Progressive delayed hemidystonia following clinically mild traumatic brain injury

A 16-year-old boy presented with progressive left hemidystonia over 3 years. The possibilities of symptomatic hemidystonia due to focal lesions such as infarct (vasculitis), tumours, tuberculoma, arteriovenous malformations or heredodegenerative disorders such as Wilson disease were considered. Imaging showed a peculiar scar involving right basifrontal region extending upto anterior, centromedian and dorsomedial nuclei of thalamus due to blowout fracture of roof of orbit. This scar was responsible for progressive left hemidystonia. On probing the history, it was revealed that patient had sustained a mild traumatic brain injury (mTBI) 3 years ago. Burke-Fahn-Marsden dystonia severity rating scale showed improvement from 19 to 6 after treatment with tablet trihexyphenidyl 16 mg and clonazepam 1 mg. A linear scar reaching upto thalamus due to blowout fracture of roof of orbit following clinically mTBI is unique. Delayed, progressive hemidystonia has been reported following severe head injury, however is less common following clinically mTBI.

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Endobronchial metastasis of mixed Mullerian tumour of the uterus

Endobronchial metastasis occurs in only 2%–5% of non-pulmonary cancers. Here we report on an 84-year-old woman who presented with breathlessness and light-headedness while on holiday in Australia, 2 years post-treatment for endometrial cancer. Initial CT pulmonary angiogram identified a soft tissue mass in the left hemithorax. A chest radiograph performed after repatriation was consistent with a large left pleural effusion, but bedside ultrasound showed a lobulated mass involving the left hemidiaphragm. A pleural procedure in the traditional 'triangle of safety' would have resulted in inadvertent puncture of the underlying mass. Serial imaging confirmed the mass was rapidly progressing, and metastatic malignant mixed Mullerian endometrial carcinoma was diagnosed by endobronchial biopsy. A tunnelled intrapleural catheter was inserted for symptom relief, and the patient deteriorated and died at home 2 weeks later. To our knowledge, this is the first case of endobronchial metastasis from malignant mixed Mullerian tumour of the uterus.

http://ift.tt/2pUbtar

Intramural oesophageal haematoma following traumatic neck injury

This case describes a previously well 90-year-old woman who presented with neck pain, swelling, dysphagia and hoarseness following a motor vehicle collision. Oesophageal oedema was visualised on CT of cervical spine and subsequent CT angiography highlighted an actively bleeding intramural oesophageal haematoma (IOH) extending from the cervical oesophagus to the carina. This rare phenomenon (IOH) has been described as a possible consequence of blunt trauma to the neck; however, we found no cases resulting from acceleration/deceleration injury. Although this was a potentially life-threatening injury, our patient made a full recovery with conservative management.

http://ift.tt/2EbWThC

A novel bivalent fusion vaccine induces broad immunoprotection against Staphylococcus aureus infection in different murine models

Publication date: Available online 28 December 2017
Source:Clinical Immunology
Author(s): Liuyang Yang, Heng Zhou, Ping Cheng, Yun Yang, Yanan Tong, Qianfei Zuo, Jiao Luo, Qiang Feng, Quanming Zou, Hao Zeng
With more and more drug-resistant Staphylococcus aureus strains emerging in hospitals, there is an urgent need to develop an effective vaccine to combat S. aureus infection. In this study, we constructed a novel bivalent fusion vaccine, SpA-DKKAA-FnBPA37-507 (SF), based on the D domain of staphylococcal protein A (SpA) and the A domain of fibronectin-binding protein A (FnBPA). Immunisation with SF induced a more ideal protective effect compared with the single components alone in a sepsis model. It also showed broad immunoprotection against seven FnBPA isotypes. Vaccination with SF induced strong antibodies responses and Th1/Th17 polarized cellular responses. Further we demonstrated the protective effect of antibodies by the opsonophagocytic assay (OPA) and passive immunisation. Moreover, vaccination with SF showed protective efficacy in a murine pneumonia model and skin abscess model. These results suggest that SF can be regarded as a promising vaccine candidate for the prevention of S. aureus infections.



http://ift.tt/2EdPG0D

Appendicular and breast cancers in an old lady: a case report

Abstract

The presence of two or more malignant tumors of different histological entities in an individual is referred to as multiple primary malignant neoplasms (MPMN). These are becoming more frequently encountered and reported in clinical practice nowadays. Majority of MPMN are diagnosed in elderly, where senility might alter the management plan. Despite the increased reporting of MPMN in the literature, only a few elaborated on the management of such cases. Also, the combination of synchronous primary appendicular and breast cancers—to our knowledge—has never been reported. Here we present the first report of an appendicular adenocarcinoma synchronously presenting along with invasive ductal carcinoma of the breast. We highlight the diagnostic essentials and the multidisciplinary management approach including surgical excision and adjuvant therapy.

http://ift.tt/2E7olNE

Endoscopic management of duodeno-ileal fistula secondary to diffuse B-cell lymphoma

Abstract

Lymphoma arising in the gastrointestinal tract is relatively common and can affect multiple sites. The development of a gastrointestinal fistula secondary to lymphoma is very rare and has not previously been reported between the duodenum and ileum. This is the first reported care where a fistula secondary to lymphoma has been treated by an endoscopic covered duodenal stent occluding the defect rather than surgical intervention. This strategy permitted early commencement of curative intent chemotherapy which led to tumour shrinkage and fistula closure.

http://ift.tt/2pTJs2U

Acute cholecystitis in a parastomal hernia causing a small bowel obstruction

Abstract

A parastomal hernia is the abnormal protrusion of intra-abdominal tissue and organs through a defect in the abdominal wall around an ostomy. Commonly, they involve intra-abdominal fat, omentum or bowel. However, there are rare cases that involve other organs. We present the case of an 89-year-old gentleman with a gallbladder in his parastomal hernia. Due to his acute cholecystitis, the distended gallbladder compressed adjacent bowel loops in the parastomal hernia, resulting in a mechanical bowel obstruction. The patient was treated with antibiotics and a nasogastric tube. As his cholecystitis resolved his ostomy function returned.

http://ift.tt/2pW4bDs

Widespread papular eruption in an infant

http://ift.tt/2lfwebQ

Association of the CYP17 MSP AI (T-34C) and CYP19 codon 39 (Trp/Arg) polymorphisms with susceptibility to acne vulgaris

Summary

The aim of this study was to detect the association of the cytochrome P450 (CYP) 17 T-34C and CYP19 T<C polymorphisms with the risk of acne vulgaris (AV). The study enrolled 198 patients with AV (mild, moderate and severe) and 195 unrelated age-matched healthy controls from western Iran who had Kurdish ethnic background. The presence of the CYP17 TC genotype significantly increased the risk of mild, moderate and severe AV by 2.68, 2.28 and 2.94 times, respectively, while the presence of the CYP19 TC genotype significantly elevated the risk of overall AV and mild AV by 2.1 and 3.2 times, respectively. There was a synergy between the CYP 17 TC and CYP19 TT genotypes, which increased the risk of AV by 2.45-fold (P < 0.001). To our knowledge, this is the first study showing that the CYP17 T-34C and CYP19 T<C variants and their synergy are associated with susceptibility to AV in an Iranian population.

http://ift.tt/2lowOUb

Evaluation of topical liposome incorporated clove oil in the treatment of idiopathic palmar hyperhidrosis: Single-blinded placebo-controlled study

Summary

Introduction

Palmar hyperhidrosis is of great concern to patients because of its physical, occupational, and psychological impact on quality of life. Topical clove oil has been used in many conditions due to its major component Eugenol that exerts blocking effect on nerve transmission.

