Micronuclei in Exfoliated Oral Epithelial Cells in Tobacco Users and Controls with Various Oral Lesions: A Study from Gujarat, India

Abstract

To assess and compare cytogenic damage in the form of micronuclei in various oral lesions according to duration and frequency of tobacco use. The present cross sectional study was carried out from October 2015 to October 2016. We included total 420 cases with 60 cases in each of the following subgroups, no tobacco habit with no obvious oral lesion (control) and tobacco habit with no obvious oral lesion, oral sub mucous fibrosis, leukoplakia, melanoplakia, erythroplakia, oral squamous cell carcinoma. Oral mucosal cells were collected from both sides of cheek; slides were prepared and examined for cells with micronuclei. The mean micronuclei index distribution in control group, potentially malignant group, and malignancy group was 1.14, 2.63, and 4.88 respectively and was statistically significant. The mean micronuclei index in control group, smoking tobacco and smokeless tobacco group was 1.14, 2.64, and 2.76 and was statistically significant. The mean micronuclei index was significantly higher in those using tobacco, for longer duration and with frequent tobacco use. The mean micronuclei index can be used as a potential screening tool of genotoxic damage and biomarker for epithelial carcinogenesis. The method has practical utility for warning tobacco users that higher than range has a danger of malignant event and therefore this in future can be used as reinforcement to advice of avoiding tobacco before malignancy develops.

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Auditory Lateralization Training Effects on Binaural Interaction Component of Middle Latency Response in Children Suspected to Central Auditory Processing Disorder

Abstract

Many children with central auditory processing disorder (C)APD suffer from spatial processing disorder and benefit from binaural processing training including auditory lateralization training. There are subjective tests for evaluating auditory training effects in children with (C)APD but they rely on patient's attention and cooperation so there is a need for appropriate objective tests. The aim of present study was investigating effects of auditory lateralization training on binaural interaction component (BIC) of middle latency response (MLR). This study was an analytical interventional study. Sixty children suspected to (C)APD (40 boys and 20 girls) were selected based on inclusion criteria and were divided into two groups: control and training group. Auditory lateralization training included 12 formal sessions under headphone by using interaural time difference and performed as a game. MLR (monaural right ear, monaural left ear and binaural) and monaural selective auditory attention test (mSAAT) tests were performed in all the cases. BIC was calculated by subtracting binaural response from summed monaural responses. Covariance test showed that BIC latency decreased and BIC amplitude increased significantly and mSAAT score increased significantly in training group after auditory lateralization training (p value ≤ 0.001). In present study BIC of MLR had potential to show underlying neurophysiologic changes after auditory lateralization training in children suspected to (C)APD objectively. It is in agreement with behavioral improvements after training (mSAAT improvements).

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A novel tubulin inhibitor STK899704 induces tumor regression in DMBA/TPA induced skin carcinogenesis model

Abstract

Skin cancer is the most common type of cancer. The incidence rate of skin cancer has continuously increased over the past decades. In an effort to discover novel anticancer agents, we identified a novel tubulin inhibitor STK899704 which is structurally distinct from other microtubule-binding agents such as colchicine, vinca alkaloids, and taxanes. STK899704 inhibited microtubule polymerization leading to mitotic arrest, and suppressed the proliferation of various cancer cell lines as well as multidrug-resistance cancer cell lines. In this study, our investigation is further extended into animal model to evaluate the effect of STK899704 on skin carcinogenesis in vivo. Surprisingly, almost 80% of the tumors treated with STK899704 were regressed with a one fifth reduction in tumor volume. Furthermore, the efficacy of STK899704 was nearly two times higher than that of 5-fluorouracil, a widely used skin cancer therapeutic. Overall, our results suggest that STK899704 is a promising anticancer chemotherapeutic that may replace existing therapies, particularly for skin cancer.

This article is protected by copyright. All rights reserved.

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Eicosapentaenoic acid ethyl ester ameliorates atopic dermatitis-like symptoms in special diet-fed hairless mice, partly by restoring covalently bound ceramides in the stratum corneum

Abstract

Skin barrier dysfunction has a key role in the development of atopic dermatitis (AD). Covalently bound ceramides (Cer), which are essential lipids for permeability barrier homeostasis, are reportedly decreased in the stratum corneum (SC) of AD patients. Hairless mice fed a special diet develop pruritic dermatitis resembling human AD. Our previous study found that oral administration of the n-3 polyunsaturated fatty acid α-linolenic acid ameliorated skin barrier dysfunction in AD mice with concomitant increase in serum eicosapentaenoic acid (EPA). In this study, we examined the effects of EPA ethyl ester (EPA-E) on diet-induced AD in hairless mice. Oral administration of EPA-E ameliorated skin barrier dysfunction and pruritus in AD mice. In the SC of AD mice, covalently bound Cer were markedly diminished. EPA-E administration restored the lack of bound Cer. Our findings imply the possible therapeutic clinical application of EPA-E in the treatment of human AD.

