Publication date: Available online 8 December 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Eman A. Said
Background and aimPresbycusis, is usually a harbinger of aging. The negative consequences are not limited to an auditory impairment but influences a range of psychosocial and physical health concerns. The cornerstone of audiologic intervention is the use hearing aids. Optimal management should include an evaluation of quality of life (QoL) status and its assessment. Aim of this work: To quantify the quality of life of hearing impaired elderly individuals (HIEI) and to assess hearing aids impact on QoL.SubjectsElderly patients (1 2 7) above 60 years had sensorineural hearing loss ranged from mild to severe degree of hearing loss, only 24 of them (21.1%) were fitted with monaural hearing aid.MethodsEach subject of this study underwent basic audiologic evaluation, speech perception in noise, aided tonal sound field threshold and aided speech tests. Generic WHOQOL-BREF and hearing handicap inventory for the elderly (HHIE).ResultsThere were significant lower aided tonal sound field thresholds (ATSFTs) at 0.5, 1, 2 and 4 kHz of hearing aid users when compared with values of non-users at all tested frequencies. Hearing aid users perform better in all domains of WHO QOL-BREF with significant reductions in emotional, social and total scores of HHIE in users group compared with non-users indicated improvement in their QOL. There were no significant differences between scores of males and scores of females. The severity of the hearing loss had statistically significant effects on these scores for non-users but not in users group.
http://ift.tt/2kI8Iqx
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Παρασκευή 8 Δεκεμβρίου 2017
Health-related quality of life in elderly hearing aid users vs. non-users
Unusual pathological fracture of the clavicle revealing primary hyperparathyroidism: a case report
Primary hyperparathyroidism revealed by a pathological fracture is very uncommon; in the majority of cases the discovery of lytic bone lesions on imaging examinations evokes in the clinician first a neoplastic...
http://ift.tt/2yR3Owe
Association of HLA-DQB1*03:03 with pityriasis rosea in Chinese patients
Summary
Background
The association of human leucocyte antigen (HLA) with a variety of diseases has been described, especially with various autoimmune diseases. However, there are few studies on the association between HLA and pityriasis rosea (PR).
Aim
To investigate the relevance of HLA II alleles with the development of PR.
Methods
Typing for HLA-DRB1, HLA-DQA1 and HLA-DQB1 typing was performed in 55 patients with PR and 90 healthy controls (HCs), using sequence-based typing (SBT) and PCR with sequence-specific primers (PCR-SSP), respectively.
Results
We found that the frequency of HLA-DQB1*03:03 was significantly higher in the PR compared with the HC group [P = 0.001; relative risk (RR) = 2.24; 95% CI 1.38–3.6], while suggestive evidence for a protective effect of HLA-DQB1*06:06 was observed in the study cohort (P < 0.02; RR = 0.40; 95% CI 0.17–0.90).
Conclusions
The HLA-DQB1*03:03 allele may be a susceptible factor in patients with PR. In addition, the association of HLA-DQB1*03:03 with PR suggests participation of immunity in the pathogenesis of PR.
http://ift.tt/2yQM43S
Effect of age and body mass index on the yield of stromal vascular fraction
Summary
Objective
The aim of this study was to determine the influence of age, body mass index, and site of liposuction on the cell yield of SVF.
Methods
A prospective study was performed on 58 patients. The average age was 39 years old, with BMI ≤ 25 or BMI ≥ 25. Fat tissue was harvested from the abdominal region, flanks, or thighs and SVF was isolated.
Results
The yield of viable SVF was evaluated by trypan blue, and the markers of stem cells were evaluated by flow cytometry. The cells were positive for stem cells markers, the age, sex of the patient had no impact on SVF cell yield with an average of 1.17 × 10^8. However, the BMI > 25 had resulted in higher cell numbers, and the harvest site had a significant impact on cell yield with abdomen being the site of interest.
Conclusion
These data demonstrate that the age of the person does not affect the cell yield of SVF; nevertheless, the donor site and BMI might be important factors in affecting cell number.
http://ift.tt/2BlBnsJ
Cardiovascular risk and severity factors in patients admitted to hospital for spontaneous epistaxis
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): N. André, N. Klopp-Dutote, A. Biet-Hornstein, V. Strunski, C. Page
ObjectivesTo assess the role of cardiovascular risk factors, intake of drugs altering hemostasis and severity signs in patients admitted with spontaneous epistaxis.Material and methodsA single-center retrospective study covering a 7-year period in a university hospital center included 205 patients admitted with spontaneous epistaxis. Study variables comprised: cardiovascular risk factors (cardiovascular disease or history of cardiovascular disease with hemorrhagic or thromboembolic risk, high blood pressure, type-2 diabetes, dyslipidemia), intake of drugs altering hemostasis, blood pressure and minimum hemoglobin level during hospital stay. Groups of serious and non-serious epistaxis were distinguished.ResultsThere were no significant inter-group differences for mean age, sex ratio, history of high blood pressure or number of cardiovascular risk factors. Serious epistaxis was associated with significantly lower blood pressure and hemoglobinemia. Number of cardiovascular risk factors correlated with probability of blood transfusion.ConclusionThe real influence of the various study factors, including severity factors, on onset of spontaneous epistaxis remains to be elucidated.
http://ift.tt/2BluCqR
Impact of allergy on phenotypic and endotypic profiles of nasal polyposis
Publication date: Available online 8 December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): G. Mortuaire, I. Gengler, M. Balden, M. Capron, G. Lefèvre
ObjectivesTo assess the impact of allergy on clinical presentations (phenotypes) and inflammatory patterns (endotypes) of chronic rhinosinusitis with nasal polyps (CRSwNP).MethodsA single-center prospective study was conducted over an 18-month period. Fifty-seven patients with refractory CRSwNP were included. The diagnosis of allergy was based on concordant skin prick tests and symptoms. Phenotypes were determined on symptom severity score, polyp size classification and Lund-Mackay CT staging. Inflammatory endotypes were determined on biomarker analysis (IgE, IgA, IL-5, IL-9, ECP, EDN) in blood and nasal secretions. Eosinophil counts were obtained in blood, nasal secretions and polyps.ResultsPhenotype and endotype profiles were comparable in patients with (n=15) or without (n=42) allergy. Only asthma with high total IgE blood concentration showed association with allergy.ConclusionsThe present results suggest that allergy is not directly involved in the clinical expression and specific inflammatory pathways of CRSwNP. New therapies target inflammation signaling pathways, and identifying accurate blood and tissue biomarkers will be the line of research most likely to improve treatment of CRSwNP.
http://ift.tt/2ALc0PR
Circulating allergen-specific Th2 lymphocytes: CCR4+ rather than CLA+ is the predominant phenotype in peanut allergic subjects
Source:Journal of Allergy and Clinical Immunology
Author(s): Lars H. Blom, Nanna Juel-Berg, Lau Fabricius Larsen, Kirsten S. Hansen, Lars K. Poulsen
Teaser
The skin and airway homing chemokine CCR4, but not CLA, emerged as the primary discriminating homing factor, of Th2 lymphocytes, suggesting that peanut sensitization occurs both via the skin and airways.http://ift.tt/2yQMyaz
In response to Letter to the Editor entitled ‘Is an endoscopic or a microscopic approach optimal for management of attic cholesteatoma?’
Source:American Journal of Otolaryngology
Author(s): Giuseppe Magliulo, Giannicola Iannella
http://ift.tt/2y8XCMD
Anti-mumps IgM antibody positive rate with sudden sensorineural hearing loss using second-generation enzyme immunoassay: A retrospective, multi-institutional investigation in Hokkaido, Japan
Source:Auris Nasus Larynx
Author(s): Atsushi Fukuda, Shinya Morita, Yuji Nakamaru, Kimiko Hoshino, Keishi Fujiwara, Shigeru Akazawa, Tomohiro Sakashita, Nobuyuki Obara, Akihiro Homma
ObjectiveAlthough elevated anti-mumps IgM antibody levels were reported in 5.7%–7.2% of Japanese patients with sudden sensorineural hearing loss (SSNHL), there were several reports of false-positive cases, such as the continually IgM positive case and the IgM positive case in normal adults. To improve specificity, the new enzyme immuno assay (EIA) anti-mumps IgM antibody measurement kit was introduced in December 2009. This study re-examined the frequency of anti-mumps IgM antibody test positivity with SSNHL using the new measurement kit and compared the results with those from a previous report that used old kit.MethodsThis is a retrospective multi-institutional study involving patients diagnosed with SSNHL who exhibited the anti-mumps IgM antibody. We compared the positive rate of anti-mumps IgM antibody and the annual average number of mumps cases per sentinel in Hokkaido between the patients in the present study and patients previously evaluated.ResultsOverall, 100 patients with SSNHL were enrolled. One case (1.0%) was positive for anti-mumps IgM antibody. Of the 69 patients evaluated in the previous study, 5 cases (7.2%) were positive for anti-mumps IgM antibody. The positive rate of the anti-mumps IgM antibody in the present cases was significantly lower than that previously reported (p=0.042). The annual average number of mumps cases per sentinel in Hokkaido of the present and previous surveillance period was 34.47 and 42.77, respectively; no significant difference was seen in these data (p=0.4519).ConclusionThe present study revealed that 1.0% of SSNHL was positive for the anti-mumps IgM antibody using the new EIA-IgM measurement kit. After the introduction of the new EIA-IgM measurement kit, anti-mumps IgM antibody positive rate with SSNHL significantly decreased, indicating that the proportion of asymptomatic mumps among etiology of SSNHL may be lower than those previously reported.
http://ift.tt/2yQiwni
Results of a systematic literature review of treatment modalities for jugulotympanic paraganglioma, stratified per Fisch class
Abstract
Objective
Key for successful jugulotympanic paraganglioma management is a personalized approach aiming for the best practice for each individual patient. To this end, a systematic review is performed, evaluating the local control- and complication rates for the different treatment modalities stratified by the broadly accepted Fisch classification.
