Issue Information

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Issue Information

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IL-36 in hidradenitis suppurativa: Evidence for a distinctive pro-inflammatory role and a key factor in the development of an inflammatory loop

Abstract

Background

A possible regulatory involvement of the interleukin (IL)-36 family in inflammatory diseases has been suggested.

Objectives

To analyze the expression of IL-36α, β, γ, and the antagonistic cytokines IL-36Ra, IL-37, and IL38 in the skin of hidradenitis suppurativa (HS) patients.

Methods

Skin samples from lesional and corresponding perilesional HS skin, and from healthy controls were included in this study and analyzed by quantitative real-time RT-PCR. To evaluate the PCR results of IL-36α, β, and γ, a subset of skin samples was studied by immunohistochemistry.

Results

Expression levels of IL-36α, β, γ, and IL-36Ra were all significantly higher in lesional HS skin compared to healthy controls. IL-37 and IL-38 were significantly higher in perilesional HS skin compared to healthy controls and decreased in lesional HS skin.

Limitations

Descriptive study and small sample size.

Conclusions

Our results showed a possible involvement of IL-36 cytokines in the inflammatory network of HS and a dysbalance between the agonistic and antagonistic cytokines in HS skin.

This article is protected by copyright. All rights reserved.

http://ift.tt/2fIEX3f

Systemic retinoids and psychiatric disorders in patients with skin diseases: a multifactorial relationship

Abstract

Le Moigne and colleagues reviewed case reports to examine a possible causal linkage between systemic retinoids and psychiatric disorders.¹ The authors conclude that systemic retinoids should be prescribed with vigilance for patients with psychiatric disorders. While we agree with a need for vigilance, we caution against prematurely concluding that there is a causal association.

This article is protected by copyright. All rights reserved.

http://ift.tt/2yH4npp

Fat attacks!: a case of fat embolisation syndrome postliposuction

Liposuction is a procedure commonly performed in the UK usually with a low incidence of serious sequelae; however with larger patients and increased volumes of lipoaspirate, complications have been reported more frequently. One of the rare but very serious complications postliposuction is fat embolism syndrome (FES), a life-threatening condition difficult to diagnose and limited in treatment.

The authors present the case of a 45-year-old woman who was admitted to the intensive care unit postelective liposuction for bilateral leg lipoedema. She presented with the triad of respiratory failure, cerebral dysfunction and petechial rash requiring a brief period of organ support. This case highlights that with the recent increase in liposuction procedures worldwide, FES is a differential to always consider. Although still a rare condition this article emphasises the importance of thinking outside the box and how to identify and manage such a life-threatening complication.

http://ift.tt/2yo2HF5

Osteitis of the radius following Bacillus Calmette–Guérin vaccination at birth: a case report

The Bacillus Calmette–Guérin vaccine, which is used for the prevention of tuberculosis, is considered protective against the severe forms of childhood tuberculosis. However, some serious adverse reactions incl...

http://ift.tt/2xUiCIs

Skin penetration and UV-damage prevention by nanoberries

Summary

Background

Ethanolic extract from blueberry (Vaccinium myrtillus) is rich in anthocyanins and thus exhibits antioxidant activity. On the other hand, ultradeformable liposomes are capable of penetrating to the impermeable barrier of skin. Nanoberries are ultradeformable liposomes carrying blueberry extract.

Objectives

In this study, their capacity to penetrate the stratum corneum and photodamage prevention were tested, with the aim of developing a topical formulation for skin protection from environmental damage.

Methods

Nanoberries were prepared by lipid film resuspension with ethanolic extract from blueberry, followed by sonication and incorporation to a gel. Size, zeta potential, deformability, rheology, and viscoelasticity were determined. Toxicity was assessed in vivo in zebrafish model, while in vitro cytotoxicity assay was performed on HaCaT and HEK-293T cell lines. Skin penetration was evaluated with the Saarbrücken penetration model followed by tape stripping, cryosection, or optical sectioning. UV-damage protection and photoprotection were determined by ad hoc methods with UVA, UVB, and UVC radiation on HaCaT cells. Wound assay was performed on HaCaT cells.

Results

Nanoberries of about 100 nm, with differential elastic properties, did penetrate the stratum corneum, with low toxicity. When HaCaT cells were exposed to UV radiation in the presence of nanoberries, their viability was maintained.

Conclusions

Nanoberries could be effective to protect the skin from sun photodamage.

http://ift.tt/2gaqG06

Temporal brow lift vs internal browpexy in females undergoing upper blepharoplasty: Effects on lateral brow lifting

Summary

Background

Lateral brow-lifting surgical procedures in conjunction with upper blepharoplasty may prevent secondary descent following upper blepharoplasty.

Objective

To compare the results of internal browpexy (IBP) and temporal brow lift (TBL) in patients with dermatochalasis undergoing simultaneous upper blepharoplasty.

Methods

This study was a single-center, parallel-group randomized controlled trial conducted on 32 female patients suitable for upper blepharoplasty. Patients were divided into two groups: the IBP group and the TBL group. The brow lift was measured using change in the distance between the ala nasi and lateral tail of the eyebrow as nasal ala to lateral brow (NALB) in millimeter (mm), and the vertical line between the lateral tail of eyebrow and horizontal line extending the lateral cantus as lateral brow plump line (LBPL) in mm before and after the surgery. The follow-up time was 6 months.

Results

The mean ± SD age of patients was 55.93 ± 7.1 years and 53.94 ± 7.7 years in the TBL and IBP groups, respectively (P > .05). No significant change in mean LBPL at 6 months compared to baseline was observed in the TBL group (baseline: 15.7 ± 1.6 mm vs 6 month: 15.8 ± 1.3 mm; P = .602). In the IBP group, a significant increase in mean LBPL at 6 months compared to baseline was observed (baseline: 15.09 ± 2.13 mm vs 6 months: 17. 43 ± 2.68 mm; P < .001).

Conclusions

Internal browpexy combined with blepharoplasty could be considered the better procedure in patients with upper eyelid dermatochalasis in terms of long-lasting stability and lateral brow elevation.

http://ift.tt/2xRe5ZC

What you need to know about airway management

Sponsored by BoundTree and Ambu By Jonathan Lee for EMS1 BrandFocus Airway management in the prehospital environment is messy business. A recent study of prehospital intubation in trauma found that 44.3 percent of the patients had gross contamination of the airway at the time of intubation (most commonly blood, followed by vomit, teeth or brain). While the literature is divided on whether prehospital ...

http://ift.tt/2kl8BRr

Chronic refractory myofascial pain and denervation supersensitivity as global public health disease

J Chu<br />Jan 13, 2016; 2016:bcr2015211816-bcr2015211816<br />case-report

http://ift.tt/2xQvK3C

Alcohol use disorder due to social isolation after a nuclear disaster in Fukushima

Tomohiro Morita<br />Jun 21, 2015; 2015:bcr2015209971-bcr2015209971<br />case-report

http://ift.tt/2xStdUi

Unilateral brain oedema related to focal status epilepticus

Noura Abdulwahid Ali<br />Dec 13, 2013; 2013:bcr2013200864-bcr2013200864<br />case-report

http://ift.tt/2xPb2kG

Imaging in Fahr's disease: how CT and MRI differ?

Arunkumar Govindarajan<br />Nov 27, 2013; 2013:bcr2013201523-bcr2013201523<br />case-report

http://ift.tt/2xSus5W

Polycystic kidney disease and chronic renal failure in tuberous sclerosis

Mona Dhakal<br />Oct 2, 2013; 2013:bcr2013200711-bcr2013200711<br />case-report

http://ift.tt/2xRkt2S

Rarity revisited: cryptococcal peritonitis

Karim El-Kersh<br />Jul 10, 2013; 2013:bcr2013009099-bcr2013009099<br />case-report

http://ift.tt/2xSsxye

Hydroxocobalamin treatment of acute cyanide poisoning from apricot kernels

Davide Cigolini<br />May 25, 2011; 2011:bcr0320113932-bcr0320113932<br />case-report

http://ift.tt/2xPEl6L

The entrapped twin: a case of fetus-in-fetu

Rashide Yaacob<br />Sep 23, 2017; 2017:bcr-2017-220801-bcr-2017-220801<br />Rare disease

http://ift.tt/2xT0VbY

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

Nicholas Denny<br />Sep 21, 2017; 2017:bcr-2017-220514-bcr-2017-220514<br />Unusual presentation of more common disease/injury

http://ift.tt/2xR5O8d

An unusual presentation of chronic cyanide toxicity from self-prescribed apricot kernel extract

Alex Konstantatos<br />Sep 11, 2017; 2017:bcr-2017-220814-bcr-2017-220814<br />Reminder of important clinical lesson

http://ift.tt/2xQJTv6

Long-term Patient and Graft Survival of Kidney Transplant Recipients with Hepatitis C Virus Infection in the United States.

Background: Hepatitis C virus (HCV) infection is common among kidney transplant (KTx) recipients. However, the impact of HCV infection on long-term graft and recipient survival after KTx from the large-scale data remains to be determined. Methods: We used the Organ Procurement and Transplantation Network (OPTN) database to identify all adults undergoing KTx in 2004-2006 in the United States. A propensity score (PS) was created to match each HCV-positive recipient with a HCV-negative control for unbiased comparisons. Survival analysis was conducted to evaluate recipient and death-censored graft survival. Results: Out of 33,357 adult primary KTx recipients, 1470 (4.4%) were HCV-positive. 1,364 HCV-positive and -negative pairs were selected based on PS-matching. Based on the multivariable regression models, HCV is associated with a higher risk of death (hazard ratio [HR]=1.50, 95% confidence interval [95% CI=1.28-1.75) and graft failure (HR=1.26, 95% CI=1.08-1.47). Infection was a more common cause of death in HCV-positive patients than in HCV-negative recipients (HR=1.64, 95% CI=1.12-2.42). The incidence of death due to liver failure was 0.23% per year among HCV-positive recipients, whereas no HCV-negative recipients died from liver failure. Graft failure due to recurrent disease was higher in HCV-positive than in HCV-negative recipients (HR=2.00; 95% CI=1.06-3.78). Conclusion: HCV infection is associated with decreased long-term recipient and graft survival. Future studies are needed to examine whether recently available, safe and effective antiviral therapy improves the long-term clinical outcome in these patients. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2xYILb8

In response to the commentary of Dr. Lou on treatment of laryngopharyngeal reflux using a sleep positioning device: A prospective cohort study

The authors of the paper "Treatment of Laryngopharyngeal Reflux Using a Sleep Positioning Device: A Prospective Cohort Study [1]," would like to begin by thanking Dr. Lou and our scientific community for interest in this work. We further appreciate the commentary of Dr. Lou and the opportunity to further discuss this work in the American Journal of Otolaryngology. The principle critique of this commentary is that our study may overestimate treatment effect due to misdiagnosis or concurrent diagnosis of GERD.

http://ift.tt/2xWWMFJ

American Thyroid Association Set to Launch 87th Annual Meeting

ATA Meets in Victoria, BC

October 3, 2017—The American Thyroid Association (ATA) is set to launch its 87^th Annual Meeting on October 18‒22, 2017, in Victoria, British Columbia. Key opinion leaders, thyroid specialists, clinical and basic researchers, and young trainees will gather for four exciting and information-filled days of symposia, scientific presentations, and discussions on the latest advances in thyroidology and clinical management of thyroid diseases. Nearly 1200 attendees have already registered for this outstanding educational and networking opportunity.  A record-setting 519 regular and late-breaking abstracts have been accepted.

