Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Παρασκευή 5 Ιανουαρίου 2018
KLICK syndrome: an unusual phenotype
Erythrokeratoderma refers to a group of rare inherited disorders with both clinical and genetic heterogeneities.1 Lesions usually start in infancy and are characterized by localized and well-demarcated erythematous and hyperkeratotic plaques, sometimes with a migratory nature. Erythrokeratoderma is often inherited as an autosomal dominant trait caused by mutations in the genes GJB3, GJB4, or GJA1, encoding connexins 31, 30.3, and 43, respectively. Erythrokeratoderma may be associated with neurological anomalies and can be caused by ELOVL4.2 Recently, mutations in KDSR (3-ketodihydrosphingosine reductase), encoding an enzyme in the ceramide pathway were also demonstrated to lead to erythrokeratoderma.3
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Striate palmoplantar keratoderma resulting from a missense mutation in DSG1
palmoplantar keratodermas (PPKs, OMIM #144200) refer to a large phenotypically and genetically heterogeneous group of keratinisation disorders characterised by marked hyperkeratosis on the surface of the palms and soles.
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Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a critical appraisal
Summary
Aim
Blauvelt et al. (The Lancet 2017; 389: 2287-303) aimed to compare the long-term efficacy and safety of dupilumab with medium-potency topical corticosteroids (TCS) versus placebo with TCS in adults with moderate-to-severe atopic dermatitis (AD).
Setting and design
This multicentre randomised, double-blinded, placebo-controlled trial was conducted in hospitals, clinics and academic institutions across 161 sites in 14 countries.
Study exposure
Adults with moderate-to-severe AD were randomly assigned (3:1:3) to receive subcutaneous dupilumab 300mg once weekly (qw) plus TCS, dupilumab 300mg every 2 weeks (q2w) plus TCS, or placebo plus TCS until week-52.
Primary outcome measures
Co-primary efficacy endpoints were patients (%) achieving Investigator's Global Assessment (IGA) 0/1 and 2-points or higher improvement from baseline, and Eczema Area and Severity Index 75% improvement from baseline (EASI-75) at week-16.
Results
740 patients were included in the trial: 319 were randomly assigned to dupilumab qw, 106 to dupilumab q2w and 315 to the placebo arm. At week-16, more patients in the dupilumab groups achieved the co-primary endpoints: IGA 0/1 (39% [125 patients] qw dosing, 39% [41 patients] q2w dosing vs 12% [39 patients] receiving placebo; p<0.0001) and EASI-75 (64% [204] and 69% [73] vs 23% [73]; p<0.0001). Whilst no new safety signals were identified, adverse effects (AEs) were noted in 261 (83%) in those receiving dupilumab qw plus TCS, 97 (88%) dupilumab q2w plus TCS and 266 (84%) for placebo plus TCS. Rates of conjunctivitis, injection site reactions and local herpes simplex infections were higher in the dupilumab groups compared with placebo.
Conclusions
Blauvelt et al. concluded that dupilumab treatment added to TCS improved AD up to week-52 compared with TCS alone, and also demonstrated acceptable safety.
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Pneumocephalus and seizures following combined spinal-epidural for labor
Most cases of pneumocephalus following neuraxial blocks are associated with accidental dural puncture using loss of resistance to air for identification of the epidural space [1]. To our knowledge, there are no published reports in literature following use of saline for loss of resistance. We report the finding of simultaneous pneumocephalus and a cavernoma in a patient who received a combined spinal-epidural analgesia for labor, using loss of resistance to saline (LORS). The patient provided written consent for the authors to publish this report.
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Nasotracheal intubation through pharyngeal flap after pharyngeal flap construction
A 24-year-old woman provided her written consent to publish the details of her case. She had undergone multiple surgeries including pharyngeal flap construction for bilateral cleft lip and palate. All previous operations were performed under general anesthesia by oral intubation. In the present procedure, sagittal split ramus osteotomy under general anesthesia with nasotracheal intubation was planned. We obtained the three-dimensional morphological structure of the pharyngeal flap (Fig. 1). The measurements of the cross-section at the narrowest were 5.1×12.8mm for the left orifice and 3.2×13.2mm for the right.
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Clinical experiences of unilateral anterior sub-costal quadratus lumborum block for a nephrectomy
Among several quadratus lumborum (QL) blocks, an anterior sub-costal QL block is a new technique, and there are only a few reports of this new approach in the literature [1,2]. In this case, we reported two cases in which we used the anterior sub-costal QL block for a nephrectomy.
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Clinical effects of prophylactic use of phentolamine in patients undergoing pheochromocytoma surgery
To the Editor,
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Emergency insertion of the LMA protector airway in patients in the lateral position
The LMAR Protector™ Airway (Teleflex Medical Japan, Tokyo, Protector), a new type of second generation airway, has an integrated cuff pressure indicator that allows continuous cuff pressure monitoring at a glance [1,2]. Continuous cuff pressure monitoring contributes to safe management in the perioperative period in all situations. Here, we report two cases in which the Protector was inserted in an emergency situation with the patient in the lateral position.
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Respiratory effect of interscalene brachial plexus block vs combined infraclavicular plexus block with suprascapular nerve block for arthroscopic shoulder surgery
Shoulder surgery typically results in moderate to severe postoperative pain, especially within the first 24h after surgery. The interscalene nerve block (ISB) is one of the most effective analgesic techniques for shoulder surgery. A common adverse effect after ISB remains the occurrence of ipsilateral phrenic nerve block. In the literature [1] diaphragm-sparing nerve blocks alternative to ISB for shoulder surgery, such as supraclavicular block, distal nerve blocks, intraarticular analgesia, has been reported; recently [2] a new combination of suprascapular nerve block (SSB) and infraclavicular block (ICB) seemed to provide surgical anesthesia and satisfactory postoperative analgesia, but, the respiratory effects of this technique are still not well documented.
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Under pressure: Evaluating the role of intraoperative hemodynamics in postoperative acute kidney injury
In this issue of Journal of Clinical Anesthesia, Wu et al. describe their well-designed randomized trial investigating the impact of targeted mean arterial pressure (MAP) ranges on postoperative acute kidney injury (AKI) [1]. Their study is of pressing concern: postoperative AKI remains a source of shared apprehension among anesthesiologists, surgeons, and nephrologists, for which prevention and treatment strategies are a matter of ongoing debate. The healthcare burden of postoperative AKI is well-described: it is common, costly, and life-threatening.
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Incidence of lower-extremity muscle weakness after quadratus lumborum block
Since the original publication on the quadratus lumborum (QL) block in 2013, various approaches for QL block administration have been reported [1,2]. Lower-extremity muscle weakness after a posterior QL block has been reported as a complication [3]. However, there have been no reports of lower-extremity muscle weakness after a QL block using other approaches. We investigated the incidence of lower-extremity muscle weakness after each type of QL block.
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Lack of generalizability of observational studies' findings for turnover time reduction and growth in surgery based on the State of Iowa, where from one year to the next, most growth was attributable to surgeons performing only a few cases per week
Three observational studies at large teaching hospitals found that reducing turnover times resulted in the surgeons performing more cases. We sought to determine if these findings are generalizable to other hospitals, because, if so, reducing turnover times may be an important mechanism for hospitals to use for growing caseloads.
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Lidocaine post-nasal dripping (LPND): An easy way for awake nasal intubation
Several techniques of topical anesthesia for awake fiberoptic intubation (AFOI) have been described such as "spray as you go" [1,2], nebulization [2], atomization [3,4] transtracheal injection [5]. These require multiple complicated steps [1,2], specialized equipment [2–4], and are invasive [5].
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Severe type B lactic acidosis and insulin-resistant hyperglycemia related to cadaveric kidney transplantation
Lactic acidosis, increased lactate levels >2mmol/L with a high anion gap metabolic acidosis, commonly occurs due to hypoperfusion/hypoxia (type A) but may also arise due to other causes, often overlooked, such as thiamine deficiency (type B) [1]. We report the perioperative occurrence of severe type B lactic acidosis with insulin-resistant hyperglycemia related to cadaveric kidney transplantation and its rapid resolution after intravenous thiamine administration. Written consent was obtained from the patient.
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Use of dexmedetomidine in a cardiac intensive care unit
Delirium, pain and agitation, known as the "triad of Intensive Care Units (ICU)" [1] are very common in critical patients. At least 20% of patients develop delirium during their stay in the ICU, reaching 80% in those receiving mechanical ventilation [2]. There is a need to identify these patients for appropriate treatment and prevention, as this neuronal dysfunction is associated with increased mortality, length of hospitalization, dependency and disability at discharge [3,4].
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Bilateral adductor canal block catheters in patients undergoing simultaneous bilateral knee arthroplasty: A series of 17 patients
Continuous adductor canal blocks (ACB) have been shown to reduce pain with knee flexion, decrease opioid consumption, and enhance ambulation following total knee arthroplasty [1]. Of the patients who undergo bilateral knee arthroplasties, a small subset have the procedures performed during the same operative encounter rather than a staged procedure [2]. These patients present additional perioperative pain and rehabilitation challenges, in addition to a longer length of hospital stay [2,3]. Adequate analgesia is imperative for immediate postoperative rehabilitation; however, there is a paucity of research regarding regional techniques for simultaneous bilateral knee arthroplasty (SBKA).
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Videolaryngoscope versus Macintosh laryngoscope for tracheal intubation in adults with obesity: A systematic review and meta-analysis
Videolaryngoscopy has become more common since the 2000s. Despite several anecdotal reports in the literature, it remains unclear whether videolaryngoscopy is superior to direct Macintosh laryngoscopy for tracheal intubation in adults with obesity. This systematic review and meta-analysis focused on prospective randomised trials comparing videolaryngoscopes with the Macintosh laryngoscope for tracheal intubation in adults with obesity.
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Retroclavicular approach to infraclavicular brachial plexus block for distal radius fracture in a patient with implanted pacemaker
Patients with implanted pacemaker underwent upper limb surgery under regional anesthesia in the literature are rarely. We report a case of successful retroclavicular approach to infraclavicular brachial plexus block (RA-IBPB) in a patient with implanted pacemaker and with requiring open osteosynthesis due to distal radius fracture.
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Anesthetic management for laparoscopic sleeve gastrectomy to a child
Anesthesia for obese children undergoing weight loss surgery poses a challenge for the anesthetists given that this population has high risk of developing psychosocial and medical comorbidities such as pulmonary and cardiovascular disorders, hypertension, dyslipidemia, obstructive sleep apnea and type 2 diabetes mellitus [1–3].
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Ketorolac dose-response for acute pain is well known and the safety rules for adequate prescribing are clear
The study by Duttchen et al. [1] shows almost no difference in analgesic efficacy when comparing 15 and 30mg of IV ketorolac given intraoperatively to provide postoperative pain relief. In the discussion, the authors indicate that another 2017 study performed in an emergency department similarly showed that in patients with acute pain 10, 15 and 30mg are of similar analgesic efficacy [2], suggesting that these data are new.
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Takotsubo cardiomyopathy complicating thoracoabdominal aortic aneurysm repair
We describe the management of a patient with symptomatic spinal cord hypoperfusion after thoracoabdominal aortic aneurysm repair, where the neurological insult and associated emotional stress precipitated Takotsubo cardiomyopathy. Transthoracic Echocardiography showed akinetic mid and apical left ventricular segments, while basal segments were spared. Emergent coronary angiography ruled out acute coronary syndrome. Excess catecholamines have been postulated as a contributing mechanism to the disease, therefore, catecholamines were avoided to prevent further myocardial injury.