Aim of the work

To assess the efficacy of topical liposome incorporated clove oil in decreasing the rate of sweating among patients with idiopathic palmar hyperhidrosis.

Patients and method

Forty patients with palmar hyperhidrosis were treated with clove oil 45% in liposome and another twenty patients were treated as a control group with 0.9% saline solution and evaluation was carried out before and after treatment through gravimetry testing and hyperhidrosis disease severity scale (HDSS).

Result

The gravimetry testing among clove oil-treated group showed that the mean sweating rate before treatment was 80.5 ± 41.85 (SD) mg/min which decreased significantly after treatment to 52.98 ± 37.94(SD) mg/min (P value < .001). On the other hand, the placebo-treated group,(control) the mean sweating rate before treatment was 77.40 ± 29.29(SD) which did not show significant improvement after placebo application 77.35 ± 28.29(SD; P value = .957).

Conclusion

The topical application of 45% clove oil in liposome twice daily for 2 weeks showing promising result evidenced by declining in the rate of palmar sweating among patients with idiopathic palmar hyperhidrosis.

http://ift.tt/2C7icUw

Tattoos: Evaluation of knowledge about health complications and their prevention among students of Tricity universities

Summary

Introduction

Tattooing is a very popular form of body modification among young people. However, this kind of procedure entails the risk of various health complications. The objective of the study was to evaluate the students' knowledge about contraindications, complications, and health risks that skin tattooing may cause. Additionally, the purpose of the study was to assess how the profile of education (medical vs nonmedical) impacts on the knowledge of the respondents.

Methods

We surveyed a group of 1199 people, of which 326 (27%) had tattoos. The base of the study is an anonymously filled, author's online survey consisting of 25 questions.

Results

Eighty six percent of the students from the Medical University of Gdańsk indicated the risk of HCV virus infection during tattooing, while only 34% of students from other Tricity universities were aware of this danger. Sixty seven percent of people with tattoos felt that having them does not affect any diagnostic and therapeutic procedures. Most of respondents mentioned the tattoo artist (79%) and the Internet (73%) as a source of information before having a tattoo, while only 5% and 8% respondents asked a doctor or read medical literature about it. Fourty nine percent of respondents reported that before the procedure, tattooist failed to ask them about their health condition and medications.

Conclusions

Knowledge of students about safety, contraindications, and complications associated with the performance of tattooing is insufficient. As a result, a need for a better education on the topic for both people who are getting tattoos and tattooists appears evident.

http://ift.tt/2zKqFH0

Balloon dilatation of the Eustachian tube in adult patients with chronic dilatory tube dysfunction: a retrospective cohort study

Abstract

Objectives

The aim of this study is to assess the subjective and objective short-term results and safety of transnasal balloon dilatation of the Eustachian tube (BET) in adult patients with chronic dilatory Eustachian tube dysfunction (ETD).

Design

Retrospective cohort study. Data collection was performed preoperatively, 1 and 3 months after BET.

Setting

Tertiary referral hospital.

Participants

A cohort of 42 consecutive patients (66 ears).

Main outcome measures

ETDQ-7 score, bone conduction threshold, air-bone gap, the ability to perform Valsalva's and/or Toynbee's manoeuvre, tympanic membrane and middle ear conditions were collected pre- and postoperatively. Subjective satisfaction and complications were collected postoperatively.

Results

The ETDQ-7 score improved significantly from 4.28 to 3.09 1 month postoperatively and from 4.10 to 2.96 3 months postoperatively. Bone conduction thresholds did not differ significantly postoperatively. A significant improvement of air-bone gap was found postoperatively. The tympanic membrane and middle ear condition showed improvement in 62%. Subjective satisfaction 1 and 3 months postoperatively was around 43 and 48%. A small number of minor (self-limiting) complications did occur.

Conclusions

BET has shown to be a safe intervention, which may have a positive effect on objective and subjective indicators for chronic dilatory ETD in adult patients. We observed subjective positive effects in less than half of the patients. For certain indications, there was a measurable positive effect on the findings of the eardrum and ETDQ-7, whereas in other patients it seemed not to have any effect at all. Careful patient selection may improve this success rate. Randomized controlled trials with a prolonged follow-up are required to assess the value of BET in comparison to grommets.

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Reliability and validity study of Sino-nasal outcome test 22 (Thai version) in chronic rhinosinusitis

Abstract

Background

Chronic rhinosinusitis (CRS) is one of common health conditions that affects patients' health-related quality of life. Our purpose is to assess the reliability and validity of Thai-version of Sino-Nasal Outcome Test 22 in chronic rhinosinusitis.

Methods

Permission for translation of SNOT-22 from English language to Thai language was obtained from the developer. The translation process was done based on the international standard of translation method. A total of 80 subjects were recruited into the study and divided into two groups comprising of 50 patients with chronic rhinosinusitis and 30 healthy volunteers. Cronbach's α and Intraclass correlation coefficient were evaluated for its reliability. Validity test was evaluated against VAS score, SF-36 (Thai version) questionnaire and CT scan (based on Lund-Mackay score). Responsiveness was assessed between pre-operative and post-operative scores in 34 patients.

Results

The Thai version of SNOT-22 showed good reliability according to high value of Cronbach's α coefficient (r = 0.929) and intraclass correlation coefficient (r = 0.935). It also showed good validity by its ability to differential the patients with chronic rhinosinusitis from normal (p < 0.001), and different severity of symptoms (p < 0.05). In addition, the SNOT-22 Thai version also showed good responsiveness when compared between pre-operative and post-operative scores (p < 0.001) and also well-performed in effect size calculation (1.37).

Conclusion

We demonstrated that Thai -version of SNOT-22 has good reliability and validity, suitable for evaluation of chronic rhinosinusitis symptoms together with severity of the disease and response to treatment.

Trial registration

Thai clinical trials registry TCTR20170320003. Date of registration 20/03/2017 (retrospectively registered).

http://ift.tt/2lf2NqE

Causes of higher symptomatic airway load in patients with chronic rhinosinusitis

Abstract

Background

Chronic rhinosinusitis display a variety of different phenotypes. The symptoms of disease are characterised by various signs and symptoms such as nasal congestion, nasal discharge, pressure sensation in the face and reduced or complete loss of smell.

In a patient population undergoing functional endoscopic sinonasal surgery (FESS) for chronic rhinosinusitis, we wanted to investigate the clinical features and explore if the presence of biofilm, nasal polyps or other disease characteristic could serve as predictor for the symptomatic load. A patient group undergoing septoplasty without disease of the sinuses was included as control.

Methods

The Sinonasal outcome test (SNOT-20), EPOS visual analogue scale (VAS) and the Lund-Mackey CT score (LM CT score) were used to examine 23 patients with chronic rhinosinusitis without nasal polyps (CRSsNP), 30 patient with nasal polyps (CRSwNP) and 22 patients with septal deviation. Tissue samples were collected prospectively during surgery. The cohort has previously been examined for the presence of biofilm.

