Orbital cellulitis secondary to dacryocystitis: Is it common?

Publication date: Available online 6 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Salman bin Amiruddin, Balwant Singh Gendeh




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An epidemiological study of 270 cases of carcinomas of the head and neck region in a Nigerian tertiary health care facility

Publication date: Available online 6 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): B. Fomete, R. Agbara, E.T. Adebayo, O.D. Osunde, D.S. Adeola
IntroductionOral cancer is the sixth most frequently occurring malignant tumor and is the major cause of morbidity and mortality with high metastatic and invasive tendency. The incidence of oral cancer differs widely in various parts of the world with a range of 2–10 per 100,000 populations per year, approximately 300,000 new cases. Incidence and mortality as a result of oral cancer are higher in developing countries when compared to developed countries. This is the reason for the occurrence of the peak age in later decades of life.Patients and methodsAll consecutive cases of histologically diagnosed cases of orofacial carcinomas seen at the Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria over a 10 year period were retrospectively analyzed.ResultsOver the study period, a total of 1116 cases of maxillofacial conditions were seen in the unit out of which 270 represented orofacial cancers, giving a prevalence of 24.19%. Of the 270 cases, male accounted for 159(58.9%) while females were 111(41.1%) giving a male to female ratio of 1.43:1. The age ranged from 5 to 90 years, mean (SD), 48.4(16.12) years and patients in the 4th to 6th decades (47.7%) were mostly affected. There was no gender difference in terms of distribution of the tumors according to age.ConclusionSquamous cell carcinoma of the orofacial region has continued to pose great challenges to care givers and practitioners involved in their management.



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Study of interactions between odorant molecules and the hOR1G1 olfactory receptor by molecular modeling

Publication date: Available online 6 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Assia Belhassan, Hanane Zaki, Samir Chtita, Mohamed Benlyas, Tahar Lakhlifi, Mohammed Bouachrine
In order to initiate the process of determining how the molecular level receptor-odorant interactions are related to odor perception, we used the SWISS-MODEL modeling server to predict the three dimensional (3D) structure of the human olfactory receptor (hOR1G1). The model was refined using minimization and side-chain optimization using SCWRL. We then used the Autodockvina and Autodock tools to predict the binding site and binding energy for the library of 13 odorants characterized by different retention/release property values to hOR1G1 receptor, to investigate the relationship between this property and the ligand-hOR1G1 interactions. We find that when the retention property increases, hydrogen bond interactions between ligands and olfactory receptor (hOR1G1) become favorable.



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Editorial Board

Publication date: July 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences, Volume 18, Issue 2





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Acquired haemophilia A complicating alemtuzumab therapy for multiple sclerosis

Alemtuzumab is a highly efficacious therapy used in the treatment of multiple sclerosis (MS), but uncoupling of T and B cell repopulation during immune reconstitution associates with an increasing range of secondary B cell-mediated autoimmune complications. A 34-year-old woman developed Graves' disease 11 months following an initial course of alemtuzumab treatment for MS. Nine months following the second treatment with alemtuzumab, the patient presented with spontaneous intramuscular and subcutaneous haemorrhage due to development of an inhibitory autoantibody to coagulation factor VIII. Acquired haemophilia A (AHA) is an extremely rare complication in patients treated with alemtuzumab. Treatment with rituximab may induce a rapid remission of AHA; however, the patient's high John Cunningham virus (JCV) antibody index and alemtuzumab-induced T cell lymphopenia may lead to an increased risk of progressive multifocal leucoencephalopathy, a potential complication which was unacceptable to the patient.

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Parotid gland: an unusual site of breast cancer metastasis

Parotid gland metastases from breast cancer are an extremely rare and unusual event with a limited number of cases recorded in the literature. A 71-year-old woman with a history of ductal adenocarcinoma of the left breast presented to the maxillofacial clinic with an asymptomatic swelling of the left parotid gland. The presentation occurred 21 years after she underwent treatment for recurrent breast cancer. Investigations led to the diagnosis of a breast cancer metastasis which was oestrogen receptor and progesterone receptor positive and negative. Positron emission tomography scan confirmed this as a solitary metastasis. She was treated with aromatase inhibitors and a stable clinical response was observed on follow-up. Surgical intervention was avoided with its potential complications such as facial nerve injury. Metastasis from breast cancer to the parotid gland is a very rare phenomenon. However, in a patient with previous breast cancer, it should be considered as a possible differential diagnosis.

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Nerve abscess in pure neural leprosy mistaken for peripheral nerve sheath tumour with disastrous consequence: what can we learn?

A 34-year-old Indian man presented to an orthopaedician with gradually progressive hypoesthesia affecting his right lower limb and an ipsilateral common peroneal nerve swelling around the knee. The nerve swelling was diagnosed as a peripheral nerve sheath tumour based on MRI findings and was excised, only to be revealed as leprous nerve abscess on histopathology later. The patient developed right foot drop as a result of common peroneal nerve biopsy. This case presents several learning points in the diagnosis of pure neural leprosy.

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Gastric liposarcoma resected by laparoscopic total gastrectomy to achieve a wide surgical margin

Gastric liposarcoma is an extremely rare tumour that usually affects the extremities and retroperitoneum. Preoperative diagnosis is difficult, and operative procedures are not well standardised. A 61-year-old woman presented with melaena, epigastric discomfort and palpitations. Upper endoscopy revealed a submucosal tumour at the posterior gastric fundus with an actively bleeding ulcer on the top. Our preoperative diagnosis was lipoma, and we performed laparoscopic intragastric surgery. However, the histopathological diagnosis was liposarcoma. Laparoscopic total gastrectomy was performed to achieve a wide surgical margin. Several recent series have shown that a positive microscopic margin is associated with a higher rate of local recurrence than a negative margin. We have added a staged operation to obtain a wide margin in cases involving a positive surgical margin. Preoperative diagnosis of liposarcoma is still challenging. Gastric lipoma-like tumours should be resected with a wide margin because of their possibility of malignancy.

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Pathological ECG that seemed normal following electrode misplacement

We report the case of a 57-year-old woman found at home who received an ECG after having recovered from a seizure, without any clinical cardiac anomaly. The ECG revealed an elevation of the ST segment from the V1 to V5 leads and negative T waves from V1 to V5 leads. At her hospital admission, the emergency care unit (ECU) nurse performed another ECG. It no longer showed any repolarisation anomaly. However, the ECU nurse had put the precordial electrodes 3 cm too low, probably due to the patient's voluminous breasts. In the end, the pathological trace reappeared after we returned the electrodes to their initial positions. Malpositioning of the electrodes caused a seemingly normal ECG result with life-threatening consequences.

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Lentiform fork sign due to severe metabolic acidosis

Description

An 11-month-old, developmentally normal, female infant presented with acute-onset fever, vomiting, shallow breathing and gradually progressive lethargy for the past 2 days. There was no history of seizures, neck stiffness, focal motor deficits, cranial nerve palsies, tone changes, rash, diarrhoea, recurrent encephalopathies, abnormal body odour, recurrent infections or hospitalisations, drug or toxin ingestion. Her past and family history was not contributory. On examination, anthropometric parameters were normal for age. She had mild pallor, angular cheilitis, wrist widening, tachypnea (respiratory rate 58/min) with acidotic breathing. She was conscious with fluctuations in alertness (Glasgow Coma Scale (GCS) E4M5V2) and irritability with reduced spontaneous activity, mild hypotonia, preserved antigravity movements, brisk muscle stretch reflexes, bilateral extensor plantar response, absence of oculomotor abnormalities, cranial nerve palsies or bulbar signs and normal fundi. Rest of the systemic examination was unremarkable. A clinical diagnosis of acute febrile encephalopathy was considered.

Laboratory investigations showed...

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Dysphagia lusoria presenting as epigastric pain

Description

A 36-year-old African–American woman with medical history of systemic lupus erythematosus, lupus nephritis, protein S deficiency and recurrent deep venous thrombosis presented to outpatient clinic complaining of epigastric pain associated with nausea, vomiting and unintentional weight loss. Esophagogastroduodenoscopy (EGD) was performed; however, mucosal tear was noted following severe retching. Subsequently, the procedure was terminated. EGD was significant for distal oesophageal obstruction. CT of the chest with contrast was significant for pneumomediastinum. Moreover it demonstrated an aberrant right subclavian artery compressing on the posterior part of the oesophagus (figure 1). The patient was diagnosed with dysphagia lusoria. This patient's symptoms were moderate and managed with dietary modifications. Thus, surgical intervention was not recommended. There was no further progression of symptoms at 1-year follow-up.

Figure 1

Aberrant right subclavian artery compressing on the posterior part of the oesophagus.

Dysphagia lusoria is a condition...

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Painful testicular metastasis from prostate adenocarcinoma

A 60-year-old man presented with unilateral testicular pain and urinary frequency. His presenting prostate-specific antigen (PSA) was 100 ng/mL, and a biopsy revealed Gleason 4+4 prostate adenocarcinoma. The significance of his initial PSA was somewhat complicated by possible prostatitis and early initiation of bicalutamide. PSA rose on two occasions prior to radiotherapy but coincided with a flare of testicular pain on one of these. Whole-body staging diffusion-weighted MRI scan was negative. He was treated with 3 years of androgen deprivation therapy (ADT) and radical radiotherapy. PSA fell to undetectable levels on ADT. Twelve months following completion of ADT, PSA rose to 3.6 ng/mL. No disease recurrence was noted on restaging MRI pelvis. The patient was well, except for persistent testicular symptoms, which failed to resolve following multiple antibiotics. Testicular tumour markers were negative. Ultrasound findings were consistent with chronic epididymitis. A right orchidectomy was performed for symptomatic relief, confirming metastatic prostate adenocarcinoma.

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The association between cardiovascular disease and type 2 diabetes in adults with atopic dermatitis: a systematic review and meta-analysis

Abstract

Recent studies examining the association between atopic dermatitis (AD) and cardiovascular disease (CVD) and type 2 diabetes have shown inconsistent results. We compared the risk of CVD and diabetes between adult patients with and without AD by searching the Pubmed, Embase, and Web of Science databases. Data extraction was done by two independent reviewers. We found a total of 2,855 citations, of which 53 were considered relevant based on title and abstract. Sixteen publications were included in the qualitative analysis, of which 13 were also included in a quantitative meta-analysis of crude data. No association was observed between AD and unspecified, but suspected type 2, diabetes (pooled odds ratio [OR] 1.11; 95% confidence interval [CI] 0.87-1.42), hypertension (pooled OR 1.16; 95% CI 0.98-1.37), stroke (pooled OR 1.15; 95% CI 0.95-1.39) or myocardial infarction (pooled OR 1.14; 95% CI 0.83-1.56), but a positive association was observed with angina pectoris (OR 1.73; 95% CI 1.27-2.37). Meta-analysis on adjusted data gave similar results. While adults with AD in some populations have increased prevalence of cardiovascular risk factors, such as obesity and smoking, it is unlikely that AD represents an independent and clinically relevant risk factor for cardiometabolic disease.