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JCAS: The road ahead
Journal of Cutaneous and Aesthetic Surgery 2017 10(3):121-121
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Facial cutaneous sarcoid treated successfully with carbon dioxide laser in skin type 6
Journal of Cutaneous and Aesthetic Surgery 2017 10(3):122-123
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Easing the excision of earlobe keloid
Journal of Cutaneous and Aesthetic Surgery 2017 10(3):168-171
Earlobe keloids are commonly encountered in this era where ear piercing is routine in various traditions. Various medical and surgical methods have been tried for its management. Surgically, fillet flap surgery has better acceptability worldwide. Various difficulties are faced during keloid excision, and we hereby describe few innovative modifications (use of needle, hydrodissection, pressure dressing, bolster button) using cost-effective and simple materials (needles, dynaplast, buttons) to ease the excision of keloids. These have easy adaptability and also reduce the recurrence rate of earlobe keloids.
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Management of stretch marks (with a focus on striae rubrae)
Journal of Cutaneous and Aesthetic Surgery 2017 10(3):124-129
Stretch marks are one of the most common benign cutaneous lesions and encountered esthetic problems. Striae rubrae and striae albae can be differentiated on the basis of clinical appearance. Histologically, disturbances of the dermal fiber network and local expression of receptors for sexual steroids have been detected. The epidermal changes are secondary. Prevention of stretch marks using topical ointments and oils is debatable. Treatment of striae rubrae by lasers and light devices improves appearance. Microneedling and non-ablative and fractionated lasers have been used. This review provides an overview on current treatment options with a special focus on laser treatments.
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Calculating area of graft required for vitiliginous areas during split-thickness skin grafting: A simple, accurate, and cost-effective technique
Journal of Cutaneous and Aesthetic Surgery 2017 10(3):160-162
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Periorbital biometric measurements using ImageJ software: Standardisation of technique and assessment of intra- and interobserver variability
Journal of Cutaneous and Aesthetic Surgery 2017 10(3):130-135
Purpose: To assess the reliability and repeatability of periorbital biometric measurements using ImageJ software and to assess if the horizontal visible iris diameter (HVID) serves as a reliable scale for facial measurements. Methods: This study was a prospective, single-blind, comparative study. Two clinicians performed 12 periorbital measurements on 100 standardised face photographs. Each individual's HVID was determined by Orbscan IIz and used as a scale for measurements using ImageJ software. All measurements were repeated using the 'average' HVID of the study population as a measurement scale. Intraclass correlation coefficient (ICC) and Pearson product-moment coefficient were used as statistical tests to analyse the data. Results: The range of ICC for intra- and interobserver variability was 0.79–0.99 and 0.86–0.99, respectively. Test-retest reliability ranged from 0.66–1.0 to 0.77–0.98, respectively. When average HVID of the study population was used as scale, ICC ranged from 0.83 to 0.99, and the test-retest reliability ranged from 0.83 to 0.96 and the measurements correlated well with recordings done with individual Orbscan HVID measurements. Conclusion: Periorbital biometric measurements using ImageJ software are reproducible and repeatable. Average HVID of the population as measured by Orbscan is a reliable scale for facial measurements.
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Large unilateral Noduloplaque over the cheek in a young man
Journal of Cutaneous and Aesthetic Surgery 2017 10(3):177-179
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Fractional CO2 laser vs fractional CO2 with topical platelet-rich plasma in the treatment of acne scars: A split-face comparison trial
Journal of Cutaneous and Aesthetic Surgery 2017 10(3):136-144
Background: It is a challenge to treat acne scars and a multimodal combination approach is necessary. While fractional CO2 lasers (FCLs) are an established treatment option, the role of platelet-rich plasma (PRP) in the treatment of acne scars is not established though it is being used extensively in other fields of medicine owing to its healing properties. We combined the two methods to assess the proposed synergistic action on acne scars. Aims and Objectives: To evaluate the effect of FCL alone vs FCL combined with PRP on the quality of acne scars. Materials and Methods: This is a left–right split-face comparison study with 30 patients with moderate-to-severe acne scars. The patients underwent three sessions of FCL and FCL + topical PRP on right and left sides of the face, respectively, at monthly intervals. Results: There was significant improvement on both sides of the face (right side, P = 0.001; left side, P = 0.0001), but the difference between the right and the left sides of the face was not statistically significant (P = 0.2891). The symptoms of redness, edema, and pain on the treated areas with laser were significantly lesser on the FCL + PRP (left) side as compared to the FCL-only (right) side. Conclusion: Both methods were effective in management of acne scars. Addition of PRP does not improve the scar quality; however, the downtime and inflammation associated with laser treatment gets significantly reduced on the PRP-treated side.
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Laser corrective surgery with fractional carbon dioxide laser following full-thickness skin grafts
Journal of Cutaneous and Aesthetic Surgery 2017 10(3):157-159
Full-thickness skin grafts (FTSGs) are frequently used to treat patients with burn injuries and to repair defects rendered by excisional (including Mohs) surgery. The evidence for corrective laser surgery after scar formation is well established. With regard to laser treatment of FTSG, the evidence is sparse. Laser treatment after FTSG is a novel concept, with minimal literature. We present a case series, one of the first to our knowledge, of the treatment of FTSG with fractional CO2 laser in five patients after Mohs surgery.
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Standardization of SMP procedure and its impact on outcome
Journal of Cutaneous and Aesthetic Surgery 2017 10(3):145-149
Background: Cosmetic deformities can result from various types of alopecia or even post hair transplantation procedures. Patients with such deformities seek aesthetically appealing longer-lasting options. Scalp concealers are commonly used by men and women to camouflage these deformities. Scalp micropigmentation (SMP) is one of the concealers recently gaining popularity. Objectives: SMP is a novel technique wherein microdot tattoos are placed in a stippling pattern to mimic hair follicles that are cut close to the scalp and various variables affecting its outcome were evaluated. Methods: Forty-five subjects were recruited for the study. The various factors affecting outcome of SMP—angle of needle against the scalp, depth of needle into the scalp, time of the needle contact in scalp, speed of the rotor, resistance of scalp, color of pigment, viscosity of dye, needle number, needle thickness, and pattern of dot placement—were systematically studied in 15 patients through clinical photographs and trichoscopy. Ideal depth of pigment deposition was assessed through histopathological examination. After using these optimum variables, standardized SMP was performed in 30 patients with hair loss (3 patients with cicatricial and 27 patients with diffuse non-cicatricial alopecia). SMP was also used to create an aesthetically denser hairline. The outcome of the procedure was evaluated using standardized global photographs. Results: The ideal parameters were established to achieve standard reproducible results. There were great patient satisfaction and acceptance of the procedure. All the patients showed moderate to great improvement after the procedure with satisfactory scalp coverage. Adverse events were transient which were seen in the form of edema and redness. Conclusion: SMP offers a non-medical, tattoo-based cosmetically appealing and effective "cover-up" that hides the unsightly conditions. The cosmetic tattoo placement creates an illusion of thicker hair.
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A pilot study to evaluate effectiveness of botulinum toxin in treatment of androgenetic alopecia in males
Journal of Cutaneous and Aesthetic Surgery 2017 10(3):163-167
Introduction: Androgenetic alopecia is a common form of alopecia with multifactorial etiology. Finasteride and minoxidil are approved by the FDA for the treatment of androgenetic alopecia. Balding scalp is believed to have relative microvascular insufficiency. Blood vessels in the scalp travel through the intramuscular plane. Intramuscular injection of botulinum toxin relaxes muscles and thereby increases blood flow in balding scalp. We conducted a pilot study to evaluate the efficacy of botulinum toxin in androgenetic alopecia management. Material and Methods: The study was conducted in a tertiary care center. A total of 10 male patients with androgenetic alopecia meeting inclusion criteria of the study were included. In the scalp, 30 sites were injected with 5 U of botulinum toxin in each site. Preprocedure photograph taken and evaluation was done, which was repeated after 24 weeks. Efficacy was assessed by photography and self-assessment scoring was done by patients. Results: Of 10 patients, 8 had good to excellent response on photographic assessment. At the end of 24 weeks, 1 patient showed poor and 1 showed fair response to treatment. As per self-assessment, 7of 10 patients showed good to excellent response. Two patients had fair response and 1 patient showed poor response to treatment. Conclusion: Botulinum toxin was found to be safe and effective therapy for the management of androgenetic alopecia in this pilot study. Studies with larger sample size and randomized controlled trials are required to establish the role of botulinum toxin in the management of androgenetic alopecia.
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Innovative usage of accessory auricles as full-thickness skin graft
Journal of Cutaneous and Aesthetic Surgery 2017 10(3):150-152
Accessory auricles are relatively rare malformations arising from the first branchial arch which contains skin, fat and cartilage. The treatment is usually surgical removal for the cosmetic purpose. We are sharing our experience of utilising the accessory auricle skin as full thickness graft for post.burn reconstruction of the fingers contracture of a child. Even though this type of association is rare, it is an innovative idea following Sir Harold Gilles' principle 'Never throw anything away'.
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Use of the CONUT index as a predictor of integration of cutaneous grafts in burn patients
Journal of Cutaneous and Aesthetic Surgery 2017 10(3):172-176
Objective: To present the initial experience of 12 patients with burns treated with cutaneous grafts and to analyse the variables that influence their integration. Materials and Methods: We analysed data from 12 patients seen in a year in the regional hospital of high speciality of Oaxaca. Quantified variables: Age, sex, burned body surface, depth of burn, airway injury, nutritional status by CONUT index, type of graft, development of local infection and days of hospital stay. Results: We included 10 men (83%) and 2 women (17%) with median age of 28 years, median burned body surface area of 19%, depth: 75% were mixed burns and 25% were third degree; with median time between injury and application of grafts of 13 days, 1 patient presented airway injury and 50% concomitant trauma. Regarding Nutritional Status: Fifty percent had severe malnutrition, 33% moderate and 16% mild. About 67% of the grafts were meshed and 33% intact, the mean integration percentage was 80%, 25% developed local infection and the average length of hospital stay was 21 days. Conclusions: Cutaneous grafts are the definitive treatment of burns, in their integration process influence different factors, including nutritional status. The CONUT index seems to be a useful, safe and widely available tooling in the nutritional assessment of the burned patient and can be related to the percentage of integration of the grafts and the days of hospital stay.
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Use of a hyaluronic acid soft-tissue filler to correct congenital and post-traumatic lip asymmetry
Journal of Cutaneous and Aesthetic Surgery 2017 10(3):153-156
Background: The use of hyaluronic acid soft-tissue fillers for enhancement of lip features is a popular and minimally invasive office-based procedure used worldwide due to its relative simplicity and favorable safety profile. Materials and Methods: Hyaluronic acid was used in illustrative cases to attempt correction of congenital and acquired lip asymmetries. Results: In the cases presented, accurate and cosmetically acceptable results were attained and maintained for the duration of the product life. Conclusions: Hyaluronic acid may be used successfully when lip asymmetry is evident and is a relatively simple nonsurgical alternative.
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The 22nd international pigment cell conference, Singapore
Journal of Cutaneous and Aesthetic Surgery 2017 10(3):180-181
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Local Anesthetic Systemic Toxicity: A Review of Recent Case Reports and Registries
This review summarizes presenting features, management, and outcomes of local anesthetic systemic toxicity (LAST) from published cases and those submitted to online registries capturing use of intravenous lipid emulsion (ILE) therapy. The results of single-center and multicenter registries and epidemiologic studies complement this information. Between March 2014 and November 2016, 47 separate cases of LAST were described in 35 peer-reviewed articles. Local anesthetic systemic toxicity events occurred as a result of penile blocks (23%), local infiltration (17%), and upper/lower extremity, torso, and neuraxial blockade. Twenty-two patients (47%) were treated with ILE, and 2 patients (4.3%) died. During the same time period, 11 cases submitted to lipidrescue.org were treated with ILE and survived. The incidence of LAST reported in registries is 0.03% or 0.27 (95% confidence interval, 0.21–0.35) per 1000 peripheral nerve blocks (denominator of 251,325). Seizure (53% and 61% from case reports and registries, respectively) was the most common presenting feature. Accepted for publication October 9, 2017. Address correspondence to: Marina Gitman, MD, Department of Anesthesiology, College of Medicine, University of Illinois, 1740 W Taylor St, Suite 3200 W, Chicago, IL 60612 (e-mail: gitman@uic.edu). The authors declare no conflict of interest. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.