Design
A systematic literature review according to the PRISMA statement was performed. A detailed overview of individual treatment outcomes per Fisch class is provided.
Main outcome measures
local control, cranial nerve damage, complications, function recovery.
Results
Eighteen studies were selected, resembling 83 patients treated with radiotherapy and 299 with surgery. Excellent local control was found post surgery for class A and B tumours and risk of cranial nerve damage was <1%. For class C1-4 tumours, local control was 80-95% post surgery (84% post radiotherapy) and, cranial nerve damage was found in 71-76% (none post radiotherapy; p < 0.05). There was no difference in treatment outcomes between tumours of different C class. For class C1-4De/Di tumours, local control was 38-86% (98% post radiotherapy; p < 0.05), cranial nerve damage/complication rates were 67-100% (3% post radiotherapy; p < 0.05). C1-4DeDi tumours showed lesser local control and cranial nerve damage rates when compared to C1-4De tumours.
Conclusions
An individual risk is constituted for surgery and radiotherapy, stratified per Fisch class. For class A and B tumours surgery is a suitable treatment option. For class C and D tumours radiotherapy results in lower complication rates and similar or better local control rates when compared to the surgical group.
This article is protected by copyright. All rights reserved.
http://ift.tt/2BPqvzq
Elevated levels of the antimicrobial peptide LL-37 in hidradenitis suppurativa are associated with a Th1/Th17 immune response
Summary
Hidradenitis suppurativa (HS) is an inflammatory skin disease with poorly understood immunopathogenic mechanisms. LL-37 is an antimicrobial peptide, which is transcribed from the CAMP (cathelicidin antimicrobial peptide) gene. Previous reports showed upregulated levels of CAMP and LL-37 in HS lesions and therefore the aim of this study was to compare levels of LL-37 in HS to other inflammatory skin diseases and to establish immunomodulatory functions of LL-37 in HS. We confirm an upregulation of the LL-37 peptide in lesional HS skin with comparable levels as in psoriasis patients and are able to positively correlate the presence of LL-37 in HS with the presence of T cells, macrophages, neutrophils, IFNγ, IL-17, IL-23, TNFα, IL-32 and IL-1β. Mechanistically, LL-37 boosts the proliferation of unspecifically activated CD4+ T cells via an increased calcium signalling independent of antigen presenting cells. Targeting LL-37 may therefore represent a new therapeutic option for the treatment of this recalcitrant disease, but it has to be kept in mind that LL-37 also has an antimicrobial function.
This article is protected by copyright. All rights reserved.
http://ift.tt/2nHsNPa
Monocytes enhance neutrophil-induced blister formation in an ex vivo model of bullous pemphigoid
Abstract
Background
Lesions of bullous pemphigoid (BP), an autoimmune subepidermal blistering disease characterized by the presence of tissue-bound and circulating autoantibodies to hemidesmosomal antigens, harbour a mixed inflammatory cellular infiltrate. In various models, neutrophils, eosinophils, mast cells, monocytes as well as B and T cells have been shown to be involved in the pathogenesis of BP. However, their interactions with and effective role in blister formation remains uncertain. This study was aimed at investigating the effect of monocyte/neutrophil interaction on blister formation in an ex vivo BP model.
Methods
Skin cryosections were incubated with purified human neutrophils and monocytes, in the presence or absence of BP autoantibodies. Production of reactive oxygen species (ROS), degranulation, mediator release (neutrophil elastase (NE), myeloperoxidase (MPO), matrix metalloproteinase-9 (MMP-9)), binding of Fcγ receptor (CD16, CD32, CD64), and cell adhesion (CD18, ICAM-1) were investigated using appropriate inhibitors. Dermal-epidermal separation (DES) was assessed by light microscopy and quantified by Fiji software.
Results
Monocytes and neutrophils synergistically interact resulting in a significantly higher DES compared to either monocytes or neutrophils separately (P < 0.0001). Monocyte/neutrophil-induced DES was associated with increased ROS production and was dependent on adhesion and FcγRIII binding. Upon stimulation by the granule-poor fraction of monocyte supernatants, neutrophils increased their release of MMP-9, thereby also DES at the dermal-epidermal junction of skin cryosections.
Conclusion
Our observations suggest that the interaction of cells, as shown here for monocytes and neutrophils, enhances mediator release resulting in an increased subepidermal blister formation. Thus, blocking intercellular cross-talk promises a new therapeutic approach for blocking tissue damage in BP.
This article is protected by copyright. All rights reserved.
http://ift.tt/2BPR7At
In response to Letter to the Editor entitled ‘Is an endoscopic or a microscopic approach optimal for management of attic cholesteatoma?’
We are grateful to Zhengcai-Lou et al. for having appreciated our study entitled 'Endoscopic versus microscopic approach in attic cholesteatoma surgery [1].
http://ift.tt/2B1xfxs
A Hat-Trick Knock-Reversible Triple Organ Injury in a New Mother With HELLP Syndrome
No abstract availablehttp://ift.tt/2y90TeD
Sodium Bicarbonate for Control of ICP: A Systematic Review
Objective: Our goal was to perform a systematic review of the literature on the use of intravenous sodium bicarbonate for intracranial pressure (ICP) reduction in patients with neurologic illness. Methods: Data sources: articles from MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to April 2015), reference lists of relevant articles, and gray literature were searched. Data extraction: 2 reviewers independently extracted data including population characteristics and treatment characteristics. The strength of evidence was adjudicated using both the Oxford and Grading of Recommendation Assessment Development and Education methodology. Results: Our search strategy produced a total 559 citations. Three original articles were included in the review. There were 2 prospective studies, 1 randomized control trial and 1 single arm, and 1 retrospective case report. Across all studies there were a total of 19 patients studied, with 31 episodes of elevated ICP being treated. Twenty-one of those episodes were treated with sodium bicarbonate infusion, with the remaining 10 treated with hypertonic saline in a control model. All elevated ICP episodes treated with sodium bicarbonate solution demonstrated a significant drop in ICP, without an elevation of serum partial pressure of carbon dioxide. No significant complications were described. Conclusions: There currently exists Oxford level 4, Grading of Recommendation Assessment Development and Education D evidence to support an ICP reduction effect with intravenous sodium bicarbonate in TBI. No comments on its impact in other neuropathologic states, or on patient outcomes, can be made at this time.http://ift.tt/2y8ScAX
Intraoperative Blood Pressure Discrepancy Between Arms During Prone Position!
