Source:Auris Nasus Larynx
Author(s): Mohammad Waheed El-Anwar, Alaa Omar Khazbak, Diaa Bakry Eldib, Hesham Youssef Algazzar
ObjectiveThis study aimed to describe the positions of the lamina papyracea (LP) in patients who had nasal polypi, by computed tomography (CT) analysis.MethodsParanasal CT scans of patients diagnosed to have nasal polypi were included in the study. CT images were acquired with multiplanar reformates to obtain delicate details in coronal planes for all subjects. Positions of the LP were registered then analyzed in relation to nasal polypi grading.ResultsForty seven subjects (94 nasal sides) were included in the current study. Grade I lamina detected in 50% or more of all cases. Patients who had larger polypi (polyp grade 3, 4) were associated with significantly more medial LP (grade II) than smaller polypi (polyp grade 0, 1, 2) (P=0.00386).ConclusionThe current study improves surgeons' awareness of LP position in different grades of nasal polypi and highlights that larger polypi are significantly associated with more medial LP than smaller polypi. This may be one of the causes of the higher incidence of complication in larger polypi and can help for safer surgery.



http://ift.tt/2xy2Qoa

Natural and induced immunization against CCL20 ameliorate experimental autoimmune encephalitis and may confer protection against multiple sclerosis

Publication date: Available online 20 September 2017
Source:Clinical Immunology
Author(s): Michal Abraham, Arnon Karni, Karin Mausner-Fainberg, Ido D. Weiss, Amnon Peled
Th-17 type immune response that occurs in multiple sclerosis (MS) is linked to CCR6-CCL20 interaction. We confirmed the dependency on CCR6 in EAE development. Vaccination of mice with hCCL20, but not mCCL20, produced anti-murine CCL20 and ameliorated EAE. The EAE clinical score negatively correlated with anti CCL20 levels. A beneficial effect was transferred by sera from hCCL20-immunized mice. Immunized mice with cyclic peptide that include a bacterial outer membrane protein A (ompA), that share homology sequence with hCCL20 produced anti CCL20, anti ompA and anti-cyclic peptide. Immunization of mice with ompA or the cyclic peptide ameliorated EAE. The cyclic peptide inhibited CCL20 activity in an adhesion assay. A significantly higher level of anti CCL20 were found in healthy individuals compared to RR-MS patients. There was no similar difference for anti-CXCL10. Natural or induced immunization against CCL20 confer protection against EAE and may be beneficial in MS.



http://ift.tt/2w96d1A

Case 29-2017: A 59-Year-Old Woman with Pain and Swelling in the Right Hand and Ankles

Presentation of Case. Dr. Miranda Theodore (Medicine): A 59-year-old woman was admitted to this hospital because of stiffness, swelling, and severe pain in her right thumb and both ankles. The patient had been well until 9 days before admission, when stiffness, swelling, and pain developed in the…

http://ift.tt/2yrDZAJ

Th1 Signatures Are Present in the Lower Airways of Children with Severe Asthma, Regardless of Allergic Status