Three leaders in the thyroid field, Carmelo Nucera, MD, PhD (Harvard Univ.), Gregory Brent, MD (UCLA), and Julie Ann Sosa, MD (Duke Univ.), will present the opening session on Wednesday evening, "A Year in Thyroidology," in which they will discuss the top recent papers in basic, clinical, and surgical thyroidology.

Weiping Teng, MD, PhD, of First Affiliated Hospital, China Medical University, Shenyang, will give one of two plenary lectures. His topic, "Effect of Iodine Intake on Thyroid Disorders: Learning from China," describes the results of the Chinese government's initial implementation of universal salt iodization in 1999, intended to reduce the high iodine deficiency disorders prevalent across the country (except in Shanghai), and its subsequent reduction of the concentration of salt iodine when excessive iodine intake became a serious problem in many provinces. Dr. Teng provides comparisons with CDC results from the US and some from WHO for pregnant women.

On day three of the meeting, the plenary lecture, "Understanding How Breaches in Immune Tolerance Lead to Autoimmune Thyroid Disease (AITD)," will be given by John C. Cambier, PhD, of the Department of Immunology and Microbiology, University of Colorado School of Medicine. Dr. Cambier and his research team are studying the thyroid antigen-reactive B cells in the peripheral blood of both recent-onset and long-standing AITD patients.

The ATA will reveal the recipient of the 2017 Van Meter Award the first morning of the meeting, and the winner, recognized for outstanding contributions to research on the thyroid gland or related subjects, will present the Van Meter Award Lecture. The Paul Starr Award lecturer is Quan-Yang Duh, MD, recognized for his outstanding contributions to clinical thyroidology, and Julie Ann Sosa, MD will deliver the 2017 Lewis E. Braverman Lectureship with a talk entitled "Re-Telling the Story About Thyroid Cancer – Rising Incidence, Mortality, and Maybe an Explanation."  Yuri Nikiforov, MD, PhD is this year's Sidney H. Ingbar Awardee speaking on "Genomic Evolution of Thyroid Nodules and Cancer – New Answers to Old Questions." The ATA will also present the John B. Stanbury Thyroid Pathophysiology Medal to James A. Fagin, MD, and the 2017 Distinguished Service Award to Bryan R. Haugen, MD, both of whom are past presidents of the Society.

The program highlights presentations by the seven recent ATA Research Grant recipients. This year's awardees are investigating research topics that include the genetics of advanced thyroid cancer, mouse modeling of medullary thyroid carcinoma, and the role of the renal sodium/iodide symporter in iodide metabolism and thyroid function. See the ATA website for full details www.thyroid.org.  In addition to the plenary and award lectures at the Annual Meeting, many specialized symposia, panel and small workshop educational formats will be offered.

Dr. John Morris, President of the American Thyroid Association, remarks, "ATA meeting attendees will have the opportunity to network with clinicians and investigators, colleagues and newcomers, making scientific and professional connections that will last throughout their careers. Given that we will be located in one of the most beautiful places in the world, it is a meeting not to be missed."

###

 The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 43 countries around the world. Celebrating its 94^th anniversary, the ATA continues to deliver its mission of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health.  These efforts are carried out via several key endeavors:

• The publication of the highly regarded professional journals Thyroid, Clinical Thyroidology, and VideoEndocrinology
• Annual scientific meetings
• Biennial clinical and research symposia
• Research grant programs for young investigators
• Support of online professional, public, and patient educational programs
• Development of guidelines for clinical management of thyroid disease and thyroid cancer

 The ATA promotes thyroid awareness and information online through Clinical Thyroidology for the Public and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet. Every fifth year, the American Thyroid Association joins with the Latin American Thyroid Society, the European Thyroid Association, and the Asia and Oceania Thyroid Association to cosponsor the International Thyroid Congress (ITC).

The post American Thyroid Association Set to Launch 87th Annual Meeting appeared first on American Thyroid Association.

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American Thyroid Association Symposia Highlight Novel Thyroid Research

87^th Annual Meeting of the ATA – Victoria, BC

October 2, 2017—The 87^th Annual Meeting of the American Thyroid Association (ATA), taking place October 18‒22, 2017, in Victoria, British Columbia, will offer informative symposia presented by pioneering investigators and key opinion leaders.

New exciting formats this year include an interactive Grand Rounds symposium, moderated by Mary Samuels, MD, focusing on the diagnosis and management of thyroid dysfunction, plus a session featuring recent publications from VideoEndocrinology, one of the flagship journals of the ATA. Andrew Bauer, MD, will lead a special half-day pediatric endocrinology forum in which several experts will discuss the latest research in pediatric endocrinology and clinical disease management.

Opportunity for lively discussions in clinical symposia will focus on advances in the understanding of thyroid cancer. Bryan Haugen, MD, will chair a session entitled "New Directions in Thyroid Nodules and Thyroid Cancer," featuring discussions on the updated Bethesda classification system for reporting thyroid cytopathology, the 8^th edition of the thyroid cancer staging system written by the American Joint Committee on Cancer (AJCC), and the art of balancing necessary thyroid surgeries while reducing risks in a cost-conscious manner.

John Lazarus, MD, will moderate a symposium covering the engaging topic of thyroid disease and pregnancy. The experts in this session will review the controversies surrounding subclinical hypothyroidism during pregnancy, the potential relationships between pregnancy and thyroid cancer, and the newly published "ATA Guidelines for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum."

Basic research symposia will feature:

• Peter Kopp, MD, moderating a discussion of "Thyroid Hormone Transporters," featuring presentations on the role of thyroid hormone receptors in the brain and novel clinical translational approaches
• Antonio Di Cristofano, PhD, chairing presentations in the session "Modulation of TSH Receptors in Thyroid Disease"
• Electron Kebebew, MD, facilitating the symposium "MicroRNAs in Thyroid Cancer"
• Young Kee Shong, MD, PhD, leading a stimulating session on "Novel Molecular Mechanisms in Thyroid Cancer," with an international presentation team on the topics of nuclear receptor signaling and novel genetic mechanisms in benign and malignant thyroid tumors

The annual meeting will focus on recent advances regarding mechanisms, screening, diagnosis, and management of thyroid disorders with attention to translating the latest research findings and clinical management guidelines into practice to enhance patient care.

###

 The American Thyroid Association (ATA) is the leading worldwide organization dedicated to the advancement, understanding, prevention, diagnosis, and treatment of thyroid disorders and thyroid cancer. ATA is an international membership medical society with over 1,700 members from 43 countries around the world. Celebrating its 94^th anniversary, the ATA continues to deliver its mission of being devoted to thyroid biology and to the prevention and treatment of thyroid disease through excellence in research, clinical care, education, and public health.  These efforts are carried out via several key endeavors:

• The publication of the highly regarded professional journals Thyroid, Clinical Thyroidology, and VideoEndocrinology
• Annual scientific meetings
• Biennial clinical and research symposia
• Research grant programs for young investigators
• Support of online professional, public, and patient educational programs
• Development of guidelines for clinical management of thyroid disease and thyroid cancer

The ATA promotes thyroid awareness and information online through Clinical Thyroidology for the Public and extensive, authoritative explanations of thyroid disease and thyroid cancer in both English and Spanish. The ATA website serves as the clinical resource for patients and the public who look for reliable information on the Internet. Every fifth year, the American Thyroid Association joins with the Latin American Thyroid Society, the European Thyroid Association, and the Asia and Oceania Thyroid Association to cosponsor the International Thyroid Congress (ITC).

The post American Thyroid Association Symposia Highlight Novel Thyroid Research appeared first on American Thyroid Association.

http://ift.tt/2xeG2Gv

Reviewers’ list December 2017

http://ift.tt/2g8XFSs

Preoperative fasting in children

1A012A033J03

http://ift.tt/2yHpLuy

Paediatric airway infections

1C022D013D00

http://ift.tt/2xSgLDG

Error and Root Cause Analysis

1I032A063I00

http://ift.tt/2yGpTup

Burnout and resilience in anaesthesia and intensive care medicine

1H022H013J02

http://ift.tt/2xRkHof

Complex pain in children and young people: part I—assessment

1H022E033J02

http://ift.tt/2xQZWt5

Decision Making and Psychological Outcomes in Low-Risk Papillary Thyroid Cancer

Condition:   Thyroid Cancer
Intervention:   Behavioral: Questionnaires
Sponsor:   Memorial Sloan Kettering Cancer Center
Recruiting

http://ift.tt/2xOIFmz

Trail Evaluating Apatinib With IMRT for Inoperable or Iodine Refractory Thyroid Cancer

Condition:   Thyroid Cancer
Interventions:   Drug: Apatinib;   Radiation: Intensity modulated radiation therapy
Sponsor:   Xiayun He, MD
Recruiting

http://ift.tt/2g9kJjL

FDA OKs Botox for Forehead Lines, Its Third Facial Indication

OnabotulinumtoxinA (Botox Cosmetic, Allergan) is now indicated for the temporary improvement in the appearance of moderate to severe forehead lines associated with frontalis muscle activity in adults.
FDA Approvals

http://ift.tt/2xVVzyo

Technology to Target Skin Cancer Mortality

Apps that evaluate a single mole or lesion won't do the trick because people don't know which lesions to target. A whole-body surveillance approach is needed.
Medscape Dermatology

http://ift.tt/2xeG4hA

Dermatologic Microsutures Using Human Hair

Could human hair serve as suture threads? Find out more about this novel technique for closing facial wounds.
ePlasty, Open Access Journal of Plastic Surgery

http://ift.tt/2hABKXL

Assessment of changes in lactate concentration with intravascular microdialysis during high-risk cardiac surgery using the trend interchangeability method

Abstract

Background

Blood lactate is a strong predictor of mortality, and repeated blood lactate assays are recommended during surgery in high-risk patients. We hypothesized that the use of intravascular microdialysis incorporated in a central venous catheter would be interchangeable with the reference blood gas technique to monitor changes in blood lactate.