This article is protected by copyright. All rights reserved.

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Uterine rupture in a primigravid patient, an uncommon but severe obstetrical event: a case report

A spontaneous rupture of the unscarred uterus in a primigravid patient is extremely rare and is associated with high perinatal and maternal morbidity and mortality.

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DNA damage signaling and polyploid macrophages in chronic inflammation

Veronika Horn | Antigoni Triantafyllopoulou

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Immunoresolvents signaling molecules at intersection between the brain and immune system

Jesmond Dalli | Charles N Serhan

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New roles and controls of mast cells

Eric Espinosa | Salvatore Valitutti

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Recent advances in inflammasome biology

David E Place | Thirumala-Devi Kanneganti

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A ravenous defense: canonical and non-canonical autophagy in immunity

Payel Sil | Ginger Muse | Jennifer Martinez

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Control of innate-like B cell location for compartmentalised IgM production

Lucy H Jackson-Jones | Cécile Bénézech

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Heme and hemolysis in innate immunity: adding insult to injury

Rui Martins | Sylvia Knapp

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Innate sensing of cancer's non-immunologic hallmarks

Ruth Seelige | Stephen Searles | Jack D Bui

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Type I interferon-mediated autoinflammation and autoimmunity

Stefanie Kretschmer | Min Ae Lee-Kirsch

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Negative selection, epitope mimicry and autoimmunity

Noel R Rose

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Monogenic lupus: it's all new!

Patricia Costa-Reis | Kathleen E Sullivan

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What's up in the ALPS

Frédéric Rieux-Laucat

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Molecular control of regulatory T cell development and function

Yohko Kitagawa | Shimon Sakaguchi

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Insights into immune tolerance from AIRE deficiency

Irina Proekt | Corey N Miller | Michail S Lionakis | Mark S Anderson

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Biomarker-guided stratification of autoimmune patients for biologic therapy

Sabine Ivison | Christine Des Rosiers | Sylvie Lesage | John D Rioux | Megan K Levings

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Have we pushed the needle for treatment of Type 1 diabetes?

Nida Naushad | Ana Luisa Perdigoto | Jinxiu Rui | Kevan C Herold

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Hemophagocytic syndrome: primary forms and predisposing conditions

Fernando E Sepulveda | Geneviève de Saint Basile

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Leveraging blood and tissue CD4+ T cell heterogeneity at the single cell level to identify mechanisms of disease in rheumatoid arthritis

Chamith Y Fonseka | Deepak A Rao | Soumya Raychaudhuri

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Lessons from CTLA-4 deficiency and checkpoint inhibition

Bernice Lo | Ussama M Abdel-Motal

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Psoriasis: a mixed autoimmune and autoinflammatory disease

Yun Liang | Mrinal K Sarkar | Lam C Tsoi | Johann E Gudjonsson

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Reliability of temporal bone high-resolution CT in patients with facial paralysis in temporal bone fracture

Publication date: Available online 5 December 2017
Source:American Journal of Otolaryngology
Author(s): Yaofeng Chen, Kai Zhang, Yanfeng Xu, Yanxu Che, Linna Guan, Yefeng Li
ObjectiveThis study aimed to investigate the reliability of temporal bone high-resolution CT (HRCT) in patients with traumatic facial paralysis.MethodsHRCT with cross-sectional scanning and multi-planar reformation (MPR) was performed on 26 cases with traumatic facial paralysis, and the preoperative imaging manifestations were compared with surgical findings.ResultsPreoperative HRCT revealed fallopian canal damage at the posterior genu in 1 case, geniculate ganglion in 22 cases, labyrinthine segment in 4 cases, tympanic segment in 13 cases and mastoid segment in 0 case, while surgical findings confirmed fallopian canal damage at the posterior genu in 7 cases, geniculate ganglion in 23 cases, labyrinthine segment in 4 cases, tympanic segment in 17 cases and mastoid segment in 7 cases. The accuracy of temporal bone HRCT in revealing damage at those segments of fallopian canal was 14.3%, 95.7%, 100%, 76.5, and 0%, respectively.ConclusionTemporal bone HRCT can generally estimate the extent of damage and provide important information for traumatic facial paralysis before surgery. However, it is unreliable in revealing the damage of fallopian canal at the posterior genu and mastoid segment.



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Intestinal permeability and Ménière's disease

Publication date: Available online 5 December 2017
Source:American Journal of Otolaryngology
Author(s): F. Di Berardino, E. Ciusani, C. Caccia, V. Leoni, U. De Grazia, E. Filipponi, D. Zanetti, L. Elli
PurposeMénière disease (MD) is a multifactorial chronic disabling condition characterized by episodic vertigo, ear fullness, and hearing loss. MD patients often complain of aspecific gastrointestinal symptoms associated with autonomic dysregulation, frequently outweighed by the otological manifestations. Dietary modifications have been reported to improve the typical MD symptoms in some cases. Our purpose was to test the urinary levels of lactulose and mannitol (double sugar test) and the fecal calprotectin, both markers of altered intestinal permeability, in subjects with definite MD in an active and inactive stage.Materials and methodsTwenty-six with definite unilateral MD were studied: 14 patients were symptomatic for at least 3months with moderate to severe vertigo spells and a functional level ≥4; 12 patients had been asymptomatic (no vertigo spells) for at least 3months and had a functional level=1 at the time of testing. Twenty healthy volunteers were recruited as "control group".ResultsLactulose and mannitol absorption was significantly increased in the symptomatic M patients compared to the asymptomatic group (p<0.02 and p<0.004, respectively) and to the controls. FC were also higher than normal only in the symptomatic group. (p<0.01).ConclusionsAn altered intestinal permeability, according to the two assays, was found only in symptomatic MD patients. The rationale for a possible relationship between MD and intestinal permeability is forwarded. The double-sugar test and FC quantification might be implemented in the MD diagnostic workup.



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Symptomatic unilateral vocal fold paralysis following cardiothoracic surgery

Publication date: Available online 6 December 2017
Source:American Journal of Otolaryngology
Author(s): Cassandra Puccinelli, Mara C. Modzeski, Diana Orbelo, Dale C. Ekbom
PurposeUnilateral vocal fold paralysis (UVFP) is a complication associated with cardiothoracic procedures that presents clinically as dysphonia and/or dysphagia with or without aspiration. The literature lacks both data on recovery of mobility and consensus on best management. Herein, our goals are to 1) Identify cardiothoracic procedures associated with symptomatic UVFP at our institution; 2) Review timing and nature of laryngology diagnosis and management; 3) Report spontaneous recovery rate of vocal fold mobility.Materials and methodsRetrospective case series at single tertiary referral center between 2002 and 2015. 141 patients were included who underwent laryngology interventions (micronized acellular dermis injection laryngoplasty and/or type 1 thyroplasty) to treat symptomatic UVFP diagnosed subsequent to cardiothoracic surgery.ResultsPulmonary procedures were most often associated with UVFP (n=50/141; 35.5%). 87.2% had left-sided paralysis (n=123/141). Median time to diagnosis was 42days (x¯=114±348). Over time, UVFP was diagnosed progressively earlier after cardiothoracic surgery. 63.4% of patients (n=95/141) underwent injection laryngoplasty as their initial intervention with median time from diagnosis to injection of 11days (x¯=29.6±54). 41.1% (n=58/141) ultimately underwent type 1 thyroplasty at a median of 232.5days (x¯=367±510.2) after cardiothoracic surgery. 10.2% (n=9/88) of those with adequate follow-up recovered full vocal fold mobility.ConclusionsMany cardiothoracic procedures are associated with symptomatic UVFP, predominantly left-sided. Our data showed poor recovery of vocal fold mobility relative to other studies. Early diagnosis and potential surgical medialization is important in the care of these patients.



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IL-24 is a common and specific autoantigen of IgE in chronic spontaneous urticaria

Publication date: Available online 5 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Oliver Schmetzer, Elisa Lakin, Fatih A. Topal, Patricia Preusse, Denise Freier, Martin K. Church, Marcus Maurer
BackgroundThe efficacy of omalizumab (anti-IgE) and elevated IgE levels in chronic spontaneous urticaria (CSU) suggest autoallergic mechanisms.ObjectiveTo identify autoallergic targets of IgE in CSU patients.MethodsSera of CSU patients together with idiopathic anaphylaxis patients and healthy controls (seven of each) were screened for IgE-autoantibodies using an array of >9,000 proteins. Sera of 1062 CSU patients and 482 healthy controls were used in an IgE-anti-Interleukin-24 (IL-24) specific ELISA to investigate the association of IgE-anti-IL-24 and CSU.ResultsBy array analyses, over 200 IgE-autoantigens were found in CSU patients that were not in controls. Of the 31 IgE-autoantigens detected in >70% of patients, eight were soluble or membrane bound and expressed in skin. Of these, only IgE-autoantibodies to IL-24 were found in all CSU patients. In vitro studies showed IL-24 to release histamine from human mast cells sensitized with purified IgE of CSU patients but not controls. By ELISA analyses, the mean ± SD levels of IgE-anti-IL-24 were 0.52 ± 0.24 IU/ml in CSU and 0.27 ± 0.08 IU/ml in controls with 80% of CSU patients but only 20% of controls having levels >0.33 IU/ml (P< 0.0001). IgE-anti-IL-24 showed acceptable predictive properties for CSU, with a likelihood ratio of 3.9. Clinically, IgE-anti-IL-24 levels showed an association with disease activity as assessed by the urticaria activity score and with reduced basophil counts.ConclusionOur findings show that CSU patients frequently exhibit IgE-autoantibodies against many autoantigens and that IL-24 is a common, specific, and functional autoantigen of IgE-antibodies in CSU.