Publication date: Available online 20 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Julia A. Wisniewski, Lyndsey M. Muehling, Jacob D. Eccles, Brian J. Capaldo, Rachana Agrawal, Debbie-Ann Shirley, James T. Patrie, Lisa J. Workman, Alexander J. Schuyler, Monica G. Lawrence, W. Gerald Teague, Judith A. Woodfolk
BackgroundThe pathogenesis of severe asthma in childhood remains poorly understood.ObjectiveTo construct the immunological landscape in the airways of children with severe asthma.MethodsComprehensive analysis of multiple cell types and mediators was performed by flow cytometry and multiplex assay using bronchoalveolar lavage (BAL) specimens (n=68) from 52 highly characterized allergic and non-allergic children (0.5-17 years) with severe treatment-refractory asthma. Multiple relationships were tested by linear mixed-effects modeling.ResultsMemory CCR5⁺ Th1 cells were enriched in BAL fluid versus blood, and pathogenic respiratory viruses and bacteria were readily detected. IFN-γ⁺IL-17⁺ and IFN-γ^-IL-17⁺ subsets constituted secondary Th types, and BAL CD8⁺ T cells were almost exclusively IFN-γ⁺. The Th17-associated mediators, IL-23 and MIP-3α/CCL20 were highly expressed. Despite low Th2 numbers, Th2 cytokines were detected and Th2-skewing correlated with total IgE levels. ILC2s and basophils were scarce in BAL fluid. Levels of IL-5, IL-33 and IL-28A/IFN-λ2, were increased in multi-sensitized children and correlated with IgE to dust mite, ryegrass and fungi, but not cat, ragweed or food sources. Additionally, levels of IL-5, but no other cytokine, increased with age and correlated with eosinophil numbers in BAL fluid and blood. Both plasmacytoid and IgE⁺FcεRI⁺ myeloid dendritic cells were present in BAL fluid.ConclusionsThe lower airways of children with severe asthma display a dominant Th1 signature, and atypical cytokine profiles that link to allergic status. Our findings deviate from established paradigms, and warrant further assessment of the pathogenicity of Th1 cells in severe asthma.

Graphical abstract

Teaser

A Th1 signature dominates the lower airways of children with severe asthma, regardless of allergic status. Our findings warrant further investigation of the contributions of Th1 cells to the development and maintenance of severe asthma.


http://ift.tt/2jLHGhh

Human CD40L-expressing type 3 innate lymphoid cells induce IL-10-producing immature transitional regulatory B cells

Publication date: Available online 20 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Zsolt István Komlósi, Nóra Kovács, Willem van de Veen, Anna Kirsch, Heinz Benedikt Fahrner, Marcin Wawrzyniak, Ana Rebane, Barbara Stanic, Oscar Palomares, Beate Rückert, Günter Menz, Mübeccel Akdis, György Losonczy, Cezmi A. Akdis
BackgroundType 3 innate lymphoid cells (ILC3s) are involved in the maintenance of mucosal homeostasis; however, their role in immunoregulation has been unknown. Immature transitional regulatory B (itBreg) cells are innate-like B cells with immunosuppressive properties, and the in vivo mechanisms by which they are induced have not been fully clarified.ObjectiveWe aimed to investigate the ILC3-B cell interaction that probably takes place in human tonsils.MethodsILC3s were isolated from peripheral blood and palatine tonsils, expanded and cocultured with naïve B cells. Tonsillar ILC3s and Breg cells were visualized with immunofluorescence histology. The frequencies of ILC3s were measured in tonsil tissue of allergic and non-allergic patients; and in peripheral blood of allergic asthmatics and healthy controls.ResultsA mutually beneficial relationship was revealed between ILC3s and B cells: ILC3s induced IL-15 production in B cells via BAFF-receptor, while IL-15, a potent growth factor for ILC3s, induced the expression of CD40L on circulating and tonsillar ILC3s. IL-15-activated CD40L⁺ILC3s helped B cell survival, proliferation and the differentiation of IL-10-secreting, functional itBreg cells in a CD40L- and BAFF-receptor-dependent manner. ILC3s and Breg cells were in close connection with each other in palatine tonsils. The frequency of ILC3s was reduced in tonsil tissue of allergic patients and in peripheral blood of allergic asthmatics.ConclusionHuman CD40L⁺ILC3s provide innate B cell help, and are involved in an innate immunoregulatory mechanism by the induction of itBreg cell differentiation, which takes place in palatine tonsils in vivo. This mechanism may contribute to the maintenance of the immune tolerance and become insufficient in allergic diseases.