Results

Patients with CRSsNP and CRSwNP had significantly higher degree of symptoms compared to the septoplasty group (SNOT-20 scores of 39.8, 43.6 and 29.9, respectively, p = 0.034). There were no significant differences in the total SNOT-20 or VAS symptoms scores between the CRSsNP and CRSwNP subgroups. However patients with nasal polyps showed significantly higher scores of symptoms related to sinonasal discomfort such as cough, runny nose and need to blow nose (p = 0.011, p = 0.046, p = 0.001 respectively). Patients with nasal polyps showed a significantly higher LM CT score compared to patients without polyps (12.06 versus 8.00, p = 0.001). The presence of biofilm did not impact the degree of symptoms.

Conclusion

The presence of nasal polyp formations in CRS patients was associated with a higher symptomatic airway load as compared to patients without polyps. These findings suggest that nasal polyps could be an indicator of more substantial sinonasal disease. The presence of biofilm did not impact the degree of symptoms, however, as biofilm seem to be a common feature of chronic rhinosinusitis (89% in this cohort), it is more likely to be involved in the development of the CRS, rather than being a surrogate marker for increased symptomatic load.

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Predicting reactivity threshold in children with anaphylaxis to peanut

Abstract

Background

Peanut allergy necessitates dietary restrictions, preferably individualised by determining reactivity threshold through an oral food challenge (OFC). However, risk of systemic reactions often precludes OFC in children with severe peanut allergy.

Objective

We aimed to determine if clinical and/or immunological characteristics were associated with reactivity threshold in children with anaphylaxis to peanut and secondarily, to investigate if these characteristics were associated with severity of the allergic reaction during OFC.

Methods

A double-blind placebo controlled food challenge (DBPCFC) with peanut was performed in 96 5-15-year-old children with a history of severe allergic reactions to peanut and/or sensitisation to peanut (skin prick test (SPT) ≥ 3 mm or specific immunoglobulin E (s-IgE) ≥ 0.35 kUA/L). Investigations preceding the DBPCFC included a structured interview, SPT, lung function measurements, serological immunology assessment (IgE, IgG and IgG₄), basophil activation test (BAT) and conjunctival allergen provocation test (CAPT). International standards were used to define anaphylaxis and grade the allergic reaction during OFC.

Results

During DBPCFC, all 96 children (median age 9.3, range 5.1, 15.2) reacted with anaphylaxis (moderate objective symptoms from at least two organ systems). Basophil activation (CD63+ basophils ≥ 15%), peanut SPT and the ratio of peanut s-IgE/total IgE were significantly associated to reactivity threshold and lowest observed adverse events level (LOAEL) (all p < 0.04). Basophil activation best predicted very low threshold level (< 3 mg of peanut protein), with an optimal cut-off of 75.8% giving a 93.5% negative predictive value. None of the characteristics were significantly associated with the severity of allergic reaction.

Conclusion and Clinical Relevance

In children with anaphylaxis to peanut, basophil activation, peanut SPT and the ratio of peanut s-IgE/total Ig-E were associated with reactivity threshold and LOAEL, but not with allergy reaction severity.

This article is protected by copyright. All rights reserved.

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Post-tonsillectomy hemorrhage: Underlying factors and prevention

Tonsillectomy is the most frequently applied treatment for recurrent tonsillitis, tonsillar focal infection, and obstructive sleep apnea (OSA), while post-tonsillectomy hemorrhage (PTH) is a common complication. Although with continual innovation in techniques of tonsillectomy and surgical instruments, PTH still occur except for the different incidence of PTH. Thus, PTH remains a controversial subject in otolaryngology. Recently, in an excellent work, Burton and colleagues refined a technique to reduce PTH [1].

http://ift.tt/2EabkCY

Diagnostic potential and future directions of biomarkers in gingival crevicular fluid and saliva of periodontal diseases: Review of the current evidence

Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Noha Ayman Ghallab
ObjectivesThe holy grail of biomarker research in periodontology is to develop a high impact diagnostics which have a significant impact on clinical decision-making, patient outcomes and healthcare providers. In the field of periodontal diagnostics, oral fluid-based biomarkers have been studied mainly in the gingival crevicular fluid (GCF) and saliva.MethodsA literature search was performed using the Cochrane library and PubMed databases from 2000 to January 2017.ResultsCurrently, there are more than 90 different components in the GCF that have been investigated as diagnostic and prognostic markers of periodontal disease progression involving; inflammatory mediators, markers of oxidative stress, host-derived enzymes, tissue-breakdown products and mediators of bone homeostasis. Furthermore, various biomarkers in saliva have been proposed which reveal a promising outlook for saliva as a key diagnostic medium for periodontal disease. Recent systematic reviews with high value of evidence have shown that potential salivary biomarkers can provide important complimentary diagnostic information and can be used as tests for screening diagnosis, prognosis and predicting periodontal disease progression.ConclusionFuture developments in proteomic analysis and personalized medicine will pave the way allowing novel diagnostic tools. Still, the application into the field of dentistry will depend on how practitioners will apply this into their daily clinical practice.Clinical relevanceStill, the application into the field of dentistry will depend on how practitioners will apply this into their daily clinical practice.



http://ift.tt/2BP0bGc

Elevated expression of activated TH2 cells and milk-specific TH2 cells in milk-induced eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is an allergic inflammatory disease that is triggered by food allergens and characterized by progressive esophageal dysfunction. Esophageal biopsy specimens are characterized by eosinophilia and expression of TH2 cytokines.

http://ift.tt/2pRCmMb

Risk factors and clinical outcomes associated with fixed airflow obstruction in older adults with asthma

Asthma in older adults is associated with increased morbidity and mortality compared with asthma in younger patients. Fixed airflow obstruction (FAO) is associated with decreased survival in younger patients, but its significance remains unclear in older adults with asthma.

http://ift.tt/2E8fJGJ

Living in lower income zip codes is associated with more severe chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a chronic inflammatory condition afflicting the upper airways. In 2014, approximately 29.4 million adults reported being told by a doctor or other health professional in the past 12 months that they had sinusitis.1 The pathogenesis of CRS is multifactorial, likely due to a combination of host and environmental factors.2 Determining whether the host factors are due to nonmodifiable, such as race, or modifiable risk variables is important. Previous analyses of the effect of socioeconomic status on CRS have yielded conflicting results.

http://ift.tt/2pQw8MP

Efficacy of omalizumab treatment in a man with occupational asthma and eosinophilic granulomatosis with polyangioitis

Omalizumab is a humanized monoclonal antibody that binds to free-circulating immunoglobulin E (IgE). Several studies have shown the clinical efficacy of omalizumab in severe, persistent allergic asthma, including occupational cases.1

http://ift.tt/2E8Ip23

The importance of reducing risk in peanut allergy: Current and future therapies

The prevalence of peanut allergy has steadily increased during the past 10 years, especially in children. A 2009 to 2010 survey of more than 40,000 children (aged 0–17 years) in the United States found that peanut allergy was the most common food allergy, affecting 2% (1.5 million) of children nationwide.1 Data from a 2014 meta-analysis of 29 studies from multiple European countries using various reporting methods estimated the occurrence of peanut allergy to be 0.3% (by positive food challenge result) to 4.1% (by peanut specific IgE positivity) in children aged 2 to 5 years and 0.4% (by self-reporting) to 9.8% (by peanut specific IgE positivity) in children aged 6 to 17 years.