Methods

Microdialysis and central venous blood lactate measurements were recorded simultaneously in high-risk cardiac surgical patients. The correlation between absolute values was determined by linear regression, and the Bland–Altman test for repeated measurements was used to compare bias, precision, and limits of agreement. Changes in lactate measurements were evaluated with a four-quadrant plot and trend interchangeability method (TIM).

Results

In the 23 patients analysed, the central venous catheter was used as part of standard care, with no complications. The correlation coefficient for absolute values (n=104) was 0.96 (P<0.0001). The bias, precision, and limits of agreement were −0.19, 0.51, and −1.20 to 0.82 mmol litre⁻¹, respectively. The concordance rate for changes in blood lactate measurements (n=80) was 94% with the four-quadrant plot. In contrast, the TIM showed that 23 (29) changes in lactate measurements were not interpretable, and among the remaining 57 (71) interpretable changes, 18 (32) were interchangeable, 8 (14) were in the grey zone, and 31 (54) were not interchangeable.

Conclusions

Microdialysis with a central venous catheter appears to provide reliable absolute blood lactate values. Although changes in blood lactate measurements showed an excellent concordance rate, changes between the two methods were poorly interchangeable with the TIM.

Clinical trial registration

NCT02296593.

http://ift.tt/2xerW7S

Influence of Bayesian optimization on the performance of propofol target-controlled infusion

Abstract

Background

Target controlled infusion (TCI) systems use population-based pharmacokinetic (PK) models that do not take into account inter-individual residual variation. This study compares the bias and inaccuracy of a population-based vs a personalized TCI propofol titration using Bayesian adaptation. Haemodynamic and hypnotic stability, and the prediction probability of alternative PK models, was studied.

Methods

A double-blinded, prospective randomized controlled trial of 120 subjects undergoing cardiac surgery was conducted. Blood samples were obtained at 10, 35, 50, 65, 75 and 120 min and analysed using a point-of-care propofol blood analyser. Bayesian adaptation of the PK model was applied at 60 min in the intervention group. Median (Absolute) Performance Error (Md(A)PE) was used to evaluate the difference between bias and inaccuracy of the models. Haemodynamic (mean arterial pressure [MAP], heart rate) and hypnotic (bispectral index [BIS]) stability was studied. The predictive performance of four alternative propofol PK models was studied.

Results

MdPE and MdAPE did not differ between groups during the pre-adjustment period (control group: 6.3% and 16%; intervention group: 5.4% and 18%). MdPE differed in the post-adjustment period (12% vs. −0.3%), but MdAPE did not (18% vs. 15%). No difference in heart rate, MAP or BIS was found. Compared with the other models, the Eleveld propofol PK model (patients) showed the best prediction performance.

Conclusions

When an accurate population-based PK model was used for propofol TCI, Bayesian adaption of the model improved bias but not precision.

Clinical trial registration

Dutch Trial Registry NTR4518.

http://ift.tt/2yFRxbb

Comparative usability of modern anaesthesia ventilators: a human factors study

Abstract

Background

The anaesthesia ventilator represents the key equipment for intraoperative respiratory care. Improper operation of this device may threaten a patient's health. A self-explanatory interface facilitates handling and decreases the risk of operating errors. This study systematically evaluates the usability of user interfaces in four modern anaesthesia ventilators.

Methods

Twenty naïve operators were asked to execute 20 tasks on each of four different anaesthesia ventilators (Avance CS²™, GE Healthcare; Flow-i™, Maquet; and Perseus™ and Primus™, Dräger) in a randomized order. The success of task execution, frequency of requests for assistance, and processing times were recorded. During the tasks, the operators' visual focus was measured via eye-tracking. Additionally, subjective assessments of usability were evaluated by a standardized questionnaire. For comparison, six experienced operators undertook the same protocol.

Results

The overall rate of falsely executed tasks was low. Naïve operators requested assistance least when using the Perseus (26). Pooled processing times were shortest for the Perseus (222 s), followed by the Primus (223 s), the Avance (238 s), and the Flow-i (353 s). Task-specific processing times differed considerably between the devices. Eye-tracking analyses revealed associated interface issues that impeded the operators' performance. Operators rated usability best for the Perseus [mean (sd): 67 (17) arbitrary units] and worst for the Flow-i [50 (16) arbitrary units]. Results from experienced operators support these findings by trend.

Conclusions

The usability of modern anaesthesia ventilators differs considerably. Interface issues of specific tasks impair the operator's efficiency. Eliminating the specific usability issues might improve the operator's performance and, as a consequence, the patient's safety.

http://ift.tt/2xe6wrG

The efficacy of GlideScope ® videolaryngoscopy compared with direct laryngoscopy in children who are difficult to intubate: an analysis from the paediatric difficult intubation registry

Abstract

Background

We analysed data from the Paediatric Difficult Intubation Registry examining the use of direct laryngoscopy and GlideScope^® videolaryngoscopy.

Methods

Data collected by a multicentre, paediatric difficult intubation registry from 1295 patients were analysed. Rates of success and complications between direct laryngoscopy and GlideScope videolaryngoscopy were analysed.

Results

Initial (464/877 = 53% vs 33/828 = 4%, Z-test = 22.2, P < 0.001) and eventual (720/877 = 82% vs. 174/828 = 21%, Z-test = 25.2, P < 0.001) success rates for GlideScope were significantly higher than direct laryngoscopy. Children weighing <10 kg had lower success rates with the GlideScope than the group as a whole. There were no differences in complication rates per attempt between direct laryngoscopy and GlideScope. The direct laryngoscopy group had more complications associated with the greater number of attempts needed to intubate. There were no increased risks of hypoxia or trauma with GlideScope use. Each additional attempt at intubation with either device resulted in a two-fold increase in complications (odds ratio: 2.0, 95% confidence interval: 1.5–2.5, P < 0.001).

Conclusions

During difficult tracheal intubation in children, direct laryngoscopy is an overly used technique with a low chance of success. GlideScope use was associated with a higher chance of success with no increased risk of complications. GlideScope use in children with difficult tracheal intubation has a lower success rate than in adults with difficult tracheal intubation. Children weighing less than 10 kilograms had lower success rates with either device. Attempts should be minimized with either device to decrease complications.

http://ift.tt/2yFQ70e

Atopy in people aged 40 and over: relation to airflow limitation

Abstract

Background

Previous studies have reached conflicting conclusions about the role of atopy as a risk factor for COPD. In part, this is attributable to variation in the definitions of airflow limitation and the treatment of people with asthma.

Objective

To establish whether there is any independent association between atopy and post-bronchodilator airflow limitation in the general population aged 40 years and over.

Methods

A cross-sectional survey was conducted in a general population sample of 2415 people aged 40 years and over in Australia. A history of ever being diagnosed with asthma was elicited by questionnaire. Atopy was defined as any skin prick test wheal to common aero-allergens ≥4mm. Airflow limitation was defined as post-bronchodilator spirometric (FEV₁/FVC) ratio < lower limit of normal. Analyses were adjusted for potential confounding due to age, sex, smoking, race and socio-economic status.

Results

The prevalences of atopy, ever diagnosed asthma and post-bronchodilator airflow obstruction were 44.8%, 19.3% and 7.5%, respectively. In the population as a whole, atopy was associated with lower FEV₁ (adjusted difference -0.068L, 95% confidence interval(CI) -0.104 to -0.032), FVC (adj. difference -0.043L, 95%CI -0.086 to -0.0009) and post-bronchodilator FEV₁/FVC ratio (adj. difference -0.011, 95%CI -0.017 to -0.0055). The effect of atopy on lung function was no longer apparent when participants who reported ever diagnosed asthma were excluded (FEV₁ -0.011L, [95% CI -0.05 to 0.028L], FVC -0.012L [95% CI -0.060 to 0.036] and FEV₁/FVC ratio -0.0012 [95% CI -0.0072 to 0.0047L]).

Conclusion and Clinical Relevance

The apparent association between atopy and post-bronchodilator airflow limitation in the general population appears to be explained by the association between atopy and having ever diagnosed asthma and the effect of asthma on lung function.

This article is protected by copyright. All rights reserved.

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Target-Specific Delivery of an Antibody That Blocks the Formation of Collagen Deposits in Skin and Lung

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.


http://ift.tt/2xVw5kM

Conventional vs. Daylight Photodynamic Therapy for patients with actinic keratosis on face and scalp: 12-month follow-up results of a randomized, intraindividual comparative analysis

Abstract

Introduction

Daylight PDT (DLPDT) is a new PDT procedure. Several trials demonstrate that DLPDT achieves similar response rates with conventional PDT (CPDT) in the treatment of nonhyperkeratotic actinic keratoses (AKs) in a nearly painless way. It seems that DLPDT represents a more convenient and equally effective treatment modality. Data on long-term efficacy of DLPDT are limited.

Objective

To compare short- and long-term efficacy, safety and tolerability of DLPDT with that of CPDT in face and scalp AKs.

Methods

The study, an intraindividual right-left comparison study, was conducted in 3 centers in North, Center and South Greece. Eligible patients received either DLPDT or CPDT randomly allocated to alternate sides of face or scalp. Patients were evaluated at baseline, 3 and 12 months after treatment. Assessments included lesion response at 3 and 12 months, PDT associated pain during PDT session, local skin reactions 3 days after treatment as well as patients' preference 3 months after treatment.

Results

A total of 46 patients completed the study. Three months after treatment the overall lesion complete response rate was 78% for DLPDT and 80.6% for CPDT. At the 12-months follow-up response rate decreased to 71.8% and 73.7% for DLPDT and CPDT accordingly. Regarding response based on lesion grade, response rates obtained in grade I lesions were higher with DLPDT, while treatment with CPDT resulted to higher rates of cured grade II lesions at both follow-up visits. Results were not supported by statistical significance. DLPDT was associated with significantly lower pain and reduced severity of local skin reactions. Patients' preference favored DLPDT.

Conclusions

Our study demonstrated that DLPDT is similar to CPDT in terms of long-term efficacy and recurrence rates in the treatment of face and scalp AKs. DLPDT demonstrated a better tolerability profile as it was associated with lower pain and less severe adverse events.

This article is protected by copyright. All rights reserved.