Graphical abstract

Teaser

ILC3-mediated induction of Breg cells is a novel, innate immunoregulatory mechanism that may contribute to the maintenance of immune tolerance and become insufficient in allergy, as the frequency of ILC3s is reduced in allergic diseases.


http://ift.tt/2jKGlqS

Advances and Highlights in Allergen Immunotherapy: On the way to sustained clinical and immunologic tolerance

Publication date: Available online 20 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Margot Berings, Cagatay Karaaslan, Can Altunbulakli, Philippe Gevaert, Mübeccel Akdis, Claus Bachert, Cezmi A. Akdis
Allergen immunotherapy (AIT) is an effective treatment strategy for allergic diseases and has been used for more than 100 years. In recent years, however, the expectations on concepts, conduct, statistical evaluation and reporting have been significantly developed. Products have undergone dose-response and confirmative studies in adults and children to provide evidence for the optimal dosage, safety and efficacy of AIT vaccines using subcutaneous and sublingual delivery pathways in large patient cohorts, ensuring solid conclusions to be drawn from them for the advantage of patients and societies alike. Those standards should be followed today, and products answering to them should be preferred over others lacking optimization and proof of efficacy and safety. Molecular and cellular mechanisms of AIT include early mast cell and basophil desensitization effects, regulation of T and B cell responses, regulation of IgE and IgG4 production and inhibition of responses from eosinophils, mast cells and basophils in the affected tissues. There were many developments to improve vaccination strategies, demonstration of new molecules involved in molecular mechanisms and demonstration of new biomarkers for AIT during the last few years. The combination of probiotics, vitamins and biologicals with AIT are highlighting current advances. Development of allergoids, recombinant and hypoallergenic vaccines to skew the immune response from IgE to IgG4 and regulation of dendritic cell, mast cell, basophil, innate lymphoid cell, T and B cell responses to allergens are also discussed in detail.



http://ift.tt/2jLHyyj

High prevalence of severe asthma in a large random population study

Publication date: Available online 20 September 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Roxana Mincheva, Linda Ekerljung, Apostolos Bossios, Bo Lundbäck, Jan Lötvall
BackgroundThe prevalence of asthma severity is not well described at a population level.ObjectiveTo determine the prevalence of phenotypic signs of asthma severity among individuals with asthma in a general population, and to describe risk factors for asthma severity.MethodsEpidemiological study conducted between 2008 and 2012 (West Sweden Asthma Study). A postal questionnaire was sent to random population (N = 30,000) in West Sweden, with 18,087 responses. A total of 2,006 individuals were carefully phenotyped. Only individuals with "active asthma" (symptoms or medication in the last year, N = 744) were analyzed in this study, to determine degree of severity of the disease within an asthma cohort. Phenotypes of severity were calculated based on: 1) multiple symptoms during the day despite the ongoing use of asthma medications, 2) FEV1 below 70% of predicted value, 3) daily or almost daily use of rescue medications, 4) nighttime symptoms once a week or more, and 5) oral corticosteroid use/emergency room visits. Asthmatics were grouped as non-severe, one sign of severity or two or more signs of severity.ResultsA total of 36.2% of asthmatics expressed at least one sign of asthma severity, and 13.2% had two or more signs. The group with two or more signs was older in age, had higher BMI, a higher rate of tobacco smoking and lower lung function. Bronchial hyperreactivity, airway inflammation and sensitization were significantly different among the three groups. At a population level, the prevalence of asthma severity was 3.1% for one sign, and 1.3% for at least two signs.ConclusionMore than one in three asthmatics show at least one sign of asthma severity. The phenotypes of asthma severity are highly diverse, which is important to consider when implementing personalized medicine in asthma.Clinical implicationsOur data is based on a random population, which results in minimal bias vs patient selection, and argues that asthma severity is present in 13% to 36% of asthmatics.