No abstract availablehttp://ift.tt/2yPREnk
Perioperative and Anesthetic Considerations for Neurosurgical Laser Interstitial Thermal Therapy Ablations
Objective: To describe the anesthetic considerations in patients undergoing laser interstitial thermal therapy (LITT) for neurosurgical procedures. Background: LITT for neurosurgical procedures is being increasingly used in a variety of central nervous system diseases. Several studies have demonstrated promising results including a shorter hospital stay. Given the rising trend for the use of LITT, anesthesiologists need to be familiar with the anesthetic considerations to provide care for patients undergoing these types of procedures. Materials and Methods: PubMed was searched in April 2016 using different combinations of the following MeSH terms: "Central nervous System," "laser therapy," "Ablation Techniques," "Anesthesia," and "Spinal Cord Neoplasms." A total of 54 relevant manuscripts were included in this review article. Conclusions: LITT is a promising therapeutic approach for multiple central nervous system disorders. Anesthesiologists must be familiar with the anesthetic considerations and the technical aspects of the procedure when providing care for patients undergoing LITT. The literature is scarce on the impact of different anesthesia and analgesia techniques on clinical outcomes. Therefore, studies comparing different anesthetic regimens and the impact on outcomes are needed to make relevant recommendations on the anesthesia care of these patients.http://ift.tt/2yPRCvI
Innovations in Functional Neurosurgery and Anesthetic Implications
Functional neurosurgery has undergone rapid growth over the last few years fueled by advances in imaging technology and novel treatment modalities. These advances have led to new surgical treatments using minimally invasive and precise techniques for conditions such as Parkinson's disease, essential tremor, epilepsy, and psychiatric disorders. Understanding the goals and technological issues of these procedures is imperative for the anesthesiologist to ensure safe management of patients presenting for functional neurosurgical procedures. In this review, we discuss the advances in neurosurgical techniques for deep brain stimulation, focused ultrasound and minimally invasive laser-based treatment of refractory epilepsy and provide a guideline for anesthesiologists caring for patients undergoing these procedures.http://ift.tt/2y94jON
Complementary Use of Effect Site-Target Controlled Infusion and SmartPilot View for Anesthetic Management in Semi-awake Craniotomy Near BIS 85
No abstract availablehttp://ift.tt/2y8Sckr
Ultra–low-dose Naloxone as an Adjuvant to Patient Controlled Analgesia (PCA) With Morphine for Postoperative Pain Relief Following Lumber Discectomy: A Double-blind, Randomized, Placebo-controlled Trial
Background: Lumbar discectomy is one of the most commonly performed neurosurgical procedures. Many patients experience postoperative pain after lumbar discectomy. This study evaluated the effect of ultra–low-dose naloxone infusion on pain intensity after lumbar discectomy in individuals receiving patient-controlled analgesia (PCA) with morphine. Materials and Methods: In a double-blind, randomized, controlled trial, a total of 80 patients scheduled for open discectomy was randomly assigned to receive naloxone (group N) or placebo (group P). After surgery, all patients were connected to a morphine PCA pump. Both groups received 500 mL of normal saline using a continuous infusion pump through a separate intravenous line for 24 hours. However, group N received a total dose of 0.25 μg/kg/h naloxone, which was added to the normal saline infusion. All patients were asked to grade the intensity of their pain, severity of nausea, vomiting, and pruritus on a 0 to 10 visual analog scale before being discharged from the postanesthesia care unit and at 1, 6, 12, and 24 hours postoperatively. Results: It was observed that both groups had a statistically significant (Phttp://ift.tt/2y94eKZ
Propofol Pharmacodynamics and Bispectral Index During Key Moments of Awake Craniotomy
Background: During awake craniotomy, the patient's language centers are identified by neurological testing requiring a fully awake and cooperative patient. Hence, anesthesia aims for an unconscious patient at the beginning and end of surgery but an awake and responsive patient in between. We investigated the plasma (Cplasma) and effect-site (Ceffect-site) propofol concentration as well as the related Bispectral Index (BIS) required for intraoperative return of consciousness and begin of neurological testing. Materials and Methods: In 13 patients, arterial Cplasma were measured by high-pressure liquid chromatography and Ceffect-site was estimated based on the Marsh and Schnider pharmacokinetic/dynamic (pk/pd) models. The BIS, Cplasma and Ceffect-site were compared during the intraoperative awakening period at designated time points such as return of consciousness and start of the Boston Naming Test (neurological test). Results: Return of consciousness occurred at a BIS of 77±7 (mean±SD) and a measured Cplasma of 1.2±0.4 μg/mL. The Marsh model predicted a significantly (Phttp://ift.tt/2yPre5d
Posterior Reversible Encephalopathy Syndrome Triggered by Vertebral Artery Angiogram
No abstract availablehttp://ift.tt/2yPp997
The Correlation Between Recordable MEPs and Motor Function During Spinal Surgery for Resection of Thoracic Spinal Cord Tumor
Background: Motor evoked potentials (MEPs) are commonly used during surgery for spinal cord tumor resection. However, it can be difficult to record reliable MEPs from the muscles of the lower extremities during surgery in patients with preoperative weakness due to spinal cord compression. In this study, motor function of patients' lower extremities and their association with intraoperative MEP recording were compared. Patients and Methods: Patients undergoing thoracic spinal cord tumor resection were studied. Patients' motor function was checked immediately before the surgical procedure. MEP responses were recorded from the tibialis anterior and foot muscles, and the hand muscles were used as control. Electrical current with train of eight pulses, 200 to 500 V was delivered through 2 corkscrews placed at C3' and C4' sites. Anesthesia was maintained by total intravenous anesthesia using a combination of propofol and remifentanil after induction with intravenous propofol, remifentanil, and rocuronium. Rocuronium was not repeated. Bispectral Index was maintained between 40 to 50. Results: From 178 lower limbs of 89 patients, myogenic MEPs could be recorded from 100% (105/105) of the patients with 5 of 5 motor strength in lower extremity; 90% (36/40) from the patients with 4/5 motor strength; only 25% (5/20) with 3/5; and 12.5% (1/8) with 2/5 motor strength; none (0/5) were able to be recorded if the motor strength was 1/5. Summary: The ability to record myogenic MEPs is closely associated with the patient's motor function. They are difficult to obtain if motor function is 3/5 motor strength in the lower extremity. They are almost impossible to record if motor function is worse than 3/5.http://ift.tt/2yPmLPK
Airway Management With a Stereotactic Headframe In Situ—A Mannequin Study
Background: Stereotactic headframe-based imaging is often needed for target localization during surgery for insertion of deep brain stimulators. A major concern during this surgery is the need for emergency airway management while an awake or sedated patient is in the stereotactic headframe. The aim of our study was to determine the ease of emergency airway management with a stereotactic headframe in situ. Materials and Methods: We conducted an observational study using a mannequin. A Leksell stereotactic headframe was placed on a mannequin in the operating room and the frame was fixed to the operating room table. Anesthesia personnel were asked to insert a #4 laryngeal mask and then to intubate the mannequin, using both direct (DL) and video laryngoscopy (VL). In addition, participants were asked to perform the same airway techniques in the mannequin without the headframe. Data were analyzed for time taken for airway management using different devices with and without the headframe. In addition, we compared the time taken to secure the airway between different participant groups. Results: Thirty anesthesia personnel (7 residents, 12 fellows, and 11 consultants) participated in the study. With the headframe in situ, 97% of participants were able to insert a laryngeal mask on their first attempt; 93% and 97% of participants were able to intubate the mannequin using DL and VL respectively on their first attempt. Without the stereotactic headframe, all participants were able to insert the laryngeal mask and intubate on the first attempt. The average time taken to insert a laryngeal mask and intubate the mannequin using DL and VL with the headframe in situ was 39.3, 58.6, and 54.8 seconds, respectively. Conclusions: Our study showed that both laryngeal mask insertion and tracheal intubation can be performed with a stereotactic headframe in situ. A laryngeal mask is the quickest airway device to insert and can be inserted while the mannequin is in the standard surgical position. Further study is needed to validate the results in patients.http://ift.tt/2y90HMB
Cortical Arousal With Deep Brain Stimulation After General Anesthesia for Laparoscopic Cholecystectomy
No abstract availablehttp://ift.tt/2y90Ak9
Hemodynamic Disturbances in the Early Phase After Subarachnoid Hemorrhage: Regional Cerebral Blood Flow Studied by Bedside Xenon-enhanced CT
Background: The mechanisms leading to neurological deterioration and the devastating course of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) are still not well understood. Bedside xenon-enhanced computerized tomography (XeCT) enables measurements of regional cerebral blood flow (rCBF) during neurosurgical intensive care. In the present study, CBF characteristics in the early phase after severe SAH were explored and related to clinical characteristics and early clinical course outcome. Materials and Methods: Patients diagnosed with SAH and requiring mechanical ventilation were prospectively enrolled in the study. Bedside XeCT was performed within day 0 to 3. Results: Data from 64 patients were obtained. Median global CBF was 34.9 mL/100 g/min (interquartile range [IQR], 26.7 to 41.6). There was a difference in CBF related to age with higher global CBF in the younger patients (30 to 49 y). CBF was also related to the severity of SAH with lower CBF in Fisher grade 4 compared with grade 3. rCBF disturbances and hypoperfusion were common; in 43 of the 64 patients rCBFhttp://ift.tt/2y90Hw5
Analgosedation With Dexmedetomidine in a Patient With Superior Vena Cava Syndrome in Neurosurgery
No abstract availablehttp://ift.tt/2y97FRP
Neonatal Sevoflurane Exposure Induces Adulthood Fear-induced Learning Disability and Decreases Glutamatergic Neurons in the Basolateral Amygdala
Background: Neonatal mice exposed to sevoflurane show certain cognitive and behavioral impairments in adulthood. However, the mechanisms underlying long-term cognitive deficits induced by sevoflurane exposure remain unknown. The present study was performed to investigate whether there is differential neuronal activation between naive mice and sevoflurane-exposed neonates in fear-conditioning tests based on immediate early gene (c-Fos) expression. Methods: Male mice were exposed to 3% sevoflurane (SEVO group) or carrier gas alone (no anesthesia, NA group) for 6 hours on postnatal day 6. The mice were allowed to mature before performing the contextual fear-conditioning test. A reduced freezing response was confirmed in the SEVO group. Neural activation in the regions of the medial prefrontal cortex, hippocampus, and amygdala was investigated using c-Fos immunostaining 2 hours after the test. The types of neurons activated were also identified. Results: The number of c-Fos-positive cells decreased by 27% in the basolateral amygdala in the SEVO group, while no significant changes were observed in other regions. Furthermore, glutamatergic, but not γ-aminobutyric acid (GABA)ergic, neurons expressed c-Fos after the contextual fear-conditioning test in both groups. The number of glutamatergic neurons in the basolateral amygdala in the SEVO group was reduced by 27%. Conclusions: Decreased neural activation in the basolateral amygdala may be associated with reduced freezing time in neonatal sevoflurane-exposed mice. Fewer glutamatergic neurons responding to fear stimuli in the basolateral amygdala may contribute to decreased neural activation and learning deficits in mice exposed to sevoflurane as neonates.http://ift.tt/2y90oRX
Intravenous Clevidipine for Inducing Hypotensive Challenge During Carotid Balloon Test Occlusion
No abstract availablehttp://ift.tt/2y90lWh
Anti-melanoma differentiation-associated gene 5 (MDA5) dermatomyositis: a concise review with an emphasis on distinctive clinical features
Anti-MDA5 dermatomyositis exhibits unique clinical features including mucocutaneous ulceration, palmar papules, non-scarring alopecia, panniculitis, arthritis, and interstitial lung disease.Early intervention may reduce disease-related morbidity and improve survival in affected individuals.Knowledge of the salient features of anti-MDA5 dermatomyositis enhances its recognition and facilitates treatment.