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The Prevalence of Cosmetic Facial Plastic Procedures among Facial Plastic Surgeons
Facial plast Surg
DOI: 10.1055/s-0037-1617423
This is the first study to report on the prevalence of cosmetic facial plastic surgery use among facial plastic surgeons. The aim of this study is to determine the frequency with which facial plastic surgeons have cosmetic procedures themselves. A secondary aim is to determine whether trends in usage of cosmetic facial procedures among facial plastic surgeons are similar to that of nonsurgeons. The study design was an anonymous, five-question, Internet survey distributed via email set in a single academic institution. Board-certified members of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) were included in this study. Self-reported history of cosmetic facial plastic surgery or minimally invasive procedures were recorded. The survey also queried participants for demographic data. A total of 216 members of the AAFPRS responded to the questionnaire. Ninety percent of respondents were male (n = 192) and 10.3% were female (n = 22). Thirty-three percent of respondents were aged 31 to 40 years (n = 70), 25% were aged 41 to 50 years (n = 53), 21.4% were aged 51 to 60 years (n = 46), and 20.5% were older than 60 years (n = 44). Thirty-six percent of respondents had a surgical cosmetic facial procedure and 75% has at least one minimally invasive cosmetic facial procedure. Facial plastic surgeons are frequent users of cosmetic facial plastic surgery. This finding may be due to access, knowledge base, values, or attitudes. By better understanding surgeon attitudes toward facial plastic surgery, we can improve communication with patients and delivery of care. This study is a first step in understanding use of facial plastic procedures among facial plastic surgeons.
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Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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Ablative Fractional CO2 Laser for Facial Atrophic Acne Scars
Facial plast Surg
DOI: 10.1055/s-0037-1606096
Ablative fractional carbon dioxide laser resurfacing is a well-established treatment for acne scars. However, there are limited consensus and guidelines regarding the procedure, such as its treatment plan, efficacy, and safety. In this study, we performed a systematic review to assess the efficacy and safety of the fractional carbon dioxide laser treatment procedure, and to provide evidence-based recommendations concerning its practical use on atrophic acne scars. A comprehensive search was performed in, EMBASE, Ovid, Web of Science, and Cochrane databases, using the keywords "scar(s)," "acne vulgaris," "carbon dioxide," and "fraction* laser(s)" for the period from January 1987 to December 2016. The initial literature search identified 337 articles. The final selection included 30 studies: 12 retrospective studies and 18 prospective randomized clinical trials. Ablative fractional carbon dioxide laser is an effective therapy for the treatment of acne scars. The treatment session, interval, and parameters should be customized for each patient. Combination therapy should be considered for ice-pick type acne scars. The use of dermocosmetics in pre- and postoperative care may be beneficial to patients.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
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The efficacy of pre-operative preparation with intravenous iron and/or erythropoietin in anaemic patients undergoing orthopaedic surgery: An observational study
BACKGROUND Pre-operative anaemia and transfusion are common among patients undergoing elective orthopaedic surgery. Application of 'patient blood management' might be the most effective way to reduce both anaemia and transfusion. Pre-operative administration of iron and/or erythropoietin (EPO) is one of the cornerstones of the first pillar of patient blood management, but in a daily clinical setting, efficacy and long-term safety of this measure have not been analysed thoroughly to date. OBJECTIVE To investigate the influence of pre-operative preparation (PREP) of patients with iron and/or EPO on peri-operative transfusion needs and long-term survival. DESIGN AND METHODS This was a single-centre, retrospective study. After approval of our local ethics committee, data of 5518 patients who received total hip or total knee replacement between 2008 and 2014 were included. Patients receiving iron and/or EPO were included in the PREP group, whereas patients without iron and/or EPO were included in the no preparation group. From the full data set, a bias-reduced subset of 662 patients was obtained by means of propensity score-matching to compare peri-operative red blood cell utilisation and long-term survival of patients between groups. RESULTS Patients in the PREP group needed a lower number of units of red blood cells than patients in the no preparation group (0.2 ± 0.8 vs. 0.5 ± 1.3, P
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Effect of pressure-controlled inverse ratio ventilation on dead space during robot-assisted laparoscopic radical prostatectomy: A randomised crossover study of three different ventilator modes
BACKGROUND Pressure-controlled inverse inspiratory to expiratory ratio ventilation (PC-IRV) is thought to be beneficial for reducing the dead space volume. OBJECTIVE To investigate the effects of PC-IRV on the components of dead space during robot-assisted laparoscopic radical prostatectomy (RLRP). DESIGN A randomised crossover study of three different ventilator modes. SETTING A single university hospital from September 2014 to April 2015. PATIENTS Twenty consecutive study participants undergoing RLRP. INTERVENTIONS Patients were ventilated sequentially with three different modes in random order for 30 min: volume control ventilation (VCV; inspiratory to expiratory ratio 0.5), pressure control ventilation (PCV; inspiratory to expiratory ratio 0.5) and PC-IRV. Inverse inspiratory to expiratory ratio was adjusted individually by observing the expiratory flow-time wave to prevent the risk of dynamic pulmonary hyperinflation. MAIN OUTCOME MEASURES The primary outcome included physiological dead space (VDphys), airway dead space (VDaw), alveolar dead space (VDalv) and shunt dead space (VDshunt). VDphys was calculated by Enghoff's method. We also analysed respiratory dead space (VDresp) and VDaw using a novel analytical method. Then, VDalv and VDshunt were calculated by VDalv = VDresp − VDaw and VDshunt = VDphys − VDresp, respectively. RESULTS The VDphys/expired tidal volume (VTE) ratio in PC-IRV (29.2 ± 4.7%) was significantly reduced compared with that in VCV (43 ± 8.5%) and in PCV (35.9 ± 3.9%). The VDshunt/VTE in PC-IRV was significantly smaller than that in VCV and PCV. VDaw/VTE in PC-IRV was also significantly smaller than that in VCV but not that in PCV. There was no significant change in VDalv/VTE. CONCLUSION PC-IRV with the inspiratory to expiratory ratio individually adjusted by the expiratory flow-time wave decreased VDphys/VTE in patients undergoing RLRP. TRIAL REGISTRATION University Hospital Medical Information Network in Japan 000014004. Correspondence to Go Hirabayashi, MD, Department of Anaesthesiology, Mizonokuchi Hospital, Teikyo University School of Medicine, 3–8–3 Mizonokuchi, Takatsu-ku, Kawasaki, Kanagawa 213–8507, Japan Tel: +81 44 844 3333; fax: +81 44 844 3390; e-mail: hirabayashi1967@gmail.com 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/2ylyqmW). © 2018 European Society of Anaesthesiology
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Primary mucinous eccrine carcinoma of the buccal space: A case report and review of the literature
Mucinous eccrine carcinoma is a rare entity that most commonly affects the head and neck. Due to its low frequency of occurrence, review of its etiology, histopathology, and treatment strategies is beneficial to all clinicians who may encounter similar appearing masses.
http://ift.tt/2EbQN06
Risk factors of sensorineural hearing loss in patients with unilateral safe chronic suppurative otitis media
Chronic suppurative otitis media (CSOM) is the major cause of hearing impairment, especially conductive hearing loss. Few patients also had sensorineural component, the sensorineural hearing loss (SNHL) in CSOM is controversial, especially for safe mucosal type. This study aims to assess the relationship between the frequency of SNHL development in patients with safe mucosal CSOM and its relation to patient's age, sex, duration of disease, size of perforation and different audiological findings.
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Fluorescence microscopy for the evaluation of elastic tissue patterns within fibrous proliferations of the skin on hematoxylin-eosin-stained slides
Diagnosis of fibrous tumors can be challenging and expensive due to the use of special stains.
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The alveolar bone protective effects of natural products: A systematic review
Source:Archives of Oral Biology, Volume 87
Author(s): Irlan Almeida Freires, Gustavo Machado Santaella, Janaina de Cássia Orlandi Sardi, Pedro Luiz Rosalen
ObjectivesThis systematic review was carried out to identify which naturally-occurring agents and constituents isolated therefrom have effects in preventing bone loss in a ligature-induced periodontitis model.Materials and methodsEight databases were systematically searched for studies of experimental periodontitis. The data were extracted, analyzed, and the treatment outcomes were given scores based on the level of bone destruction as compared to their untreated induced-periodontitis control.Results294 articles were found, of which 15 met the inclusion criteria. The selected studies tested a multi-herbal formulation; extracts (leaves, barks or fruit) of different plant species; and propolis. The most usual dosing protocol consisted of 3-times-a-day, 11-day treatment. The combined gel of Myracrodruon urundeuva (5%) and Lippia sidoides (0.5%) was the most active treatment, reducing 45–65% bone loss in the region of molars as compared to 73.4% of doxycycline (gold-standard). Ginkgo biloba extract (28–56 mg/kg) and propolis (100–200 mg/kg) prevented bone destruction by 50% and 40–44%, respectively. The other tested samples showed intermediate/weak activity in modulating bone resorption.ConclusionsThe gel of M. urundeuva and L. sidoides, and G. biloba and propolis extracts showed strong alveolar bone protective effectiveness in induced-periodontitis in rats. Further translational research should bridge the gap between the rat study outcomes and the clinical efficacy and long-term toxicity of these formulations in humans. The compilation of the vast literature database presented herein may drive further in vivo and clinical studies with the selected efficacious formulations to subsidize their pharmaceutical application.
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Epigenetic mechanisms in odontogenic tumors: A literature review
Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Jorge Sandoval-Basilio, Rogelio González-González, Ronell Bologna-Molina, Mario Isiordia-Espinoza, Gabriela Leija-Montoya, Sofia L. Alcaraz-Estrada, Idanya Serafín-Higuera, Javier González-Ramírez, Nicolás Serafín-Higuera
ObjectiveEpigenetic mechanisms, such as DNA methylation, regulate important biological processes as gene expression and it was suggested that these phenomena play important roles in the carcinogenesis and tumor biology. The aim of this review is to provide the current state of knowledge about epigenetic alterations, focusing mainly on DNA methylation, reported in odontogenic tumors.DesignLiteratures were searched based in the combination of the following keywords: odontogenic tumors, epigenetics, DNA methylation, histone modifications, non-coding RNA, microRNA, DNA methyltransferases. Electronic databases (Medline/PubMed, Scopus and Web of Science) were screened.ResultsThe analysis of epigenetic alterations in different tumors has rapidly increased; however, limited information is available about epigenetic mechanisms involved in the formation of odontogenic tumors. DNA methylation is the most studied epigenetic modification in these tumors and the participation of non-coding RNA's in odontogenic tumors has been recently addressed. Differential expression of DNA methyltransferases, altered DNA methylation patterns and aberrant expression of non-coding RNA's were reported in odontogenic tumors.ConclusionsCurrent studies suggest epigenetics as an emerging mechanism, possibly implicated in etiopathogenesis of odontogenic tumors. Deeper understanding of the epigenetic abnormalities in these tumors could show potential applications as biomarkers or therapeutic possibilities in the future.