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PGE2 suppresses human group 2 innate lymphoid cell function

Publication date: Available online 5 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jovana Maric, Avinash Ravindran, Luca Mazzurana, Åsa K. Björklund, Aline Van Acker, Anna Rao, Danielle Friberg, Sven-Erik Dahlén, Akos Heinemann, Viktoria Konya, Jenny Mjösberg
BackgroundGroup 2 innate lymphoid cells (ILC2) are involved in the initial phase of type 2 inflammation and can amplify allergic immune responses by orchestrating other type 2 immune cells. PGE2 is a bioactive lipid that plays protective roles in the lung, particularly during allergic inflammation.ObjectiveWe set out to investigate how PGE2 regulates human ILC2 function.MethodsThe effects of PGE2 on human ILC2 proliferation, intracellular cytokine and transcription factor expression were assessed by flow cytometry. Cytokine production was measured by ELISA and real-time quantitative PCR was performed to detect PGE2 receptor expression.ResultsPGE2 inhibited the expression of GATA3, as well as the production of type 2 cytokines, IL-5 and IL-13, from human tonsil and blood ILC2 in response to stimulation with a combination of IL-25, IL-33, TSLP and IL-2. Furthermore, PGE2 downregulated the expression of IL-2Rα (CD25). In line with that observation, PGE2 decreased ILC2 proliferation. These effects were mediated by the combined action of the EP2 and EP4 receptors, which were specifically expressed on ILC2.ConclusionOur findings reveal that PGE2 limits ILC2 activation and propose that selective EP2 and EP4 receptor agonists might serve as promising therapeutic approach in treating allergic diseases by suppressing ILC2 function.

Graphical abstract

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Generation of adult human T cell progenitors for immunotherapeutic applications

Publication date: Available online 5 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Laura Simons, Kuiying Ma, Corinne de Chappedelaine, Ranjita Devi Moiranghtem, Elodie Elkaim, Juliette Olivré, Sandrine Susini, Kevin Appourchaux, Christian Reimann, Hanem Sadek, Olivier Pellé, Nicolas Cagnard, Elisa Magrin, Chantal Lagresle-Peyrou, Tom Taghon, Antonio Rausell, Marina Cavazzana, Isabelle André-Schmutz




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Thymic stromal lymphopoietin does not activate human basophils

Publication date: Available online 5 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Nina Salabert-Le Guen, Caroline Hémont, Agathe Delbove, Caroline Poli, Cécile Braudeau, Aurélie Fantou, Karine Amouriaux, Gaelle Bériou, Jérôme C. Martin, Luc Colas, Vassili Soumelis, Régis Josien




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Modulating allergic response by engineering the major Parietaria allergens

Publication date: Available online 5 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Angela Bonura, Daniela Di Blasi, Bianca Barletta, Cinzia Butteroni, Silvia Corinti, Francesco Gervasi, Raphael MelisMario, Carina Uasuf, Cibella Fabio, Gabriella Di Felice, Paolo Colombo
An engineered recombinant hybrid composed of the two major Parietaria allergens (PjEDcys) with reduced allergenicity, retained immunogenicity but immunomodulatory activity for Allergen Immunotherapy of Parietaria allergic patients.



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Changes in regulatory B cell levels in bone marrow, blood and sputum of asthmatics following inhaled allergen challenge

Publication date: Available online 6 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): John-Paul Oliveria, Amani I. El-Gammal, Michelle Yee, Caitlin D. Obminski, Tara X. Scime, Rick M. Watson, Karen Howie, Paul M. O'Byrne, Roma Sehmi, Gail M. Gauvreau

Teaser

Capsule Summary: Following allergen exposure in the airways of subjects with allergic asthma, Bregs appear to efflux from the bone marrow and accumulate in the lungs with a possible role in dampening local inflammatory responses.


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Polyunsaturated fatty acids in plasma at 8 years and subsequent allergic disease

Publication date: Available online 5 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jessica Magnusson, Sandra Ekström, Inger Kull, Niclas Håkansson, Sara Nilsson, Magnus Wickman, Erik Melén, Ulf Risérus, Anna Bergström
BackgroundPolyunsaturated fatty acids (PUFAs) are hypothesized to modulate the risk of allergic disease. However, evidence from previous studies is inconclusive, and limited longitudinal data exist using circulating biomarkers of PUFA intake and metabolism.ObjectiveWe aimed to investigate associations between n-3 and n-6 PUFAs at age 8 years and asthma, rhinitis, and aeroallergen sensitization at age 16 years.MethodsProportions of n-3 PUFAs (very long-chain n-3 [VLC n-3; sum of eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid] and α-linolenic acid) and n-6 PUFAs (linoleic acid and arachidonic acid [AA]) in blood samples at age 8 years were measured for 940 children from the prospective Swedish birth cohort BAMSE (Children, Allergy, Milieu, Stockholm, Epidemiology). Allergic disease phenotypes were defined by using questionnaires and IgE measures at the ages of 8 and 16 years. Logistic regression was used to examine potential associations.ResultsA higher proportion of total VLC n-3 PUFAs in plasma at age 8 years was associated with a reduced risk of prevalent asthma, rhinitis, and aeroallergen sensitization at age 16 years and with incidence of asthma between 8 and 16 years (adjusted odds ratio, 0.67; 95% CI, 0.47-0.94). AA was associated with a reduced risk of asthma, aeroallergen sensitization, and allergic rhinitis. The findings were most evident for allergic phenotypes of asthma and rhinitis. Additionally, AA was associated with an increased probability of asthma and rhinitis remission between 8 and 16 years of age.ConclusionHigher proportions of certain VLC n-3 and very long-chain n-6 PUFAs in plasma phospholipids at age 8 years were associated with a reduced risk of allergic disease at age 16 years.



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Effect of Grass Sublingual Tablet Immunotherapy is Similar in Children and Adults: A Bayesian Approach To Design Pediatric Sublingual Immunotherapy Trials

Publication date: Available online 5 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Amarjot Kaur, David Skoner, Joseph Ibrahim, Qing Li, Richard F. Lockey, Michael Blaiss, Albrecht Bufe, Jens Strodl Andersen, Giorgio Walter Canonica, Hendrik Nolte
BackgroundLarge sample sizes are needed for sublingual immunotherapy (SLIT) trials due to inherent data variability secondary to inconsistent allergen exposure. Obtaining large sample sizes for pediatric SLIT trials is challenging, but a Bayesian approach using prior adult data can reduce the necessary sample size.ObjectiveTo describe how a Bayesian framework utilizing prior information from adult trials can be used to improve pediatric SLIT clinical development.MethodsData were compiled using a frequentist approach (conventional clinical trial approach independent of prior data) from trials conducted during the clinical development of timothy grass SLIT-tablet.ResultsThe treatment effect of timothy grass SLIT-tablet was considered similar between pediatric (N=795) and adult (N=2299) data pools, with relative total combined symptom plus medication score improvement (95% CI) vs placebo of 21% (11.0, 30.4) and 20% (14.6, 24.4), respectively. Phleum pratense-specific IgG4 and IgE blocking factor increased from baseline in both children and adults treated with timothy grass SLIT-tablet. Given the reasonable assumption in similarity of treatment response between adults and children, a Bayesian approach is described to demonstrate rigorous efficacy criterion for pediatric trials incorporating information from prior adult trials, and thereby reduce the sample size.ConclusionsData support the similarity of efficacy and immunologic changes between children and adults treated with SLIT for allergic rhinoconjunctivitis. Therefore, it is appropriate to utilize data from adult trials to design feasible trials in children, which may reduce unsafe off-label use by promoting more quickly proper labeling of approved products.

Teaser

Capsule Summary SLIT effects are similar between children and adults. Analytical approaches that allow borrowing information from adult data are appropriate and will make future pediatric SLIT trials more feasible and therefore, quicker to complete, possibly reducing unsafe off-label use of non-approved SLIT formulations.


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Cover 1

Publication date: December 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 6





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Brief Overview of This Month's JACI

Publication date: December 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 6





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Advances in environmental and occupational disorders in 2016

Publication date: December 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 6
Author(s): William J. Sheehan, Jonathan M. Gaffin, David B. Peden, Robert K. Bush, Wanda Phipatanakul
In this review we highlight recent studies that advance the knowledge and understanding of the effects of various environmental factors and associated immune responses in patients with allergic diseases. This review will focus on new literature regarding allergic and immune responses to a variety of environmental factors, including aeroallergens, stinging insects, fungi, pollutants, viral respiratory tract infections, climate change, and microbial exposures.



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Table of Contents

Publication date: December 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 6





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Editorial Board

Publication date: December 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 6





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Information for Readers

Publication date: December 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 6





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News & Notes

Publication date: December 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 6





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Continuing Medical Education Calendar

Publication date: December 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 6





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Biomarkers in connective tissue diseases

Publication date: December 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 6
Author(s): Neelakshi R. Jog, Judith A. James
Autoimmune connective tissue diseases are clinically variable, making biomarkers desirable for assessing future disease risk, supporting early and accurate diagnosis, monitoring disease activity and progression, selecting therapeutics, and assessing treatment response. Because of their correlations with specific clinical characteristics and often with disease progression, autoantibodies and other soluble mediators are considered potential biomarkers. Additional biomarkers might reflect downstream pathologic processes or appear because of ongoing inflammation and damage. Because of overlap between diseases, some biomarkers have limited specificity for a single autoimmune connective tissue disease. This review describes select current biomarkers that aid in the diagnosis and treatment of several major systemic autoimmune connective tissue disorders: systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, and anti-neutrophil cytoplasmic antibody–associated vasculitides. Newly proposed biomarkers that target various stages in disease onset or progression are also discussed. Newer approaches to overcome the diversity observed in patients with these diseases and to facilitate personalized disease monitoring and treatment are also addressed.



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Biomarkers in connective tissue diseases

Publication date: December 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 6





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Mechanisms of allergen immunotherapy for inhaled allergens and predictive biomarkers

Publication date: December 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 6
Author(s): Mohamed H. Shamji, Stephen R. Durham
Allergen immunotherapy is effective in patients with IgE-dependent allergic rhinitis and asthma. When immunotherapy is given continuously for 3 years, there is persistent clinical benefit for several years after its discontinuation. This disease-modifying effect is both antigen-specific and antigen-driven. Clinical improvement is accompanied by decreases in numbers of effector cells in target organs, including mast cells, basophils, eosinophils, and type 2 innate lymphoid cells. Immunotherapy results in the production of blocking IgG/IgG4 antibodies that can inhibit IgE-dependent activation mediated through both high-affinity IgE receptors (FcεRI) on mast cells and basophils and low-affinity IgE receptors (FcεRII) on B cells. Suppression of TH2 immunity can occur as a consequence of either deletion or anergy of antigen-specific T cells; induction of antigen-specific regulatory T cells; or immune deviation in favor of TH1 responses. It is not clear whether the altered long-term memory resides within the T-cell or the B-cell compartment. Recent data highlight the role of IL-10–producing regulatory B cells and "protective" antibodies that likely contribute to long-term tolerance. Understanding mechanisms underlying induction and persistence of tolerance should identify predictive biomarkers of clinical response and discover novel and more effective strategies for immunotherapy.