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Anti-inflammatory effect of an adhesive resin containing indomethacin-loaded nanocapsules

Publication date: December 2017
Source:Archives of Oral Biology, Volume 84
Author(s): Bruna Genari, Maria Beatriz Cardoso Ferreira, Liciane Fernandes Medeiros, Joice Soares de Freitas, Stefania Giotti Cioato, Iraci Lucena da Silva Torres, Adriana Raffin Pohlmann, Silvia Stanisçuaski Guterres, Vicente Castelo Branco Leitune, Fabrício Mezzomo Collares, Susana Maria Werner Samuel
ObjectiveTo analyze the anti-inflammatory and analgesic effects of an adhesive resin containing indomethacin-loaded nanocapsules in rat model.DesignAdhesive resin disks with or without indomethacin-loaded nanocapsules were subcutaneously implanted into right hind paw of rats. A week after surgical procedure, 2% formalin solution was intradermally injected into plantar surface of paw. Nociceptive and inflammatory responses were evaluated by formalin test. Paw edema by pletismometer and mechanical hyperalgesia by von Frey test were performed on day 2, day 4, day 6, day 8, day 10 and day 12 after surgery. IL-6, IL-10, and lactate dehydrogenase (LDH) serum levels were determined by ELISA-sandwich test.ResultsGroup containing indomethacin-loaded nanocapsules (NC) presented lower edema in the right hind paw at 24h after formalin injection than those of the control group (CT) (P<0.01). NC group showed decrease in the nociceptive response in phase I (neurogenic pain) compared to CT group (NC − 66.86±22.83s X CT − 130.17±35.83s, P<0.001). NC group presented supporting higher intensity of stimulus on days 8 and 12 (24h and 72h after formalin injection) (P<0.01 and P<0.02 respectively). The IL-6 serum level was also significantly higher in the NC group than CT group (p<0.001).ConclusionsThese results indicate that an adhesive resin containing indomethacin-loaded nanocapsules has anti-inflammatory and nociceptive activities in a chemical model of acute inflammation. The present investigation confirms an adhesive resin with drug-loaded nanocapsules may be useful for improving therapeutic effect for adhesives to be used in deep cavities.



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The incidence and management of non-head and neck incidentalomas for the head and neck surgeon

Publication date: November 2017
Source:Oral Oncology, Volume 74
Author(s): Axel Sahovaler, David H. Yeh, Deric Morrison, Sandrine de Ribaupierre, Jonatan Izawa, Adam Power, Richard Inculet, Neil Parry, David A. Palma, Mark Landis, Andrew Leung, Kevin Fung, S. Danielle MacNeil, John Yoo, Anthony C. Nichols




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Synchronous, bilateral tonsillar carcinomas: Patient characteristics and human papillomavirus genotypes

Publication date: November 2017
Source:Oral Oncology, Volume 74
Author(s): Camelia Nami Saber, Christian Grønhøj, David Hebbelstrup Jensen, Cecilie Nørregaard, Amanda Carlander, Emilie Garnæs, Katalin Kiss, Lena Specht, Christian von Buchwald
IntroductionThe incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing, but data on the incidence of synchronous, bilateral tonsillar squamous cell carcinomas (BiTSCCs) is sparse. In this study, we report the incidence and tumour characteristics of BiTSCCs in a population-based, consecutive cohort of OPSCCs.MethodsWe identified all patients diagnosed with tonsillar squamous cell carcinoma (TSCC) in eastern Denmark during a 15-year period to detect the incidence of synchronous BiTSCCs. The tumours were assessed for p16^Ink4a expression, the presence of HPV DNA and HPV genotypes. Furthermore, we systematically reviewed the literature examining BiTSCCs.ResultsOf the total of 1119 TSCCs diagnosed in eastern Denmark from 2000 to 2014, we identified 12 BiTSCCs, nine of which initially presented as a cancer of unknown primary (CUP) in the neck. Nine cases were bilaterally HPV16 positive (HPV16+), while two cases were HPV16+ in one tonsil and respectively, HPV33 and HPV35 positive in the contralateral tonsil. One case was bilaterally HPV-negative. We also identified an increase in the incidence of BiTSCCs after 2012 when histological examination of the entire tonsil tissue became routine, suggesting that BiTSCCs might be underdiagnosed. In the literature, we identified 15 studies from six countries, encompassing 25 cases in total.ConclusionsBiTSCCs were primarily HPV16+ and were most often diagnosed as part of the diagnostic work-up for CUP. We found an incidence of 9% BiTSCCs in patients with TSCC after 2012 and we therefore recommend focusing on putative BiTSCC with total embedding and histological examination of tonsils harvested by bilateral tonsillectomies.



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Delayed Presentation of Posttraumatic Diaphragmatic Hernia Masquerading as Recurrent Acute Asthmatic Attack

Diaphragmatic hernia following blunt abdominal injury is extremely rare and often diagnosed late. Missed diagnosis is also common with this condition. We herein present a delayed presentation of diaphragmatic hernia following blunt abdominal injury that was initially misdiagnosed as recurrent acute asthmatic attack due to repeated presentation with episodic difficulty in breathing.

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Bullous Exudative Retinal Detachment after Retinal Pattern Scan Laser Photocoagulation in Diabetic Retinopathy

Laser retinal photocoagulation is the gold standard treatment for diabetic retinopathy. We describe 3 cases in which bullous exudative retinal detachment (ERD) developed after pattern scan laser photocoagulation (PASCAL) in diabetic retinopathy. ERD spontaneously resolved in all 3 cases with various visual courses. This case series highlights 2 key points: first, ERD can occur regardless of gender, age, glycemic control, or vitreous status and despite a moderate number of laser shots, even with PASCAL; second, ERD in nonvitrectomized eyes may cause irreversible visual loss, even if the ERD resolves within 1 month.
Case Rep Ophthalmol 2017;8:475–481

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Recurrent Diabetic Macular Edema: What to Do

Diabetic macular edema (DME) is a leading cause of blindness in the working population. Herein, we report the case of a patient with recurrent DME for about 6 years, uncontrolled by several medical and surgical treatments, that was successfully treated with a single sustained-release fluocinolone acetonide intravitreal implant in her right eye. The affected eye had presented a visual acuity of 2/10 and a central macular thickness of 488 µm prior to the injection. After treatment with the fluocinolone acetonide intravitreal implant, the patient's right eye presented an improvement in best corrected visual acuity to 6/10 and a reduction of central macular thickness to 198 µm. These functional and anatomical results were continuous and sustained during a follow-up period of more than 12 months, and with an acceptable and manageable safety profile. These results show that fluocinolone acetonide intravitreal implantation is an effective treatment option in DME and should be considered in the DME treatment pathway.
Case Rep Ophthalmol 2017;8:465–474

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Primary Renal Lymphoma Presenting as End-Stage Renal Disease

Primary renal lymphoma is a rare entity, even more so in children. Children with primary renal lymphoma present with variable clinical features such as constitutional signs and symptoms, acute kidney injury, palpable abdominal masses, and gross hematuria. Herein we report a child who presented with seemingly advanced chronic kidney disease and was eventually diagnosed with primary lymphoma. He responded well to intensive chemotherapy and recovered renal function, although he was left with some functional limitations as a consequence of his treatment regimen. Our report highlights the importance of keeping neoplastic conditions under consideration when taking care of children with severe kidney disease of unclear etiology.

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Formation of Condyle-Like Structure after Treatment of Temporomandibular Joint Ankylosis: Literature Review and Long-Term Follow-Up of Two Patients

Treatment of ankylosis is one of the greatest challenges in temporomandibular joint (TMJ) surgery. To provide a satisfactory mouth opening, as well as normal jaw function, and to prevent reankylosis in the long term are the most important principles in the treatment of TMJ ankylosis. These functions have been attained in both of the presented patients in the long term. It is known that heterotopic bone formation is rare in the maxillofacial area, but rapid bone regeneration which reconstitutes a new condyle is rarer. The purpose of the presented paper is to reveal the existence of an inherent capability of the mandible, rapid bone growth of the ramus mandible, and reformation of a previously nonexisting condyle after resection of the ramus in patients with TMJ ankylosis. In this paper, two unusual cases of unexpected condyle-like structure formation after treatment of ankylosis were presented.

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Aggressive Adenoid Cystic Carcinoma of Maxillary Sinus in a 43-Year-Old Male: Rare Case Report and Review of Literature

Adenoid cystic carcinoma (ACC) is a rare malignant tumor, mostly involving the minor salivary glands. Herein, we present a case of ACC in a 43-year-old man with symptoms of dental abscess as the initial presentation of the tumor. In spiral computed tomography (CT) scan, soft tissue mass with the erosion of maxillary sinus wall on the right side of the alveolar ridge was evident. Histopathological examination of the excised tumor with immunohistochemical studies (C-kit, Vimentin, pan-cytokeratin, p53, p63, and ki67 positive reaction) confirmed grade 2 ACC in the maxillary sinus. The patient underwent hemimaxillectomy and right-neck dissection. Due to the extension of tumor cells excessively into the surrounding tissues and involvement of orbital bone, complete and total resection of the tumor with safe margins could not be done. After surgery, adjuvant radiotherapy was considered for the patient. At the end of treatment, the patient lost his eye vision. Seventeen months from initial diagnosis, he was still alive without lung or distant metastasis.

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A Case of Chronic Cough and Pneumonia Secondary to a Foreign Body

Foreign body aspiration occurs when a solid or semisolid object becomes lodged in the larynx or trachea. It can be a life-threatening emergency, especially if it is large enough to occlude the airway. However, small aspirated objects may go unnoticed until symptoms occur. Therefore, it is frequently misdiagnosed. A high level of clinical suspicion, patient's risk factors, and thorough history and physical examination are essential in making the diagnosis. It should be considered in cases where there is unresolved chronic cough with or without associated recurrent pneumonia especially in patients with risks for aspiration.

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Xanthogranulomatous Pyelonephritis with Incomplete Double Ureter

Introduction. Xanthogranulomatous pyelonephritis (XGP) is a type of chronic renal inflammation that usually occurs in immunocompromised middle-aged women with chronic urinary tract infection or ureteral obstruction induced by the formation of ureteral stones. XGP with an incomplete double ureter is extremely rare. Case Presentation. A 76-year-old woman was referred to our department to undergo further examination for a left renal tumor that was detected by ultrasonography. Dynamic contrast computed tomography (CT) revealed an enhanced tumor in the upper renal parenchyma. Laparoscopic radical nephrectomy was performed based on a preoperative diagnosis of renal cell carcinoma. Histological sections showed the aggregation of foam cells; thus, XGP was diagnosed. Conclusion. We herein report a rare case of XGP in the upper pole of the kidney, which might have been associated with an incomplete double ureter.