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Influence on proliferation and adhesion of human gingival fibroblasts from different titanium surface decontamination treatments: An in vitro study
Publication date: March 2018
Source:Archives of Oral Biology, Volume 87
Author(s): Cao Jie, Tong Wang, Pu Yinfei, Tang Zhihui, Meng Huanxin
ObjectivesTo investigate the effects of different decontamination treatments on microstructure of titanium (Ti) surface as well as proliferation and adhesion of human gingival fibroblasts (HGFs).Material and methodsTi discs with machined (M) and sand blasted, acid etched (SAE) surfaces were treated with five different decontamination treatments: (1) stainless steel curette (SSC), ultrasonic system with (2) straight carbon fiber tip (UCF) or (3) metal tip (UM), (4) rotating Ti brush (RTB), and (5) Er:YAG laser (30 mJ/pulse at 30 Hz). Surface roughness was analyzed under optical interferometry. HGFs were cultured on each disc. Proliferation and adhesive strength were analyzed. qRT-PCR and ELISA were performed to detect the RNA and protein expression of FAK, ITGB1, COL1A1, and FN1 respectively from different Ti surfaces.ResultsSurface roughness increased on M surface. Proliferation, adhesive strength and gene expression were higher on M surface than SAE surface. Decontamination treatments affected surface parameters significantly (P < 0.001), making M surface less smooth while SAE surface became less rough. SSC, UCF, UM and RTB decreased proliferation on M surfaces significantly (P < 0.05). UCF, RTB and laser increased proliferation on SAE surface significantly (P < 0.05). UM decreased adhesive strength on M surface significantly and laser increased adhesive strength on SAE surface significantly (P < 0.05). Gene expression increased with time and was altered by decontamination treatments significantly (P < 0.001).ConclusionsDecontamination treatments influence surface roughness and cell behavior of HGFs. Laser might be an optimal decontamination treatment which has the least negative effect on M surface and the most positive effect on SAE surface.
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Varicocele due to renal arteriovenous malformation mimicking a renal tumor: a case report
Renal arteriovenous malformation is an aberrant vascular connection between the renal artery and vein. Acquired renal arteriovenous malformation (arteriovenous fistulae) accounts for approximately 70% of renal...
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What you should know about alopecia totalis
A look at alopecia totalis, a condition resulting in the loss of all the hair on the scalp. Included is detail on causes and the recovery rate.
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The Use of Omalizumab in Allergen Immunotherapy
Abstract
Although omalizumab (anti-IgE) is currently only approved for the treatment of asthma and chronic idiopathic urticaria, it has also been studied as an off-label treatment for numerous allergic conditions, including use as an adjunct to allergen immunotherapy in the treatment of allergic rhinitis, asthma, venom hypersensitivity, and food allergy. We conducted a review of publications involving the use of omalizumab with allergen immunotherapy, by searching PubMed with key search terms of "omalizumab" and "immunotherapy." Omalizumab has been used in combination with inhalant allergen immunotherapy for the treatment of seasonal allergic rhinitis and co-morbid asthma. While there have been no randomized controlled trials evaluating the addition of omalizumab to venom IT, several case reports and small patient series have been published on the use of omalizumab with venom IT. Omalizumab has been used in conjunction with oral immunotherapy for the treatment of milk, peanut, and egg, as well as other foods in multi-allergen protocols. In conclusion, omalizumab used in conjunction with immunotherapy has shown promising results, especially in the reduction of adverse reactions. At this stage, larger, randomized, placebo-controlled trials are needed to better identify those patients who would benefit the most from the addition of omalizumab to immunotherapy, as well as optimal dosing strategies and duration of treatment.
This article is protected by copyright. All rights reserved.
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A Decade of Research on the 17q12-21 Asthma Locus: Piecing Together the Puzzle
Publication date: Available online 4 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Michelle M. Stein, Emma E. Thompson, Nathan Schoettler, Britney A. Helling, Kevin M. Magnaye, Catherine Stanhope, Catherine Igartua, Andréanne Morin, Charles Washington, Dan Nicolae, Klaus Bønnelykke, Carole Ober
Chromosome 17q12-21 remains the most highly replicated and significant asthma locus. Genotypes in the core region defined by the first GWAS correlate with expression of two genes, ORMDL3 and GSDMB, making these prime candidate asthma genes, although recent studies have implicated GSDMA distal to and PGAP3 proximal to the core region as independent loci. We review here 10 years of studies on the 17q12-21 locus and suggest that genotype-specific risks for asthma at the proximal and distal loci are not specific to early onset asthma and mediated by PGAP3, ORMDL3, and/or GSDMA expression. We propose that the weak and inconsistent associations of 17q SNPs with asthma in African Americans is due to the high frequency of some 17q alleles, the breakdown of linkage disequilibrium on African-derived chromosomes, and possibly different early life asthma endotypes in these children. Finally, the inconsistent association between asthma and gene expression levels in blood or lung cells from older children and adults suggests that genotype effects may mediate asthma risk or protection during critical developmental windows and/or in response to relevant exposures in early life. Thus, studies of young children and ethnically diverse populations are required to fully understand the relationship between genotype and asthma phenotype and the gene regulatory architecture at this locus.
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Role of airway glucose in bacterial infections in patients with chronic obstructive pulmonary disease
Publication date: Available online 5 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Patrick Mallia, Jessica Webber, Simren K. Gill, Maria-Belen Trujillo-Torralbo, Maria Adelaide Calderazzo, Lydia Finney, Eteri Bakhsoliani, Hugo Farne, Aran Singanayagam, Joseph Footitt, Richard Hewitt, Tatiana Kebadze, Julia Aniscenko, Vijay Padmanaban, Philip L. Molyneaux, Ian M. Adcock, Peter J. Barnes, Kazihuro Ito, Sarah L. Elkin, Onn Min Kon, William O. Cookson, Miriam F. Moffat, Sebastian L. Johnston, John S. Tregoning
BackgroundPatients with chronic obstructive pulmonary disease (COPD) have increased susceptibility to respiratory tract infection, which contributes to disease progression and mortality, but mechanisms of increased susceptibility to infection remain unclear.ObjectivesThe aim of this study was to determine whether glucose concentrations were increased in airway samples (nasal lavage fluid, sputum, and bronchoalveolar lavage fluid) from patients with stable COPD and to determine the effects of viral infection on sputum glucose concentrations and how airway glucose concentrations relate to bacterial infection.MethodsWe measured glucose concentrations in airway samples collected from patients with stable COPD and smokers and nonsmokers with normal lung function. Glucose concentrations were measured in patients with experimentally induced COPD exacerbations, and these results were validated in patients with naturally acquired COPD exacerbations. Relationships between sputum glucose concentrations, inflammatory markers, and bacterial load were examined.ResultsSputum glucose concentrations were significantly higher in patients with stable COPD compared with those in control subjects without COPD. In both experimental virus-induced and naturally acquired COPD exacerbations, sputum and nasal lavage fluid glucose concentrations were increased over baseline values. There were significant correlations between sputum glucose concentrations and sputum inflammatory markers, viral load, and bacterial load. Airway samples with higher glucose concentrations supported more Pseudomonas aeruginosa growth in vitro.ConclusionsAirway glucose concentrations are increased in patients with stable COPD and further increased during COPD exacerbations. Increased airway glucose concentrations might contribute to bacterial infections in both patients with stable and those with exacerbated COPD. This has important implications for the development of nonantibiotic therapeutic strategies for the prevention or treatment of bacterial infection in patients with COPD.
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Transplantation and Risk for Malignant Melanoma
A study of renal transplant patients shows a 5x increased risk for malignant melanoma.
Medscape Dermatology
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The elegy of Dom Casmurro
Silva, ACS; (2018) The elegy of Dom Casmurro. Comparative Literature Studies (In press).
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Immune-infiltrate characterization in localized osteosarcoma patients treated within protocol ISG-OS1.
Palmerini, E; Agostinelli, C; Picci, P; Pileri, SA; Lollini, P-L; Scotlandi, K; Benassi, MS; ... Ferrari, S; + view all Palmerini, E; Agostinelli, C; Picci, P; Pileri, SA; Lollini, P-L; Scotlandi, K; Benassi, MS; Marafioti, T; Ferrari, S; - view fewer (2017) Immune-infiltrate characterization in localized osteosarcoma patients treated within protocol ISG-OS1. Presented at: Annual Meeting of the American-Society-of-Clinical-Oncology (ASCO), Chicago, IL.
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Outdoor learning, science trails and inquiry - an introduction
McCrory, A; (2017) Outdoor learning, science trails and inquiry - an introduction. Journal of Emergent Science , 13 pp. 29-30. Green open access
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On-line control of glucose concentration in high-yielding mammalian cell cultures enabled through oxygen transfer rate measurements
Goldrick, S; Lee, K; Spencer, C; Holmes, W; Kuiper, M; Turner, R; Farid, SS; (2017) On-line control of glucose concentration in high-yielding mammalian cell cultures enabled through oxygen transfer rate measurements. Biotechnology Journal 10.1002/biot.201700607 . (In press).
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Cognitive Impairment Before Intracerebral Hemorrhage Is Associated With Cerebral Amyloid Angiopathy
Banerjee, G; Wilson, D; Ambler, G; Osei-Bonsu Appiah, K; Shakeshaft, C; Lunawat, S; Cohen, H; ... CROMIS-2 Collaborators, ; + view all Banerjee, G; Wilson, D; Ambler, G; Osei-Bonsu Appiah, K; Shakeshaft, C; Lunawat, S; Cohen, H; Yousry, T; Lip, GYH; Muir, KW; Brown, MM; Al-Shahi Salman, R; Jäger, HR; Werring, DJ; CROMIS-2 Collaborators, ; - view fewer (2017) Cognitive Impairment Before Intracerebral Hemorrhage Is Associated With Cerebral Amyloid Angiopathy. Stroke , 49 pp. 40-45. 10.1161/STROKEAHA.117.019409 . Green open access
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Save Money or Feel Cozy?: A Field Experiment Evaluation of a Smart Thermostat that Learns Heating Preferences
Shann, M; Alan, A; Seuken, S; Costanza, E; Ramchurn, SD; (2017) Save Money or Feel Cozy?: A Field Experiment Evaluation of a Smart Thermostat that Learns Heating Preferences. In: Larson, K and Winikoff, M and Das, S and Durfee, E, (eds.) Proceedings of AAMAS 2017. International Foundation for Autonomous Agents and Multiagent Systems (IFAAMAS): São Paulo, Brazil.
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Morphological changes in human serum albumin in presence of cationic amphiphilic drugs
Yaseen, Z; Aswal, VK; Zhou, X; Kabir-ud-Din, .; Haider, S; (2018) Morphological changes in human serum albumin in presence of cationic amphiphilic drugs. New Journal of Chemistry 10.1039/C7NJ02591B . (In press).
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Moda, transferências culturais e história do livro
Silva, ACS; (2017) Moda, transferências culturais e história do livro. dObra[s] , 10 (22) pp. 177-201. 10.26563/dobras.v10i22.642 . Green open access
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Comparing Materials for Self-Guided Learning in Interactive Science Exhibitions
Hauan, NP; DeWitt, J; (2017) Comparing Materials for Self-Guided Learning in Interactive Science Exhibitions. Visitor Studies , 20 (2) pp. 165-186. 10.1080/10645578.2017.1404349 .
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National policy and SMEs in technology transfer: the case of Israel
Belman Inbal, A; Tzachor, A; (2015) National policy and SMEs in technology transfer: the case of Israel. Climate Policy , 15 (1) pp. 88-102. 10.1080/14693062.2013.770299 .
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High-Strength, Low-shrinkage Composite with Potential to Self-bond to Dentine
Liaqat, S; Bozec, L; Ashley, P; Young, A; (2013) High-Strength, Low-shrinkage Composite with Potential to Self-bond to Dentine. In: (Proceedings) 2015 IADR/AADR/CADR General Session. IADR: Boston, Massachusetts.