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Biomarkers for severe eosinophilic asthma

Publication date: December 2017
Source:Journal of Allergy and Clinical Immunology, Volume 140, Issue 6
Author(s): Steven W. Yancey, Oliver N. Keene, Frank C. Albers, Hector Ortega, Stewart Bates, Eugene R. Bleecker, Ian Pavord
The last decade has seen the approval of several new biologics for the treatment of severe asthma-targeting specific endotypes and phenotypes. This review will examine how evidence generated from the mepolizumab clinical development program showed that blood eosinophil counts, rather than sputum or tissue eosinophil counts, evolved as a pharmacodynamic and predictive biomarker for the efficacy of treatment with mepolizumab in patients with severe eosinophilic asthma. Based on the available evidence and combined with clinical judgement, a baseline blood eosinophil threshold of 150 cells/μL or greater or a historical blood eosinophil threshold of 300 cells/μL or greater will allow selection of patients with severe eosinophilic asthma who are most likely to achieve clinically significant reductions in the rate of exacerbations with mepolizumab treatment.



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Initial intravenous immunoglobulin doses should be based on adjusted body weight in obese patients with primary immunodeficiency disorders

Immunoglobulin therapy plays a critical role in the treatment of immunodeficiency disorders as well as autoimmune and inflammatory conditions. In immunodeficient patients, there has been controversy whether in...

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Effect of inhaled allergens and air pollutants on childhood rhinitis development

Rhinitis is a common pediatric disease that involves upper airway infection, in which allergic rhinitis affects 9.7% children in the United States.1 Some rhinitis symptoms are related to allergen exposures. Epidemiologic and experimental studies have documented that exposure to traffic-related air pollutants (TRAPs) increases the risk of allergen sensitization and allergic diseases,2–4 which suggests that allergens and TRAPs may have synergistic effects on the development of rhinitis. TRAPs include primary emissions from motor vehicles, such as carbon monoxide, nitrogen oxides, and particulate matter.

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Clinical predictors for satisfaction with incus vibroplasty: a preliminary study

Abstract

Objective

We aimed to evaluate the subjective satisfaction after incus vibroplasty and to determine predictive factors affecting patient satisfaction in sensorineural hearing loss.

Design

A retrospective review of audiological data and an additional survey about subjective satisfaction after surgery were performed in 14 patients who underwent incus vibroplasty surgery. A numeric rating scale reflecting the degree of satisfaction after incus vibroplasty, compared with experiences using a conventional hearing aid, was used. Patients who showed median or better satisfaction were deemed the highly satisfied (HS) group, and the others were deemed the less satisfied (LS) group. To find the predictive factors correlated with satisfaction for incus vibroplasty, comparative analysis between two groups was performed.

Results

We found that the numeric rating scale for satisfaction was variable, ranged from 0 to 10, and was negatively correlated with age at operation (p < 0.01). The HS group had a younger age (27.6 ± 22.2 years) and better preoperative air conduction threshold at 250 Hz (20.7 ± 7.9 dB) than the LS group (68.0 ± 9.7 years, 32.1 ± 10.7 dB). The LS group (13.6 ± 9.9 dB) showed a larger change of air–bone gap after surgery than the HS group (5.7 ± 6.7 dB) at 250 Hz (p = 0.12).

Conclusions

Age at operation and the preoperative air conduction threshold level at 250 Hz appear to be potential predictive factors for subjective satisfaction with incus vibroplasty. Furthermore, more conservative selection of candidates and caution during surgery, considering inevitable air–bone gap development postoperatively, may be necessary to achieve higher satisfaction for incus vibroplasty.

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Elevated parathyroid hormone levels after successful parathyroidectomy for primary hyperparathyroidism: a clinical review

Abstract

Introduction

Surgery for primary hyperparathyroidism (PHPT) is traditionally deemed to be successful if serum calcium levels return to normal 6 months after parathyroidectomy. Regular monitoring of serum calcium and parathyroid hormone (PTH) in the follow-up of patients after parathyroidectomy for PHPT has drawn attention to the presence of a normocalcemic group of patients with elevated PTH (NCePTH) during the post-operative period. The etiological factors and mechanisms underlying this condition, its consequences, and the possibility of treatment are the object of this study.

Materials and methods

We conducted an unlimited PubMed search updated on March 31, 2017, which yielded 1628 results. We selected 37 articles, 33 of which included cases of NCePTH in their series and 23 performed statistical studies to assess factors associated with NCePTH.

Results

The maximum mean prevalence of NCePTH in the various series was 23.5%, ranging from 3 to 46%. Many factors were associated with NCePTH. The most important were higher pre-operative PTH, low pre-operative 25 (OH) D3, lower pre-operative creatinine clearance and greater adenoma weight. The origin of NCePTH may be multifactorial, since several factors were implicated in the etiology. NCePTH does not seem to be related to an increase in PHPT recurrence, although this possibility should not be dismissed. Vitamin D deficiency should be corrected. Treatment with calcium supplements seems to be clearly beneficial.

Conclusion

The prevalence of NCePTH is high. The causes of secondary hyperparathyroidism should be investigated carefully. Patients require treatment and long-term follow-up.

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3D endoscopic ear surgery: a clinical pilot study

Abstract

Objective

To evaluate the feasibility and efficacy of a new high-resolution 3D endoscope in endoscopic ear and lateral skull base surgery.

Methods

Eight patients, five women and three men, were included in this clinical pilot prospective study. Their age was 38 ± 17.3 years (mean ± SD, range 17–54 years). The right side was involved in five cases, and the left side in three cases. There were three cases of chronic otitis, one case of cholesteatoma of the external auditory canal, one case of otosclerosis, one case of cochlear implant surgery, and two cases of stage 2 vestibular schwannoma operated on with a retrosigmoid approach to preserve hearing.

Results

There were no intraoperative or postoperative complications. The new system was used during all procedures without the necessity to switch to a 2D mode. The surgeons felt comfortable using the system and its major advantages were considered to be in measuring the distances for ossicular chain reconstruction and in the sense of depth provided in the middle ear and cerebellopontine angle.

Conclusion

The sense of depth provided by the 3D system is effective in both middle ear and lateral skull base surgery. Further improvements (smaller and/or more angled endoscopes) should be considered for future developments in endoscopic ear surgery.

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Schluckbeschwerden bei einer Patientin mit postcricoidaler Raumforderung

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-121342

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Quantitative sensory response of the SCM muscle on sustained low level activation simulating co-contractions during bruxing

Publication date: February 2018
Source:Archives of Oral Biology, Volume 86
Author(s): Lydia Eberhard, Sophia Terebesi, Nikolaos Nikitas Giannakopoulos, Daniel Hellmann, Hans-Jürgen Schindler, Marc Schmitter, Doreen Pfau
ObjectiveBruxism is discussed as an etiological factor in the pathogenesis of orofacial and cervical pain. As the sternocleidomastoid muscle (SCM) is co-activated during clenching, our aim was to investigate, whether the muscle loading leads to peripheral or central sensitizations.DesignIn twenty-one healthy female volunteers, somatosensory profiles of the SCM were recorded according to the test battery of the German Research Network on Neuropathic Pain (DFNS) prior to and after an isometric muscle exercise. QST comprised thermal and mechanical stimuli. A submaximal activation of the SCM (15% MVC) was kept for 10min in sitting position. In separate test sessions one month apart, one sham and one verum experiment were conducted in randomized order. During the muscle loading, the parameters cold detection threshold (CDT), mechanical pain sensitivity (MPS) and pressure pain treshold (PPT) were tested and experimental pain recorded by visual analogoue scales (VAS). All test sessions were performed during the follicular phase of the menstrual cycle (day 5), to avoid effects on pain perception. Data were analyzed with Repeated Measures ANOVA (SPSS 22.0)ResultsNo significant changes were found during or after (sham) loading except for stimulus-response-function (SR, P=0.01) and PPT (P=0.02) in the sham test. No effect was observed in the verum experiment (P=0.12 up to 1.0).ConclusionProlonged low level contraction of the SCM does not evoke painful sensitization. In contrast, submaximal muscle activation seems to have a protective effect corresponding to a training effect preventing sensitization.



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Ink-enhanced dermoscopy is a useful tool to differentiate acquired solitary plaque porokeratosis from other scaly lesions

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Aprotinin and coronary artery bypass surgery

No abstract available

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Procedural sedation and analgesia for adults in Europe: Safety first

No abstract available

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Predictive models for acute kidney injury after cardiac surgery

No abstract available

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European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults

No abstract available

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Safety and quality of procedural sedation and analgesia practice for adult patients throughout Europe: A step forward

No abstract available

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Fibrinogen on Admission in Trauma score: Early prediction of low plasma fibrinogen concentrations in trauma patients

BACKGROUND Early recognition of low fibrinogen concentrations in trauma patients is crucial for timely haemostatic treatment and laboratory testing is too slow to inform decision-making. OBJECTIVE To develop a simple clinical tool to predict low fibrinogen concentrations in trauma patients on arrival. DESIGN Retrospective cohort study. SETTING Three designated level 1 trauma centres in the Paris Region, from January 2011 to December 2013. PATIENTS Patients admitted in accordance with national triage guidelines for major trauma and plasma fibrinogen concentration testing on admission. INTERVENTION Construction of a clinical score [Fibrinogen on Admission in Trauma (FibAT) score] in a derivation cohort to predict fibrinogen plasma concentration 1.5 g l−1 or less after multiple regressions. One point was given for each predictive factor. The score was the sum of all. Validation was performed in a separate validation cohort. MAIN OUTCOME MEASURE Predictive accuracy of FibAT score. RESULTS In total, 2936 patients were included, 2124 in the derivation cohort and 812 in the validation cohort. In the derivation cohort, a multivariate logistic model identified the following predictive factors for plasma fibrinogen concentrations 1.5 g l−1 or less: age less than 33 years, prehospital heart rate more than 100 beats per minute, prehospital SBP less than 100 mmHg, blood lactate concentration on admission more than 2.5 mmol l−1, free intraabdominal fluid on sonography, decrease in haemoglobin concentration from prehospital to admission of more than 2 g dl−1, capillary haemoglobin concentration on admission less than 12 g dl−1 and temperature on admission less than 36°C. The FibAT score had an area under the receiver operating characteristic curve of 0.87 [95% confidence interval (0.86 to 0.91)] in the derivation cohort and of 0.82 (95% confidence interval (0.86 to 0.91)] in the validation cohort to predict a low plasma fibrinogen. CONCLUSION The FibAT score accurately predicts plasma fibrinogen levels 1.5 g l−1 or less on admission in trauma patients. This easy-to-use score could allow early, goal-directed therapy to trauma patients.