http://ift.tt/2kGtXcg
Merkel Cell Carcinoma: an Update and Review Part 1. Pathogenesis, Diagnosis, and Staging
Capsule Summary: word count not required for CME articles; please note that bulleted points appear at the start of each section but are not included in the total word count
http://ift.tt/2kGrJtG
Merkel Cell Carcinoma: An Update and Review. Part II: Current and Future Therapy
Capsule Summary: word count not required for CME articles as these appear before each section and are included in the text word count
http://ift.tt/2jdbnsc
“Omics” in oral cancer: New approaches for biomarker discovery
Source:Archives of Oral Biology
Author(s): Vertika Rai, Rashmi Mukherjee, Ananta K. Ghosh, Aurobinda Routray, Chandan Chakraborty
ObjectivesIn this review paper, we explored the application of "omics" approaches in the study of oral cancer (OC). It will provide a better understanding of how "omics" approaches may lead to novel biomarker molecules or molecular signatures with potential value in clinical practice. A future direction of "omics"-driven research in OC is also discussed.MethodsStudies on "omics"-based approaches [genomics/proteomics/transcriptomics/metabolomics] were investigated for differentiating oral squamous cell carcinoma,oral sub-mucous fibrosis, oral leukoplakia, oral lichen planus, oral erythroplakia from normal cases. Electronic databases viz., PubMed, Springer, and Google Scholar were searched.ResultsOne eighty-one studies were included in this review. The review shows that the fields of genomics, transcriptomics, proteomics, and metabolomics-based marker identification have implemented advanced tools to screen early changes in DNA, RNA, protein, and metabolite expression in OC population.ConclusionsIt may be concluded that despite advances in OC therapy, symptomatic presentation occurs at an advanced stage, where various curative treatment options become very limited. A molecular level study is essential for detecting an OC biomarker at an early stage. Modern "Omics" strategies can potentially make a major contribution to meet this need.
http://ift.tt/2nIVET6
Genetic markers of nasolabial morphology
Source:Archives of Oral Biology
Author(s): Tarek El-Bialy
http://ift.tt/2Ao7IiH
Interleukin-21 receptor signaling is not critically required for imiquimod-induced psoriasiform dermatitis in mice
Abstract
Psoriasis is largely mediated by interleukin (IL)-23/ T helper (Th) 17 axis, and IL-21 is a pleiotropic cytokine expressed by Th17 cells. Despite previously reported possible pathogenic roles of IL-21 in human psoriasis, we found that IL-21 receptor (IL-21R) signaling was not crucial for imiquimod-induced psoriatic inflammation, using IL-21R−/− mice. The severity of imiquimod-induced psoriatic manifestation and pro-inflammatory Th17 cytokine levels, IL-17A-producing γδ T cells and CD4+ T cells, and in vitro IL-17A production by γδ T cells after IL-23 stimulation was comparable between wild-type and IL-21R−/− mice. Collectively, IL-21R signaling was not critically involved in IMQ-induced psoriatic inflammation despite an increased IL-21 expression in the IMQ-treated mouse skin. Our data may represent the significant differences between human psoriasis and murine psoriasis model, and further studies using other models will be required to elucidate the role of IL-21 in psoriasis pathogenesis.
This article is protected by copyright. All rights reserved.
http://ift.tt/2jy15zJ
Skin Cancer Prevention Campaign in Childhood: Survey based on 3,676 children in Brazil
Abstract
Background and Objectives
Primary skin cancer prevention campaigns are essential and more effective among children, not only because of the importance of sun exposure effects during this period, but also because at this age is when individuals are developing behaviors. The Brazilian Society of Dermatology - Regional State of Sao Paulo developed and conducted, the program named "The Sun, Friend of Childhood", a school health education and disease prevention project for children and parents. Our objective was to evaluate the cognitive and behavioral effects of the children and parents before and after an education model-based intervention of sun protection.
Methods
We carried out a study on a school population of Social Service of Industry – Regional State of São Paulo, from the first to the fifth years of the regular course (6-10 years). Our educational project was planned to be based on two children's learning tools (comic magazine and a DVD cartoon). Questionnaires in relation to habits and knowledge in sun exposure where applied to the children (3,776) before and (2,748) after the intervention. A questionnaire was applied to 3,663 parents regarding personal details and habits of their children.
Results
According to the McNemar′s statistical test, all changes in the children in acquire new knowledge about good practices for sun exposure were statistically significant.
Conclusions
Educative sun exposure programs in childhood are a relevant tool to modify the history of life for next generations, to concern the skin cancer and good health practices.
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Safety and Efficacy of Apremilast Through 104 Weeks in Patients With Moderate to Severe Psoriasis Who Continued on Apremilast or Switched From Etanercept Treatment: Findings From the LIBERATE Study
Abstract
Background
Apremilast, an oral phosphodiesterase 4 inhibitor, has demonstrated efficacy in patients with moderate to severe psoriasis.
Objective
To evaluate long-term efficacy and safety of apremilast in biologic-naive patients with moderate to severe plaque psoriasis and safety of switching from etanercept to apremilast in the phase 3b LIBERATE trial.
Methods
Two hundred fifty patients were randomized to placebo, apremilast 30 mg BID, or etanercept 50 mg QW through Week 16; thereafter, all patients continued or switched to apremilast through Week 104 (extension phase). Skin, scalp, and nail involvement at Weeks 16, 52, and 104 were assessed using the Psoriasis Area and Severity Index (PASI; 0–72), Scalp Physician Global Assessment (ScPGA; 0–5), and Nail Psoriasis Severity Index (NAPSI; 0–8); patient-reported outcomes (PROs) were assessed using the Dermatology Life Quality Index (DLQI; 0–32) and pruritus visual analog scale (VAS; 0–100 mm).
Results
The apremilast-extension phase (Weeks 16–104) included 226 patients in the placebo/apremilast (n=73), apremilast/apremilast (n=74), and etanercept/apremilast (n=79) groups, and at Week 104, 50.7%, 45.9%, and 51.9% of these patients, respectively, maintained ≥75% reduction from baseline in PASI score (based on last observation carried forward analysis). Across treatment groups, ScPGA 0 (clear) or 1 (minimal) was achieved by 50.0%–59.2% of patients; NAPSI mean change from baseline was −48.1% to −51.1%; DLQI score ≤5 was achieved by 66.0%–72.5% of patients; and pruritus VAS mean change from baseline was −24.4 to −32.3. AEs in ≥5% of patients (diarrhea, nausea, nasopharyngitis, upper respiratory tract infection, and headache) did not increase with prolonged apremilast exposure.
Conclusions
Apremilast demonstrated significant and sustained improvements in skin, scalp, nails, and PROs (pruritus and quality of life) over 104 weeks in patients with moderate to severe plaque psoriasis. Safety was consistent with the known safety profile of apremilast.
This article is protected by copyright. All rights reserved.