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Middle aortic syndrome with renal artery stenosis

Abstract

A 39-year lady referred to Vascular Surgery OPD from Cardiology with uncontrolled hypertension, non- functional left kidney and absent bilateral femoral pulses. Investigations revealed middle aortic syndrome with non-functional left kidney with bilateral renal artery stenosis. She successfully underwent bypass of stenotic segment with polyester graft from descending thoracic aorta to left common iliac artery with reverse saphenous vein graft interposed between polyester and right renal artery.

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The early laparoscopic repair of a traumatic lumbar hernia: safe and successful

Abstract

Abdominal wall hernias are a rare but important consequence of blunt trauma. The optimal timing and the method of repair are not well described in the current surgical literature. Advances in laparoscopic techniques have offered new options for treatment of this problem. We describe the case of a 43-year-old man who suffered a blunt traumatic lumbar hernia. He was taken to the operating room during his initial hospitalization where a laparoscopic repair was performed with the additional implantation of prosthetic mesh. His post-operative course was uneventful. In selected cases, early operative repair may be appropriate and result in improved outcomes.

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A rare case of benign metastasizing leiomyoma †

Abstract

Benign metastasizing leiomyoma is a rare disorder involving distant metastases secondary to a smooth muscle tumour of the myometrium. This case report describes a 48-year-old woman with multiple pulmonary nodules noted on post-operative chest x-ray. Further investigation revealed a history of total abdominal hysterectomy for benign fibroids of the uterus, 6 years prior to the scan. CT-guided fine needle aspirate of the pulmonary nodules showed smooth muscle proliferation within lung parenchyma, suggesting smooth muscle tumour confirmed with immunohistochemistry. Management is still controversial in view of low case numbers; however, treatment with hormone therapy and castration has been attempted.

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Elective laparoscopic repair after reduction might be useful strategy for incarcerated obturator hernia: a case report

Abstract

Obturator hernia is a rare clinical condition that causes intestinal obstruction. Recent reports have suggested that laparoscopic repair may be useful for incarcerated obturator hernia in select patients. The patient was a 64-year-old female who presented to our emergency department with a chief complaint of abdominal pain. Computed tomography (CT) imaging revealed an incarcerated obturator hernia on her right side, without apparent findings of irreversible ischaemic change or perforation. She had a previous history of cardiovascular surgery and was taking an anticoagulant medication. We performed a reduction of the incarcerated intestine. After heparin displacement, laparoscopic repair was electively performed. During laparoscopy, an occult obturator hernia was found on the left side. We repaired the bilateral obturator hernia using a mesh prosthesis. Elective laparoscopic repair after reduction might be a useful procedure for incarcerated obturator hernias in those patients without findings of irreversible ischaemic change or perforation.

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Coincidence or not? A rare case of rectal leiomyosarcoma amidst incidental findings of anal squamous cell carcinoma: case presentation and literature review

Abstract

Leiomyosarcoma accounts for only a small percentage of colorectal malignancies and remains a difficult disease to diagnose and treat. Here, we describe a case of leiomyosarcoma in a middle-age female first identified on colonoscopy. The cancer had invaded the posterior vaginal wall necessitating an abdominoperineal resection with partial vaginectomy and pelvic floor reconstruction with neovagina creation. Final pathologic analysis revealed invasion into the posterior vaginal wall without direct involvement of the vaginal squamous mucosa. Interestingly, a second carcinoma was found in the anal epithelium. Histology demonstrated this to be an anal squamous cell carcinoma positive for P16 immunohistochemistry, indicating HPV infection. Little is known as to whether leiomyosarcoma is also related to other carcinomas of the GI tract. This case of rectal leiomyosarcoma with temporal and spatial relationship to anal canal squamous cell carcinoma begs the question if HPV can trigger other neoplasms.

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Raised serum lactate in a cirrhotic patient presenting after a trivial fall

Abstract

We present the case of a pelvic fracture in a 69-year-old man with Child–Pugh class C cirrhosis who presented to the Accident and Emergency department after a slip on wet grass. After initially being systemically well, he became haemodynamically unstable in the Emergency department requiring resuscitation via the massive transfusion pathway. He was admitted to intensive care unit for resuscitation following a CT angiogram which showed no arterial bleed, but significant retroperitoneal haematoma. He received a prophylactic embolization of the internal iliac artery 2 days later and his acetabular fracture was managed with skeletal traction. He died 7 weeks later as a result of his liver failure. We propose that a high index of suspicion would have led to an earlier diagnosis of his venous bleed and earlier transfusion.

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Operable synchronous ampullary carcinoma and hepatocellular carcinoma: a case report and review of the literature

Abstract

We report a rare case of synchronous double primary malignancies of the liver and ampulla. A 70-year-old white female was diagnosed with ampullary and hepatocellular carcinoma. The management and outcome of this rare case of synchronous double primary hepatic and periampullary malignancies, amenable to surgical resection is discussed.

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Endoscopic use of EpiFix—dehydrated Human Amnion/Chorion Membrane (dHACM) allograft in patients with Gastric Leak following Sleeve Gastrectomy

Abstract

Leak following laparoscopic sleeve gastrectomy is one of the most feared complications and its management can be difficult and frustrating for patients and physicians involved. Using multimodality approach and having variable options to plan management for patients presenting with leak following bariatric surgery can be advantageous for physicians. The use of endoscopic injection of EpiFix—dehydrated Human Amnion/Chorion Membrane (dHACM) allograft can be a novel adjunct in facilitating healing of the leak site by iatrogenic introduction of tissue growth factors, cytokines and building connective tissue matrix.

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Infective endocarditis, embolic stroke and splenic abscess: a case report

Abstract

We present the case of a patient presenting with embolic stroke secondary to aortic valve endocarditis, additionally complicated by splenic abscess, successfully treated by emergent valve replacement followed by delayed, robotic splenectomy.

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Surgical management of digital ischemia caused by constriction band formation in a patient with ichthyosis vulgaris

Abstract

Ichthyosis is a broad and loosely defined group of hereditary and acquired disorders characterized by filaggrin dysfunction and impaired epidermal homeostasis that results in dry, scaly and thickened skin. Individuals with truncation mutations in the profilaggrin gene coding for filaggrin are strongly predisposed to severe forms of ichthyosis. The phenotypical expression of ichthyosis caused by the same genotypical mutation can vary considerably in severity and in regards to how much constricting scar tissue develops. Here, we report a case of digital ichthyosis threatening the neurovascular integrity to the small finger to discuss the importance of early diagnosis and role of Z-plasty flaps in the surgical treatment of constriction band formation.

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Giant mediastinal mass: one-port video-assisted thoracoscopic surgery

Abstract

A 45-year old man with intermittent dyspnea was found to have a large mediastinal mass on chest radiograph. Computerized tomography scan revealed a 14.7 cm anterior mediastinal mass with cystic and solid components. The patient underwent a thoracoscopic resection of the mass without complication. Techniques utilized during this surgery may be helpful in avoiding pitfalls for other surgeons.

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Metastatic Epicardial Leiomyoma with uncertain malignant potential

Abstract

A 49-year-old female with history of uterine leiomyoma and intermittent shortness of breath presented to the emergency department with new onset of tachycardia and chest pain. Subsequent cardiac work up revealed hypoechoic mass compressing the right ventricle. Computer tomography guided biopsy for tissue characterization revealed a benign spindle cell tumor. Surgical resection of a large epicardial tumor was undertaken. The histologic examination of the tumor was consistent with Estrogen and Progesterone positive leiomyoma of uncertain malignant potential. To the authors' knowledge, this is the first case report of a metastasizing epicardial leiomyoma that exhibits an unknown malignant potential. This case brings together common gynecologic disorder with complex thoracic surgery diagnosis and management. Differential diagnosis of cardiac tumors in patients with history of uterine leiomyoma should include metastasizing leiomyoma. The mainstay of therapy is surgical resection with immediate symptom relieve.

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Table of Contents

Publication date: October 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 4





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Instructions for Authors

Publication date: October 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 4





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Allergic sensitization in American children of Middle Eastern ethnicity at age 2

Publication date: Available online 20 September 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Suzanne Havstad, Alexandra R. Sitarik, Christine Cole Johnson, Edward M. Zoratti, Dennis R. Ownby, Albert M. Levin, Ganesa Wegienka




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Editorial Board

Publication date: October 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 4





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Practical aspects of immunoglobulin replacement

Publication date: October 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 4
Author(s): Mark Ballow




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Information for Readers

Publication date: October 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 4





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Expression of immunoglobulin D is increased in chronic rhinosinusitis

Publication date: October 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 4
Author(s): Mofiyinfolu Sokoya, Vijay R. Ramakrishnan, Daniel N. Frank, Jeremy Rahkola, Anne Getz, Todd T. Kingdom, Jennifer M. Kofonow, Quyen Nguyen, Edward N. Janoff
BackgroundImmunoglobulin (Ig) D is largely localized to the upper airway and reacts with colonizing respiratory pathogens.ObjectiveTo determine whether chronic rhinosinusitis (CRS) is associated with increased IgD expression.MethodsWe performed immunofluorescent staining for cytoplasmic IgD, IgA, IgM, and surface plasma cell marker CD138 (syndecan-1) in sinus tissue of patients with CRS with and without nasal polyps (CRSwNP and CRSsNP, respectively) and control subjects without CRS (n = 6 each). Sinonasal mucus antibody levels of patients with CRSwNP or CRSsNP and control subjects were measured by enzyme-linked immunosorbent assay (n = 13, 11, and 9 subjects, respectively). Cells per square millimeter and antibody levels were compared by analysis of variance. Histopathology was performed with sinus tissue from subjects in the 3 groups (n = 6, 8, and 13 subjects respectively).ResultsCells expressing cytoplasmic IgD exceeded those with cytoplasmic IgA and IgM and represented most CD138⁺ plasma cells in the lamina propria. The frequencies of IgD⁺ plasma cells were significantly higher in patients with CRSsNP and CRSwNP compared with control subjects (P < .01). Only patients with CRSwNP showed increased frequencies of IgM and IgA plasma cells (P < .01). In contrast to high plasma cell frequencies in tissues, the levels of secreted IgD were lower than those of IgA, IgM, and IgG but were highest in the CRSwNP group compared with the other groups (P < .05).ConclusionIgD plasma cells are prominent in sinus tissues and are increased in CRS. That IgD protein also shows the lowest concentration of antibodies in secretions suggests that its activity might be targeted to the tissue rather than secretions.