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High versus low PEEP for abdominal surgery

No abstract available

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Blood glucose concentrations in prehospital trauma patients with traumatic shock: A retrospective analysis

BACKGROUND Deranged glucose metabolism after moderate to severe trauma with either high or low concentrations of blood glucose is associated with poorer outcome. Data on prehospital blood glucose concentrations and trauma are scarce. OBJECTIVES The primary aim was to describe the relationship between traumatic shock and prehospital blood glucose concentrations. The secondary aim was to determine the additional predictive value of prehospital blood glucose concentration for traumatic shock when compared with vital parameters alone. DESIGN Retrospective analysis of the predefined, observational database of a nationwide Helicopter Emergency Medical Service (34 bases). SETTING Emergency trauma patients treated by Helicopter Emergency Medical Service between 2005 and 2013 were investigated. PATIENTS All adult trauma patients (≥18 years) with recorded blood glucose concentrations were enrolled. OUTCOMES Primary outcome: upper and lower thresholds of blood glucose concentration more commonly associated with traumatic shock. Secondary outcome: additional predictive value of prehospital blood glucose concentrations when compared with vital parameters alone. RESULTS Of 51 936 trauma patients, 20 177 were included. In total, 220 (1.1%) patients died on scene. Hypoglycaemia (blood glucose concentration 2.8 mmol l−1 or less) was observed in 132 (0.7%) patients, hyperglycaemia (blood glucose concentration exceeding 15 mmol l−1) was observed in 265 patients (1.3%). Blood glucose concentrations more than 10 mmol l−1 (n = 1308 (6.5%)) and 2.8 mmol l−1 or less were more common in patients with traumatic shock (P 

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Dobutamine and its haemodynamic effects in pleural effusion

No abstract available

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Median effective dose of intranasal dexmedetomidine sedation for transthoracic echocardiography examination in postcardiac surgery and normal children: An up-and-down sequential allocation trial

BACKGROUND Dexmedetomidine (DEX) has been used for sedation in young infants and children undergoing transthoracic echocardiography (TTE). The median effective dose of intranasal DEX has not been described for postcardiac surgery children. Postcardiac surgery children could require more DEX to achieve satisfactory sedation for TTE examination than children suspected of congenital heart disease. OBJECTIVES To study whether postcardiac surgery children need a larger dose of DEX for TTE than normal children. DESIGN A double-blind sequential allocation trial with doses determined by the Dixon and Massey up-and-down method. SETTING A tertiary care teaching hospital from 25 October to 30 November 2016. PATIENTS Children under the age of 3 years requiring intranasal DEX for TTE. INTERVENTIONS Children were allocated to a postcardiac surgery group (n = 20) or a normal group (n = 19). The first patient in both groups received intranasal DEX (2 μg kg−1): using the up-and-down method of Dixon and Massey, the next dose was dependent on the previous patient's response. MAIN OUTCOME MEASURES Median effective dose was estimated from the up-and-down method of Dixon and Massey and probit regression. A second objective was to study haemodynamic stability and adverse events with these doses. RESULTS The median effective dose (95% confidence interval) of intranasal DEX was higher in postcardiac surgery children than in normal children, 3.3 (2.72 to 3.78) μg kg−1 versus 1.8 (1.71 to 2.04) (μg kg-1), respectively (P 

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Reply to: alveolar recruitment manoeuvres after cardiac surgery

No abstract available

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Clinical signs and electroencephalographic patterns of emergence from sevoflurane anaesthesia in children: An observational study

BACKGROUND Few studies have systematically described relationships between clinical–behavioural signs, electroencephalographic (EEG) patterns and age during emergence from anaesthesia in young children. OBJECTIVE To identify the relationships between end-tidal sevoflurane (ETsevoflurane) concentration, age and frontal EEG spectral properties in predicting recovery of clinical–behavioural signs during emergence from sevoflurane in children 0 to 3 years of age, with and without exposure to nitrous oxide. The hypothesis was that clinical signs occur sequentially during emergence, and that for infants aged more than 3 months, changes in alpha EEG power are correlated with clinical–behavioural signs. DESIGN An observational study. SETTING A tertiary paediatric teaching hospital from December 2012 to August 2016. PATIENTS Ninety-five children aged 0 to 3 years who required surgery below the neck. OUTCOME MEASURES Time–course of, and ETsevoflurane concentrations at first gross body movement, first cough, first grimace, dysconjugate eye gaze, frontal (F7/F8) alpha EEG power (8 to 12 Hz), frontal beta EEG power (13 to 30 Hz), surgery-end. RESULTS Clinical signs of emergence followed an orderly sequence of events across all ages. Clinical signs occurred over a narrow ETsevoflurane, independent of age [movement: 0.4% (95% confidence interval (CI), 0.3 to 0.4), cough 0.3% (95% CI, 0.3 to 0.4), grimace 0.2% (95% CI, 0 to 0.3); P > 0.5 for age vs. ETsevoflurane]. Dysconjugate eye gaze was observed between ETsevoflurane 1 to 0%. In children more than 3 months old, frontal alpha EEG oscillations were present at ETsevoflurane 2.0% and disappeared at 0.5%. Movement occurred within 5 min of alpha oscillation disappearance in 99% of patients. Nitrous oxide had no effect on the time course or ETsevoflurane at which children showed body movement, grimace or cough. CONCLUSION Several clinical signs occur sequentially during emergence, and are independent of exposure to nitrous oxide. Eye position is poorly correlated with other clinical signs or ETsevoflurane. EEG spectral characteristics may aid prediction of clinical–behavioural signs in children more than 3 months.

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Reply to: predictive models for acute kidney injury after cardiac surgery

No abstract available

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Estimating and reporting error rates, and detecting improvements

No abstract available

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Reply to: high versus low positive end-expiratory pressure for abdominal surgery

No abstract available

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Reply to: estimating and reporting rates, and detecting improvements

No abstract available

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Reply to: aprotinin and coronary artery bypass surgery

No abstract available

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Alveolar recruitment manoeuvres after cardiac surgery

No abstract available

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Reply to: dobutamine and its haemodynamic effects in pleural effusion

No abstract available

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Burkholderia cenocepacia integrates cis-2-dodecenoic acid and cyclic dimeric guanosine monophosphate signals to control virulence [Microbiology]

Quorum sensing (QS) signals are used by bacteria to regulate biological functions in response to cell population densities. Cyclic diguanosine monophosphate (c-di-GMP) regulates cell functions in response to diverse environmental chemical and physical signals that bacteria perceive. In Burkholderia cenocepacia, the QS signal receptor RpfR degrades intracellular c-di-GMP when it...

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Catch bond drives stator mechanosensitivity in the bacterial flagellar motor [Biophysics and Computational Biology]

The bacterial flagellar motor (BFM) is the rotary motor that rotates each bacterial flagellum, powering the swimming and swarming of many motile bacteria. The torque is provided by stator units, ion motive force-powered ion channels known to assemble and disassemble dynamically in the BFM. This turnover is mechanosensitive, with the...

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Coexpression of NOS2 and COX2 accelerates tumor growth and reduces survival in estrogen receptor-negative breast cancer [Pharmacology]

Proinflammatory signaling pathways are commonly up-regulated in breast cancer. In estrogen receptor-negative (ER−) and triple-negative breast cancer (TNBC), nitric oxide synthase-2 (NOS2) and cyclooxygenase-2 (COX2) have been described as independent predictors of disease outcome. We further explore these findings by investigating the impact of their coexpression on breast cancer survival....

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Still Bay and Howiesons Poort sites (South Africa) are consistent with the risk hypothesis [Social Sciences]

d'Errico et al.'s (1) conclusion that cultural differences between the Still Bay (SB) and the Howiesons Poort (HP) sites in South Africa (SA) are not accounted for by the risk hypothesis (2) is premature. The risk hypothesis is well-modeled by interaction between risk and mobility as a driver for artifact...

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Intercellular competition and the inevitability of multicellular aging [Evolution]

Current theories attribute aging to a failure of selection, due to either pleiotropic constraints or declining strength of selection after the onset of reproduction. These theories implicitly leave open the possibility that if senescence-causing alleles could be identified, or if antagonistic pleiotropy could be broken, the effects of aging might...

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Reply to Read: Middle Stone Age cultural variability and the risk hypothesis [Social Sciences]

Read's letter (1) on our article (2) unfortunately misinterprets the conclusions we reached and hypotheses we proposed. We struggle to find a passage in which we state that the risk hypothesis does not account for the material culture differences that we observe between the Still Bay and Howiesons Poort cultural...

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In This Issue [This Week in PNAS]

Cas9-expressing mosquito strains pave the way toward gene drives SEM image of genome-edited adult female mosquito. Left compound eye is split up, and there are three maxillary palps instead of the normal two. Image courtesy of Michelle Bui and Alexander Knyshov (University of California, Riverside, CA). Previous efforts to use...

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Transcription start site-associated small RNAs in the PTEN gene [Biological Sciences]

The PTEN gene is inactivated in various cancers. PTEN has a pseudogene in the human genome, PTENpg1, which up-regulates PTEN expression by acting as a miRNA sponge. Interestingly, one of the antisense RNAs from the PTENpg1 locus, PTENpg1 asRNA α, is found to epigenetically down-regulate PTEN transcription by recruitment of...

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Multiple pathways in pressure-induced phase transition of coesite [Earth, Atmospheric, and Planetary Sciences]

High-pressure single-crystal X-ray diffraction method with precise control of hydrostatic conditions, typically with helium or neon as the pressure-transmitting medium, has significantly changed our view on what happens with low-density silica phases under pressure. Coesite is a prototype material for pressure-induced amorphization. However, it was found to transform into a...

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Reply to Liu et al.: Yin and yang of PTEN regulation [Biological Sciences]

In a letter to the editor, Liu et al. (1) find that PTEN contains some transcript variants that are polyadenylated and prematurely terminated in the first intron of PTEN. These transcripts are suggested to be 5′-UTR–containing promoter-spanning and to encode for three small RNAs (sRNAs), with one of these (sRNA3)...

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Differential effects of global and local climate data in assessing environmental drivers of epidemic outbreaks [Ecology]

This Commentary is the response of a China historian to the paper by the team of biologists headed by Huidong Tian (1) on the differential effects of using long-term or short-term data to reconstruct climatic drivers of human epidemics. The Tian et al. paper is a response to an anomaly...

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High postural costs and anaerobic metabolism during swimming support the hypothesis of a U-shaped metabolism-speed curve in fishes [Physiology]

Swimming performance is considered a key trait determining the ability of fish to survive. Hydrodynamic theory predicts that the energetic costs required for fishes to swim should vary with speed according to a U-shaped curve, with an expected energetic minimum at intermediate cruising speeds and increasing expenditure at low and...