http://ift.tt/2pRZQB0

Mevalonate kinase deficiency presenting as recurrent rectal abscesses and perianal fistulae

We present the case of a 13-month-old, nonconsanguineous, Hispanic boy with rectal abscesses and perianal fistulae beginning at 2 months of age. At the time of initial consultation, he had undergone 11 prior operations for abscess drainage. His infectious history was notable for recurrent upper respiratory tract infections, acute otitis media, chronic diarrhea, and an episode of thrush that resolved with oral nystatin at 2 months of age. He did not have a history of pneumonia, growth failure, or signs of endocrinopathy.

http://ift.tt/2E4WqxQ

Gender effects in allergology – Secondary publications and update

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Gender aspects and influence of hormones on bronchial asthma – Secondary publication and update

There is good evidence for gender-specific differences in asthma regarding all affected areas, from intra- to extra-cellular mediators to the whole organ structure und functioning of the lung. These result fro...

http://ift.tt/2Cemitb

Adverse reactions to food: the female dominance – A secondary publication and update

Gender-specific differences are evident in food intolerance and allergy. In this review, we will highlight and summarize the dissimilarities in prevalence of adverse food reactions, focusing on IgE-mediated fo...

http://ift.tt/2BQ3Weu

Sex hormone allergy: clinical aspects, causes and therapeutic strategies – Update and secondary publication

Sex hormone allergy as a clinical syndrome has been known for almost a century. Due to the diversity of clinical presentation regarding symptoms and disease patterns, the optimal patient care represents an eno...

http://ift.tt/2CivjBy

Gender aspects in allergies of pets – A secondary publication and update

Allergies need not only affect humans; this multifactorial and complex disease can also affect animals. Comparative allergology investigates the many similarities between the pathogenesis, clinics, diagnosis, ...

http://ift.tt/2BPdq9X

Lymphomas in IgG4-related disease: clinicopathologic features in a Western population

Abstract

Lymphomas that occur in the setting of IgG4-related disease (IgG4-RD) are uncommon. Most reported cases derive from Asia and are MALT lymphomas occurring in orbital IgG4-RD. The spectrum of lymphomas among IgG4-RD patients in the Western world remains poorly defined. The aim of this study was to report our experience with lymphomas occurring in IgG4-RD. Eight cases were identified from the pathology and consultation files. The median age was 61 years (range 22–68) at IgG4-RD diagnosis and 63.5 years (range 33–79) at lymphoma diagnosis, with a M:F ratio of 4:4. The diagnosis of lymphoma and IgG4-RD was concurrent in three cases and asynchronous in five (interval 4.3–16.4 years). Concurrent cases included a MALT lymphoma and a diffuse large B cell lymphoma (DLBCL) occurring with IgG4-related sialadenitis and a follicular lymphoma occurring with orbital IgG4-RD. Asynchronous cases included a lymphoplasmacytic lymphoma with large cell transformation and intervening IgG4-related pancreatitis, a MALT lymphoma after lacrimal IgG4-RD, two DLBCLs after multiorgan IgG4-RD, and a DLBCL after IgG4-related sialadenitis. Our findings suggest that lymphomas in IgG4-RD are more varied in location and type than the experience reported from Asia to date. Pathologists should be aware of the potential for lymphoma to develop in patients with IgG4-RD and should have a high degree of suspicion when lymphadenopathy or extranodal masses persist despite appropriate therapy for IgG4-RD. The co-occurrence of IgG4-RD and lymphoma that is reported here and previously suggests a possible etiologic association.

http://ift.tt/2zIz91e

Choreoathetosis – an unusual adverse effect of dihydroartemisinin-piperaquine: a case report

Dihydroartemisinin-piperaquine is a combination of dihydroartemisinin and piperaquine which is highly effective in the treatment of uncomplicated falciparum malaria. Its adverse effects are generally tolerable...

http://ift.tt/2zGZqx8

A Simulation Study to Evaluate Improvements in Anesthesia Work Environment Contamination After Implementation of an Infection Prevention Bundle

BACKGROUND: Microbiological contamination of the anesthesia work environment (AWE) is a potential source of health care–associated infections. Medication syringes, stopcocks, and many other areas are routinely contaminated during anesthetic care, and adherence to hand hygiene recommendations is poor. Using a simulation model, we investigated whether AWE contamination could be reduced by implementing an intervention bundle focused on infection prevention. METHODS: Twenty-five anesthesia providers were enrolled in this nonrandomized simulation scenario crossover design study. Subjects were asked to complete 2 general anesthesia scenarios in a mock operating room: a baseline scenario and an intervention scenario in which the bundle was implemented. The bundle included: double gloving before intubation, confining all airway equipment to 1 area, and performing hand hygiene before touching the anesthesia cart. Before each scenario, a manikin's oropharynx and face were marked with ultraviolet fluorescent tracers. After each scenario, the AWE was inspected with a ultraviolet light source to detect contaminant, and all sites were photographed. A blinded observer scored the images for the presence or absence of tracer at 20 sites. Videos of the scenarios were analyzed for duration and number of hand hygiene and glove removal events. Data were analyzed using a mixed effects model. Subjects completed a survey about their experience and the value of the scenarios. RESULTS: The intervention was associated with a decreased subject contamination score of 4.0 (95% confidence interval, 2.2–5.6; P

http://ift.tt/2lmt6u9

Anesthetic Management and Procedural Outcomes of Patients Undergoing Off-Pump Transapical Implantation of Artificial Chordae to Correct Mitral Regurgitation: Case Series of 76 Patients