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Contemporary issues in anaphylaxis and the evolution of epinephrine autoinjectors

Publication date: October 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 4
Author(s): Paul A. Greenberger, Dana V. Wallace, Phillip L. Lieberman, Sean M. Gregory
BackgroundFood allergy and anaphylaxis appear to be increasing in the United States, especially in young children, and preparedness is paramount to successful emergency management in the community. Although the treatment of choice for anaphylaxis is epinephrine delivered by autoinjection, some devices are challenged by less user-friendly designs or pose the risk of injury, especially in young patients. Human factors engineering has played a larger role in the development of more recent epinephrine autoinjector technologies and will continue to play a role in the evolution and future design of epinephrine autoinjectors.ObjectiveTo discuss contemporary issues related to the identification and management of anaphylaxis, current and future epinephrine autoinjector design, and unmet needs for the treatment of special populations, namely, young children weighing less than 15 kg.MethodsThe literature was reviewed and select articles retrieved to support expert clinical opinions on the need for improved recognition of anaphylaxis, epinephrine autoinjector design, and unmet needs in special populations.ResultsAnaphylaxis may be underrecognized and poorly defined in infant- and toddler-aged children, current devices may not be adequate to safely treat these patients (ie, inappropriate needle length), and health care professionals may not be aware of these issues.ConclusionAs epinephrine autoinjector technology continues to evolve, device characteristics that promote safe, user-friendly experiences and give clinicians and their patients confidence to successfully treat anaphylaxis during an emergency, without injury, will be favored.



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Risk factors for severe anaphylaxis in the United States

Publication date: October 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 4
Author(s): Megan S. Motosue, M. Fernanda Bellolio, Holly K. Van Houten, Nilay D. Shah, Ronna L. Campbell
BackgroundAnaphylaxis is an acute systemic allergic reaction and may be life-threatening.ObjectiveTo assess risk factors associated with severe and near-fatal anaphylaxis in a large observational cohort study.MethodsWe analyzed administrative claims data from Medicare Advantage and privately insured enrollees in the United States from 2005 to 2014. Severe anaphylaxis was defined as anaphylaxis resulting in hospital or intensive care unit (ICU) admission, requiring endotracheal intubation, or meeting criteria for near-fatal anaphylaxis.ResultsOf 38,695 patients seen in the emergency department for anaphylaxis during the study period, 4,431 (11.5%) required hospitalization, 2,057 (5.3%) were admitted to the ICU, 567 (1.5%) required endotracheal intubation, and 174 (0.45%) were classified as having a near-fatal episode. Multivariable analysis revealed that medication-related anaphylaxis (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.38–1.63; P < .001), age of 65 years or older (OR, 3.15; 95% CI, 2.88–3.44; P < .001), and the presence of cardiac disease (OR, 1.56; 95% CI, 1.50–1.63; P < .001) or lung disease (OR, 1.23; 95% CI, 1.16–1.30; P < .001) were associated with increased odds of severe anaphylaxis requiring any hospital admission, ICU admission, or intubation or being a near-fatal reaction.ConclusionIn this large contemporary cohort study, 11.6% of patients had severe anaphylaxis. Age of 65 years or older, medication as a trigger, and presence of comorbid conditions (specifically cardiac and lung disease) were associated with significantly higher odds of severe anaphylaxis. Additional studies examining risk factors for severe anaphylaxis are needed to define risk assessment strategies and establish a framework for management.



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

Publication date: Available online 21 September 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Yuzo Suzuki, Yoshiyuki Oyama, Hironao Hozumi, Shiro Imokawa, Mikio Toyoshima, Koshi Yokomura, Hidenori Nakamura, Shigeki Kuroishi, Masato Karayama, Kazuki Furuhashi, Noriyuki Enomoto, Tomoyuki Fujisawa, Yutaro Nakamura, Naoki Inui, Naoki Koshimizu, Takashi Yamada, Kazutaka Mori, Masafumi Masuda, Toshihiro Shirai, Hiroshi Hayakawa, Mitsuhiro Sumikawa, Takeshi Johkoh, Takafumi Suda
BackgroundChronic 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.ObjectiveTo investigate the occurrence of persistent impairment of pulmonary function in CEP and determine its predictive factors.MethodsThis observational study consisted of 133 consecutive patients with CEP who were followed for longer than 1 year. Spirometry was performed at the time of diagnosis and at follow-up.ResultsDuring the observational period (6.1 ± 4.1 years), relapse occurred in 75 patients (56.4%). Remarkably, 42 patients (31.6%) had a persistent pulmonary function defect (27 obstructive, 10 restrictive, and 4 obstructive and restrictive cases) at the last evaluation. Logistic analyses showed that the relapse was associated with neither persistent obstructive nor restrictive defects. Persistent obstructive defect was significantly associated with the comorbidity of asthma and obstructive defect at the initial CEP diagnosis, whereas persistent restrictive defect was significantly related to reticulation at high-resolution computer tomography and restrictive defect at diagnosis.ConclusionPersistent impairment of pulmonary function is common in CEP. Concurrent asthma and obstructive defects at diagnosis were predictors for persistent obstructive impairments, whereas reticulation at high-resolution computer tomography and restrictive defect at diagnosis predicted persistent restrictive impairment. Attention should be paid to these persistent impairments in the management of CEP.



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Serum periostin during omalizumab therapy in asthma: a tool for patient selection and treatment evaluation

Publication date: Available online 20 September 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Marco Caminati, Davide Gatti, Annarita Dama, Leonardo Lorenzetti, Gianenrico Senna




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Idiopathic CD4 lymphocytopenia

Publication date: October 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 4
Author(s): Hale Yarmohammadi, Charlotte Cunningham-Rundles
BackgroundIdiopathic CD4 lymphocytopenia (ICL) is a rare condition characterized by an unexplained deficit of circulating CD4 T cells leading to increased risk of serious opportunistic infections. The pathogenesis, etiology, clinical presentation, and best treatment options remain unclear.ObjectiveTo describe the clinical presentation, treatment strategies, and outcome of patients with ICL seen in a single referral center.MethodsIn a retrospective study, from January 1993 to January 2014, the demographic characteristics, clinical presentation, and treatments of patients diagnosed with ICL were reviewed.ResultsTwenty-four patients (14 female [58%] and 10 male [42%]) were evaluated. The mean age was 45 ± 17.6 years (range 7–76 years). Mean CD4 and CD8 T-cell counts at the time of diagnosis were 119 ± 84/mm³ (range 4–294/mm³) and 219 ± 258/mm³ (range 7–630/mm³), respectively. Seventeen patients (71%) had opportunistic infections, 4 (17%) had malignancies, and 3 (13%) had unexplained demyelinating disease and neurologic problems. Most patients had normal levels of immunoglobulins. Thirteen patients had abnormally low to absent response to phytohemagglutinin, concanavalin A, and antigens (candida and tetanus). Three patients had resolution of warts and 1 had mycobacterial lung infection on interleukin-2 with increases in CD4 count. The 11 patients on trimethoprim and sulfamethoxazole had no further hospital admissions for infections.ConclusionThe pathogenesis of ICL remains unclear. Although only some patients are healthy, most patients present with opportunistic infections. There is no known standard treatment aside from prophylactic antibiotics.



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Comparison of fractional exhaled nitric oxide levels measured using the NIOX VERO and NOA 280i

Publication date: October 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 4
Author(s): Yoshinari Endo, Toshihiro Shirai, Taisuke Akamatsu, Kazuhiro Asada




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An analysis of insurance and other factors associated with asthma-related emergency department visits, 2009–2014

Publication date: October 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 4
Author(s): Brenda Zagar, Michael R. Jiroutek, Ted Hancock, Kim Kelly




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Influence of rhinitis control and inspiratory loop flattening on perceived asthma control

Publication date: October 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 4
Author(s): Rachel Wilson, Matthew Greenhawt




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Disseminated Mycobacterium avium intracellulare leading to protein-losing enteropathy in an elderly man with idiopathic CD4 lymphocytopenia

Publication date: October 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 4
Author(s): Carlos J. Perez-Lopez, Erving Arroyo, Maristely Rodriguez, Damarys Ortiz, Sylvette Nazario




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Kounis syndrome should be excluded when physicians treat patients with anaphylaxis

Publication date: October 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 4
Author(s): Youichi Yanagawa, Akihiko Kondo, Kouhei Ishikawa, Hiroki Nagasawa, Ikuto Takeuchi, Kei Jitsuiki, Hiromichi Ohsaka, Kazuhio Omori




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Basic Science Methods for Clinical Researchers, First edition, Morteza Jalali, Francesca Saldanha, Mehdi Jalali (Eds.). Academic Press, Cambridge, Massachusetts (2017)

Publication date: October 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 4
Author(s): Kasey R. Strothman




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Zespoły nietolerancji amin biogennych. II. Tyramina, serotonina i inne

Publication date: Available online 27 September 2017
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Krzysztof Łukasz Piwowarek, Jerzy Kruszewski
Histamine intolerance is the most important biogenic amines intolerance syndrome, but not the only one. Clinically, significant reactions may be induced by tyramine, serotonin, putrescine, cadaverine, phenylethylamine and tryptamine. Substantial variation of these highly bioactive compounds determines multiplicity of potentially caused symptoms. In addition, the situation is complicated by frequent co-occurrence in food products. Therefore, the diagnostics of biogenic amines intolerance syndromes is difficult and depends heavily on meticulously collected information through an interview. The intention of the following literature review is to present the aforementioned subject.



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Wybrane reakcje krzyżowe w alergiach górnych dróg oddechowych i pokarmowych

Publication date: Available online 20 September 2017
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Krzysztof Buczyłko, Emilia Majsiak
Allergic rhinitis, stomatitis, pharyngitis, laryngitis and oesophagitis are characterized by IgE-mediated reactions. There was a strong correlation between mites component resolved diagnostic (CRD) and chronic allergic rhinitis. CRD had important influence on cross- reaction's diagnostics. The majority of birch allergic patients are IgE-sensitized to the major birch pollen allergen Bet v 1 as well as to the major apple CRD Mal d 1 and soy bean allergen Gly m 4. Birch pollen-related oral allergy syndrome (OAS) is a common type of food allergy, transient and mild in nature. More information is discovered about the possible causal association between allergy and vocal pathologies or eosinophilic eosophagitis (EoE). Cross-reactivity of the wheat CRD may be important. Allergenic extracts and molecular components are available at present in FABER test. Allergen molecular diagnostics may represent a useful way in allergy work-up. Many data suggest that components resolved diagnostics constitutes a reliable tool for the diagnosis of pollen-food syndromes or other form of cross-reactivity.