Graphical abstract

Teaser

Every third asthmatic showed at least one sign of asthma severity which indicates that there are still many unmet needs in managing this disease. Asthma severity phenotypes are very diverse prompting an individualized approach to patients.


http://ift.tt/2jLHtL1

Outpatient management of pediatric acute mastoiditis

Publication date: November 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 102
Author(s): Ahmed Alkhateeb, Francis Morin, Haya Aziz, Mayuri Manogaran, William Guertin, Melanie Duval
ObjectiveEvaluate the Montreal Children's Hospital experience with outpatient management of uncomplicated acute mastoiditis with parenteral antibiotic therapy alone and determine if it is a safe alternative to inpatient management.Subjects and methodA retrospective review of pediatric patients diagnosed with acute mastoiditis at a tertiary care pediatric hospital between 2013 and 2015 was performed. Patients with syndromes, immunodeficiency, cholesteatoma, chronic otitis media, cochlear implant in the affected ear, or incidental mastoid opacity were excluded.Results56 children age 6 months to 15 years old were treated for acute mastoiditis, including 29 hospitalizations and 27 outpatients. Patients managed as outpatient with daily intravenous ceftriaxone had a 93% cure rate. Eighteen hospitalized and one outpatient had complications of acute mastoiditis. Children with complications were more likely to be febrile (p = 0.045). Two patients failed outpatient therapy and were admitted; one for myringotomy and piperacillin-tazobactam treatment and one required a mastoidectomy. 4/27 children treated as outpatient underwent myringotomy and tube insertion, 2 underwent myringotomy and tube along with admission and 21 did not require tube insertion. The average total duration of intravenous antibiotic therapy was respectively 4.9 and 18.9 days in the outpatient and hospitalized group. The average duration of admission was 5.9 days.ConclusionOutpatient medical therapy of uncomplicated pediatric mastoiditis is safe, successful, and efficient. Benefits include efficient use of surgical beds, cost savings and patient and family convenience. Careful patient selection and close monitoring are keys for successful outcome.



http://ift.tt/2yrCGBN

Salivary cotinine levels in children with otolaryngological disorders

Publication date: November 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 102
Author(s): Christine M. Clark, Jillian N. Printz, Lauren E. Stahl, Brett E. Phillips, Michele M. Carr
ObjectiveTo determine if salivary cotinine, a biomarker for tobacco smoke exposure, is elevated more often or to a higher degree in children meeting criteria for tonsillectomy or tympanostomy tube insertion.MethodsSaliva samples were obtained from 3 groups of children for salivary cotinine measurement. Group 1 served as healthy controls. Group 2 consisted of subjects meeting tympanostomy tube criteria. Group 3 consisted of patients meeting tonsillectomy criteria. Environmental tobacco smoke (ETS) exposure was defined as a salivary cotinine concentration ≥1.0 ng/mL. Demographic data, smoke exposure history, and co-morbidities were also determined.Results331 patients were included, with 112 in Group 1, 111 in Group 2, and 108 in Group 3. No differences were encountered for smoke exposure by history or smoker's identity, salivary cotinine level, or frequency of positive cotinine results. 42.6% of Group 1 had positive salivary cotinine compared to 51.8% of Group 2 and 47.7% of Group 3. Group 1 had a mean salivary cotinine level of 2.42 ng/mL compared to 2.54 ng/mL in Group 2 and 2.60 ng/mL in Group 3. The frequency of positive cotinine levels was higher than expected based on parental history. Among subjects with positive cotinine levels, 93 had no ETS exposure, and 64 had ETS exposure by history.ConclusionApproximately 50% of children who undergo tonsillectomy and tympanostomy tube insertion have objective evidence of ETS exposure. Parental history underestimates passive smoke exposure, which can impact perioperative care.



http://ift.tt/2wAsARP

A 5-year randomized trial on the safety and efficacy of pimecrolimus in atopic dermatitis: a critical appraisal – author response

http://ift.tt/2xTngsR

Scrotal hair in infancy: A case series

Abstract

Scrotal hair is a clinical condition that occurs rarely in infancy. Its prevalence is not known. We present a retrospective analysis of six patients referred to our pediatric endocrinology clinic. Except for scrotal hair development, all physical examinations were normal. Underlying pathologic hyperandrogenism was excluded in each case. Clinical regression was observed in all four infants with documented follow-up visits. Scrotal hair in infancy is not well known to most pediatricians and dermatologists and can cause parental anxiety. Our cases are typical of the benign course of isolated scrotal hair.