BACKGROUND: Transapical implantation of artificial chordae using the NeoChord system (NeoChord Inc, Minneapolis, MN) is an emerging beating-heart technique for correction of mitral regurgitation (MR) through a minimally invasive left minithoracotomy. The purpose of the study was to describe the anesthetic management and procedural success of patients undergoing this procedure. METHODS: All patients (n = 76) who underwent mitral valve repair with the NeoChord system in our institution from December 2011 to December 2016 were included in this observational prospective study. Balanced anesthesia with a combination of fentanyl, propofol, and sevoflurane was used in all patients. Each patient's core temperature was maintained at >36°C whenever possible. Two- and 3-dimensional transesophageal echocardiography was used in all patients to navigate the device to the posterior mitral valve leaflet (68 of 76 patients), anterior mitral valve leaflet (3 of 76 patients), or both leaflets (5 of 76 patients). After effective leaflet capture, the artificial chordae were deployed. Position and function of the artificial chordae were assessed by evaluating the degree of MR when the neochordae were tensed. After surgery, all patients were transferred to the intensive care unit. RESULTS: The mean age of the patients was 60 ± 13 years (range, 33–87 years), and the male/female ratio was 52/24. Most patients had severe MR (grade 4+ in 25 [33%] patients, grade 3+ in 51 [67%] patients). The average preoperative EuroSCORE II was 1.23% ± 1.16% (range, 0.46%–4.23%). The median duration of the procedure was 120 minutes (interquartile range [IQR] 115–145 minutes). After the procedure, 42 (56%) patients had trivial MR, 27 (36%) had grade 1+ MR, 4 (5%) had grade 2+ MR, and 2 (3%) had >2+ MR. One patient underwent conversion to conventional mitral valve repair due to perforation of the posterior mitral valve leaflet. The whole procedure was well tolerated by the patients, with hemodynamics remaining stable in the majority of the cases. Only 20 (26%) patients needed low-dose inotropic support perioperatively. All patients had an uneventful postoperative course. The median time to extubation was 4 hours (IQR, 2.6–6), and the length of intensive care unit stay was 22 hours (IQR, 21–24). Five (6.6%) patients required allogeneic blood products. CONCLUSIONS: Anesthesia for transapical NeoChord implantation can be safely performed under beating-heart conditions, with low perioperative morbidity and rare blood transfusions. Transesophageal echocardiography is crucial for the guidance, safety, and effectiveness of the procedure. Accepted for publication November 13, 2017. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Institutional review board: Vilnius Regional Bioethics Committee, M. K. Ciurlionio St 21/27, LT 03101, Vilnius, Lithuania. E-mail: rbtek@mf.vu.lt. Reprints will not be available from the authors. Address correspondence to Arturas Lipnevicius, MD, Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Vilnius University, Santariskiu 2, Vilnius, LT 08661 Lithuania. Address e-mail to artaslip@yahoo.com. © 2017 International Anesthesia Research Society

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Clinical Utility of Intraoperative Motor-Evoked Potential Monitoring to Prevent Postoperative Spinal Cord Injury in Thoracic and Thoracoabdominal Aneurysm Repair: An Audit of the Japanese Association of Spinal Cord Protection in Aortic Surgery Database

BACKGROUND: Spinal cord ischemic injury is the most devastating sequela of descending and thoracoabdominal aortic surgery. Motor-evoked potentials (MEPs) have been used to intraoperatively assess motor tract function, but it remains unclear whether MEP monitoring can decrease the incidence of postoperative motor deficits. Therefore, we reviewed multicenter medical records of patients who had undergone descending and thoracoabdominal aortic repair (both open surgery and endovascular repair) to assess the association of MEP monitoring with postoperative motor deficits. METHODS: Patients included in the study underwent descending or thoracoabdominal aortic repair at 12 hospitals belonging to the Japanese Association of Spinal Cord Protection in Aortic Surgery between 2000 and 2013. Using multivariable mixed-effects logistic regression analysis, we investigated whether intraoperative MEP monitoring was associated with postoperative motor deficits at discharge after open and endovascular aortic repair. RESULTS: We reviewed data from 1214 patients (open surgery, 601 [49.5%]; endovascular repair, 613 [50.5%]). MEP monitoring was performed in 631 patients and not performed in the remaining 583 patients. Postoperative motor deficits were observed in 75 (6.2%) patients at discharge. Multivariable logistic regression analysis revealed that postoperative motor deficits at discharge did not have a significant association with MEP monitoring (adjusted odds ratio [OR], 1.13; 95% confidence interval [CI], 0.69–1.88; P = .624), but with other factors: history of neural deficits (adjusted OR, 6.08; 95% CI, 3.10–11.91; P

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Exploring Beyond the Duration of Analgesia: Can Adjuncts Improve More Meaningful Outcomes in Obstetric Patients?

No abstract available

http://ift.tt/2lmJw5N

Does Lactate Affect the Association of Early Hyperglycemia and Multiple Organ Failure in Severely Injured Blunt Trauma Patients?

BACKGROUND: Early hyperglycemia is associated with multiple organ failure (MOF) after traumatic injury; however, few studies have considered the contribution of depth of clinical shock. We hypothesize that when considered simultaneously, glucose and lactate are associated with MOF in severely injured blunt trauma patients. METHODS: We performed a retrospective investigation at a single tertiary care trauma center. Inclusion criteria were patient age ≥18 years, injury severity score (ISS) >15, blunt mechanism of injury, and an intensive care unit length of stay >48 hours. Patients with a history of diabetes or who did not survive the initial 48 hours were excluded. Demographics, injury severity, and physiologic data were recorded. Blood glucose and lactate values were collected from admission through the initial 24 hours of hospitalization. Multiple metrics of glucose and lactate were calculated: the first glucose (Glucadm, mg/dL) and lactate (Lacadm, mmol/L) at hospital admission, the mean initial 24-hour glucose (Gluc24hMean, mg/dL) and lactate (Lac24hMean, mmol/L), and the time-weighted initial 24-hour glucose (Gluc24hTW) and lactate (Lac24hTW). These metrics were divided into quartiles. The primary outcome was MOF. Separate Cox proportional hazard models were generated to assess the association of each individual glucose and lactate metric on MOF, after controlling for ISS, admission shock index, and disposition to the operating room after hospital admission. We assessed the interaction between glucose and lactate metrics in the multivariable models. Results are reported as hazard ratios (HRs) for an increase in the quartile level of glucose and lactate measurements, with 95% confidence intervals (CIs). RESULTS: A total of 507 severely injured blunt trauma patients were evaluated. MOF occurred in 46 of 507 (9.1%) patients and was associated with a greater median ISS (33.5, interquartile range [IQR]: 22–41 vs 27, IQR: 21–34; P

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In Response

No abstract available

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The Syringe Driver: Continuous Subcutaneous Infusions in Palliative Care, 4th ed.

No abstract available

http://ift.tt/2lmDsdr

Teledermatology Platform May Allow High-quality Acne Evaluation

Patient-taken iPhone photos transmitted and stored in the Network Oriented Research Assistant (NORA) teledermatology program may be as useful for acne evaluations as in-person consultations, a pilot study suggests.
Reuters Health Information

http://ift.tt/2C4jy27

Phase II trial of eribulin mesylate in recurrent or metastatic salivary gland malignancies

Abstract

Background

This study examined the microtubule inhibitor eribulin in recurrent/metastatic salivary gland cancers (RMSGCs), a disease where no therapeutic standard exists.

Methods

This phase II clinical trial treated patients with progressive recurrent/metastatic salivary gland cancers with eribulin 1.4 mg/m² i.v. on days 1 and 8 of a 21-day cycle until disease progression/unacceptable toxicities. The primary endpoint was the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 objective response rate.

Results

Between May 2012 and August 2015, 29 patients were enrolled in this study. The median age was 63 years (range 34-75 years) and 20 of the subjects were men (69%). The most common histologies were adenoid cystic carcinoma (ACC; n = 11) and adenocarcinoma (n = 4). Neutropenia was the most common toxicity (grade 3; n = 5; 17% and grade 4 n = 3; 10%). The objective responses were observed in 3 of 29 patients (10%), 20 of 29 patients (69%) demonstrated a decrement in tumor size, and disease control was observed in 26 of 29 patients (90%).

Conclusion

Although the objective responses to eribulin were uncommon, disease control was observed in the majority of patients.

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Improving learning and confidence through small group, structured otoscopy teaching: a prospective interventional study

Otologic diseases are common and associated with significant health care costs. While accurate diagnosis relies on physical exam, existing studies have highlighted a lack of comfort among trainees with regards...