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Attentional Modulation of Envelope-Following Responses at Lower (93–109 Hz) but Not Higher (217–233 Hz) Modulation Rates

Abstract

Directing attention to sounds of different frequencies allows listeners to perceive a sound of interest, like a talker, in a mixture. Whether cortically generated frequency-specific attention affects responses as low as the auditory brainstem is currently unclear. Participants attended to either a high- or low-frequency tone stream, which was presented simultaneously and tagged with different amplitude modulation (AM) rates. In a replication design, we showed that envelope-following responses (EFRs) were modulated by attention only when the stimulus AM rate was slow enough for the auditory cortex to track—and not for stimuli with faster AM rates, which are thought to reflect 'purer' brainstem sources. Thus, we found no evidence of frequency-specific attentional modulation that can be confidently attributed to brainstem generators. The results demonstrate that different neural populations contribute to EFRs at higher and lower rates, compatible with cortical contributions at lower rates. The results further demonstrate that stimulus AM rate can alter conclusions of EFR studies.

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Benign vocal fold lesions: update on nomenclature, cause, diagnosis, and treatment.

Purpose of review: The management of benign vocal fold lesions (BVFLs) continues to evolve. This article will review the recent literature surrounding the nomenclature, cause, diagnosis, and treatment of BVFLs, including polyps, nodules, cysts, and reactive lesions. Recent findings: The taxonomy of vocal fold lesions has been refined, and it serves as a common descriptive language for diagnosis, treatment algorithms, and reporting of outcomes. Though these lesions are known to be the result of phonotrauma, investigation into inflammatory mediators, apoptosis, and laryngopharyngeal reflux provide further elucidation of their underlying pathophysiology. The future of diagnosis, for which direct fiberoptic visualization and stroboscopy are the current gold standard, may utilize narrow-band imaging and videokymography; the clinical utility of ultrasound and optical coherence tomography is more remote. Angiolytic laser therapy and intralesional steroid injection are acceptable options for treatment of BVFLs. Voice therapy and microsurgical excision are mainstays of treatment. Summary: Recent clinical and basic science research has expanded upon an extensive literature surrounding the nomenclature, cause, diagnosis, and treatment of benign subepithelial vocal fold lesions. There remains a strong need for the advancement of rigorous diagnostic principles, evaluation of therapeutic interventions, and development of best practices guidelines. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Update on pediatric sinus surgery: indications and outcomes.

Purpose of review: To review the recent literature of pediatric endoscopic sinus surgery (ESS). Recent findings: Sinus balloon catheter dilation is an important addition to the surgical treatment tools for pediatric chronic rhinosinusitis (PCRS). ESS is a safe and effective therapeutic modality for uncomplicated PCRS. For PCRS complicated by comorbidities including cystic fibrosis and primary ciliary dyskinesia, ESS and adjuvant medical therapy confers significant sinus, pulmonary, and quality of life benefits to pediatric patients. Summary: ESS is a safe and effective treatment modality in the management of pediatric acute and chronic sinus disorders. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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NUT Midline Carcinoma: A Series of Five Cases, Including One with Unusual Clinical Course

Abstract

NUT midline carcinomas (NMCs) are rare, poorly differentiated tumors with aggressive biological behavior and a characteristic molecular signature. Availability of NUT antibody has facilitated diagnosis of NMC without molecular testing. We report a series of head and neck NMCs diagnosed using NUT IHC at our institute, including one case with an unusual course. Immunohistochemistry for NUT was performed in nasal and sinonasal tumors with diagnoses of undifferentiated carcinoma, poorly differentiated squamous cell carcinoma and malignant neoplasm, not otherwise specified, to identify cases of NMC. Clinicopathological features were reviewed. Five cases of NMC were identified, accounting for 9.6% of poorly differentiated/undifferentiated carcinomas of the sinonasal region. These patients had a sex ratio of 2:3, and ranged in age from of 10 to 31 years (mean: 25.2 years). Patient 4 had previously been diagnosed with basal cell carcinoma arising in left nasolacrimal duct, and inverted papilloma of nasal cavity. She presented to us with a left lacrimal fossa mass extending into nasal cavity, which was diagnosed as NMC. NMC is a rare neoplasm, the awareness of which is imperative for pathologists to identify cases in which NUT IHC should be ordered. NUT IHC should be performed in all cases of a poorly differentiated carcinoma, particularly those with foci of squamous differentiation, irrespective of patient age and unusual tumor location, as seen in one of our cases. Although considered a highly aggressive and lethal neoplasm, NMC can have a more prolonged clinical course on occasion.

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Beyond the Percentages of PD-L1-Positive Tumor Cells: Induced Versus Constitutive PD-L1 Expression in Primary and Metastatic Head and Neck Squamous Cell Carcinoma

Abstract

Anti-PD1 antibody has been approved for metastatic squamous cell carcinoma of the head and neck (SCCHN) and objective response rates of approximately 20% have been reported. Defining PD-L1 expression at ≥ 1% tumor cells as positive, PD-L1-positive tumors showed a higher response rate. However, it is unclear whether 1% is the optimal cutoff, and studies on lung cancer suggested 50% cutoff as a stronger predictive biomarker. 96 primary SCCHN from oropharynx and oral cavity and 34 corresponding metastatic lesions were typed for membranous PD-L1 expression. p16 immunohistochemistry was used as a surrogate marker for HPV status in SCCHN from the oropharynx. Fifty-two of 96 (54%) tumors were PD-L1-positive, 72% if PD-L1 expression in tumor-infiltrating immunocytes was also included as positive. Fifteen of 34 primary-metastasis tumor pairs differed in PD-L1 expression, and p16(+) cases more frequently showed PD-L1 expression in immunocytes than p16(−) cases (82 vs. 45%, p < 0.05). PD-L1-positive SCCHN showed two distinct patterns of expression. In the induced pattern of expression, PD-L1-positive tumor cells were limited to the periphery of tumor nests at the tumor–immunocyte interface, comprising < 5% of tumor cells, and were almost always associated with PD-L1-positive immunocytes. In contrast, tumors with constitutive PD-L1 expression had a higher percentage of positive tumor cells, often diffusely distributed throughout the tumor, and often were not accompanied by PD-L1-positive immunocytes. We propose that distinguishing these two biologically distinctive patterns of PD-L1 expression and typing metastatic instead of primary lesions might better predict immunotherapeutic response to anti-PD1/PD-L1 regimens beyond just the percentage of PD-L1-positive tumor cells.

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Development of a Rapid Analysis Method for Bone Resection Margins for Oral Squamous Cell Carcinoma by Immunoblotting

Abstract

The purpose of this proof-of-principle study was to develop a rapid and approachable method to analyse bone resection margins in patients with oral squamous cell carcinoma (OSCC) in an intraoperative setting, similar to assessing frozen sections of soft tissue. Bone excision and risk of remaining tumour cells could be minimised, thus improving reconstruction measures and facilitating convalescence. Frozen, sawed wafers of porcine bone artificially combined with porcine skin (simulating OSCC properties) were used to develop and evaluate a new molecular method: protein transfer from non-decalcified, sawed wafers onto a membrane stained by immunofluorescence (Tissue-ProtTrans). Tissue-ProtTrans was based on the detection of keratin 5/6 as a marker of tumour cells. The results were compared to standard immunohistochemistry (IHC) and H&E results of the same wafers after decalcification. Tissue-ProtTrans resulted in a total assay time of 3.5 h using the Trans-Blot^® Turbo™ Transfer System (Bio-Rad) for protein transfer. Amersham Protran^® Premium Nitrocellulose Membranes 0.2 µm (GE Healthcare) were stained with a primary antibody to keratin 5/6 (Dako Agilent) and a secondary antibody labelled with IRDye^® 800CW (LI-COR). Visualisation was performed with an infrared laser scanner (Odyssey). Upon comparison, five independent experiments on porcine specimens processed with the Tissue-ProtTrans showed similar results to standard IHC and H&E analysis. In comparison to standard IHC results (requiring several days due to decalcification) Tissue-ProtTrans provided similar results, but was much faster (3.5 h). This highly promising method has good potential for further time reduction and will be suitable for intraoperative assessment.

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Treatment Strategies for the Opioid-Dependent Patient

Abstract

Purpose of Review

This review is intended to help the headache physician think through and plan for management issues concerning the use of opioids. We ask the headache physician to consider if there are instances where prescribing or continuing prescriptions of opiates is plausible, and if so, how can the physician proceed as safely as possible. Our goal is to start a conversation regarding the inevitable encounter with a patient on opiates or requesting opiates.

Recent Findings

The use of opiates in our society has reached a crisis in staggering death and addiction rates. Recent guideline published by the CDC can assist us in developing an algorithmic approach towards opiate use. Recent advances in addiction medicine can also assist us in protecting our patients.

Summary

Every headache physician will undoubtedly encounter patients on opiates. There still are appropriate reasons to treat patients with opiates. Every headache physician may need to prescribe opiates and they may be indicated. It is important to learn the correct way to approach, manage, and treat patients on opiates.

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Kojic acid: Side effects and benefits

Learn about kojic acid, a substance found in skin-lightening cosmetic products. We look at its effects, uses, and possible side effects.

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Update on Quinolone Allergy: A Complementary Note

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The use of CT-scan in foreign body aspiration in children: A 6 years' experience

Publication date: November 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 102
Author(s): Vincent Pitiot, Margaux Grall, Dominique Ploin, Eric Truy, Sonia Ayari Khalfallah
IntroductionA foreign body aspiration is a risky situation, common in pediatric emergency. The "gold standard" to rule out a foreign body or proceed to its extraction, is rigid bronchoscopy (RB) under general anesthesia. However, RB is an intrusive exam with possible complications. Depending on authors, RB in emergency is a procedure at risk of complications in 4–17% of cases. Advances in radiology allow CT-scanners of fast acquisition and high definition, which could be used as an alternative to RB.Materials and methodsThis is a retrospective analysis of 6 years from May 2010 to May 2016, in a tertiary referral center. All children that presented a foreign body aspiration suspicion and had a cervical-thoracic CT with multiplanar reconstruction were analyzed.Results200 children were included. The average age was 30 months. 132 were considered normal and 68 pathological. Among the 68 RB performed for pathological scanner, a foreign body was found in 59 cases, and we had 9 cases of false positives. Among the 132 considered normal, 27 have had a RB despite this, due to persistent symptoms, all were negative; 105 were discharged home without endoscopy with monitoring instructions. 1 child was reviewed three months later for asthma, without second choking event reported. A new CT-scan found a foreign body that was removed by RB. Due to the nature of the foreign body it is very unlikely to link it to the first choking event, but retrospectively we cannot be certain. Considering this case as the only false negative, the negative predictive value (NPV) of CT was 99.2% and positive predictive value (PPV) of 83.8%.ConclusionThe use of CT -scan with multiplanar reconstruction in suspected foreign body aspiration is a reliable alternative to endoscopy under general anesthesia, especially in asymptomatic patients, avoiding too many negative endoscopies.