http://ift.tt/2hiH1De

Warming up to the idea of wet wraps

Abstract

Atopic dermatitis (AD) is a prevalent condition in the pediatric population that can have a significant effect on a child's quality of life. Management is multifactorial, involving topical pharmacotherapy, emollients, and a bathing regimen in conjunction with close supervision from the caregiver and physician. In the case of moderate to severe or refractory AD, wet wraps can be used. As part of our wet wrap regimen, we propose warming damp cotton pajamas in the dryer before application. This makes the wet wraps more comfortable for children, increasing adherence to the prescribed regimen.

http://ift.tt/2hm83pt

Orofacial granulomatosis in a 12-year-old girl successfully treated with intravenous pulse corticosteroid therapy and chloroquine

Abstract

Orofacial granulomatosis, a rare disease in childhood, is characterized by orofacial swelling in the absence of systemic disease. We report the case of a 12-year-old girl with asymptomatic erythematous infiltration of her upper lip, cheeks, and chin that had persisted for more than 2 years; biopsy confirmed granuloma formation. Because a large area was affected, intralesional corticosteroids were inappropriate and six cycles of 3-day intravenous pulse corticosteroid therapy (dexamethasone 1.5mg/kg), repeated once after 4 weeks, was given. Our patient also received oral chloroquine and topical emollients. At the end of the sixth pulse cycle, the infiltration had completely resolved, leaving slight residual erythema.

http://ift.tt/2hi9zfY

Health-related quality of life in children with cutaneous adverse drug reactions

Abstract

Adverse drug reactions (ADRs) are a common problem in children. Health-related quality of life in patients with such conditions has not been well studied. In this study we found that health-related quality of life is adversely affected in children who developed ADRs with cutaneous manifestations.

http://ift.tt/2hleDg7

Acquired progressive lymphangioma: Case report with partial response to imiquimod 5% cream

Abstract

Acquired progressive lymphangioma (APL), or benign lymphangioendothelioma, is an unusual entity derived from vascular structures. Clinically and histopathologically it may resemble Kaposi's sarcoma and well-differentiated angiosarcoma, causing a diagnostic problem. We report an individual with APL initially diagnosed with Kaposi's sarcoma who underwent unnecessary laboratory testing. Imiquimod 5% cream stopped the progression of the lesion. Awareness of this rare entity may prevent patients from undergoing excessive testing. Imiquimod may be used as a safe, effective treatment option.

http://ift.tt/2hhFpJL

Tick bite mimicking indeterminate cell histiocytosis

Abstract

Ticks are a well-known vector for viral, bacterial, and rickettsial infections, many of which are accompanied by cutaneous eruptions, but the bite itself can induce a spectrum of inflammatory reactions, including foreign body granuloma, tick bite alopecia, and cutaneous lymphoid hyperplasia. We describe the development of an indeterminate cell histiocytic infiltrate at the site of a tick bite. Although the etiology of intermediate cell histiocytosis is not well understood, this case raises the possibility that such infiltrates may represent an inflammatory reaction in some patients.

http://ift.tt/2hluQlA

Extensive orf infection in a toddler with associated id reaction

Abstract

Orf is a zoonotic parapoxvirus typically transmitted to humans by a bite from goats or sheep. We present an unusual case of multiple orf lesions on the fingers of a 13-month-old child who was bitten by a goat and subsequently developed progressive swelling, blistering, and necrotic papulonodules of the hand followed by an additional diffuse, pruritic, papular rash. A primary diagnosis of orf infection was confirmed using real-time polymerase chain reaction, and the diffuse eruption was clinically consistent with an id reaction. Extensive necrosis and papular id reaction associated with orf rarely have been described.

http://ift.tt/2hhA7hC

Bullous diaper dermatitis with cloth diaper use

Abstract

Irritant diaper dermatitis occurs at a higher frequency with cloth diaper use than disposable diapers. We present four cases of vesiculobullous, erosive diaper dermatitis occurring in older infants and toddlers with cloth diaper use that resolved completely after transitioning to disposable diapers. This is the first report of vesicles and bullae as a type of irritant diaper dermatitis.