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Increased decision thresholds trigger extended information gathering across the compulsivity spectrum
Hauser, TU; Moutoussis, M; NSPN Consortium, ; Dayan, P; Dolan, RJ; (2017) Increased decision thresholds trigger extended information gathering across the compulsivity spectrum. Translational Psychiatry , 7 (12) , Article 1296. 10.1038/s41398-017-0040-3 . Green open access
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Identifying the factors that determine the severity and type of alien bird impacts: Data File
Evans, TG; Kumschick, S; Şekercioğlu, ÇH; Blackburn, TM; (2018) Identifying the factors that determine the severity and type of alien bird impacts: Data File. [Dataset]. UCL Division of Biosciences: London, UK. Green open access
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Degree of tinnitus improvement with stapes surgery – a systematic review
Publication date: Available online 5 January 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Aliciane Mota G. Cavalcante, Isabella Monteiro de Castro Silva, Bianca Jessica Neves, Carlos Augusto Oliveira, Fayez Bahmad Junior
IntroductionOtospongiosis is temporal bone osteodystrophy, characterized by disordered bone resorption and neoformation in genetically predisposed individuals. Clinically, otospongiosis is characterized by progressive conductive and/or mixed hearing loss and by tinnitus (40–90% – average of 75%).ObjectiveA systematic review of the last two decades of publications that report the degree of tinnitus improvement with stapes surgery.Methods125 articles published in the last 20 years mentioning the relationship between otosclerosis and tinnitus. Literature has always shown that the hearing improvement after stapes surgery was the main result sought and found. However, recent articles has reinforced the need for surgery for the tinnitus improvement. The ideal time to assess tinnitus through different scales is in the sixth month post-operative. The estimated average hearing improvement is 93% and tinnitus is 85.52%.ResultsSummaries of 12 articles were reviewed which fulfilled the search criteria of the survey, and 8 studies were included in the study according the selection criteria. This studies investigating the degree of tinnitus improvement with stapes surgery, using different scales as: Tinnitus Functional Index, Visual Analog Scale, Tinnitus Functional Index and Visual Analog Scale, Visual Analog Scale and "questionnaire asking about tinnitus", Newman's method and Tinnitus Score Advocated by the Japan Audiological Society. The total of the samples of the evaluated articles was of 254 participants.ConclusionWe conclude that stapes surgery is quite effective for the treatment of tinnitus (average improvement is 85.52%), and hearing loss (average improvement is 93%). When deciding about the surgical indication in patients with otosclerosis, the presence and level tinnitus should be considered as well as the level of hearing.
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Comparison of anxiety and child-care education characteristics of mothers who have children with or without speech delays
Publication date: Available online 5 January 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Talih Özdaş, Ayşe Sanem Şahli, Behiye Sarıkaya Özdemir, Erol Belgin
IntroductionSpeech delay in a child could be the cause and/or result of the emotional disorder. The child rearing attitude that the parents have accepted could have both positive and negative effects on the personality of the child.ObjectiveThe current study aimed to investigate the sociodemographic features and the mothers' anxiety of children with speech delay.MethodsOne hundred five mothers with children aged between 3 and 6 years with speech delays were included in the patient group, and 105 mothers who have children aged between 3 and 6 years with normal speech and language development were included in the control group. An information form questionnaire including demographic characteristics, the Family Life and Childrearing Attitude Scale (PARI – Parental Attitude Research Instrument) and beck anxiety scale were requested from all mothers in the patient and the control groups.ResultsIn the current study, there was a significant difference between the groups in terms of gender (p=0.001). According to Parental Attitude Research Instrument, the mean of mothers of the children with speech delays was higher than the mean of mothers of normal children in terms of the answers to overprotective mother aspect (p<0.01). The mothers of children with speech delays had more overprotective motherhood attitudes; however, the difference in terms of the answers to the aspects of democratic attitude and provision of equality, refusal to be a housewife, husband-wife conflict, and suppression and discipline were not statistically significant. The beck anxiety scale, a significant difference was detected between the two groups (p<0.01). It was found that the mothers of children with speech delays had more severe levels of anxiety.ConclusionThe social structure of the family, the attitudes and the behaviors of the mother, and the anxiety levels of the mothers have important effects on child development. Thus, it is necessary to perform further studies related to speech delays, in which many factors play a role in the etiology.
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Treatment of a complex orthopaedic infection due to extensively drug-resistant Pseudomonas aeruginosa
According to the Centers for Disease Control and Prevention (CDC), approximately 51 000 healthcare-associated infections caused by Pseudomonas aeruginosa occur annually in the USA, more than 6000 of which (13%) are caused by multidrug resistant (MDR) strains. Ceftolozane/tazobactam (TOL/TAZ) (Zerbaxa) was approved by the US Food and Drug Administration (FDA) in December 2014 for the treatment of complicated intra-abdominal and urinary tract infections. At this time, clinical data on the role of TOL/TAZ treatment outside of FDA-approved indications is limited. Herein, we present a case of extensively drug-resistant (XDR) P. aeruginosa osteomyelitis of the upper extremity, which was successfully treated with TOL/TAZ for 8 weeks with optimal clinical and laboratory responses. Monotherapy with TOL/TAZ appears effective for treatment of complicated bone and joint infections with XDR P. aeruginosa in combination with comprehensive surgical management, particularly when few antibiotic options exist.
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Axillary artery aneurysm combined with brachial plexus palsy due to Takayasu arteritis
We report the case of a young female patient who presented with a right axillary artery aneurysm with neurological symptoms due to Takayasuarteritis (TA). Decompression of the aneurysm and arterial repair with an interposition vein bypass resulted in a full recovery. The case emphasises that peripheral aneurysms can occur due to TA and that there may be neurological complications.
http://ift.tt/2AwUZoL
Uterocutaneous fistula following B-Lynch suture for primary postpartum haemorrhage
A 30-year-old woman, who had undergone emergency lower segment caesarean section (LSCS) for failed induction 2 months back, presented with a fistulous opening along with discharge from her previous incision scar. She had developed a massive primary postpartum haemorrhage at the time of LSCS 2 months back, which was managed with B-Lynch suture and vessel ligation. Fistulogram revealed a connection between the uterus and the skin. The diagnosis was confirmed by a contrast-enhanced CT scan. Patient was subjected to laparotomy. She was found to have an extensive necrosis of the anterior uterine wall. Total abdominal hysterectomy was done to avoid the risk of sepsis and haemorrhage. Postoperative period was uneventful. Histopathological examination confirmed the necrosis of the uterine wall. This case describes an extremely rare occurrence of uterocutaneous fistula as a result of uterine infarction following the application of B-Lynch suture for primary postpartum haemorrhage.
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Efficacy and safety of maintenance electroconvulsive therapy for sustaining resolution of severe aggression in a major neurocognitive disorder
We report a novel electroconvulsive therapy (ECT) regimen for sustaining the resolution of behavioural and psychological symptoms of dementia (BPSD) using alternating acute and maintenance ECT (M-ECT) trials. A 64-year-old man presenting with major neurocognitive disorder was admitted for acute behavioural disturbances and physical aggression. With few treatment options, the impact on patients' quality of life often supersedes cognitive symptoms and is a predictor of long-term institutionalisation. Recent studies indicate that ECT may be an effective and safe way to address BPSD. Clinicians have little information about when and how to stop a successful course of acute ECT or the long-term advantages of M-ECT with subsequent intermittent acute ECT. This case emphasises the benefit of M-ECT and describes potential challenges associated with abrupt discontinuation. This case is the first to detail tapering ECT for treatment of aggression in dementia by interchanging acute and M-ECT courses in response to symptom burden.
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Varicella zoster meningitis: an atypical case of zoster reactivation in immunocompetent young adult
Varicella virus is a neurotropic virus that can reactivate later in life to cause zoster or shingles. Typically, it affects elderly, immunocompromised population. We report an unusual case of an immunocompetent young adult presenting with occipital headache and zoster rash, without preherpetic and postherpetic neuralgia, who was diagnosed with varicella meningitis on Polymerase chain reaction (PCR). He was treated with intravenous acyclovir and later discharged on famciclovir. Diagnosis of varicella meningitis is difficult in the absence of typical features of zoster rash and requires high index of suspicion. Rapid diagnostic tests including varicella PCR and antithecal antibody testing can help in the confirmation of varicella zoster meningitis.
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Postsurgical pyoderma gangrenosum after an autologous stem cell transplantation for multiple myeloma
We report a man who underwent autologous stem cell transplantation (ASCT) for multiple myeloma. Two months after ASCT, he presented with necrotising cholecystitis due to gallbladder stones and was submitted to laparoscopic cholecystectomy. About a week later, he developed progressive skin ulcers at sites where trochanters had been inserted. Progressive enlargement and necrotic aspect of these ulcers took place despite debridement and large spectrum antibiotics. New ulcers developed at the site of enoxaparin injection at the right arm (pathergy phenomenon). A skin biopsy and clinical evaluation favoured the diagnosis of pyoderma gangrenosum (PG). He was treated with daily methylprednisolone and dapsone with improvement of the lesions. This is the first case in the literature of PG after ASCT. Despite the risk factors, the onset of an autoinflammatory disease right after the transplant is intriguing since PG is extremely rare in immunocompromised patients.
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Embolic stroke in a postpartum patient with Fontan physiology
In cardiac physiology, single ventricle typically refers to the presence of a dominant systemic ventricle along with a hypoplastic ventricle. The Fontan operation is used to repair the single ventricle by directing deoxygenated systemic venous flow to the pulmonary arterial circulation. Normal pregnancy physiology, particularly increased intravascular volume, increased heart rate, increased cardiac output, hypercoagulability and decreased systemic vascular resistance, can exacerbate cardiac disease in patients with Fontan circulation, leading to pregnancy complications. Despite the known risks, there are limited data addressing the question of anticoagulation in pregnant patients with Fontan physiology. Herein we present the case of a Fontan patient who had a successful pregnancy and delivery, and developed an embolic stroke in the postpartum period.
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Rash and subcutaneous fat necrosis after DEB-TACE with doxorubicin
A 73-year-old woman with hepatocellular carcinoma localised to the liver was treated with doxorubicin-loaded drug-eluting beads through transcatheter arterial chemoembolisation (DEB-TACE). She developed subcutaneous, erythematous, tender nodules in her abdomen 3 days after the procedure. PET/CT scan that was done to evaluate for evidence of disease progression showed mild avidity of these nodules. Biopsy showed fatty necrosis. Nodules started to improve spontaneously 2 weeks after onset. At 8 weeks after onset, lesions stabilised in size and the associated tenderness and erythema resolved. This represents a rare side effect of TACE procedure in general. It can happen secondary to non-target embolisation of hepatic falciform artery, planned embolisation of extrahepatic collateral supplies and even when there is no clear cause. Spontaneous resolution of acute symptoms usually occurs over the course of few weeks, though subcutaneous lesions consisting of necrotic fat tissue may persist for longer periods.
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Radius-Maumenee syndrome: a rare cause of glaucoma
Case presentation of a 41-year-old woman with long-standing bilateral eye injection whose clinical findings included bilateral episcleral vessel engorgement and tortuosity, raised intraocular pressure with open iridocorneal angles and left optic disc cupping. All remaining objective examination was normal. She underwent cranial and orbits CT and CT-angiography scans which were unremarkable. Optical coherence tomography of the peripapillary nerve fibre layer and automated perimetry were compatible with advanced glaucomatous damage on the left eye. The patient was diagnosed with idiopathic elevated episcleral venous pressure or Radius-Maumenee syndrome. If medical therapy is unable to prevent disease progression, left eye filtering surgery will be proposed.
http://ift.tt/2CMNOPl
Vedolizumab-induced acute pancreatitis: the first reported clinical case
Drug-induced acute pancreatitis (DIAP) is a rare, but clinically significant diagnosis. Vedolizumab, an α4β7 integrin inhibitor, which was approved in 2015 for treatment of moderate to severe inflammatory bowel disease, is a well-tolerated medication with a favourable safety profile and minimal serious adverse events in premarketing clinical trials. We present the first reported case of acute pancreatitis directly attributable to vedolizumab.
http://ift.tt/2AwUrzd
Isolated lateral leg compartment syndrome following an ankle sprain
Description
A 25-year-old man came to the emergency room after an inversion ankle sprain during a soccer game with friends. He was unable to play after the injury but was able to walk. He complained about a lateral ankle pain that was rapidly increasing in intensity and spreading to the leg. At the first physical examination, we found a lateral malleolus oedema with normal and almost painless dorsi and plantar ankle flexion, but with severe pain with foot inversion and important weakness on foot eversion. He was initially managed with pain medication and leg elevation while waiting for the imagological study. The plain X-ray and ankle CT showed no significant bone or soft tissue lesion.