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Consensus on the management of patients with psoriatic arthritis in a dermatology setting
Abstract
Background
Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis (PsO). Early diagnosis and prompt therapeutic intervention are crucial for limiting PsA progression and prevention of disability. Dermatologists are in a privileged position to detect early PsA. The management of patients with PsA in the dermatology setting is widely variable.
Objective
To provide practical recommendations for the management of patients with PsA in the dermatology setting including early diagnosis and treatment.
Methods
A consensus document was written by an expert panel composed by dermatologists (n=12) and rheumatologists (n=6). Eleven highly relevant questions were selected and elaborated with answers/statements based on a narrative literature review. The resulting document was discussed in a face-to-face meeting adopting a nominal group technique to reach consensus (i.e. 100% agreement) by using the Delphi method.
Results
A consensus was achieved in defining the following: the clinical characteristics differentiating inflammatory and non-inflammatory signs and symptoms of joint disease; the most important differential diagnoses of PsA in clinical practice; the most useful screening questionnaires, serum laboratory tests and imaging techniques for the detection of early PsA; the criteria for dermatologist to refer patients with PsO to rheumatologist; the criteria for the diagnosis of PsA; the selection of the indices that the dermatologist could use for measuring the activity and severity of PsA in clinical practice; when systemic steroids and/or intra-articular steroid injections are indicated in the treatment of PsA. Finally, systemic treatments including synthetic and biological disease modifying anti rheumatic drugs to be considered for the treatment of PsA have been reported.
Conclusions
The implementations of these practical recommendations could be very helpful for the management of patients with PsA in the dermatology setting including early diagnosis and treatment.
This article is protected by copyright. All rights reserved.
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Early stage mycosis fungoides screening investigations: a retrospective analysis of 440 cases
Abstract
Early stages of mycosis fungoides (MF stages IA and IB) carry similar long-term life expectancies as an age-, sex-, and race- matched control population (1-3). Despite this, the ten-year disease progression risk in stage IA and IB MF has been reported to be between 10% and 39% (4); hence, investigative screening is frequently performed at presentation. We conducted a retrospective chart review of screening investigations performed on 440 patients with stage T1/IA (52%) and T2/IB (48%) MF.
This article is protected by copyright. All rights reserved.
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Reflectance Confocal Microscopy evaluation of Trichobacteriosis Axilaris
Abstract
We read with great interest the paper by Navarrete-Dechent et al recently published on the Journal of European Academy of Dermatology1, in which the authors detail the dermoscopic findings of trichobacteriosis and highlight the importance of dermoscopy in these cases. We present the case of a 44-year-old man, who emanated an unpleasant axilary odor during a routine check-up. Close examination of the axillary hair shafts showed soft, brown to yellow irregular masses adherent to the central segment of the hairs, suggesting the diagnosis of trichobacteriosis axilaris (TA).
This article is protected by copyright. All rights reserved.
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Peak Airflow Measurement in Patients With Glottic Insufficiency After Vocal Fold Augmentation
http://ift.tt/2hwo8JT
Implementing Quality Improvement and Patient Safety in Residency Education
http://ift.tt/2zLOge0
Association of Enrollment in an Aerodigestive Clinic With Reduced Hospital Stay
http://ift.tt/2xQyb20
Anesthesia Exposure and Neurotoxicity in Children
http://ift.tt/2zLOdik
Survival Outcomes for T3N0M0 Squamous Cell Carcinoma of the Glottic Larynx
http://ift.tt/2yzBLkW
Reporting of Effect Size and Confidence Intervals
http://ift.tt/2zLfotE
Error in Byline
http://ift.tt/2hwo1hr
Laryngoscopic Findings and Response to Gabapentin
http://ift.tt/2zLfmC2
Measuring Institutional Quality in Head and Neck Surgery Using Hospital-Level Data
http://ift.tt/2yzJLCi
Prognosis of 5-Year Survival of Chemoradiotherapy-Treated Patients With Nasopharyngeal Carcinoma
http://ift.tt/2hwnSdT
Nationwide Variation in Rates of Thyroidectomy Among US Medicare Beneficiaries
http://ift.tt/2xQk9gS
Extracapsular Dissection vs Superficial Parotidectomy
http://ift.tt/2hwyk55
Interferon-γ Treatment of Human Laryngotracheal Stenosis–Derived Fibroblasts
http://ift.tt/2zO6s4M
Minimal Important Difference in Voice Handicap Index–10
http://ift.tt/2xQihow
Double Parathyroid Adenomas in Monozygotic Twins
http://ift.tt/2xQjYSX
Krouse Classification for Sinonasal Inverted Papilloma With Recurrence
http://ift.tt/2yzNSOO
JAMA Otolaryngology–Head & Neck Surgery
http://ift.tt/2zNPX8N
First-Generation Deescalation Trials in HPV-Positive Oropharyngeal Cancer
http://ift.tt/2iH0LhL
Immunotherapy and Overall Survival in Elderly Patients With Melanoma
http://ift.tt/2AvI769
Practicing Safe Dermatology—Screening Out Liability
http://ift.tt/2AA5YzF
Trends in Medical Liability Claims Against Dermatologists
http://ift.tt/2ACBRaw
Optical Coherence Tomography Features of Dermatophytoma
http://ift.tt/2Ay3kfG
Knowledge to Detect Scalp and Neck Melanoma
http://ift.tt/2AxE0X7
Preference-Based QOL Measures for Economic Evaluations in Early Melanoma
http://ift.tt/2zBoM03
Topical Tacalcitol for a Family With Follicular Keratosis of the Chin
http://ift.tt/2njjjcK
Allergen Concerns and Popular Skin Care Products—Reply
http://ift.tt/2njiTmG
Allergen Concerns and Popular Skin Care Products
http://ift.tt/2zBoYwj
Laboratory Monitoring During Systemic Terbinafine Therapy for Pediatric Onychomycosis
http://ift.tt/2zBXKpt
Dermatologist Density and Volume and Costs of Dermatology Procedures
http://ift.tt/2zBY1sv
Allergen Concerns and Popular Skin Care Products
http://ift.tt/2njj9lE
Reticular Hyperpigmented Eruption in a Young Woman
http://ift.tt/2hTu5nW
Cutaneous Squamous Cell Carcinoma in Organ Transplant Recipients
http://ift.tt/2hW3C9v
Hair Repigmentation With Anti–PD-1 and Anti–PD-L1 Immunotherapy—Reply
http://ift.tt/2hU43AZ
Treatment of Refractory Mycosis Fungoides With Brentuximab Vedotin
http://ift.tt/2jMkkZj
Hair Repigmentation With Anti–PD-1 and Anti–PD-L1 Immunotherapy
http://ift.tt/2jMSX1k
Geographic Distribution of Nonphysicians Who Billed Medicare for Dermatologic Services
http://ift.tt/2jRq9ox
Hair Repigmentation With Anti–PD-1 and Anti–PD-L1 Immunotherapy
http://ift.tt/2jQsHTx
Dermatology Practice Consolidation Fueled by Private Equity Investment
http://ift.tt/2zVEF4m
ICON Intimidation and Predatory Behavior: From Hollywood, “to the Newsroom,” to the Halls of Congress
Violence and Gender , Vol. 0, No. 0.
http://ift.tt/2jbGq7s
Descriptive Error in the Text
http://ift.tt/2A3PbUY
Patient Perceptions of Primary Care–Based Skin Cancer Screening
http://ift.tt/2yjofzf
Prior Authorizations for Diagnostic Skin Biopsies
http://ift.tt/2A2b6eZ
Attempting to Define “Hypoallergenic”
http://ift.tt/2zr3hzR
Purpura Annularis Telangiectodes of Majocchi Associated With Apremilast
http://ift.tt/2yhTg6D
Delay and Disparity in Time to Surgical Treatment for Melanoma
http://ift.tt/2yzv4z2
Robert Chesebrough and the Dermatologic Wonder of Petroleum Jelly
http://ift.tt/2yjJtg8
Performance Characteristics of and Allergens in Best-selling Moisturizers
http://ift.tt/2ztsHgj
Coverage of IVIG for Autoimmune Blistering Diseases by US Insurers
http://ift.tt/2yjJpgo
Association of Delays in Surgery for Melanoma With Insurance Type
http://ift.tt/2yA1tFR
Secukinumab-Induced Psoriasiform Eruption
http://ift.tt/2yiU1MK
Pubic Hair Grooming Injuries and Identification of High-Risk Individuals
http://ift.tt/2ztr5Ts
The Treatment of Actinic Keratoses—The Rule Rather Than the Exception
http://ift.tt/2yhPXMO
Improvement of Genetic Testing for Cutaneous Melanoma
http://ift.tt/2ztslpZ
The Black Panther, From Politics to Popular Culture
http://ift.tt/2ygQaQh
Risk Factors for Melanoma in Renal Transplant Recipients
http://ift.tt/2zsN7pv
Nathaniel Hawthorne’s “The Birthmark”
http://ift.tt/2yfRv9T
Pneumocystis Pneumonia in Patients With Autoimmune Blistering Diseases
http://ift.tt/2zsFnUw
Erythema With Nonscarring, Tense Blisters and No Anti-BP180 Antibodies
http://ift.tt/2yiTryy
An unusual presentation of eosinophilic angiocentric fibrosis
http://ift.tt/2nI0Qqm
Hepatic portal venous gas: acute deterioration in an elderly patient
http://ift.tt/2kc2RpC
Severe Fournier’s gangrene—a conjoint challenge of gynaecology and plastic surgery
http://ift.tt/2kcKsZJ
Hairdressers Doing Scalp Exams Could Save Lives
On self-examination, 50% of melanomas go undetected. They frequently show up on the head and neck. Could hairdressers be trained to conduct frontline population-based screening?