http://ift.tt/2hjGAVm

Demodicosis in two patients with a previous history of Langerhans cell histiocytosis

Abstract

Demodex mites are commensal organisms rarely found in healthy children. Human demodicosis can be classified as a primary or a secondary form. The secondary form in children usually affects severely immunodepressed children. To our knowledge, this is the first report of human demodicosis associated with Langerhans cell histiocytosis. These cases show that this skin disorder can occur months after completing chemotherapy, without recurrence of the systemic disease.

http://ift.tt/2hiQQks

An unusual case of temporal bone encephalomeningocele occurring together with normal pressure hydrocephalus

Publication date: Available online 20 September 2017
Source:American Journal of Otolaryngology
Author(s): Bernard Tan Wen Sheng, David Low Yong Ming, Heng Wai Yuen
Temporal bone encephalomeningoceles are uncommon clinical entities that can be challenging to diagnose and treat. Common presenting complaints include symptoms of aural fullness, hearing loss, clear otorrhea and meningitis. Common etiologies are chronic middle ear disease and trauma. A significant proportion of cases are spontaneous, which occurs in relation to benign intracranial hypertension. Normal pressure hydrocephalus associated with temporal bone encepahomeningoceles has not been previously described.The authors present an unusual case of spontaneous right sided temporal bone encephalomeningocele associated with symptomatic normal pressure hydrocephalus. Surgical repair of the defect was successful. The diagnostic and management approach to this unique case are discussed.



http://ift.tt/2ysSHrh

Porokeratosis ptychotropica: a diagnostic and therapeutic challenge

Abstract

The porokeratoses are characterized by the formation of cornoid lamellae. Porokeratosis ptychotropica (PP), is a rare form first described by Lucker, where the dyskeratotic skin changes are mainly located around the gluteal cleft or genital area (1, 2).

A 56-year-old man presented with mildly pruritic symmetrical hyperkeratotic brown plaques with subtle fine scaling, and smaller satellite plaques, affecting both buttocks, and partially the intergluteal cleft. (Figure 1 a) The plaque began a year before on the right buttock, and a second plaque followed on the left. Treatment with emollients, antifungals, and topical steroids was unsuccessful. He was otherwise healthy.

This article is protected by copyright. All rights reserved.

http://ift.tt/2xjGULz

Incidence, Prevalence, and Mortality of Adamantiades-Behçet's disease in Korea: A Nationwide, Population-based Study (2006–2015)

Abstract

Background

The epidemiology of Adamantiades-Behçet's disease varies among ethnic populations worldwide. Trends in the incidence of Adamantiades-Behçet's disease have not been investigated based on the Korean National Health Insurance database.

Objectives

This study investigated the incidence and mortality of Adamantiades-Behçet's disease by age using nationwide population data in Korea.

Methods

A nationwide population-based cohort study was performed using the Korean National Health Insurance Claims Database from 2006 to 2015. The incidence of Adamantiades-Behçet's disease was calculated by age, sex, calendar year, and habitat. And comorbid metabolic diseases were also analyzed in patients with Adamantiades-Behçet's disease.

Results

The annual incidence of Adamantiades-Behçet's disease per 100,000 person-years was 3.976 (2.587 for males and 5.373 for females) from 2006 to 2015. The incidence of Adamantiades-Behçet's disease peaked among people in their 40s (6.561 per 100,000 person-years). Incidence was significantly higher in subjects with comorbid metabolic conditions, such as diabetes mellitus, hypertension, and dyslipidemia. The mortality rate per 1,000 person-years increased with age in Adamantiades-Behçet's disease patients.

Conclusions

This study showed the incidence, prevalence, and mortality of Adamantiades-Behçet's disease. Metabolic conditions increased the risk of Adamantiades-Behçet's disease among Koreans.

This article is protected by copyright. All rights reserved.

http://ift.tt/2yfbncP

Low and high body mass index in Hidradenitis suppurativa patients – different subtypes?