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Burping Your Baby 101

 

Every parent has wondered at least once … of all the things that come with an instruction manuals, how is a baby not one of them?! I know I'm supposed to burp my baby, but how do I do it? For how long? Until she's how old? I've ushered many parents through the process, and I've walked that road twice now, myself. Here are my tips.

The post Burping Your Baby 101 appeared first on ChildrensMD.

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Neck rejuvenation by direct anterior medial cervicoplasty: the modified zigzag-plasty according to Tschopp

Abstract

Background

Conventional cervicofacial rhytidectomy has become the standard treatment of skin excess of the ageing neck. However, some patients want to avoid an extensive surgical procedure, especially if the anterior neck is the predominant problem zone.

Objective

To report on the efficacy and safety of a zigzag-shaped skin excision combined with platysma plication.

Methods & Materials

We present a retrospective case review series of 6 female patients. Skin excess was marked preoperatively using the skin pinching technique, then transferred into a zigzag-shaped area and finally excised using the method according to Tschopp, which is described. Patients were followed up for at least one year.

Results

All patients (age: 55 to 82 yrs., median: 65 yrs.) were very satisfied with the results. On an overall patient satisfaction scale of 1 to 10 (1 being the best), the scars were graded on average 1,85 (median: 2) 1 year after surgery. No scar hypertrophy, functional impairment, nerve damage or other serious complications were observed.

Conclusion

In selected patients, the direct anterior zigzag-shaped excision poses an effective, safe and easy surgical option for both skin and fat excess and platysma banding. The technique is easily reproducible, with low morbidity and high patient satisfaction.

This article is protected by copyright. All rights reserved.

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Role of T-helper 17 cells and T regulatory cells in alopecia areata: Comparison of lesion and serum cytokine between controls and patients

Abstract

Background

Alopecia areata (AA) is an organ-specific autoimmune disease with T-cell-mediated attack of hair follicle autoantigens. As T-helper 17 (Th17) cells and T regulatory (Treg) cells are crucially involved in the pathogenesis, the role of Th17 and Treg cytokines has not been studied yet.

Objective

To determine whether AA is associated with alterations in lesional and serum Th17 and Treg cytokines, and studied whether they were associated with clinical type.

Methods

Scalp skin samples from 45 patients and 8 normal controls were obtained for PCR specific for IFN-γ, TNF-α, TGF-β, IL-1, IL-2, IL-4, IL-10, IL-12A, IL-13, IL-17, IL-22 and IL-23. Serum cytokines were measured from 55 patients and 15 normal controls using ELISA.

Results

Lesional IL-17 and IL-22 were significantly increased in patients group. Moreover, positive correlations were shown between lesional IL-17, IL-22 and disease severity. Serum IL-1, IL-17, TNF-α, and TGF-β were significantly increased, and positive correlation was shown between serum IL-17 and disease severity.

Conclusion

These results showed significantly high Th17 cytokines in both lesion and serum in AA patients, which may highlight a functional role of these cytokines in the pathogenesis of AA.

This article is protected by copyright. All rights reserved.

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Design, development and optimization of a transungual duple nail lacquer for onychomycosis therapy

Abstract

Onychomycosis is a degenerative fungal infection inflicting toes and finger nails which is caused by both dermatophytes and non-dermatophytes such as Trichophyton rubrum and Candida spp. respectively. The infection apparently causes nail mutilation making nails stiff, skinny, flawed, and dyschromic. Owing to the anatomical presentation of the disease, a topical application is warranted which asserts positive attributes like ease of preparation, improved adherence, negligible drug interactions, low systemic adverse effects and voluntary removal.

This article is protected by copyright. All rights reserved.

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Letter on ‘European dermatology forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 2: Scleromyxedema, scleredema and nephrogenic systemic fibrosis’

Abstract

We read with interest the guidelines recently published on sclerosing diseases of the skin (Part 2: Scleromyxedema, scleredema and nephrogenic systemic fibrosis)[1, 2]. However, we are concerned that the guideline recommendations proposed for prevention of nephrogenic systemic fibrosis (NSF) are potentially dangerous. Although we recognise the challenges in constructing comprehensive guidelines, we are concerned that this may be because the guidelines have not involved a multidisciplinary team.

This article is protected by copyright. All rights reserved.

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A novel scale for measurement of acquired dermal macular hyperpigmentation (ADHM) severity

Abstract

Acquired dermal macular hyperpigmentation (ADMH) is a hypernym which includes lichen planus pigmentosus (LPP), Riehl's melanosis (RM), pigmented contact dermatitis (PCD) and erythema dyschromicum perstans (EDP). There is considerable overlap between the clinical and histopathological features of these conditions. Despite affecting a large number of patients, there is no validated quantitative scale for LPP/EDP/RM/PCD/ADMH.

This article is protected by copyright. All rights reserved.

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The importance of reducing risk in peanut allergy: Current and future therapies

Publication date: Available online 28 December 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Wayne G. Shreffler, Joe L. Baumert, Benjamin C. Remington, Stef J. Koppelman, Chitra Dinakar, David M. Fleischer, Edwin Kim, Stephen A. Tilles, Jonathan M. Spergel




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Elevated expression of activated TH2 cells and milk-specific TH2 cells in milk-induced eosinophilic esophagitis

Publication date: Available online 28 December 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Antonella Cianferoni, Melanie A. Ruffner, Ryan Guzek, Shabo Guan, Terri Brown-Whitehorn, Amanda Muir, Jonathan M. Spergel
BackgroundEosinophilic esophagitis (EoE) is an allergic inflammatory disease that is triggered by food allergens and characterized by progressive esophageal dysfunction. Esophageal biopsy specimens are characterized by eosinophilia and expression of TH2 cytokines.ObjectiveTo ascertain whether TH2 cells can exist in the peripheral blood in patients with milk-induced EoE.MethodsPeripheral blood mononuclear cells from 20 children with milk-induced EoE were collected during active EoE (EoE-A) while consuming milk and inactive EoE (EoE-I) while not consuming milk, and 8 healthy patients without EoE were used as controls. The samples were analyzed for T-cell phenotype, including intracellular cytokines before and after incubation with milk antigens and assessed by flow cytometry.ResultsWe found a significant increase in CD4⁺ TH2 cells in the peripheral blood of patients with EoE-A compared with the controls. Furthermore, we observed a significant mean (SD) increase in the activation marker of CD154⁺ T cells (0.17% [0.047^%]) in patients with EoE-A compared with control patients (0.034% [0.007%]) and EoE-I (0.025% [0.008]). These CD4⁺ T cells expressed significantly increase levels of TH2 cytokines (interleukins 4, 5, and 13) compared with the EoE-I and control groups. CD3⁺CD4⁺CD154⁺IL-5⁺ cells were significantly increased by milk antigens in both milk-induced EoE-A (0.050% [0.008%] to 0.079% [0.017%]) and EoE-I (0.0045% [0.002%] to 0.014% [0.008%]) compared with the controls (0.008% [0.003%] to 0.003% [0.001%]).ConclusionOur findings indicate that in EoE peripheral T cells have specific activation to milk allergens.