Medscape Medical News
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Eating out with a food allergy in the UK: Change in the eating out practices of consumers with food allergy following introduction of allergen information legislation
Abstract
Background
Strict allergen avoidance is important in day-to-day management of food allergy and avoidance when eating outside the home can present particular difficulties. EU legislation (EU FIC) introduced in December 2014 aimed to improve food allergen information provision for customers by requiring retailers of non-prepacked foods to provide information related to the content of one or more of 14 specified food allergens within their foods.
Objectives
To investigate the impact of EU FIC on the behaviours, experiences and attitudes of consumers with food allergy when eating out.
Methods
As part of longitudinal research, participants with food allergy from across the UK took part in either A) pre and post legislation in-depth interviews, or B) pre and post legislation surveys. In-depth interviews were carried out with 28 participants pre and post legislation, and analysed using the framework approach. Self-report surveys were completed by 129 participants pre and post legislation, and responses were subject to quantitative analyses.
Results
Improvements in allergen information provision and raised awareness of food allergy in eating out venues was reported following introduction of EU FIC. Whilst participants favoured written allergen information, they expressed greater confidence in communicating with eating out staff and in trusting the allergen information that they provided. Improvements were judged to be gradual, sporadic or inconsistent in implementation.
Conclusion & clinical relevance
For many participants, the 'ideal' eating out experience was one in which a range of information resources were available, and where written allergen information was complemented by proactive and accommodating staff within an allergy-aware environment. Whilst the onus is on legislators and food providers to ensure that adequate allergen information is provided, clinicians play an important role in encouraging patients with food allergy to pursue their legal right to make allergen enquiries in order to avoid accidental allergen ingestion when eating out.
This article is protected by copyright. All rights reserved.
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Odontoblast-like differentiation and mineral formation of pulpsphere derived cells on human root canal dentin in vitro
Abstract
Background
The revitalization or regeneration of the dental pulp is a preferable goal in current endodontic research. In this study, human dental pulp cell (DPC) spheres were applied to human root canal samples to evaluate their potential adoption for physiological tissue-like regeneration of the dental root canal by odontoblastic differentiation as well as cell-induced mineral formation.
Methods
DPC were cultivated into three-dimensional cell spheres and seeded on human root canal specimens. The evaluation of sphere formation, tissue-like behavior and differentiation as well as mineral formation of the cells was carried out with the aid of optical light microscopy, immunohistochemical staining and scanning electron microscopy (SEM).
Results
Spheres and cells migrated out of the spheres showed an intense cell-cell- and cell-dentin-contact with the formation of extra cellular matrix. In addition, the ingrowth of cell processes into dentinal tubules and the interaction of cell processes with the tubule walls were detected by SEM-imaging. Immunohistochemical staining of the odontoblast specific matrix proteins, dentin matrix protein-1, and dentin sialoprotein revealed an odontoblast-like cell differentiation in contact with the dentin surface. This differentiation was confirmed by SEM-imaging of cells with an odontoblast specific phenotype and cell induced mineral formation.
Conclusions
The results of the present study reveal the high potential of pulp cells organized in spheres for dental tissue engineering. The odontoblast-like differentiation and the cell induced mineral formation display the possibility of a complete or partial "dentinal filling" of the root canal and the opportunity to combine this method with other current strategies.
http://ift.tt/2kFiTMH
Identification of a 62 kDa major allergen from Artemisia pollen as a putative galactose oxidase
Abstract
Background
Around 20 years ago, a 60-70 kDa protein was reported as a major allergen of mugwort (Artemisia vulgaris) pollen. This study was to identify and characterize its molecular properties.
Methods
Sera from 113 Chinese and 20 Dutch Artemisia allergic/sensitized subjects (and pools thereof) were used to identify the 60-70 kDa allergen. Pollen extracts of seven Artemisia species were compared by immunoblotting. Transcriptomics and proteomics (mass spectrometry) of A. annua pollen were used to identify the putative 60-70 kDa Artemisia allergen. Both the natural purified and recombinant allergens were evaluated for IgE reactivity by ImmunoCAP. Fourteen Chinese Artemisia allergic patients were tested intradermally with purified natural allergen.
Results
Immunoblots revealed two major bands at 12 and 25 kDa, and a weak band at 70 kDa for all seven Artemisia species. Using a combined transcriptomic and proteomic approach, the high molecular mass allergen in A. annua pollen was shown to be a 62 kDa putative galactose oxidase, with a putative N-glycosylation site. More than 94% of Artemisia pollen allergic patients had IgE response to this allergen. Although recognition of a non-glycosylated recombinant version was only confirmed in a minority (16%) and at much lower IgE levels, this discrepancy cannot be explained simply by reactivity to the carbohydrate moiety on the natural allergen. Intradermal testing with the natural allergen was positive in five out of nine sensitized patients.
Conclusions
The previously reported 60-70 kDa allergen of Artemisia pollen is most likely a 62 kD putative galactose oxidase here designated Art an 7.
This article is protected by copyright. All rights reserved.
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Dreidimensionale Analyse nasaler Physiologie
Zusammenfassung
Die menschliche Nase übernimmt einen großen Teil der Präkonditionierung eingeatmeter Luft. Zahlreiche pathologische Veränderungen können die Physiologie der Nase beeinträchtigen. Die Anfänge der Strömungsanalysen wurden mit dreidimensionalen Abgussmodellen und farbig markierten Flüssigkeiten durchgeführt. Temperatur und Feuchtigkeit konnten hierbei nicht berücksichtigt werden. Heute sind wesentlich komplexere Analysen mittels „computational fluid dynamics" (CFD) möglich, die auf dreidimensionalen Modellen basieren, welche aus Datensätzen der Computertomographie (CT) oder Magnetresonanztomographie (MRT) erstellt werden. Hierbei können Strömungsgeschwindigkeiten, Temperatur, Feuchtigkeit und Druckdifferenzen in Abhängigkeit von multiplen Randbedingungen simuliert und hochauflösend dargestellt werden. Die Analyse pathologischer Veränderungen oder operativer Eingriffen ist dadurch möglich.
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Paclitaxel, Cisplatin,5-FU vs. Radiotherapy Plus Paclitaxel, Cisplatin as Preoperative Therapy for Locally Advanced ESC
Interventions: Combination Product: Paclitaxel, Cisplatin Plus 5-FU (TCF); Radiation: radiochemotherapy
Sponsors: Tianjin Medical University Cancer Institute and Hospital; Shanghai Chest Hospital; Henan Cancer Hospital; The First Affiliated Hospital with Nanjing Medical University; First Affiliated Hospital of Chongqing Medical University; The First Affiliated Hospital of Anhui Medical University
Not yet recruiting
http://ift.tt/2kDbM7z
Rapid Assessment of Esophageal Adenocarcinoma Risk Test
Intervention: Device: Cytosponge
Sponsor: Columbia University
Not yet recruiting
http://ift.tt/2j6Ktlw
Sequential or Concurrent Chemoradiotherapy in Patients With Locoregionally Advanced NPC
Interventions: Drug: gemcitabine and cisplatin (Induction and adjuvant chemotherapy); Radiation: IMRT; Drug: gemcitabine and cisplatin (Induction chemotherapy); Radiation: IMRT and concurrent cisplatin
Sponsors: Chaosu Hu; Zhejiang Cancer Hospital; Jiangxi Provincial Cancer Hospital; First Affiliated Hospital of Wenzhou Medical Univeristy; Affiliated Hospital of Jiangnan University; Fujian Cancer Hospital
Not yet recruiting
http://ift.tt/2kEzmAA
Survival study of treatment adherence by patients given oral oxibutynin for hyperhidrosis
Abstract
Introduction
In recent years, increasing use has been made of oral anticholinergics such as oxybutynin for the management of hyperhidrosis. The primary aim of this study is to determine the variables associated with adherence to this treatment, and secondarily to obtain data on its effectiveness, safety and adverse effects.