Abstract

Introduction

Overweight is a well established risk factor for Hidradenitis Suppurativa (HS). In this cross sectional study, we compare HS patients with a high body mass index (BMI) with HS patients with a low BMI to investigate differences in disease characteristics.

Materials and method

Patients were recruited from 17 dermatological centers from 4 continents. A total of 246 patients with a BMI below 25 were compared to 205 patients with a BMI of above 35.

Results

Patients with a high BMI suffered more severe disease (Hurley, physician global assessment, number of areas affected and patient reported severity, p < 0.001 for all). There was no difference in smoking (p = 0.783) nor in family history (p = 0.088). In both low and high BMI patients, early onset of HS was a predictor of positive family history (p < 0.001, for each). For low BMI patients, an increase in BMI significantly increased patient reported severity (p < 0.001). For patients with a high BMI, number of pack years significantly increased patient reported severity (p = 0.001). Cluster analysis of eruption patterns were location specific for low BMI patients but severity specific for high BMI patients.

Discussion

Patients with a low and high body mass index could represent two clinically different subtypes. We suggest a non-linear relationship between BMI and impact of HS. As patients go from a low BMI patient to a high BMI patient (or from high to low), eruption patterns and risk factors may change.

This article is protected by copyright. All rights reserved.

http://ift.tt/2xjHRUa

Optimizing the Safety Profile of Everolimus by Delayed Initiation in De Novo Heart Transplant Recipients: Results of the Prospective Randomized Study EVERHEART.

Background: Although everolimus potentially improves long-term heart transplantation (HTx) outcomes, its early postoperative safety profile had raised concerns and needs optimization. Methods: This 6-month, open-label, multicenter randomized trial was designed to compare the cumulative incidence of a primary composite safety endpoint comprising wound healing delays, pericardial effusion (PCEs), pleural effusion (PLEs) needing drainage, and renal insufficiency events (estimated glomerular filtration rate [eGFR] = 2R, rejection with hemodynamic compromise, graft loss, or death was the secondary composite efficacy endpoint. Results: Overall, 181 patients were randomized to the EVR-I (n=89) or EVR-D (n=92) arms. Incidence of primary safety endpoint was higher for EVR-I than EVR-D arm (44.9% vs 32.6%; P=0.104), mainly driven by a higher rate of PCEs (33.7% vs 19.6%; P=0.04); wound healing delays, acute renal insufficiency events, and PLEs occurred at similar frequencies in the study arms. Efficacy failure was not significantly different in EVR-I arm vs EVR-D arm (37.1% vs 28.3%; P=0.191). Three patients in the EVR-I arm and 1 in the EVR-D arm died. Incidence of clinically significant adverse events leading to discontinuation was higher in EVR-I arm vs EVR-D arm (P=0.02). Conclusions: Compared with immediate initiation, delayed everolimus initiation appeared to provide a clinically relevant early safety benefit in de novo HTx recipients, without compromising efficacy. 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/2yfqlzP

Navigating T Cell Immunometabolism in Transplantation.

Recently, a new discipline termed "immunometabolism" has transformed the field of immunology. It encompasses the study of the intrinsic metabolic pathways of different immune subsets and their impact on cellular fate and function. For instance, broadly speaking, pro-inflammatory cells depend upon glycolysis and glutamine oxidation while cells involved in anti-inflammatory response such as Foxp3+ regulatory T cells (Tregs) utilize predominantly fatty acid oxidation. However, while a useful paradigm, this actually is a reductionist view and the engagement of these metabolic pathways is not mutually exclusive between these subsets. Over the past several years, new insights and new methods to better dissect, define, and harness the metabolic properties of immune cells for immunotherapeutic purposes have come to the forefront. In this review, we will discuss the metabolic heterogeneity of different T cells subsets as well as basic principles of integrative technologies, such as metabolomics, that can be used to better understand the metabolic signatures of immune responses. Given the interest of exploiting this information in the context of transplantation, we will highlight the scope of immunometabolism in unraveling novel mechanisms of immune regulation that can be manipulated to promote Treg stability and function while inhibiting T effectors to establish long-term transplantation tolerance. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2xjVyTd