At second evaluation, approximately 1 hour later (4 hours after initial trauma), the patient pain was worst and he had an important oedema and tenderness of the lateral leg compartment (figure 1). He...
http://ift.tt/2CLZWQU
Bilateral secondary spontaneous pneumothorax
Description
A 40-year-old male patient presented to the emergency department with complaints of shortness of breath associated with bilateral pleuritic chest pain. He denied any history of trauma and had smoked 40 cigarettes daily for the past 22 years.
On examination, the patient appeared breathless with a respiratory rate of 25 breaths/min and peripheral capillary oxygen saturation (SpO2) of 92% on room air. Neck examination showed no tracheal deviation and chest examination identified decreased bilateral chest expansion with no intercostal retractions. On chest palpation, there was a slightly diminished tactile fremitus on both sides. Chest percussion revealed a hyper-resonant note heard over the right and left upper and mid zones. On auscultation, there were no audible breath sounds and whispered voice sounds were abolished over the right and left upper and mid zones.
The gasometric evaluation revealed the presence of hypoxaemia and hypocapnia. A posteroanterior chest radiograph showed...
http://ift.tt/2AuZnVj
Blue toe syndrome as a first sign of systemic sclerosis
We describe an unusual case of blue toe syndrome as the primary and solitary manifestation of systemic sclerosis. The possible cause was long-term occupational exposure in construction work. Blue toe syndrome is a small vessel disease, characterised by the sudden development of painful, blue discolouration in one or more toes. The most common aetiology is atheroembolic disease; however, it can also appear in several conditions ranging from hypercoagulability disorders to underlying systemic diseases such as vasculitis or autoimmune diseases. Here, we describe the case of a 57-year-old man who presented with blue toe syndrome without underlying atheroembolic disease. He was found to have positive anticentromere antibodies, which indicated that systemic sclerosis was the likely primary underlying cause. An extensive systemic evaluation and a thorough physical examination revealed no other symptoms associated with systemic sclerosis. He was prescribed nifedipin and rosuvastatin, and showed complete resolution of symptoms after 3 months.
http://ift.tt/2CHicdU
A Multicenter, Randomized, Case-control Study of Unilateral vs Bilateral Neck Dissection for cN0 Supraglottic Laryngeal Cancer
Conditions: Laryngeal Neoplasms; Malignant Neoplasm of Supraglottis Primary; Neck Dislocation
Interventions: Procedure: Unilateral Neck Dissection; Procedure: Bilateral Neck Dissection
Sponsors: Cancer Institute and Hospital, Chinese Academy of Medical Sciences; Liaoning Tumor Hospital & Institute; Hebei Medical University Fourth Hospital; Jilin Provincial Tumor Hospital; The first affiliated hospital of Jinzhou Medical University
Recruiting
http://ift.tt/2F1dF3t
Interventions: Procedure: Unilateral Neck Dissection; Procedure: Bilateral Neck Dissection
Sponsors: Cancer Institute and Hospital, Chinese Academy of Medical Sciences; Liaoning Tumor Hospital & Institute; Hebei Medical University Fourth Hospital; Jilin Provincial Tumor Hospital; The first affiliated hospital of Jinzhou Medical University
Recruiting
http://ift.tt/2F1dF3t
Vaccination Against Human Papillomavirus (HPV) With the 9-valent Vaccine in HIV-positive Women (the Papillon Study)
Conditions: HPV - Anogenital Human Papilloma Virus Infection; Hiv
Intervention: Biological: Vaccine
Sponsor: Centre Hospitalier Universitaire Saint Pierre
Not yet recruiting
http://ift.tt/2EcwKyF
Intervention: Biological: Vaccine
Sponsor: Centre Hospitalier Universitaire Saint Pierre
Not yet recruiting
http://ift.tt/2EcwKyF
Early Non Invasive Ventilation and Hematological Malignancies
Conditions: Hematological Malignancies; Chronic Hypoxemic Respiratory Failure; Blood And Marrow Transplantation; Malignant Neoplasm of Breast; Malignant Neoplasms of Bone and Articular Cartilage; Malignant Neoplasms of Digestive Organs; Malignant Neoplasms of Eye Brain and Other Parts of Central Nervous System; Malignant Neoplasms of Female Genital Organs; Malignant Neoplasms of Ill-defined Secondary and Unspecified Sites; Malignant Neoplasms of Independent (Primary) Multiple Sites; Malignant Neoplasms of Lip Oral Cavity and Pharynx; Malignant Neoplasms of Male Genital Organs; Malignant Neoplasms of Mesothelial and Soft Tissue; Malignant Neoplasms of Respiratory and Intrathoracic Organs; Malignant Neoplasms of Thyroid and Other Endocrine Glands; Malignant Neoplasms of Urinary Tract; Malignant Neoplasms Stated as Primary Lymphoid Haematopoietic
Interventions: Other: Non-Invasive Positive Pressure Ventilation (NIPPV); Other: High Flow Nasal Cannula Oxygen Therapy
Sponsor: M.D. Anderson Cancer Center
Recruiting
http://ift.tt/2F0VWcp
Interventions: Other: Non-Invasive Positive Pressure Ventilation (NIPPV); Other: High Flow Nasal Cannula Oxygen Therapy
Sponsor: M.D. Anderson Cancer Center
Recruiting
http://ift.tt/2F0VWcp
Indications for Trans-Nasal Flexible Laryngo-Oesophagoscopy in a head and neck clinic, our experience in 194 patients
Abstract
Lamm introduced fibre-optic imaging in 1930s 1. In the following decades it has been utilized in otolaryngology as an alternative to indirect mirror laryngoscopy. In its present form it allows for image capture and video recording when connected to a camera, it also allows for manoeuvring around anatomical structures due to its flexibility and articulation. It now forms an essential part of any head and neck examination especially when assessing for suspected cancer.
This article is protected by copyright. All rights reserved.
http://ift.tt/2CJpJsW
Asthma onset pattern and patient outcomes in a chronic rhinosinusitis population
Background
Chronic rhinosinusitis (CRS) is strongly associated with comorbid asthma. This study compares early-onset and late-onset asthma in a CRS population using patient-reported and clinical characteristics.
Methods
At enrollment into a clinical registry, CRS patients completed the 22-item Sino-Nasal Outcome Test (SNOT-22), Asthma Control Test (ACT), mini-Asthma Quality of Life Questionnaire (miniAQLQ), the 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29), and medication use questionnaires. Patients also reported comorbid asthma and age at first asthma diagnosis. Early-onset (<18 years) and late-onset (>18 years) asthma groups were defined. Analysis of variance (ANOVA), chi-square, and Kruskal-Wallis tests were used to compare patient responses.
Results
A total of 199 non-asthmatic (56.1%), 71 early-onset asthmatic (20.0%), and 85 late-onset asthmatic (23.9%) CRS patients completed the survey. Body mass index (BMI) was significantly higher in late-onset asthmatic (p = 0.046) while age, gender, race, and smoking history did not differ with time of asthma onset. SNOT-22, ACT, and miniAQLQ were not different between asthma groups, but late-onset asthmatics had significantly lower physical function than non-asthmatics (p = 0.008). Compared to non-asthmatics, late-onset asthmatics showed increased rates of nasal polyps (p < 0.001), higher Lund-Mackay scores (p = 0.005), and had received more oral steroid courses (p < 0.001) and endoscopic surgeries (p = 0.008) for CRS management. Late-onset asthmatics compared to early-onset asthmatics showed increased nasal polyposis (p = 0.011) and oral steroid courses for CRS (p = 0.003).
Conclusion
While CRS-specific and asthma-specific patient-reported outcome measures (PROMs) were not significantly different among groups, CRS patients with late-onset asthma had poorer physical function, more frequent nasal polyposis, and required increased treatment for CRS. Late-onset asthma may predict more severe disease in CRS.
http://ift.tt/2Av06pH
Are multiple sinus cultures necessary during sinus surgery for chronic rhinosinusitis?
Background
Multiple cultures are commonly obtained from different sinuses where purulence is encountered during endoscopic sinus surgery (ESS). This brings into question the utility and necessity of obtaining multiple cultures. The purpose of this study was to evaluate if multiple cultures obtained during a single case is informative in finding additional pathogens or if it is a redundant, cost-increasing practice. We hypothesized that multiple sinus cultures are necessary to identify the pathogens responsible for an individual's sinus disease. We seek to add information on the utility of performing multiple sinus cultures from a patient care and a health economics standpoint.
Methods
This study was a retrospective review of a single rhinologist's surgical database from 2008 to 2016. Patients that underwent ESS for chronic rhinosinusitis (CRS) and had multiple cultures obtained during surgery were included. Culture difference was recorded as a discrepancy of an infectious pathogen between cultures.
Results
We identified 231 patients with multiple sinus cultures. Of those, 39.4% had a difference of pathogens noted on culture between different sinuses. Only 5% of the cohort received clinically relevant benefit from the second culture obtained in regard to a change in antibiotics.
Conclusion
In this retrospective review we showed that, for the practitioner who obtains sinus cultures intraoperatively, limiting this practice to a single culture rather than multiple is cost-effective and sufficient for identifying the pathogen to be treated. This study, and the resultant change in practice, has the potential to reduce healthcare costs associated with the surgical care of the patient with CRS.
http://ift.tt/2CIMCwx
Comparative analysis of the Hom family of outer membrane proteins in isolates from two geographically distinct regions: The United States and South Korea
Abstract
Background
Helicobacter pylori encodes numerous outer membrane proteins (OMPs), but only a few have been characterized in depth. Deletion, duplication, and allelic variation of many of the H. pylori OMPs have been reported, which suggests that these proteins may play key roles in host adaptation. Herein, we characterize the variation observed within the Hom family of OMPs in H. pylori obtained from two geographically distinct populations.
Materials and Methods
PCR genotyping of the hom genes was carried out using clinical isolates from South Korea and the United States. A combination of statistical, phylogenetic, and protein modeling analyses was conducted to further characterize the hom variants.
Results
Variations in the closely related hom genes, homA and homB, occur in regions that are predicted to encode environmentally exposed loops. A similar phenomenon is true for homCS as compared to homCL. Conversely, little variation was observed in homD. Certain variants of the Hom family of proteins were more prominent in isolates from the Korean population as compared to isolates from the United States.
Conclusion
En masse, our data show that the homA, homB, and homC profiles vary based upon the geographic origin of the strain; however, the fourth member of the hom family, homD, is more highly conserved. Additionally, protein topology modeling showed that many of the less well-conserved regions between homA and homB and between homCS and homCL corresponded to predicted environmentally exposed loops, suggesting that the divergence of the Hom family may be due to host adaptation/pressure.
http://ift.tt/2CLd60g
Levels of malondialdehyde in the gastric juice: Its association with Helicobacter pylori infection and stomach diseases
Abstract
Background
Helicobacter pylori (H. pylori) infection causes elevation of lipid peroxidation product malondialdehyde (MDA) and this association may be due to the bacterium causing reactive oxygen species-mediated damage to DNA in the gastric epithelium. The aim of this study was to investigate the gastric juice MDA levels in relation to H. pylori infection and associated gastric diseases.