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Shifts in time and space interact as climate warms [Ecology]

Beetles found on Mediterranean shores in cold periods turned up in Finland in mild interglacials (1). Paleontologists see such range shifts as systematic responses to changing climate. No surprise, then, that recent global trends for poleward and upward range shifts are attributed to current warming (2, 3). However, range shifts...

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Metal transporter Slc39a10 regulates susceptibility to inflammatory stimuli by controlling macrophage survival [Biochemistry]

Zn plays a key role in controlling macrophage function during an inflammatory event. Cellular Zn homeostasis is regulated by two families of metal transporters, the SLC39A family of importers and the SLC30A family of exporters; however, the precise role of these transporters in maintaining macrophage function is poorly understood. Using...

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The power of negative [theoretical] results [Evolution]

In PNAS, Paul Nelson and Joanna Masel present a theoretical result showing that aging in multicellular organisms is inevitable (1). The argument is as simple as it is powerful. Cellular senescence is a well-known consequence of the second law of thermodynamics, due to mutations, epigenetic misregulation, and protein misfolding. Molecular...

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Model-driven engineering of supramolecular buffering by multivalency [Chemistry]

A supramolecular system in which the concentration of a molecule is buffered over several orders of magnitude is presented. Molecular buffering is achieved as a result of competition in a ring–chain equilibrium of multivalent ureidopyrimidinone monomers and a monovalent naphthyridine molecule which acts as an end-capper. While we previously only...

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Dabbling with Piezo2 for mechanosensation [Physiology]

Nature has devised various strategies for sensing food so species can coexist and exploit different types of prey. Sharks can detect amino acids in blood as low as 1 ppb, while hawks and buzzards scan the Earth from a height of ∼10,000 feet looking for rodents. However, not all birds...

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Phenological shifts conserve thermal niches in North American birds and reshape expectations for climate-driven range shifts [Ecology]

Species respond to climate change in two dominant ways: range shifts in latitude or elevation and phenological shifts of life-history events. Range shifts are widely viewed as the principal mechanism for thermal niche tracking, and phenological shifts in birds and other consumers are widely understood as the principal mechanism for...

http://ift.tt/2BLVFIG

Equilibration of energy in slow-fast systems [Applied Mathematics]

Ergodicity is a fundamental requirement for a dynamical system to reach a state of statistical equilibrium. However, in systems with several characteristic timescales, the ergodicity of the fast subsystem impedes the equilibration of the whole system because of the presence of an adiabatic invariant. In this paper, we show that...

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Cancer cells induce interleukin-22 production from memory CD4+ T cells via interleukin-1 to promote tumor growth [Immunology and Inflammation]

IL-22 has been identified as a cancer-promoting cytokine that is secreted by infiltrating immune cells in several cancer models. We hypothesized that IL-22 regulation would occur at the interface between cancer cells and immune cells. Breast and lung cancer cells of murine and human origin induced IL-22 production from memory...

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The perioperative significance of systemic arterial diastolic hypertension in adults

Purpose of review Hypertension affects approximately one third of the U.S. population and is the most common preventable medical reason that surgical cases are postponed or cancelled. However, subtypes of hypertension and their perioperative risks are poorly studied and understood. We will review the natural history and pathophysiology of essential hypertension and discuss the perioperative significance of diastolic blood pressure elevation. Recent findings There is evidence that elevated preoperative diastolic blood pressures are associated with an increased perioperative risk of cardiovascular and cerebrovascular events and increased postoperatively 30-day mortality. However, lower preoperative diastolic blood pressures were found, in one study, to be associated with renal injury. Summary Diastolic hypertension and hypotension both carry perioperative risk. Further study needs to be dedicated to elucidating the risks and developing strategies for acute and chronic management of diastolic blood pressure changes in order to improve perioperative safety. Correspondence to Edwin G. Avery IV, MD, Chief Anesthesia Officer, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA. Tel: +1 216 844 7334; fax: +1 216 844 3781; e-mail: edwin.avery@uhhospitals.org Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Perioperative pulmonary thromboembolism: current concepts and treatment options

Purpose of review Anesthesiologists are familiar with pulmonary emboli prophylaxis paradigms and many have witnessed acute intraoperative embolization. Clinicians must balance conservative anticoagulation and aggressive intervention in perioperative submassive pulmonary emboli, yet the bulk of the literature excludes surgery as a relative contraindication. This review will summarize the current treatment options for acute pulmonary emboli, drawing attention to special considerations in perioperative submassive pulmonary emboli, and discuss right ventricular monitoring to improve assessment of intervention efficacy. Recent findings Recent reviews have identified the elevated risk and inadequacy of treatment of pulmonary embolism in intra and postoperative patients, in part because of the risks of systemic anticoagulation. Early studies of catheter-directed therapies have shown promising efficacy with a reduction in bleeding risk, which is especially important for perioperative patients. Success relies on defining endpoints, yet the practice of measuring mean pulmonary artery pressure alone to assess intervention efficacy is flawed. Summary Identifying submassive pulmonary emboli that requires treatment and optimizing therapy remains difficult. Researchers must consider avoiding systemic anticoagulation and focus on designing trials that evaluate intervention efficacy in surgical patients. The success of catheter-directed therapy in early trials warrants further investigation into using these therapies in the treatment of perioperative submassive pulmonary emboli. Correspondence to Paul M. Heerdt, MD, PhD, Division of Applied Hemodynamics, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street B425, New Haven, CT 06520, USA. E-mail: paul.heerdt@yale.edu Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Surgery and discontinuation of angiotensin converting enzyme inhibitors: current perspectives

Purpose of review The current article reviews the current evidence for continuing or discontinuing angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) during the perioperative period. Recent findings In patients undergoing treatment of hypertension with ACEIs or ARBs, there are both benefits associated with continuing these medications during the perioperative period and higher risk for perioperative hypotension and its complications. Summary Since the introduction of ACEIs and ARBs into clinical practice, their use during the perioperative period has been controversial. Although these medications increase the risk of serious hypotension immediately after induction and maintenance of anesthesia, their use has numerous benefits, making it reasonable to continue them during perioperative period. Correspondence to Nikola Bradic, MD, Department of Cardiovascular Anesthesiology and Cardiac Intensive Medicine, Clinic of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, Gojko Susak Avenue No. 6, 10000 Zagreb, Croatia. e-mail: nbradic@kbd.hr Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Drug-induced sleep endoscopy: from obscure technique to diagnostic tool for assessment of obstructive sleep apnea for surgical interventions

Purpose of review Provide a practical update on drug-induced sleep endoscopy (DISE) for anesthesia providers, which can also serve as a reference for those preparing to establish a DISE program. Recent findings New developments in surgical approaches to OSA and the growing global incidence of the condition have stimulated increased interest and demand for drug-induced sleep endoscopy. New techniques include transoral robotic surgery and hypoglossal nerve stimulation. Recent DISE literature has sought to address numerous debates including relevance of DISE findings to those during physiologic sleep and the most appropriate depth and type of sedation for DISE. Propofol and dexmedetomidine have supplanted midazolam as the drugs of choice for DISE. Techniques based on pharmacokinetic models of propofol are superior to empiric dosing with regard to risk of respiratory compromise and the reliability of dexmedetomidine to achieve adequate conditions for a complete DISE exam is questionable. Summary The role of DISE in surgical evaluation and planning for treatment of OSA continues to develop. Numerous questions as to the optimal anesthetic approach remain unanswered. Multicenter studies that employ a standardized approach using EEG assessment, pharmacokinetic–pharmacodynamic modelling, and objectively defined clinical endpoints will be helpful. There may be benefit to undertaking DISE studies in non-OSA patients. Correspondence to Joshua H. Atkins, Associate Professor of Anesthesiology & Critical Care, Associate Professor of Otorhinolaryngology: Head & Neck Surgery, Department of Anesthesiology & Critical Care, Perelman School of Medicine at the University of Pennsylvania, 680 Dulles Building, 3400 Spruce Street, Philadelphia, PA 19104, USA. Tel: +1 215 203 4781; e-mail: Joshua.Atkins@uphs.upenn.edu Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Eighth Edition of the UICC Classification of Malignant Tumours: an overview of the changes in the pathological TNM classification criteria—What has changed and why?

Abstract

The TNM classification of malignant tumours is a mainstay tool in clinical practice and research for prognostic assessment of patients, treatment allocation and trial enrolment, as well as for epidemiological studies and data collection by cancer registries worldwide. Pathological TNM (pTNM) represents the pathological classification of a tumor, assigned after surgical resection or adequate sampling by biopsy, and periodical updates to the relative classification criteria are necessary to preserve its clinical relevance by integrating newly reported data. A structured approach has been put in place to fulfil this need and, based upon this process, the Eighth Edition of Union for International Cancer Control (UICC) TNM Classification of Malignant Tumours has been published, introducing many significant changes, including novel classification criteria for specific tumour types. In this review, we aim to describe the major changes introduced in the pTNM classification criteria and to summarize the evidence supporting these changes.

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Lacrimal Caruncle Nevus with Papilloma

Purpose: The aim of this article is to report a case of lacrimal caruncle nevus with papilloma. Methods: This is a case report of a 39-year-old female with a progressively enlarging pigmented lesion on the left lacrimal caruncle. She had been aware of a raised whitish wart on the top of this pigmented lesion for several months before her initial visit. Slit lamp examination revealed a papillomatous lesion over a well-circumscribed, pigmented lesion on the left lacrimal caruncle. Results: The histopathological examination of the excised tumor disclosed 2 characteristic findings, which include nests of nevus cells within the dermis and papillomatous structures which had fibrovascular cores overlying squamous cell epithelia with variable levels of acanthosis. The findings were consistent with an intradermal nevus and a papilloma arising from the conjunctival epithelium of the nevus. Conclusion: This is the first case report of a lacrimal caruncle nevus with papilloma. The clinical history and pathological findings of this case underscore the fact that an intradermal nevus primarily occurred on the lacrimal caruncle, after which a papilloma arose from the epithelium of the nevus as a consequence of human papillomavirus autoinoculation.
Case Rep Ophthalmol 2017;8:535–538

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International Forum of Allergy & Rhinology 2017 Reviewers

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Issue Information

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Epacadostat + Pembro for Melanoma: Beneficial, Well Tolerated

This combination produced impressive response and disease control rates with good tolerability in treatment-naive patients with advanced melanoma.
Medscape Oncology

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Medikamentöse Therapie des Nebennierenkarzinoms

Zusammenfassung

Hintergrund

Das Nebennierenkarzinom ist eine seltene Erkrankung mit ungünstiger Prognose und variablem Verlauf. Neben der möglichst vollständigen Resektion als wichtigste Therapie werden verschiedene medikamentöse Optionen eingesetzt.