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A Pathway-Based Association Analysis Identified FMNL1-MAP3K14 as Susceptibility Genes for Leprosy

Abstract

The nuclear transcription factor-κB (NF-κB) plays a pivotal role in controlling both innate and adaptive immunity and regulates the expressions of many immunological mediators. Abundant evidences have showed that the importance of NF-κB pathway in the host immune responses against Mycobacterium leprae in the development of leprosy. However, no particular association study between leprosy and NF-κB pathway related gene polymorphisms was reported. Here, we performed a large scale and two-stage candidate association study to investigate the association between 94 NF-κB pathway related genes and leprosy. Our results showed that rs58744688 was significantly associated with leprosy (P=7.57×10^-7, OR=1.12) by combining the previous genome wide association datasets and four independent validation sample series, consisting of a total of 4631 leprosy cases and 6413 healthy controls. This founding implicated that MAP3K14 and FMNL1 were susceptibility genes for leprosy, which suggested the involvement of macrophage targeting and NF-κB pathway in the development of leprosy.

This article is protected by copyright. All rights reserved.

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Characterization of the facial microbiome in twins discordant for rosacea

Abstract

Previously, we determined that genetic and environmental factors contributed equally towards rosacea in twins. To assess an environmental factor, we characterized the malar cheek bacterial microbiome from twins discordant for rosacea. We found no significant difference in facial microbiome alpha and beta diversity between related twins discordant for rosacea. However, the relative percentage abundance of Gordonia and Geobacillus, low abundant genera, was positively and negatively associated with rosacea severity, respectively. Our data demonstrate a significant correlation between facial microbiome and severity of rosacea in genetically matched twins and importantly that overall microbiome composition is largely unchanged.

This article is protected by copyright. All rights reserved

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The Partial Duplication of the 5′ Segment of KMT2A Revealed KMT2A-MLLT10 Rearrangement in a Boy with Acute Myeloid Leukemia

The duplication of 5′ segment of KMT2A is a rare molecular event in childhood leukemia, and the influence on prognosis is unknown. Here, we report on a boy who developed acute monocytic leukemia. Fluorescence in situ hybridization revealed the duplication of the 5′ segment with 2 normal alleles at KMT2A which was eventually found to be fused with MLLT10. Chemotherapy promptly induced the first complete remission in the patient at our facility, and the patient remained in first complete remission with negative minimal residual disease at 3.5 years from diagnosis. Our case is similar to two previously reported patients who had partial duplication of the 5′ segment of KMT2A with a KMT2A-MLLT10 rearrangement. Further studies and experience with this cryptic translocation may shed more light on the management of acute myeloid leukemia.

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Low-dose Methotrexate: Determinants for Adverse Events

What are the relative risks of adverse events in patients exposed to low-dose methotrexate vs. placebo, and what factors might predispose patients to these events?
The British Journal of Dermatology

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Study Shows Increased Risk of Uterine Fibroids in African-American Women With a Common Form of Hair Loss

In a study of medical records gathered on hundreds of thousands of African-American women, Johns Hopkins researchers say they have evidence that women with a common form of hair loss have an increased chance of developing uterine leiomyomas, or fibroids.

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The Sphenopalatine Ganglion Block for Post-dural Puncture Headache

Condition:   Post-Dural Puncture Headache
Intervention:   Procedure: Sphenopalatine ganglion block
Sponsor:   Brigham and Women's Hospital
Not yet recruiting

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CXCR3 blockade combined with cyclosporine A alleviates acute graft-versus-host disease by inhibiting alloreactive donor T cell responses in a murine model

Publication date: February 2018
Source:Molecular Immunology, Volume 94
Author(s): Shengchao Miao, Bo Tang, Huihui Liu, Zhenhua Wang, Yongjin Shi, Yujun Dong, Wei Liu, Chenchen Qin, Hanyun Ren
Chemotaxis of T cells to acute graft-versus-host disease (aGvHD) target tissues directed by chemokines and their receptors plays a key role in the pathogenesis of aGvHD. Blockade of lymphocyte migration by targeting chemokine receptors may be a viable strategy for the prevention and treatment of aGvHD, which is quite distinguishable from typical efforts to use immunosuppressive medications that have been associated with some side effects. CXCR3 and its ligands have been reported to be correlated with aGvHD pathogenesis. Using the small-molecule CXCR3 antagonist AMG487, we demonstrated that AMG487 combined with cyclosporine A (CsA) effectively alleviated aGvHD with a prolonged mean survival time and significantly inhibited the infiltration of inflammatory cells in aGvHD target tissues in a murine aGvHD model. In addition, AMG487 combined with CsA inhibited the activation, proliferation and differentiation of donor-derived T cells in the spleens. Further results showed that the concentrations of Th1 cells associated with pro-inflammatory cytokines such as IFN-γ and TNFα in serum were decreased. In addition, AMG487 treatment did not alter CXCR3 and CCR5 expression in donor-derived T cells but elevated the serum CXCL9 and CXCL10 levels. This novel and effective approach has the potential to develop a new clinical method to prevent and treat aGvHD.



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Identification of the cognate peptide-MHC target of T cell receptors using molecular modeling and force field scoring

Publication date: February 2018
Source:Molecular Immunology, Volume 94
Author(s): Esteban Lanzarotti, Paolo Marcatili, Morten Nielsen
Interactions of T cell receptors (TCR) to peptides in complex with MHC (p:MHC) are key features that mediate cellular immune responses. While MHC binding is required for a peptide to be presented to T cells, not all MHC binders are immunogenic. The interaction of a TCR to the p:MHC complex holds a key, but currently poorly comprehended, component for our understanding of this variation in the immunogenicity of MHC binding peptides. Here, we demonstrate that identification of the cognate target of a TCR from a set of p:MHC complexes to a high degree is achievable using simple force-field energy terms. Building a benchmark of TCR:p:MHC complexes where epitopes and non-epitopes are modelled using state-of-the-art molecular modelling tools, scoring p:MHC to a given TCR using force-fields, optimized in a cross-validation setup to evaluate TCR inter atomic interactions involved with each p:MHC, we demonstrate that this approach can successfully be used to distinguish between epitopes and non-epitopes. A detailed analysis of the performance of this force-field-based approach demonstrate that its predictive performance depend on the ability to both accurately predict the binding of the peptide to the MHC and model the TCR:p:MHC complex structure. In summary, we conclude that it is possible to identify the TCR cognate target among different candidate peptides by using a force-field based model, and believe this works could lay the foundation for future work within prediction of TCR:p:MHC interactions.



http://ift.tt/2E8ttkq

Increased PD-1+CD154+ Tfh cells are possibly the most important functional subset of PD-1+ T follicular helper cells in adult patients with minimal change disease