This article is protected by copyright. All rights reserved.

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An efficient method for eccrine gland isolation from human scalp

Abstract

We describe a simple and efficient method to isolate eccrine sweat glands from the human scalp. This method is inspired by the hair graft harvesting method used in hair transplantation. Based on the recently described anatomical relationship between the scalp hair follicle and the eccrine gland, we have found that scalp follicular unit grafts are an excellent eccrine gland isolation source, especially for the coiled component. In order to make the gland visible for stereoscopic microdissection, the follicular units need to be previously stained with a vital dye like Methylene Blue or Neutral Red. The simplicity and efficiency of this isolation method should encourage further research into human eccrine sweat gland function which has always been hindered by the difficulty of gland isolation.

This article is protected by copyright. All rights reserved.

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Leiomyoma of the soft palate: Case report and review of articles

Publication date: Available online 1 February 2018
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Fahd Alharbi
Leiomyomas are benign tumors arising from smooth muscle, most commonly seen in uterine myometrium, gastrointestinal tract, skin and lower extremities of middle-aged women. Leiomyomas are uncommon in the oral cavity and leiomyomas of head and neck region account for less than 1% of all leiomyomas. The purpose of this article is to present a case of 18 years old male patient with a history of several months of oral leiomyoma on the right side of the soft palate. The clinical features, differential diagnosis and management of leiomyoma are discussed with review of the literatures.



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Ken Hashimoto, M.D., Ph.D. (1931–2017): A tribute

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Issue Information

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Issue Information

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Alterations of the Gut Microbiota in Hashimoto's Thyroiditis Patients

Thyroid , Vol. 0, No. 0.


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The Vitamin D3 analogue calcipotriol suppresses CpG-activated TLR9-MyD88 signalling in murine plasmacytoid dendritic cells

Summary

Background

Plasmacytoid dendritic cells (pDCs) are involved in the pathogenesis of psoriasis by secreting interferon-α. Vitamin D3 analogues are widely used to treat psoriasis, and the representative analogue calcipotriol (CAL) uniquely downregulates the cytokine production and chemotactic activity of pDCs. However, the molecular mechanism of action of CAL is not well understood.

Aim

To investigate effects of CAL on the Toll-like receptor 9–myeloid differentiation primary response gene 88 (TLR9-MyD88) signalling pathway, which induces cytokine production, in murine pDCs.

Methods

pDCs were isolated from mouse spleen cells by negative selection or were generated from mouse bone-marrow cells, and were stimulated with CpG-oligodeoxynucleotide (ODN) with or without CAL for 24 h. mRNA expression of TLR9 and MyD88 was assessed by real-time PCR, and the amount of TLR9 was measured by western blotting.

Results

CAL suppressed the CpG-ODN-induced increased expression of MyD88 and TLR9 in pDCs.

Conclusions

CAL may downregulate pDCs by inhibiting TLR9-MyD88 signalling.

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Issue Information - TOC

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Issue Information - Cover

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Editorial echoes

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Comparison of the effectiveness of pulsed dye laser vs pulsed dye laser combined with ultrapulse fractional CO2 laser in the treatment of immature red hypertrophic scars

Summary

Introduction

The objective was to investigate the clinical effect of an adjustable pulse width Pulsed Dye Laser (PDL) vs an adjustable pulse width PDL combined with fractional CO₂ laser in treating immature red hypertrophic scars.

Methods

Fifty-six patients (56 sites)were randomly divided into a treatment group and control group. The control group was treated with the 595 nm PDL at a fluence of 7-15J/cm² and pulse widths of 1.5-3 ms, 7 mm spot size. The treatment group was treated with a fractional CO₂ laser (UltraPulse CO₂: Deep FX, Energy: 30~50 mJ, Frequency: 300 Hz, Density 5%, Scan Shape, and Spot Size were decided by shape and area of scar) after utilizing the 595 nm adjustable pulse width PDL (Fluence: 7-15J/cm², Pulse widths: 1.5-3 ms, Spot size: 7 mm). MEBT/MEBO, previously described as a post-treatment wound ointment, was used after laser treatment. The scars of the treatment group and the control group were evaluated for changes in pigment, height, vascularity, and pliability using the Vancouver Scar Scale (VSS) after two laser treatments.