Ziel

Neben den gängigen medikamentösen Therapieoptionen wird in diesem Artikel der aktuelle Stand zu zielgerichteten Therapieoptionen beleuchtet.

Material und Methoden

Selektive Literaturrecherche (PubMed) sowie Auswertung des eigenen Patientenkollektivs.

Ergebnisse und Diskussion

Unter den verschiedenen medikamentösen Therapieoptionen stellt Mitotan – trotz vieler Nebenwirkungen – weiterhin die Therapie der ersten Wahl sowohl im adjuvanten Setting als auch bei der fortgeschrittenen Erkrankung dar. Im weiteren Verlauf wird Mitotan bei Progress oder initial schon aggressiver Erkrankung um Chemotherapeutika (z. B. Kombination von Etoposid, Doxorubicin, Cisplatin) ergänzt. Die weitere Behandlung ist dann sehr vom individuellem Erkrankungsverlauf, der Höhe der ggf. vorliegenden Tumorlast und des Allgemeinzustands des Patienten abhängig.

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Nodal Factors Predictive of Recurrence After Thyroidectomy and Neck Dissection for Papillary Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Nail-Extracting Behavior as an Unusual Manifestation of Adjustment Disorder, Confused with Onychotillomania

Abstract

Nails are the subject of various psychocutaneous disorders. This spectrum of disorders includes onychophagia, nail tic disorder, onychotillomania, and nail destruction associated with psychiatric disorders.[1] Although self-induced nail injuries, such as biting and rubbing, are common, there was an extraordinary case of self-inflicted, nail-extracting behaviors in an unusual presentation of adjustment disorder.

This article is protected by copyright. All rights reserved.

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The Dreaded “Stomach Bug”

What causes the "stomach bug"?

Acute Gastroenteritis (AGE) in U.S. children, commonly referred to as the "the stomach bug" by frustrated parents everywhere, is most often caused by a short list of viruses.  The usual suspects each have their own peak incidence during the year but can also be found in random outbreaks.

 

Until recently, the most common stomach virus was Rotovirus, which peaks in the fall and winter months, and can cause severe diarrhea, especially in young infants and children. Fortunately, a Rotovirus vaccine was introduced in 2006, resulting in a 90% decrease in cases every year. Other common bugs include Norovirus, Adenovirus, Sapovirus and Astrovirus – each with distinct symptoms and peak seasons, and all of which no fun!

 

What are the most common symptoms of the "stomach bug"?

• Diarrhea
  • -generally frequent and watery or loose
  • -can contain mucous or blood (but usually not)
  • –causes fluid and electrolyte losses
  • -may last a week or more
• Vomiting
  • –affects more than half of sufferers.
  • –causes fluid and electrolyte losses
  • -usually lasts 1-2 days

Symptoms vary by age, from person to person and from day to day.  Other symptoms can include fever, crampy abdominal pain, muscle aches, fatigue, loss of appetite and runny nose or sore throat.

The first infection with one of the common viruses suspects generally results in the most severe or prolonged illness.  This explains why young infants and children tend to have the worst cases.

 

 

What should I be worried about?

• The severity of the illness is reflected by the degree of dehydration
• Mild Dehydration: slightly dry or sticky mouth, mild dizziness, urinating less

Most common

Give fluids at home

• Worsening dehydration: dry mouth, decreased urination, increased heart rate, faster and deeper breathing, sunken soft spot, sunken eyes, no tears with crying, listlessness or irritability. 

Infants and young children more susceptible

Call your pediatrician

• Replacing loss of water and electrolytes is #1 priority.
• Pedialyte is preferred for young infants and children.
• Water
• Sports drinks are ok for older children
• Breastfeeding and full strength formula feeding should not be stopped unless infant cannot hold it down
• Start small and go slow if there is vomiting. Popsicles are great for this.
• Resume child's usual diet as soon as child is rehydrated and not vomiting
• Avoid high fat and high sugar foods. Don't give pizza as soon as your child is hungry again!

 

Do any medications or supplements help?

• Your pediatrician may prescribe Zofran (ondansetron) dissolvable tablet, if needed
• aids in oral rehydration by stopping vomiting
• can be used with children over 6 months with viral AGE and persistent vomiting
• slow and steady fluids until child can drink freely without vomiting
• Probiotics
• reduce both the frequency and duration or diarrhea in viral AGE
• no significant side effects
• available and safe for infants and children
• Available at most drug stores
• give probiotics at the start of the illness and then daily for 5-7 days

 

Diarrhea versus the skin?

Diarrhea wreaks havoc on the tender skin of the diaper area in infants and young children.  Irritant diaper dermatitis caused by frequent stool contact with the skin is extremely common in AGE and can be a headache to manage.

A Air time.  Go diaper free and get air to the skin

B Barrier.  Use a zinc oxide based ointment or paste like Desitin with every diaper change.  Do not attempt to remove all the ointment when you change the diaper.  Just clean off what is soiled and easily removed then add more.

C  Clean.  Keep skin clean and dry.  You can rinse out wipes or use soft washcloth with warm water to clean away stool and urine.  Older infants can soak in a 10 minute baking soda bath once a day to aid in healing the skin.

D  Diaper changes.  Change diapers frequently.

 

 

How can I keep my kids from getting "the stomach bug"?

• Vaccination: Rotavirus vaccine is recommended for all infants at 2, 4 and 6 months of age.  Rotavirus vaccine provides protection in the first 1-2 years of life.
• Handwashing: Wash your hands with soap and water after diaper changes or any contact with stool or vomit.  Common alcohol based hand sanitizers are not recommended in place of washing with soap.
• Prevent spread to others: Individuals can spread the virus in stool for several days after all symptoms have stopped and may also be contagious before symptoms have begun.

Recommendations on returning to daycare or school vary, but erring on the side of caution will help reduce the spread of infection to other children.
At a minimum, children should be kept home if

• They've had 2 or more incidents of diarrhea in one day, or any stools are not contained in the diaper.
• Any stool accidents in a toilet trained child
• any vomiting within last 24 hours

 

With any luck, you can keep the bug at bay this season. But if you're not that lucky, hopefully these tips can help provide some comfort to your little ones – and a speedy recovery!

 

The post The Dreaded "Stomach Bug" appeared first on ChildrensMD.

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Response to “Phase IV head-to-head randomised controlled trial comparing ingenol mebutate 0.015% gel with diclofenac sodium 3% gel for the treatment of actinic keratosis on the face or scalp” – reply from authors

Abstract

We thank Drs Malvehy and Puig for their comments on the article; our responses follow. Drs Malvehy and Puig correctly note that the primary endpoint is complete clearance at the end of the first treatment course. Here, the rates are 34.5% for IngMeb and 23.5% for DS. It is not clear why Malvehy and Puig believe that a comparison at the same time point would be better.

This article is protected by copyright. All rights reserved.

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Body Mass Index and Olfactory Fossa Depth in Patients with and without Spontaneous Cerebrospinal Fluid Leaks

Background/Aims: Spontaneous cerebrospinal fluid (SCSF) leaks are associated with a high body mass index (BMI) and an expanded skull base. The purpose of this study is to determine if a correlation exists between BMI and olfactory fossa depth (OFD) in patients with SCSF leaks and those without. Methods: This is a cross-sectional study evaluating the correlation between OFD and BMI in patients with and without SCSF leaks. OFD was measured on computed tomography obtained in temporal proximity to the BMI. Results: Patients with SCSF leaks had a deeper mean OFD than controls (6.39 vs. 5.46 mm, p = 0.013) and a larger BMI (38.2 vs. 30.5, p = 0.0003). Pearson correlation was positive between BMI and OFD in women from the control group (R = 0.319, n = 93, p = 0.002 on the left; R = 0.313, n = 93, p = 0.002 on the right) but insignificant in men. Conclusions: The olfactory fossa is deeper and the BMI higher in patients with SCSF leaks than in those without. Differences were statistically significant. Higher BMI may predict deeper olfactory fossa in women but not in men. These findings suggest expansion of weak points in the skull base as precursors to the development of SCSF leaks in response to elevated CSF pressures, particularly in women.
ORL 2017;79:331-335

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Regulation of immunometabolism in adipose tissue

Abstract

Adipose tissue has emerged as a major player in driving obesity-related inflammatory response. In obesity, chronic infiltration of macrophages in adipose tissue mediates local and systemic inflammation and acts as a key contributor to insulin resistance. In the past few years, adipose tissue plasticity and remodeling capacity has been studied extensively to develop therapeutic targets to combat obesity and related metabolic dysfunction. Progress in understanding the potential of adipocytes and contribution of macrophages and other immune cells to control immunometabolism in disease state has provided us new potential intervention targets to explore such as the formation of heat-producing beige adipocytes in white adipose tissue and the polarization of macrophages from an inflammatory toward an anti-inflammatory phenotype. Initiation and progression of inflammatory signaling in fat pads is complex, broad, and often functions in a tissue/cell type-specific manner. We have also realized the importance of location, coordinated role of tissue cross-talk, and physiological state of the fat pad in these processes. There has been significant progress in understanding how adipose tissue regulates these crucial processes and maintains metabolic homeostasis such as identification of fat depot-specific regulation of energy metabolism, mediators of macrophage polarization, role of gut-derived antigens, and consequences of diet and calorie restriction on adipose tissue metabolic and thermogenic potential.

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Hemostasis, endothelial stress, inflammation, and the metabolic syndrome

Abstract

Obesity and the metabolic syndrome (MS) are two of the pressing healthcare problems of our time. The MS is defined as increased abdominal obesity in concert with elevated fasting glucose levels, insulin resistance, elevated blood pressure, and plasma lipids. It is a key risk factor for type 2 diabetes mellitus (T2DM) and for cardiovascular complications and mortality. Here, we review work demonstrating that various aspects of coagulation and hemostasis, as well as vascular reactivity and function, become impaired progressively during chronic ingestion of a western diet, but also acutely after meals. We outline that both T2DM and cardiovascular disease should be viewed as inflammatory diseases and describe that chronic overload of free fatty acids and glucose can trigger inflammatory pathways directly or via increased production of ROS. We propose that since endothelial stress and increases in platelet activity precede inflammation and overt symptoms of the MS, they are likely the first hit. This suggests that endothelial activation and insulin resistance are probably causative in the observed chronic low-level metabolic inflammation, and thus both metabolic and cardiovascular complications linked to consumption of a western diet.

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Combination Strategy Could Hold Promise for Ovarian Cancer

Johns Hopkins Kimmel Cancer Center researchers demonstrated that mice with ovarian cancer that received drugs to reactivate dormant genes along with other drugs that activate the immune system had a greater reduction of tumor burden and significantly longer survival than those that received any of the drugs alone.