Publication date: February 2018
Source:Molecular Immunology, Volume 94
Author(s): Tao Li, Yunpeng Shi, Weixia Sun, Haifeng Wang, Quan Wang, Yanfang Jiang
T follicular helper (Tfh) cells, especially programmed cell death protein 1 (PD-1)⁺ Tfh cells, exert important functions in the normal immune response. The purpose of this study was to determine the frequency of different subsets of PD-1⁺ Tfh cells and their functional effects in adult patients with minimal change disease (MCD). The frequencies of circulating PD-1⁺, PD-1⁺CD154⁺, and PD-1⁺interleukin (IL)-21⁺ Tfh cells, and CD38⁺CD19⁺ and CD38⁺CD19⁺CD40⁺ B cells, as well as serum IL-2, IL-4, IL-17A, IL-6, IL-21, and interferon (IFN)-γ were significantly increased in the MCD patients compared with the healthy controls (HCs) (P < 0.05). However, no significant difference was found in PD-1⁺BCL-6⁺ or PD-1⁺ICOS⁺ Tfh cells. Furthermore, the percentages of PD-1⁺ Tfh and PD-1⁺CD154⁺ Tfh cells were negatively correlated with the estimated glomerular filtration rate (eGFR), but positively correlated with the 24-h urinary protein concentration and serum IL-21 level. The percentages of PD-1⁺ Tfh and PD-1⁺CD154⁺ Tfh cells were positively correlated with the percentages of CD38⁺ plasma cells and active CD38⁺CD40⁺ plasma cells, respectively. After an 8–12-week treatment with prednisolone, the percentages of PD-1⁺, PD-1⁺CD154⁺, and PD-1⁺IL-21⁺ Tfh cells as well as the serum level of IL-21 were significantly reduced; in contrast, the serum levels of IL-4 and IL-10 were increased (P < 0.05). We conclude that increased PD-1⁺CD154⁺ Tfh cells are possibly the most important functional subset of PD-1⁺ Tfh cells and may contribute towards the pathogenesis of MCD.



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Forthcoming Meetings

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Cover Image

The cover image, by M. A. Blankestijn et al., is based on the Original Article Specific IgE to peanut 2S albumin Ara h 7 has a discriminative ability comparable to Ara h 2 and 6, DOI: 10.1111/cea.13030.

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Welcome to 2018

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Issue Information

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Reflectance confocal microscopy for the diagnosis of tinea nigra

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A Rare Case Report and Literature Review of External Auditory Canal Cholesteatoma with Circumferential Destruction of Canal Wall Exposing Facial Nerve

External auditory canal cholesteatoma (EACC) is a rare condition with an estimated incidence of 1.2 per 1000 new otological patients. It is often mistaken with keratosis obturans. We discuss an extensive primary EACC with an aural polyp in a male which was managed by modified radical mastoidectomy.

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Low dose treatment of mice with bacterial extract (OM-85) for attenuation of experimental atopic asthma in mice – Reply

Publication date: Available online 27 December 2017
Source:Allergologia et Immunopathologia
Author(s): P.M. Pitrez, R.T. Stein




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Case 40-2017: A 32-Year-Old Woman with Headache, Abdominal Pain, Anemia, and Thrombocytopenia

Presentation of Case. Dr. Emer McGrath (Neurology): A 32-year-old woman was admitted to this hospital in the fall because of severe headache and loss of peripheral vision. The patient had been in her usual state of health until 4 weeks before admission to this hospital, when she underwent elective…

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Post-tonsillectomy hemorrhage: Underlying factors and prevention

Publication date: Available online 28 December 2017
Source:American Journal of Otolaryngology
Author(s): Zheng-cai Lou, Zi-han Lou




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Inhalant allergen sensitization is an independent risk factor for the development of angioedema

Publication date: Available online 27 December 2017
Source:American Journal of Otolaryngology
Author(s): Jacob E. Kuperstock, Nicholas Pritchard, Michal Horný, Christopher C. Xiao, Christopher Brook, Michael P. Platt
Background/objectiveThe etiology and risk factors for angioedema remain poorly understood with causative triggers often going undiagnosed despite repeated reactions. The purpose of this study was to determine the relationship between inhalant allergen sensitization and angioedema.MethodsA retrospective review of patients who had in vitro inhalant allergy testing from 2006 to 2010 was performed. Patients with a diagnosis of angioedema who underwent inhalant allergy testing were identified. Analyses for co-morbidities, class of sensitization, seasonal timing of angioedema, and concurrent use of known hypertensive medications that can cause angioedema were performed.ResultsThere were 1000 patients who underwent inhalant allergy testing and qualified for the study. 37/1000 had at least one episode of angioedema and of these patients, 34 had positive inhalant sensitization testing results. Multivariate regression models showed overall sensitization status, seasonal allergen and epidermal/mite sensitization as independent risk factors (p<0.001, p=0.005, p=0.025 respectively) when controlling for ACE inhibitor use and other covariates. Tree, and epidermal/mite sensitizations were independent risk factors for angioedema in mono-sensitized subject analysis (p=0.028, p=0.029, respectively).ConclusionBoth seasonal and perennial allergen sensitizations are independent risk factors for the development of angioedema. In patients with angioedema and an unknown trigger, inhalant allergen sensitization should be considered as a potential contributing factor to the development of angioedema.



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Medium-term assessment of Eustachian tube function after balloon dilation

Publication date: Available online 28 December 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): D. Schmitt, M. Akkari, T. Mura, M. Mondain, A. Uziel, F. Venail
There is at present no consensus on the treatment of obstructive Eustachian tube dysfunction. In case of failure of well-conducted drug and pressure therapy, some authors recommend balloon dilation; the present study aimed to assess the efficacy and safety of Eustachian tube balloon dilation.Materials and methodsA single-center retrospective study assessed clinical and tubomanometric results of Eustachian tube balloon dilation, complications and satisfaction in a consecutive series managed between June 2012 and February 2015. Indications were based on clinical and paraclinical signs of obstructive tube dysfunction despite well-conducted medical treatment.ResultsForty-five procedures were performed in 38 patients. Improvement in clinical symptoms was assessed as 88%, 80% and 80% at respectively 2 months, 6 months, and>1 year. Improved function on tubomanometry was observed in 81% of cases. The procedure was well tolerated, with a minor complications rate of only 4%.ConclusionsThe present findings for efficacy, tolerance and safety were comparable to those in the literature, despite first-line failure in all patients. Eustachian tube function normalized in about one-third of cases. Despite these encouraging results, true efficacy remains to be confirmed in prospective studies with higher levels of evidence.



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Issue Information

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Clinical Snippets

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On the studies of time periods in head and neck cancer diagnosis and treatment

Publication date: Available online 27 December 2017
Source:Oral Oncology
Author(s): Pablo Varela-Centelles, José M. García-Martín, Juan Seoane-Romero




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Unraveling the conundrum of asthma phenotypes and endotypes

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The dilemma of allergy to food additives

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Chronic rhinosinusitis with nasal polyps in the elderly: Assessing current evidence

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A review of the efficacy and safety of once-daily tiotropium Respimat 2.5 micrograms in adults and adolescents with asthma

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Characterizing patients with asthma who received Global Initiative for Asthma steps 4‐5 therapy and managed in a specialty care setting

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The effect of omalizumab treatment on the low affinity immunoglobulin E receptor (CD23/fc epsilon RII) in patients with severe allergic asthma

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Systemic inflammation mediates the detrimental effects of obesity on asthma control

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Heterogeneity of asthma and the risk of celiac disease in children

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Characteristics of beef allergy in schoolchildren in Turkey

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Comparison of the effect of 5-grass pollen sublingual immunotherapy tablets and drops in children with rhinoconjunctivitis

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Evaluating satisfaction of patients with hereditary angioedema with their past and present treatments: Implications for future therapies

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For the Patient

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