Methods
Gastric juice samples were obtained from 117 patients undergoing endoscopy, and gastric juice MDA levels were determined by high-performance liquid chromatography (HPLC) system. We compared the MDA levels between patients with and without H. pylori infection and assessed the differences of MDA levels between chronic gastritis, gastric intestinal metaplasia, and gastric cancer postsurgical resection.
Results
Malondialdehyde levels in gastric juice were significantly higher in chronic gastritis patients with H. pylori infection than in those without H. pylori infection (P < .0001). In patients without H. pylori infection, patients with gastric intestinal metaplasia and gastric cancer postsurgical resection had significantly higher gastric juice MDA level than patients with chronic gastritis. As a whole, patients with gastric intestinal metaplasia and gastric cancer postsurgical resection also had significantly higher MDA levels in gastric juice as compared to patients with chronic gastritis (P < .01). However, the difference of gastric juice MDA levels between gastric intestinal metaplasia and gastric cancer postsurgical resection was not significant.
Conclusion
Malondialdehyde in gastric juice could be used as a potential diagnostic biomarker for H. pylori infection and associated gastric diseases. The gastric juice MDA levels increased proportionally with the severity of gastric diseases.
http://ift.tt/2AwwZlE
Increased TRPC6 expression is associated with tubular epithelial cell proliferation and inflammation in diabetic nephropathy
Source:Molecular Immunology, Volume 94
Author(s): Yanqin Fu, Chongxian Wang, Dongming Zhang, Yaping Xin, Jun Li, Yuanyuan Zhang, Xiaojing Chu
Although TRPC6 expression is shown to be significantly elevated in a rat model diabetic nephropathy (DN), its expression and role in human DN are unclear. We thus explored the role of TRPC6 in the pathophysiology of tubular epithelial cell injury following DN. HK-2 cells were cultured in a high-glucose medium to induce a DN cell model. Ad-TRPC6 and TRP6 siRNA were transfected to overexpress and knock down TRPC6. We found that TRPC6 expression was significantly upregulated in DN tissues and cells. TRPC6 siRNA inhibited cell proliferation and promoted cell apoptosis in HK-2 cells treated with high glucose, whereas Ad-TRPC6 showed the opposite effect. Furthermore, Ad-TRPC6 significantly promoted release of IL-8 and IL-6. Subsequent experiments demonstrated that the signaling pathway of nuclear factor of activated T cells (NFAT) was activated by Ad-TRPC6 and deactivated by TRPC6 siRNA. The NFAT signaling inhibitor, FK-506, eliminated the effect of TRPC6 on HK-2 cells. These results suggest that TRPC6 was upregulated in DN and could promote cell proliferation and inflammation by inhibiting the NFAT signaling pathway in tubular epithelial cells.
http://ift.tt/2m0Sabk
IFN-γ decreased the suppressive function of CD33+HLA-DRlow myeloid cells through down-regulation of PD-1/PD-L2 signaling pathway
Source:Molecular Immunology, Volume 94
Author(s): Xiaoxia Zhan, Shengfeng Hu, Yongjian Wu, Miao Li, Ting Liu, Siqi Ming, Minhao Wu, Min Liu, Xi Huang
Myeloid-derived suppressor cells (MDSCs) have recently been described to inhibit protective T-cell responses in tuberculosis (TB). T cells play an important role in the immunity to Mycobacterium tuberculosis, and are the major producers of IFN-γ. However, the impact of IFN-γ on MDSCs during TB is still not completely understood. Our study demonstrated a significant correlation between MDSC levels and TB progression, suggesting that MDSCs may serve as a potential marker in diagnosis or treatment of TB. Culture with GM-csf and IL-6 promoted peripheral blood mononuclear cells (PBMCs) to differentiate into functional CD33+HLA-DRlow MDSC-like cells. Moreover, we report for the first time, that IFN-γ-educated CD33+HLA-DRlow MDSCs have less suppressive potential to diminish T-cell responses, including IFN-γ production. Further investigations revealed that suppressive function of CD33+HLA-DRlow MDSCs was dependent on programmed death-1/programmed death-1 ligand-2 (PD1/PD-L2) pathway and required direct cell–cell contact. IFN-γ dampened the immuno-suppressive activity of CD33+HLA-DRlow MDSCs by inhibiting PD-1/PD-L2 pathway, indicating the existence of a negative-feedback loop between IFN-γ and functional MDSC expansion. In summary, our study revealed a novel mechanism by which IFN-γ decreases the suppressive function of MDSCs, suggesting that antagonizing suppressive functions of MDSCs by IFN-γ could enhance immune responses against TB infection.
http://ift.tt/2qwiRJu
Characterization of 16-kDa major allergen with α-amylase inhibitor domain in tartary buckwheat seeds
Source:Molecular Immunology, Volume 94
Author(s): Bei Zheng, Haina Zhang, Lei Wang, Yanfei Guo, Peng Chen
Tartary buckwheat (Fagopyrum tataricum, TB) is an important functional food containing proteins with balanced amino acid composition and more flavonoids than common buckwheat (Fagopyrum esculentum, CB). Buckwheat contains highly potent allergens that trigger an allergic reaction via an IgE mediated response. In this work, the full-length cDNA encoding Fag t 2 from tartary buckwheat seeds was cloned by screening the cDNA library of seed-filling period. The recombinant Fag t 2 (rFag t 2) expressed in Pichia pastoris SMD1168H was purified by purified by immobilized metal affinity chromatography. It demonstrated that Fag t 2 was a major allergen in tartary buckwheat with the activity of IgE binding and pepsin resistance, along with the thermal stability. The identification of natural Fag t 2 (n Fag t 2) confirmed that the Fag t 2 protein belongs to the 2S albumin family, only existing in embryo. Most interesting, we discovered that Fag t 2 had a α-amylase inhibitor domain near the end of C-terminal. The possible activity of α-amylase inhibitor of Fag t 2 will be detected in subsequent studies.
http://ift.tt/2qoTxoK
A pathogenetic role for M1 macrophages in peritoneal dialysis-associated fibrosis
Publication date: February 2018
Source:Molecular Immunology, Volume 94
Author(s): Qing Li, Min Zheng, Yueheng Liu, Wei Sun, Jun Shi, Jie Ni, Qiong Wang
Peritoneal fibrosis (PF) is a frequent complication of peritoneal dialysis (PD) accompanied by the infiltration of inflammatory cells. Recently, the function of macrophages in an inflammatory microenvironment during PD remains unknown. This study aimed to elucidate the role of distinct macrophage phenotypes in the progression of PF through macrophage depletion in a peritoneal dialysis-induced mouse model. After injection of 200 μl liposomal clodronate (LC) at the start of instillation PD fluids (PDFs), mice were injected with 100 μL LC every 4 days after the first time injection for longer macrophage depletion, while control mice were co-treated with PBS liposomes. For macrophages transfusion,primary macrophages (M0) were stimulated into M1 and M2 macrophages and transfused into the mice the next day after each LC injection. Mice were sacrificed after 6 weeks of PDFs treatment for the assessment of histological changes, ECM deposition and peritoneal ultrafiltration function. Systemic monocyte/macrophage depletion resulted in less severe structural alterations, including thickening and cubic transformation of mesothelial cells, fibrin deposition, fibrous capsule formation, and interstitial fibrosis. A strong reduction of alpha-smooth muscle actin (α-SMA) and fibronectin expression, as well as an increased E-cadherin expression was also observed, indicating an overall inhibition of peritoneal fibrosis in macrophages depletion mice.M1 macrophage reperfusion showed a significant increase in histological damages, ECM deposition and peritoneal ultrafiltration functional decline compared with those of the M2 and control groups. TLR4 expression was enhanced in M1 macrophage-treated group. These results suggest that M1 macrophages are an important mediator of peritoneal fibrosis.
Graphical abstract
http://ift.tt/2lZqDHm
Microstructural Analysis of the Effects of Thermal Runaway on Li-Ion and Na-Ion Battery Electrodes
Robinson, JB; Finegan, DP; Heenan, TMM; Smith, K; Kendrick, E; Brett, DJL; Shearing, PR; (2018) Microstructural Analysis of the Effects of Thermal Runaway on Li-Ion and Na-Ion Battery Electrodes. Journal of Electrochemical Energy Conversion and Storage , 15 (1) 10.1115/1.4038518 . Green open access
http://ift.tt/2lWBbGc
Diagnostic timeliness in teenagers and young adults with cancer: Cross-sectional findings from the BRIGHTLIGHT cohort
Lyratzopoulos, G; Herbert, A; Whelan, J; Taylor, RM; Barber, J; Gibson, F; Fern, L; (2018) Diagnostic timeliness in teenagers and young adults with cancer: Cross-sectional findings from the BRIGHTLIGHT cohort. Lancet Child and Adolescent Health (In press).
http://ift.tt/2CIe10H
Scottish ferries: sailing towards greater energy efficiency and decarbonisation?
Rehmatulla, N; (2017) Scottish ferries: sailing towards greater energy efficiency and decarbonisation? Fraser of Allander Institute Economic Commentary , 41 (1) pp. 46-58.
http://ift.tt/2lWdYDX
Mesostructure of Mesoporous Silica/Anodic Alumina Hierarchical Membranes Tuned with Ethanol (vol 33, pg 4823, 2017)
Meoto, S; Kent, N; Nigra, MM; Coppens, M-O; (2017) Mesostructure of Mesoporous Silica/Anodic Alumina Hierarchical Membranes Tuned with Ethanol (vol 33, pg 4823, 2017). [Corrigendum]. Langmuir , 33 (32) p. 8097. 10.1021/acs.langmuir.7b02472 . Green open access
http://ift.tt/2CFZ8vJ
Oligomeric states in sodium ion-dependent regulation of cyanobacterial histidine kinase-2
Allen, J; Ibrahim, IM; Wang, L; Puthiyaveetil, S; Krauß, N; Nield, J; (2017) Oligomeric states in sodium ion-dependent regulation of cyanobacterial histidine kinase-2. Protoplasma 10.1007/s00709-017-1196-7 . (In press). Green open access
http://ift.tt/2m0Gepk
Earliest hydraulic enterprise in China, 5,100 years ago
Liu, B; Wang, N; Chen, M; Wu, X; Mo, D; Liu, J; Xu, S; Liu, B; Wang, N; Chen, M; Wu, X; Mo, D; Liu, J; Xu, S; Zhuang, Y; - view fewer (2017) Earliest hydraulic enterprise in China, 5,100 years ago. Proceedings of the National Academy of Sciences of the United States of America , 114 (52) pp. 13637-13642. 10.1073/pnas.1710516114 .
http://ift.tt/2CIT0D9
Longitudinal profiles of back pain across adulthood and their relationship with childhood factors: Evidence from the 1946 British birth cohort
Muthuri, SG; Kuh, D; Cooper, R; (2018) Longitudinal profiles of back pain across adulthood and their relationship with childhood factors: Evidence from the 1946 British birth cohort. PAIN 10.1097/j.pain.0000000000001143 . (In press).
http://ift.tt/2lWATz6
Algorithmic structural segmentation of defective particle systems: A lithium-ion battery study
Westhoff, D; Finegan, DP; Shearing, PR; Schmidt, V; (2017) Algorithmic structural segmentation of defective particle systems: A lithium-ion battery study. Journal of Microscopy 10.1111/jmi.12653 . (In press).