Material and methods
Prospective study of patients with hyperhidrosis, at any location, receiving treatment with oral oxybutynin in the period 2007-2016. Epidemiological variables, treatment details, effectiveness and adverse effects were recorded. Effectiveness was determined according to the Hyperhidrosis Disease Severity Scale (HDSS) at baseline, at 3 and 12 months and in successive visits. A descriptive analysis was performed, and Cox's bivariate and multivariate regressions were calculated to determine the variables associated with treatment adherence.
Results
201 patients (140 women) with a mean age of 34 years were included. The mean initial HDSS score was 3.8 and the median follow-up period was 29 months. At 3 months, 84.57% of the patients had responded to treatment (excellent response: 72.94%), but adverse effects were reported by 68.2%. At 12 months, 54.23% had responded (excellent response: 79.82%), with adverse effects in 75.2%. The main variable associated with greater adherence was affected areas: palms of the hands and soles of the feet. The following variables were associated with poorer adherence: onset of hyperhidrosis in adolescence, failure to provide an incrementally increasing, individualised dose, initial HDSS score of 3, and partial initial response. The multivariate analysis confirmed the association between the onset of hyperhidrosis during adolescence, the failure to provide a progressively increasing dose, and palmar affectation.
Discussion
This study was conducted to identify the variables associated with adherence to treatment by hyperhidrosis patients treated with oral oxybutynin. This information would facilitate selection of patients for this treatment and enhance our understanding of the biological behaviour of such anticholinergics when used to treat hyperhidrosis.
This article is protected by copyright. All rights reserved.
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Improved adductor function after canine recurrent laryngeal nerve injury and repair using muscle progenitor cells
Objective
Muscle progenitor cells (MPCs) can be isolated from muscle samples and grown to a critical mass in culture. They have been shown to survive and integrate when implanted into rat laryngeal muscles. In this study, the ability of MPC implants to enhance adductor function of reinnervated thyroarytenoid muscles was tested in a canine model.
Study Design
Animal study.
Methods
Sternocleidomastoid muscle samples were harvested from three canines. Muscle progenitor cells were isolated and cultured to 107 cells over 4 to 5 weeks, then implanted into right thyroarytenoid muscles after ipsilateral recurrent laryngeal nerve transection and repair. The left sides underwent the same nerve injury, but no cells were implanted. Laryngeal adductor force was measured pretreatment and again 6 months later, and the muscles were harvested for histology.
Results
Muscle progenitor cells were successfully cultured from all dogs. Laryngeal adductor force measurements averaged 60% of their baseline pretreatment values in nonimplanted controls, 98% after implantation with MPCs, and 128% after implantation with motor endplate-enhanced MPCs. Histology confirmed that the implanted MPCs survived, became integrated into thyroarytenoid muscle fibers, and were in close contact with nerve endings, suggesting functional innervation.
Conclusion
Muscle progenitor cells were shown to significantly enhance adductor function in this pilot canine study. Patient-specific MPC implantation could potentially be used to improve laryngeal function in patients with vocal fold paresis/paralysis, atrophy, and other conditions. Further experiments are planned.
Level of Evidence
NA. Laryngoscope, 2017
http://ift.tt/2A5itSP
The development of the human hyoid–larynx complex revisited
Objectives/Hypothesis
The hyoid–larynx complex is highly prone to anatomical variation. The etiology of anatomical variants such as Eagle's syndrome and the aberrant hyoid apparatus can be explained from embryonic development. Modern textbooks state that the hyoid bone body develops from the second and third pharyngeal arch cartilages, and that thyroid cartilage derives from the fourth and sixth arch cartilages. This description, however, is incompatible with various anatomical variants, and it is unclear whether it was based on observations in human embryos or on comparative embryology.
Study Design
14 human embryos from the Carnegie collection between Carnegie stage 17 and 23 (42–60 days) were selected based on their histological quality.
Methods
Histological sections of the selected embryos were examined. Three-dimensional models were prepared in an interactive format. These anatomical models provide crucial spatial information and facilitate interpretation.
Results
We observed a less-complicated development of the hyoid–larynx complex than is currently described in textbooks. The body of the hyoid bone originates from a single growth center, without overt contributions from second and third pharyngeal arch cartilages. The fourth and sixth arch cartilages were not detected in human embryos; the thyroid and cricoid cartilages develop as mesenchymal condensations in the neck region.
Conclusions
Despite new research techniques, theories about hyoid–larynx complex development from the beginning of the 20th century have not been refuted properly and can still be found in modern literature. Based on observations in human embryos, we propose a new and relatively simple description of the development of the hyoid–larynx complex to facilitate better understanding of the etiology of anatomical variants.
Level of Evidence
NA Laryngoscope, 2017
http://ift.tt/2Bi5qkS
The development and validation of the speech quality instrument
Objective
Although speech perception tests are available to evaluate hearing, there is no standardized validated tool to quantify speech quality. The objective of this study is to develop a validated tool to measure quality of speech heard.
Study Design
Prospective instrument validation study of 35 normal hearing adults recruited at a tertiary referral center.
Methods
Participants listened to 44 speech clips of male/female voices reciting the Rainbow Passage. Speech clips included original and manipulated excerpts capturing goal qualities such as mechanical and garbled. Listeners rated clips on a 10-point visual analog scale (VAS) of 18 characteristics (e.g. cartoonish, garbled).
Results
Skewed distribution analysis identified mean ratings in the upper and lower 2-point limits of the VAS (ratings of 8–10, 0–2, respectively); items with inconsistent responses were eliminated. The test was pruned to a final instrument of nine speech clips that clearly define qualities of interest: speech-like, male/female, cartoonish, echo-y, garbled, tinny, mechanical, rough, breathy, soothing, hoarse, like, pleasant, natural. Mean ratings were highest for original female clips (8.8) and lowest for not-speech manipulation (2.1). Factor analysis identified two subsets of characteristics: internal consistency demonstrated Cronbach's alpha of 0.95 and 0.82 per subset. Test–retest reliability of total scores was high, with an intraclass correlation coefficient of 0.76.
Conclusion
The Speech Quality Instrument (SQI) is a concise, valid tool for assessing speech quality as an indicator for hearing performance. SQI may be a valuable outcome measure for cochlear implant recipients who, despite achieving excellent speech perception, often experience poor speech quality.
Level of Evidence
2b. Laryngoscope, 2017
http://ift.tt/2A2v9Ka
Phenomenology, genetics, and CNS network abnormalities in laryngeal dystonia: A 30-year experience
Objective
Laryngeal dystonia (LD) is a functionally specific disorder of the afferent–efferent motor coordination system producing action-induced muscle contraction with a varied phenomenology. This report of long-term studies aims to review and better define the phenomenology and central nervous system abnormalities of this disorder and improve diagnosis and treatment.
Methods
Our studies categorized over 1,400 patients diagnosed with LD over the past 33 years, including demographic and medical history records and their phenomenological presentations.
Patients were grouped on clinical phenotype (adductor or abductor) and genotype (sporadic and familial) and with DNA analysis and functional magnetic resonance imaging (fMRI) to investigate brain organization differences and characterize neural markers for genotype/phenotype categorization. A number of patients with alcohol-sensitive dystonia were also studied.
Results
A spectrum of LD phenomena evolved: adductor, abductor, mixed, singer's, dystonic tremor, and adductor respiratory dystonia. Patients were genetically screened for DYT (dystonia) 1, DYT4, DYT6, and DYT25 (GNAL)–and several were positive. The functional MRI studies showed distinct alterations within the sensorimotor network, and the LD patients with a family history had distinct cortical and cerebellar abnormalities. A linear discriminant analysis of fMRI findings showed a 71% accuracy in characterizing LD from normal and in characterizing adductor from abductor forms.
Conclusion
Continuous studies of LD patients over 30 years has led to an improved understanding of the phenomenological characteristics of this neurological disorder. Genetic and fMRI studies have better characterized the disorder and raise the possibility of making objective rather than subjective diagnoses, potentially leading to new therapeutic approaches. Laryngoscope, 128:S1–S9, 2018
http://ift.tt/2Bk2ggw
Toxicity trial of canine posterior cricoarytenoid intramuscular vincristine injections
Objectives/Hypothesis
In animal studies, intramuscular vincristine injections have been shown to block reinnervation of the denervated target muscle. This application could be used selectively to influence recovery patterns following injury of recurrent laryngeal nerves (RLNs). However, vincristine is currently Food and Drug Administration approved only for intravenous use. A formal toxicity trial of intramuscular injections was performed.
Study Design
Animal study.
Methods
Sixteen female canines underwent direct laryngoscopy with injection of moderate- (0.4 mg, n = 8) or high-dose (0.6 mg, n = 8) vincristine into the posterior cricoarytenoid (PCA) muscles. Plasma samples were collected at various time points postinjection and vincristine levels determined. At 24 hours (n = 7) or 14 days (n = 9) postinjection, animals were anesthetized and videolaryngoscopy documented vocal fold mobility and mucosal appearance. Adductor function was measured during stimulation of the RLN. Larynges were processed for histology.