Overall and peripheral lung function assessment by spirometry and forced oscillation technique in relation to asthma diagnosis and control

Abstract

Background

Classic spirometry is effort-dependent and of limited value in assessing small airways. Peripheral airway involvement, and relation to poor control, in asthma, has been highlighted recently. Forced oscillation technique (FOT) offers an effort-independent assessment of overall and peripheral lung mechanics. We studied the association between lung function variables, obtained either by spirometry or multi-frequency (5, 11 and 19 Hz) FOT, and asthma diagnosis and control.

Methods

Spirometry measures, resistance at 5 (R5) and 19 Hz (R19), reactance at 5 Hz (X5), resonant frequency (f_res), resistance difference between 5-19 Hz (R5-R19) and Asthma Control Test scores were determined in 234 asthmatic and 60 healthy subjects (aged 13-39 years). We used standardised lung function variables in logistic regression analyses, unadjusted and adjusted for age, height, gender, weight.

Results

Lower FEV₁/FVC (OR (95% CI) 0.47 (0.32, 0.69)) and FEF₅₀ (0.62 (0.46, 0.85)) per standard deviation increase, and higher R5 (3.31 (1.95, 5.62)) and R19 (2.54 (1.65, 3.91)) were associated with asthma diagnosis. Independent predictive effects of FEV₁/FVC and R5 or R19, respectively, were found for asthma diagnosis. Lower FEV₁/FVC and altered peripheral FOT measures (X5, f_res and R5-R19) were associated with uncontrolled asthma (p-values < 0.05).

Conclusions

Resistance FOT measures were equally informative as spirometry, related to asthma diagnosis, and furthermore, offered additive information to FEV₁/FVC, supporting a complementary role for FOT. Asthma control was related to FOT measures of peripheral airways, suggesting a potential use in identifying such involvement. Further studies are needed to determine a clinical value, and relevant reference values in children, for the multi-frequency FOT measurements.

This article is protected by copyright. All rights reserved.

http://ift.tt/2wIRzgK

Small airway involvement in the late allergic response in asthma

Abstract

Background

Allergy and asthma are closely linked. Inhalation of allergen induces an early allergic response (EAR) within the airways of allergic asthmatic subjects, which is followed by a late allergic response (LAR) in approximately 50% of the subjects. The LAR is defined as a drop in forced expiratory volume in 1 s (FEV₁) from baseline usually occurring 4–8 h after exposure, and is believed to affect small airways. However, FEV₁ is insensitive to changes in small airway physiology.

Objective

Our aim was to investigate and compare the pathophysiological processes in large and small airways during the EAR and the LAR, and to characterize subjects with both an EAR and a LAR (dual responders) versus those with an EAR only (single responders).

Methods

Thirty-four subjects with allergic asthma underwent an inhaled allergen challenge. Lung physiology was assessed by spirometry, impulse oscillometry (IOS), body plethysmography, inert gas washout, single breath methane dilution carbon monoxide diffusion and exhaled breath temperature, at baseline and repeatedly for 23 h post-allergen challenge.

Results

Peripheral airway resistance, air trapping and ventilation heterogeneity were significantly increased in dual responders (n=15) compared to single responders (n=19) 6–8 h post-challenge. Parameters of peripheral airway resistance and ventilation heterogeneity, measured with IOS and inert gas washout, respectively, correlated at baseline and during the allergic airway response in all subjects.

Conclusion

The LAR involves increased resistance and ventilation defects within the peripheral airways. Alternative definitions of the LAR including small airways pathophysiology could be considered.

Clinical relevance

Small airway dysfunction during the LAR suggests that dual responders may have more extensive airway pathology and underscores the relevance of small airways assessment in asthma.

This article is protected by copyright. All rights reserved.

http://ift.tt/2xpgwSg