http://ift.tt/2CJevUa
Understanding the thermo-mechanical behaviour of solid oxide fuel cell anodes using synchrotron X-ray diffraction
Heenan, TMM; Robinson, JB; Lu, X; Tjaden, B; Cervellino, A; Bailey, JJ; Brett, DJL; Heenan, TMM; Robinson, JB; Lu, X; Tjaden, B; Cervellino, A; Bailey, JJ; Brett, DJL; Shearing, PR; - view fewer (2018) Understanding the thermo-mechanical behaviour of solid oxide fuel cell anodes using synchrotron X-ray diffraction. Solid State Ionics , 314 pp. 156-164. 10.1016/j.ssi.2017.10.025 .
http://ift.tt/2lW67Gy
Clinical trial parameters that influence outcomes in lupus trials that use the systemic lupus erythematosus responder index
Kalunian, KC; Urowitz, MB; Isenberg, D; Merrill, JT; Petri, M; Furie, RA; Morgan-Cox, M-A; ... Linnik, MD; + view all Kalunian, KC; Urowitz, MB; Isenberg, D; Merrill, JT; Petri, M; Furie, RA; Morgan-Cox, M-A; Taha, R; Watts, S; Silk, M; Linnik, MD; - view fewer (2017) Clinical trial parameters that influence outcomes in lupus trials that use the systemic lupus erythematosus responder index. Rheumatology , 57 (1) pp. 125-133. 10.1093/rheumatology/kex368 .
http://ift.tt/2CDHGIt
The BRAIN test: a keyboard-tapping test to assess disability and clinical features of multiple sclerosis
Shribman, S; Hasan, H; Hadavi, S; Giovannoni, G; Noyce, AJ; (2017) The BRAIN test: a keyboard-tapping test to assess disability and clinical features of multiple sclerosis. Journal of Neurology 10.1007/s00415-017-8690-x . (In press). Green open access
http://ift.tt/2lW12hy
Multiple sclerosis, a treatable disease
Doshi, A; Chataway, J; (2017) Multiple sclerosis, a treatable disease. Clinical Medicine , 17 (6) pp. 530-536. 10.7861/clinmedicine.17-6-530 . Green open access
http://ift.tt/2CDHsRD
Clinical outcomes of staff training in Positive Behaviour Support (PBS) to reduce challenging behaviour in adults with intellectual disability: a cluster randomised controlled trial
Hassiotis, A; Poppe, M; Strydom, A; Vickerstaff, V; Hall, IS; Crabtree, J; Omar, RZ; ... Crawford, MJ; + view all Hassiotis, A; Poppe, M; Strydom, A; Vickerstaff, V; Hall, IS; Crabtree, J; Omar, RZ; King, M; Hunter, R; Biswas, A; Cooper, V; Howie, W; Crawford, MJ; - view fewer (2018) Clinical outcomes of staff training in Positive Behaviour Support (PBS) to reduce challenging behaviour in adults with intellectual disability: a cluster randomised controlled trial. British Journal of Psychiatry (In press).
http://ift.tt/2lXgiea
Time-dependent density functional theory for the charging kinetics of electric double layer containing room-temperature ionic liquids
Lian, C; Zhao, S; Liu, H; Wu, J; (2016) Time-dependent density functional theory for the charging kinetics of electric double layer containing room-temperature ionic liquids. Journal of Chemical Physics , 145 (20) , Article 204707. 10.1063/1.4968037 . Green open access
http://ift.tt/2CJQBIc
Spatial distribution and semi-annual variation of cold-dense plasma sheet
Bai, S; Shi, QQ; Tian, A; Nowada, M; Degeling, A; Zhou, X-Z; Zong, Q-G; ... Fazakerley, AN; + view all Bai, S; Shi, QQ; Tian, A; Nowada, M; Degeling, A; Zhou, X-Z; Zong, Q-G; Rae, IJ; Fu, S; Zhang, H; Pu, Z; Fazakerley, AN; - view fewer (2018) Spatial distribution and semi-annual variation of cold-dense plasma sheet. Journal of Geophysical Research (In press).
http://ift.tt/2lZgjhD
Large reductions in cesarean delivery rates in China: a qualitative study on delivery decision-making in the era of the two-child policy
Wang, E; Hesketh, T; (2017) Large reductions in cesarean delivery rates in China: a qualitative study on delivery decision-making in the era of the two-child policy. BMC Pregnancy and Childbirth , 17 , Article 405. 10.1186/s12884-017-1597-9 . Green open access
http://ift.tt/2CJ6wGW
Language Ideology and the Global Dominance of English. An interview with John O’Regan, Reader in Applied Linguistics at UCL Institute of Education, University College London
Georgiou, A; (2017) Language Ideology and the Global Dominance of English. An interview with John O'Regan, Reader in Applied Linguistics at UCL Institute of Education, University College London. Bellaterra Journal of Teaching & Learning Language & Literature , 10 (2) pp. 97-104. 10.5565/rev/jtl3.733 . Green open access
http://ift.tt/2m0FKj0
Kv4.2 channel activity controls intrinsic firing dynamics of arcuate kisspeptin neurons.
Mendonça, PRF; Kyle, V; Yeo, S-H; Colledge, WH; Robinson, HPC; (2017) Kv4.2 channel activity controls intrinsic firing dynamics of arcuate kisspeptin neurons. Journal of Physiology 10.1113/JP274474 . (In press).
http://ift.tt/2CFZ5Qz
Systematic meta-review of supported self-management for asthma: a healthcare perspective
Pinnock, H; Parke, HL; Panagioti, M; Daines, L; Pearce, G; Epiphaniou, E; Bower, P; ... PRISMS and RECURSIVE groups, ; + view all Pinnock, H; Parke, HL; Panagioti, M; Daines, L; Pearce, G; Epiphaniou, E; Bower, P; Sheikh, A; Griffiths, CJ; Taylor, SJC; PRISMS and RECURSIVE groups, ; - view fewer (2017) Systematic meta-review of supported self-management for asthma: a healthcare perspective. BMC Medicine , 15 (1) , Article 64. 10.1186/s12916-017-0823-7 . Green open access
http://ift.tt/2lWAQDq
Intravenous Drug Use-Associated Scopulariopsis Endophthalmitis Treated with Systemic and Intravitreal Voriconazole
Purpose: To report a case of intravenous (i.v.) heroin use-associated endogenous endophthalmitis caused by Scopulariopsis fungal species, and its response to intravitreal and oral voriconazole treatments. Patient: A 21-year-old-female with chronic hepatitis C and i.v. heroin use presented with subacute decreased vision to hand motion in her left eye. Results: Endogenous fungal endophthalmitis caused by Scopulariopsis was confirmed by vitreous biopsy. The patient improved clinically after vitrectomy with intravitreal voriconazole and 3 weeks of oral voriconazole. The final vision was 20/60 after 6 months. Conclusions: Scopulariopsis is a rare cause of endophthalmitis, and is often difficult to treat due to its resistance to commonly used antifungals. This case is the first report of Scopulariopsis endophthalmitis secondary to i.v. drug use.
Case Rep Ophthalmol 2018;9:37–42
http://ift.tt/2CZf2PT
Case Rep Ophthalmol 2018;9:37–42
http://ift.tt/2CZf2PT
A Case of Retinal Detachment with Unique Optical Coherence Tomography Findings after Gamma Knife® Radiosurgery Treatment for Choroidal Melanoma
Purpose: To report a case of retinal detachment with unique optical coherence tomography (OCT) findings after Gamma Knife® (GK; Elekta Instrument AB, Stockholm, Sweden) treatment for choroidal melanoma (CM). Case Report: A 48-year-old woman underwent GK therapy for CM in her right eye from the macula to the temporal side. While the tumor subsequently shrank, the patient developed radiation retinopathy, which was treated with laser photocoagulation. The tumor lesions later subsided; however, her visual acuity (VA) decreased 8 years after the initial treatment. Although the tumor lesions in the right eye had become scarred, a bullous retinal detachment with fixed folds occurred in the superior-nasal quadrants. OCT examination revealed a preretinal membrane, vitreoretinal traction, and an inner retinal break; however, no outer retinal break was clearly detectable. MRI scans showed no increase in tumorous lesions, and 123I-IMP SPECT imaging showed no photon accumulation. Thus, it was determined that there was no tumor activity. The corrected VA in her right eye was light perception, and it was determined that there was no indication for vitreous surgery. Conclusion: In this case, an inner retinal break was formed by the vitreoretinal traction around the scarred tumor and radiation retinopathy, thus suggesting the possibility of the development of a rhegmatogenous retinal detachment presumably complicated with an outer retinal break.
Case Rep Ophthalmol 2018;9:17–23
http://ift.tt/2CuF5gA
Case Rep Ophthalmol 2018;9:17–23
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Patch Grafting Using an Ologen Collagen Matrix to Manage Tubal Exposure in Glaucoma Tube Shunt Surgery
Purpose: To report the results using an ologen Collagen Matrix as a patch graft in eyes with tubal exposure after tube shunt surgery. Case Reports: Case 1 was an 82-year-old man with tubal exposure in his right eye 26 months after receiving a Baerveldt glaucoma implant. The tube was covered by surrounding conjunctival tissue combined with subconjunctival placement of an ologen Collagen Matrix as a patch graft. Two years after implantation, the tube was not exposed. Anterior-segment optical coherence tomography (AS-OCT) showed dense conjunctival tissue over the tube. Case 2 was an 82-year-old man with peripheral keratitis, anterior scleritis, and secondary glaucoma in the right eye who underwent tube shunt surgery using an Ahmed glaucoma valve and cataract surgery. Intraoperatively, scleritis-related scleral thinning prevented the tube from being covered fully by an autologous scleral flap. An ologen Collagen Matrix was placed over the scleral flap as a patch graft. Seventeen months after implantation, the tube was not exposed. Case 3 was a 52-year-old man with diabetic maculopathy and steroid-induced glaucoma in the right eye who underwent tube shunt surgery using an Ahmed glaucoma valve. Intraoperatively, a flap defect prevented the tube from being covered fully by an autologous scleral flap. An ologen Collagen Matrix was placed over the scleral flap as a patch graft. Three weeks postoperatively, AS-OCT showed thick subconjunctival tissue over the tube. Three months after implantation, the tube was not exposed. Conclusions: The ologen Collagen Matrix can be used successfully as a patch graft to prevent and treat tubal exposure after tube shunt surgery.
Case Rep Ophthalmol 2018;9:9–16
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Case Rep Ophthalmol 2018;9:9–16
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Risk factors of sensorineural hearing loss in patients with unilateral safe chronic suppurative otitis media
Source:American Journal of Otolaryngology
Author(s): Abd Elrheem Ahmed Singer, Osama G. Abdel-Naby Awad, Rafeek Mohamed Abd El-Kader, Ahmed Rabeh Mohamed
PurposeChronic suppurative otitis media (CSOM) is the major cause of hearing impairment, especially conductive hearing loss. Few patients also had sensorineural component, the sensorineural hearing loss (SNHL) in CSOM is controversial, especially for safe mucosal type. This study aims to assess the relationship between the frequency of SNHL development in patients with safe mucosal CSOM and its relation to patient's age, sex, duration of disease, size of perforation and different audiological findings.Material and methodsThis is a prospective study conducted from June 2016 to June 2017 in a tertiary referral hospital. 200 patients with unilateral mucosal type of CSOM with normal contralateral ear were included in the study. The diseased ears were taken as study ears and normal ears as control ears in all patients. Detailed otologic history, clinical and audiometric findings were recorded and analyzed. Results were statistically compared in all patients for both study and control ears using different parameters.ResultsTwenty patients had an average bone conduction threshold of all frequencies above 25dB, which implies SNHL (10%). The incidence of SNHL was statistically significant at higher speech frequencies. The incidence increased with the presence of Diabetes Mellitus, smoking, duration of disease, presence of active discharge and the increase in size of perforation. However, it is not age dependent and there was no difference between males and females.ConclusionSafe mucosal CSOM can cause SNHL with multiple predisposing factors.
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