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Hidradenitis and smoking – reply from authors

Abstract

We thank Saleem et al., for providing commentary on a relevant aspect of statistical analysis and interpretation as it relates to our study, the primary objective for which was to assess the directionality and strength of relationship between tobacco smoking (TS) and hidradenitis suppurativa (HS).¹ To our knowledge, no previous population-based study has evaluated the effect of TS on actual incidence of disease. While we were able to establish that smokers had twice the adjusted likelihood of incident disease compared to non-smokers, we agree that relative measures of risk may overestimate the effect of an exposure, particularly when the outcome of interest is rare.

This article is protected by copyright. All rights reserved.

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Factors affecting operative time in robotic thyroidectomy

Abstract

Background

The purpose of this study was to evaluate factors related to operative time in robotic thyroidectomy.

Methods

We retrospectively analyzed 240 patients who underwent robotic thyroidectomy. The total thyroidectomy cases and lobectomy cases were both categorized into those with long operative times (LOTs; upper 25% of cases) and those with short operative times (SOTs; lower 25%).

Results

Among the total thyroidectomy cases, body mass index (BMI) ≥23 kg/m² (hazard ratio [HR] 5.34; P = .008) and bilateral central neck dissection (CND; HR 14.92; P = .028) were more frequent in the LOT group in multivariate analysis. Among the lobectomy cases, BMI ≥23 kg/m² (HR 12.92; P = .003) and unilateral CND (HR 21.38; P = .017) were the only independent risk factors for prolonged operative time.

Conclusion

Body habitus and clinical nodal status in the central compartment should be considered in deciding the indications for robotic thyroidectomy.

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Nutritional and hematologic markers as predictors of risk of surgical site infection in patients with head and neck cancer undergoing major oncologic surgery

Abstract

Background

Surgical site infection is a complication of surgery for patients with head and neck cancer. We examined the risk factors for surgical site infection in patients undergoing surgery for head and neck cancer.

Methods

The study involved 369 patients who underwent surgery for head and neck cancer. Hematological and nutritional parameters were measured preoperatively and postoperatively. Univariate and multivariate analyses were used to determine the risk factors for surgical site infection.

Results

Of the 369 patients, 104 (28.2%) had surgical site infections: 45 (12.2%) superficial incisional; 6 (1.6%) deep incisional; and 53 (14.4%) organ/space infections. Multivariate analyses showed that history of radiotherapy, weight loss at diagnosis (>5%), preoperative hypoalbuminemia, neutrophil/lymphocyte ratio (NLR), reconstructive surgery, and tracheostomy were the independent factors predictive of surgical site infection. Patients with preoperative low serum albumin levels (<3.3 g/L) had a 3-fold higher risk of surgical site infection.

Conclusion

Our study shows that patient nutritional and hematological markers are associated with the risk of surgical site infection after major surgery for head and neck cancer.

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Growing incidence of thyroid carcinoma in recent years: Factors underlying overdiagnosis

Abstract

There is an increasing incidence of well-differentiated thyroid cancer worldwide. Much of the increase is secondary to increased detection of small, low-risk tumors, with questionable clinical significance. This review addresses the factors that contribute to the increasing incidence and considers environmental, and patient-based and clinician-led influences. Articles addressing the causes of the increased incidence were critically reviewed. A complex interplay of environmental, medical, and social pressures has resulted in increased awareness of the thyroid disease risk, increased screening of thyroid cancers, and increased diagnosis of thyroid cancers. Although there is evidence to suggest that the true disease incidence may be changing slightly, most of the increase is related to factors that promote early diagnosis of low-risk lesions, which is resulting in a significant phenomenon of overdiagnosis. An improved understanding of these pressures at a global level will enable healthcare policymakers to react appropriately to this challenge in the future.

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Pharyngeal perforation after anterior cervical spine surgery treated by transoral endoscopic surgery

Abstract

Background

Anterior cervical fixation has been used since 1967 for multiple pathologies like traumatism, compressive myelopathy, or spinal infections.

Methods

We report the case of a patient who had undergone cervical spine surgery 10 years previously and presented to our clinic with a pharyngeal fistula due to surgical screw displacement that was treated by transoral endoscopic surgery.

Results

The immediate postoperative period occurred without incidence and complete odynophagia resolution. The patient was discharged home the fourth day after surgery. Follow-up after 1 year showed no evidence of spinal fixation hardware mobilization.

Conclusion

We consider the transoral endoscopic approach a feasible low comorbidity technique to treat anterior cervical plate mobilization with pharyngeal and pharyngoesophageal perforations.

http://ift.tt/2kkTjwf

AHNS Series: Do you know your guidelines? Evidence-based management of oral cavity cancers

Abstract

Oral cavity squamous cell carcinoma (OCSCC) is the most common nonmelanoma head and neck cancer in the world, with an estimated 405 000 new cases expected each year. Subsites of the oral cavity include the alveolar ridge, buccal mucosa, anterior tongue, tonsillar pillar, retromolar trigone, hard palate, gingiva, and floor of the mouth. In this issue of the AHNS "Do you know your guidelines?" series, we review the evidence-based approach to the management of oral cavity carcinomas based on the framework provided by the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology.

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Therapeutic and prognostic significance of PARP-1 in advanced mycosis fungoides and sezary syndrome

Abstract

While mycosis fungoides (MF) is typically an indolent malignancy, it may infrequently undertake an aggressive course. We used proteomic analyses to identify a biomarker of the aggressive course of MF. Results of this investigation demonstrated that PARP-1, heat shock protein family A (Hsp70) member 1 like (HSAP1L), Hsp70 member 1A (HSPA1A), ATP-depending RNA-helicase (DDX17), and the α isoform of lamina-associated polypeptide 2 (TMPO) had higher expression in aggressive disease versus non-aggressive. Moreover, PARP-1 was overexpressed in patients with early stage of MF who developed later an aggressive disease. PARP-1 was evaluated as a new target for therapy, demonstrating the selective dose-dependent cytotoxic effect of PARP inhibitors on Sézary cells in comparison with non-malignant lymphocytes. In conclusion, we believe that PARP-1 may serve not only as a biomarker at initial biopsies for a disease that may become aggressive but also as a new therapeutic target of advanced MF and Sézary syndrome.

This article is protected by copyright. All rights reserved.

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The need for longer time horizons for cost-utility evaluation in bullous pemphigoid

Abstract

We read with interest the article from Mason et al offering a cost-effectiveness analysis comparing doxycycline and prednisolone as initial treatment for bullous pemphigoid (BP). ¹ As a prospective cost-utility analysis auxiliary to a multi-centre randomised controlled trial² with robust statistical modelling, the study is methodologically sound. The time horizon of the study was twelve months and the primary outcomes sought were short-term effectiveness and long-term safety.

This article is protected by copyright. All rights reserved.

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Response to “Phase IV head-to-head randomised controlled trial comparing ingenol mebutate 0.015% gel with diclofenac sodium 3% gel for the treatment of actinic keratosis on the face or scalp”

Abstract

We read with attention the recent paper by Stockfleth et al¹ on the efficacy and safety of Ingenol Mebutate 0.015% gel (IngMb) vs. diclofenac sodium 3% gel (DS) for the treatment of actinic keratosis (AK). Regarding this interesting study, we would like to address some comments to the authors.In this study, the primary endpoint was complete clearance of AKs (AKCLEAR100) at end of first treatment course (Week8, IngMeb; Week17, DS).

This article is protected by copyright. All rights reserved.

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The need for longer time horizons for cost-utility evaluation in bullous pemphigoid – reply from authors

Abstract

We thank Drs Liu and Sebaratnam for their commentary on our paper¹ and agree with their insights. The adverse event legacy or oral steroids may be a long one; their concerns support our proposed strategy of sparing oral steroids by starting on doxycycline. Of patients starting on doxycycline within the BLISTER trial, 57.8% subsequently received at least one prescription of prednisolone. Thus, the two strategies may converge over time, although possibly much less prednisolone is required to achieve remission at least in the first year.

This article is protected by copyright. All rights reserved.

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Hidradenitis and smoking

Abstract

Smoking is common in patients with hidradenitis suppurativa and may be a risk factor for the disease.¹ Garg et al reported in a large, population-based, retrospective cohort study that apparently new hidradenitis was seen in 0.20% (7,860/3,924,310) of smokers versus 0.11% (8,430/8,027,790) of non-smokers over a 3 year period.² They concluded that hidradenitis is twice as common among smokers, a finding that lay media have covered³, and suggest that populations at risk for hidradenitis be counselled for smoking cessation.²

This article is protected by copyright. All rights reserved.

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Is there a sex-shift in prevalence of allergic rhinitis and comorbid asthma from childhood to adulthood? A meta-analysis

Allergic rhinitis and asthma as single entities affect more boys than girls in childhood but more females in adulthood. However, it is unclear if this prevalence sex-shift also occurs in allergic rhinitis and...

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Issue Information

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Association of palatine tonsil size and obstructive sleep apnea in adults

Objective

The relationship between palatine tonsil (PT) size and obstructive sleep apnea (OSA) has not been well established in adults. The purpose of this study was to test the association between PT grade, PT volume, and OSA severity in U.S. adult patients.

Study Design

Cross-sectional study of all patients (age ≥ 18 years) who underwent pharyngeal surgery for OSA that included palatine tonsillectomy with tonsil volume measurement from January 2011 to June 2016.

Methods

Medical records were reviewed for PT grade (measured on clinical exam by the Brodsky tonsil grading scale), PT volume (measured intraoperatively by water displacement), and apnea–hypopnea index (AHI). Associations were evaluated with multivariate linear regression adjusting for age, sex, body mass index (BMI), smoking status, lingual tonsil volume (AHI models only), and multilevel surgery aside from lingual tonsillectomy (PT volume vs. AHI model only).

Results

The cohort (N = 83) was middle-aged (mean age 43 ± 12 years), predominantly male (61%), obese (mean BMI 33 ± 7 kg/m²), and had severe OSA (mean AHI 32 ± 28). After adjustment for confounders, PT grade was strongly associated with PT volume (beta = 1.8, 95% confidence interval [CI]: [1.0, 2.6], P < 0.001) and with AHI (beta = 13.5, 95% CI: [3.5, 23.6], P = 0.01); PT volume was not associated with AHI (beta = −0.2, 95% CI: [−2.2, 1.9], P = 0.89).

Conclusion

In contrast to past studies, subjective PT grade (vs. objective PT volume) was more strongly associated with AHI. These data suggest the space that the tonsils occupy within the oropharyngeal airway, instead of their actual measured volume, may be more predictive of OSA severity in a cohort of U.S. adult patients.

Level of Evidence

2c. Laryngoscope, 2017

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