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Isolated ascites in a newborn with 'apple peel jejunal atresia

Isolated fetal ascites was diagnosed at 20 weeks in a primiparous woman with no significant medical history. Progressive fetal ascites worsened after 28 weeks and resulted in fetal hydroceles. Delivery was by caesarian section at 33 weeks, preceded by reduction of fetal ascites under ultrasound guidance. Following delivery, the baby required further reduction of abdominal fluid and endotracheal intubation to provide respiratory support. An extensive set of investigations, including metabolic and genetic screening, was performed; all results were negative. On day two of life, the baby developed bilious aspirates and an abdominal radiograph suggested intestinal obstruction. At laparotomy, an 'apple peel' jejunal atresia, abnormal mesentery with precarious blood supply and a proximal perforation were identified and the perforation 'sewn over'. The postoperative course was unremarkable, with Monogen feeds tolerated three weeks later. The baby continued to thrive at one year, tolerating increasing amount of long-chain fatty acids in diet.

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Recurrent prosthetic heart valve thrombosis secondary to eosinophilia: a missed diagnosis

Prosthetic heart valve thrombosis (PHVT) is a major cause of morbidity and mortality in patients with mechanical heart valves. We present a case of recurrent PHVT associated with eosinophilia. A 17-year-old girl underwent aortic and mitral valve replacement for rheumatic heart disease. Over a period of 4 years, she had four episodes of PHVT despite oral anticoagulation with adequate INR. Her investigations revealed eosinophilia which was missed during the previous episodes. No further episodes of PHVT occurred after treatment of eosinophilia with steroids on limited follow-up.

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Resolution of acute hepatitis B-associated aplastic anaemia with antiviral therapy

A previously healthy 44-year-old woman presented with 3 days of worsening petechial rash, epistaxis and fatigue. Admission labs revealed pancytopenia, low reticulocyte index and elevated liver enzymes. Bone marrow biopsy demonstrated a profoundly hypocellular bone marrow without dysplasia and additional testing demonstrated an acute hepatitis B infection. In the context of an acute hepatitis B infection, elevated liver enzymes and aplastic anaemia, our patient was diagnosed with severe hepatitis-associated aplastic anaemia due to an acute hepatitis B infection. She was initiated on antiviral therapy with tenofovir and briefly received immunosuppressive therapy with a robust sustained improvement in her blood counts. Acute hepatitis B-associated aplastic anaemia is an exceptionally rare presentation of aplastic anaemia. We present acute hepatitis B-associated aplastic anaemia that resolved with antiviral therapy, which to our knowledge is the second such case reported in the literature and the first using tenofovir.

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Severe liver injury due to Epsom salt naturopathy

Description

A 38-year-old non-alcoholic, non-diabetic man with gallstone disease was prescribed three tablespoons of Epsom salt (magnesium sulfate crystals) with lukewarm water for 15 days for 'stone dissolution' by a naturopathy practitioner. He developed loss of appetite and darkening of urine from the 12th day on treatment and jaundice from the second day after treatment completion. The patient denied fevers, skin rash, joint pains, myalgia, abdominal pain, abdominal distension and cholestatic symptoms. Examination revealed a deeply icteric patient oriented to time, place and person without organomegaly or stigmata of chronic liver disease. Blood investigations revealed platelet count 190 (normal 150–450 x 10⁹/L), total bilirubin 12.8 (39.3 mmol/L) (normal 0.3–1.0 mg/dL or 5.0–17.0 mmol/L), direct bilirubin 6.9 (21.7 mmol/L) (0.0–0.2 mg/dL or 0.0–3.4 mmol/L), aspartate aminotransferase 508 (<37 U/L), alanine aminotransferase 228 (<41 U/L), -glutamyltransferase 298 (5–61 U/L), alkaline phosphatase 178 (35–129 U/L), albumin 4.2 (3.5–5.0 g/dL) and international normalised ratio 1.1 (0.9–1.2). R ratio was 3.84 and Roussel Uclaf...

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Checklist for a complete chronic urticaria medical history: an easy tool

Existing guidelines do not offer a quick, efficient alternative to the patient's recollection of relevant clinical features during anamnesis and physical examination for chronic urticaria (CU). This study aime...

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Huge right ventricular mass lesion associated with genital malignant tumor: a case report

Primary heart tumors are rare, whereas metastatic heart tumors occur more frequently.

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Case of dermatomyositis with Gottron papules and mechanic's hand: Dermoscopic features

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Case of cetuximab-induced disseminated necrotic and maculopapular eruptions: Involvement of an epidermal growth factor receptor inhibitor with epidermal necrosis

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Arteriovenous malformation manifested after subclavian central venous catheterization

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Pemphigus vulgaris developing after 6-month treatment with a dipeptidyl peptidase-4 inhibitor: A case report

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Complete resolution of facial molluscum contagiosum in a HIV-infected patient by antiretroviral therapy

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Successful control of phototherapy-resistant lymphomatoid papulosis with oral bexarotene

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Facial spiny follicular hyperkeratosis induced by vemurafenib

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Treatment of gastric eosinophilia by epicutaneous immunotherapy in piglets sensitized to peanuts

Abstract

Background

Eosinophilic Gastrointestinal Disorders (EGIDs) are hypersensitivity disorders frequently triggered by food allergy and manifested by mucosal eosinophilic infiltration at any level of the gastro-intestinal tract. This study established a model of gastric eosinophilia in peanut-sensitized piglets to evaluate the efficacy of epicutaneous immunotherapy (EPIT) for its treatment.

Methods

Experiments were carried out in piglets first sensitized by 3 intra-peritoneal injections of peanut protein extract (PPE) with adjuvant, and then given PPE orally for 10 days, a sequence leading to gastric eosinophilia assessed by endoscopy. For 3 months, 8 piglets received active EPIT, using Viaskin^® loaded with PPE, applied daily on the ear, while 8 received placebo EPIT (Placebo). Piglets were exposed to a second 10-day period of PPE orally. Lesions were scored by endoscopy on the last day of PPE exposure. After sacrifice, all parts of the digestive tract were analysed by a pathologist unaware of the piglets' status. IgE response was measured and mechanistic parameters were analyzed in the spleen.

Results

After sensitization, a significant increase of total IgE was observed in sensitized compared to naive animals (61.1±13.3 vs 27.8±6 ng/mL, p<0.01). Following oral intake of PPE, sensitized piglets developed moderate gastritis compared to naive piglets (1.5 vs 1.0, median score). After 3 months of immunotherapy, median IgE was significantly reduced in EPIT vs placebo piglets (61.4±16.3 vs 105.9±25.6 ng/mL, p<0.01). Active EPIT significantly reduced gastric mucosal lesions induced by PPE oral intake (macroscopic score 0 [0-2] vs 2 [1-3], p<0.01, respectively active vs placebo) and gastric mucosa eosinophils counts (239 eosinophils/mm² [59-645] vs 2554 eosinophils/mm² [462-8057], p<0.01, respectively active vs placebo). GATA-3, IL-5 and eotaxin mRNA expression decreased significantly after EPIT (p<0.05).

Conclusions

This study describes a large animal model of gastric eosinophil in peanut-sensitized piglets. Utilizing this model, we demonstrated the efficacy of EPIT in treating peanut-induced EGIDs.

This article is protected by copyright. All rights reserved.

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Issue Information

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Asthma comorbidities and making progress with food allergy

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Forthcoming Meetings

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Study of efficacy and safety of noncultured, extracted follicular outer root sheath cell suspension transplantation in the management of stable vitiligo

Abstract

Background

Noncultured, extracted follicular outer root sheath suspension (NC-EHF-ORS-CS) is a recently introduced technique for the treatment of stable vitiligo.

Objective

To study the clinical efficacy of this technique and to determine the viability and cell composition of the suspension.

Methods

Twenty-five patients with stable vitiligo were included in this prospective study. Fifty follicles were extracted from occipital scalp and were incubated with trypsin–ethylenediaminetetraacetic acid to separate outer root sheath cells. The cell suspension was filtered and centrifuged to obtain a cell pellet, which was resuspended and applied to the dermabraded recipient area. Cell viability of the suspension was assessed using trypan blue staining, and markers of keratinocyte stem cells (CD200) and melanocytes (S100) were evaluated using flow cytometry and immunocytochemistry, respectively.

Results

At 6 months, the mean (±SD) repigmentation was 52 ± 25.1%, and >75% repigmentation was seen in 8/25 (32%) patients. Mean percentage cell viability of the suspension was 80 ± 17.2% with a mean concentration of CD200 + and S100 + cells being 7.91 ± 8.68% and 9.93 ± 1.22% (n = 3), respectively. Recipient site infection was seen in 4 of 25 (16%) patients and a color mismatch in 11 of 25 (44%) patients.

Conclusion

NC-EHF-ORS-CS is a useful minimally invasive therapy for vitiligo.

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Acne keloidalis nuchae in Latin America: is there a different phenotype?

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Nevus trichilemmocysticus

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Dermatoscopic evaluation and histopathological correlation of acquired dermal macular hyperpigmentation

Abstract

Background

Acquired dermal macular hyperpigmentation (ADMH) is a hypernym encompassing Riehl's melanosis, lichen planus pigmentosus, and ashy dermatoses that show significant clinicopathological overlap. We sought to describe the dermatoscopic features of ADMH and correlate them with histopathological findings.

Methods

This was a prospective observational study performed in two phases. A detailed clinical and dermatoscopic examination was performed, and skin biopsies were obtained in 51 patients. Two dermatologists and a blinded dermatopathologist studied archived dermatoscopic images and histopathology specimens, respectively.

Results

Dermatoscopic features noted were (i) pigment structures; dots (82.4%), globules (66.7%) and blotches (56.9%) that spared the eccrine and hair follicle openings; (ii) telangiectasia (82.4%); (iii) accentuation of the normal pseudoreticular pigmentary network (33.3%); (iv) owl's eye structures (15.7%). Four dermatoscopic grades of disease severity were identified: grade 1 – dotted; grade 2 – Chinese letter; grade 3 – reticulate; and grade 4 – diffuse. Density of melanin incontinence on histopathology correlated positively with size of pigment structures (r = 0.7, P < 0.000) and grades of disease severity (r = 0.75, P < 0.000) on dermatoscopy.

Conclusion

Increasing grades of disease severity can be detected dermatoscopically, which correlate well with histopathological features. A carefully performed dermatoscopy aids in better patient counseling regarding disease severity.

http://ift.tt/2xcq9Fd