Results
Fifteen minutes after injection, plasma vincristine levels averaged 10.2% ± 6.7% of the intravenous maximum, suggesting about 90% of the vincristine remained within the PCA muscle. Plasma levels were usually below detectable limits within 24 hours. At the end points, all animals had grossly normal-appearing mucosa and full range of motion. Laryngeal adductor strength was normal in all cases. Histology showed moderate to severe acute inflammation in the submucosa only in the high-dose group at 24 hours. There was no necrosis of muscle or mucosa.
Conclusions
Intramuscular vincristine injections into the canine PCA muscles resulted in no significant local toxicity, even at the maximum dose. It would be reasonable to evaluate this treatment strategy in a phase I human trial.
Level of Evidence
NA Laryngoscope, 2017
http://ift.tt/2A3M1A4
Minimal clinically important difference of voice handicap index-10 in vocal fold paralysis
Objectives/Hypothesis
The Voice Handicap Index-10 (VHI-10) is commonly used to measure patients' perception of vocal handicap. Clinical consensus has previously defined clinically meaningful improvement as a decrease ≥5. This study determines the minimal clinically important difference (MCID) for VHI-10 in patients with unilateral vocal fold paralysis (UVFP) using anchor-based methodology.
Study Design
Prospective cohort questionnaire analysis.
Methods
Two hundred eighty-one UVFP patients completed the VHI-10 on two consecutive visits (within 3 months). At the follow-up visit, patients answered an 11-point Global Rating of Change Questionnaire (GRCQ) scored from −5 to +5. Relationship between the GRCQ and change in VHI-10 was quantified using analysis of variance, and MCID for the VHI-10 was determined using receiver operating characteristic (ROC) curve analysis.
Results
Overall mean VHI-10 change was −3.71 (standard deviation [SD] = 8.89) and mean GRCQ was 1.37 (SD = 2.51). Average interval between measurements was 1.73 months (SD = 0.83). Mean changes in VHI-10 scores were −7.45, −0.53, and +4.40 for patients whose GRCQ scores indicated improvement, no change, and worsening, respectively. Differences between mean scores were statistically significant (P < .001). Area under the ROC curve was 0.80, demonstrating the classification accuracy of VHI-10 change scores. A VHI-10 change of −4 was determined to be the optimal threshold that discriminated between improvement and no improvement (sensitivity and specificity 0.62 and 0.88, respectively).
Conclusions
The MCID for improvement in VHI-10 in UVFP patients is a decrease of 4. This information improves understanding of patients' response to treatment and allows comparison between different treatments. Future research should determine MCID for VHI-10 across all voice disorders.
Level of Evidence
4 Laryngoscope, 2017
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Objektive Audiometrie und klinische Anwendung
Zusammenfassung
Zur Diagnostik mannigfaltiger Hörstörungen werden neben den subjektiven Hörprüfungen v. a. objektive Testverfahren eingesetzt. Zu den objektiven Hörprüfungen gehören die Impedanzmessung mit Tympanometrie und Stapediusreflexmessung, die otoakustischen Emissionen (OAE) sowie die akustisch evozierten Potenziale (AEP). Durch die Einführung von „auditory steady-state responses" (ASSR) und in Verbindung mit statistischen Nachweismethoden kommen objektive Hörverfahren auch beim Neugeborenen-Hörscreening und bei der automatisierten Hörschwellenbestimmung zum Einsatz. Durch die Anwendung der genannten Methoden kann zwischen den verschiedenen Hörstörungen differenziert und der Grad einer Hörminderung bestimmt werden. Bei sorgfältiger Interpretation der Messergebnisse lässt sich mithilfe dieser Verfahren auch eine auditorische Synapto‑/Neuropathie von einer klassischen sensorineuralen Schwerhörigkeit unterscheiden.
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Dapsone for Recalcitrant Eosinophilic Annular Erythema: A Case Report and Literature Review
Abstract
Eosinophilic annular erythema (EAE) is a rare entity of unknown etiology that is possibly related to a hypersensitivity reaction and presents as annular erythematous plaques with tissue eosinophilia. It is classified as a figurate erythema with a controversial relationship to Wells syndrome (WS) in the literature, where it is generally considered a separate entity or subset based on clinical and histopathologic differences. EAE typically presents with recurrent, erythematous, arcuate, and annular plaques on the trunk and proximal extremities. The course of the disease is often chronic, recurrent, and relapsing. Responses to treatment are variable but are typically best with systemic steroids and antimalarials. We report a patient refractory to other therapies who had a striking response to dapsone.
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Pyoderma gangrenosum récidivant du post-partum et cardiomyopathie fatale
Source:Annales de Dermatologie et de Vénéréologie
Author(s): I. Naciri, M. Meziane, L. Benzekri, M. Ghaouti, K. Senouci, B. Hassam
IntroductionNous rapportons l'observation d'un pyoderma gangrenosum (PG) récidivant du post-partum, associé à une cardiomyopathie du post-partum (CMPP).ObservationUne femme de 23 ans signalait avoir eu un abcès du sein gauche lors de sa quatrième grossesse. Cette lésion avait évolué, après drainage chirurgical, vers une ulcération inflammatoire traitée par des soins locaux atraumatiques. Lors de sa cinquième grossesse, la patiente développait une ulcération large et douloureuse en regard d'une cicatrice de césarienne, malgré l'introduction d'une antibiothérapie à large spectre. Les prélèvements bactériologiques étaient négatifs. L'examen histologique était en faveur d'un PG. Une semaine après l'introduction d'une corticothérapie générale, elle présentait brutalement des signes d'insuffisance cardiaque. L'échocardiographie trans-thoracique permettait de retenir le diagnostic de CMPP, dont l'évolution était fatale.DiscussionCette observation soulève la question de la relation entre PG et grossesse, et décrit l'association d'un PG et d'une CMPP. La survenue du PG lors de la grossesse est rare ; elle pourrait être induite par l'élévation des taux de G-CSF constatée chez les femmes enceintes. L'association à une CMPP chez notre patiente pourrait être expliquée par le développement d'un climat anti-angiogénique en fin de grossesse, auquel s'ajouterait une agression myocardique inflammatoire neutrophilique en lien avec le PG.BackgroundWe report a case of recurrent post-partum pyoderma gangrenosum (PG) complicated by post-partum cardiomyopathy (PPCM).Patients and methodsA 23-year-old woman presented with a previous medical history of aseptic abscess of the left breast in her fourth pregnancy, which developed after surgical drainage of an inflammatory ulceration treated by atraumatic topical care. During her fifth pregnancy, the patient presented a large and painful ulceration in relation to the scar of the Caesarean section, despite the introduction of broad-spectrum antibiotic therapy. Bacteriological samples were negative. Histological examination militated in favor of PG. One week after initiation of corticosteroid therapy, the patient suddenly showed signs of heart failure. Based on trans-thoracic echocardiography PPCM was diagnosed, and the outcome was fatal.DiscussionThis observation raises the question of the relationship between PG and pregnancy and describes the association of PG and PPCM. PG occurs rarely during pregnancy and it may be induced by the rise in G-CSF levels found in pregnant women. The association with PPCM seen in our patient could have been due to the development of an anti-angiogenic climate at the end of pregnancy, together with inflammatory myocardial aggression linked to the PG.
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First evidence of bacterial translocation from the intestinal tract as a route of Helicobacter cinaedi bacteremia
Abstract
Background
The route of Helicobacter cinaedi bacteremia has not yet been clarified. Although bacterial translocation from the intestinal tract into the circulation has been suggested, it has not been demonstrated thus far. The objective of this study was to investigate the port of entry of this bacterium.
Material and Methods
We conducted a retrospective study on patients with H. cinaedi bacteremia between March 2009 and May 2013. Records of patients in whom H. cinaedi was detected in both blood and stool cultures were extracted. H. cinaedi was identified using gyrB-targeted PCR. Pulse-field gel electrophoresis was used to investigate the consistency of the genotypes.
Results
Seventy-one patients were diagnosed with H. cinaedi bacteremia during the study period. H. cinaedi was detected in both blood and stool samples of 21 patients. Pulse-field gel electrophoresis was used to investigate the consistency of the genotypes in 18 evaluable strains (from 9 patients). The pulse-field gel electrophoresis patterns of the stool- and blood-derived strains of H. cinaedi were consistent among all 9 patients. Most of the 9 patients analyzed were immunocompromised and being treated with anticancer drugs or steroids, which suggests reduced intestinal immunity.
Conclusions
This is the first study to demonstrate that bacterial translocation from the intestinal tract could represent one route of H. cinaedi bacteremia.
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