Results

The total VSS score, as well as the score for melanin, height, vascularity, pliability in both groups, showed an obvious decrease following the treatments. There were statistically significant differences between before treatment and after treatment (P < .05); however, the total score of the VSS, and score of the melanin, height, vascularity, and pliability in the control group decreased more than that of treatment group, and there was a statistically significant difference (P < .05).

Conclusions

The 595 nm adjustable pulse width PDL combined with the fractional CO₂ fractional laser appears to have a beneficial clinical effect on fresh red hypertrophic scars, with no severe adverse reactions seen.

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The Audiology of Otosclerosis

Diagnostic audiologic procedures for otosclerosis are effective tools in identifying this condition. Audiometric data usually demonstrate a conductive hearing loss at the early stages of otosclerosis. Modern middle ear analysis procedures are becoming more popular in the better diagnosis of otosclerosis. In clinical practice, cochlear otosclerosis can also be observed. Audiologic rehabilitation of otosclerosis includes fitting of hearing aids and implantable hearing devices. Current hearing technology enables patients who do not pursue surgical correction to function well and significantly improve their communication and quality of life. Otosclerosis may also be associated with annoying tinnitus, and tinnitus management is important in the rehabilitation process.

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Stapedectomy Versus Stapedotomy

Stapedectomy and stapedotomy represent the state-of-the-art surgical procedures in addressing the conductive hearing loss caused by otosclerosis. Their high rates of success and long-term stability have been demonstrated repeatedly in many studies. In comparing the short- and long-term results of the 2 procedures, it is evident that stapedotomy confers better hearing gain at high frequencies and lower complication rates. Modified stapes mobilization procedures may represent the next major development in stapes surgery in a selected patient population.

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Corrigendum to “Oral cancer-derived exosomal NAP1 enhances cytotoxicity of natural killer cells via the IRF-3 pathway” [Oral Oncol. 76 (2018) 34–41]

Publication date: Available online 1 February 2018
Source:Oral Oncology
Author(s): Yingnan Wang, Xing Qin, Xueqin Zhu, Wanjun Chen, Jianjun Zhang, Wantao Chen




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Reply to: professionalisation rather than monopolisation is the future of emergency medicine in Europe

No abstract available

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Reply to: emergency medicine is about collaboration, not monopolisation

No abstract available

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Does the β-receptor antagonist esmolol have analgesic effects?: A randomised placebo-controlled cross-over study on healthy volunteers undergoing the cold pressor test

BACKGROUND Esmolol may attenuate the sympathetic response to pain and reduce postoperative opioid consumption. It is not clear whether esmolol has an analgesic effect per se. OBJECTIVES The aim of this study was to evaluate the analgesic effect of esmolol in the absence of anaesthetics and opioids. We tested the hypothesis that esmolol would reduce the maximum pain intensity perceived during the cold pressor test (CPT) by 2 points on a 0 to 10 numeric pain rating scale (NRS) compared to placebo. DESIGN Randomised, placebo-controlled cross-over study. SETTING Postoperative recovery area, Örebro University Hospital. Study period, November 2013 to February 2014. PARTICIPANTS Fourteen healthy volunteers. Exclusion criteria included ongoing medication, pregnancy and breastfeeding and participation in other medical trials. INTERVENTIONS At separate study sessions, participants received interventions: esmolol (0.7 mg kg−1 bolus over 1 min followed by infusion at 10 μg kg−1 min−1); 0.9% normal saline bolus then remifentanil infusion at 0.2 μg kg−1 min−1 and 0.9% normal saline bolus and infusion according to a random sequence. All infusions were administered over 30 min. MAIN OUTCOME MEASURES Perceived maximum pain intensity score, pain tolerance and haemodynamic changes during CPT, and occurrence of side-effects to interventions compared to placebo, respectively. RESULTS Esmolol did not reduce perceived pain intensity or pain tolerance during the CPT. The NRS-max score was similar for esmolol, 8.5 (±1.4) and placebo, 8.4 (±1.3). The mean difference was 0.1 [95% confidence interval (−1.2 to 1.4)], P value equal to 0.83. Remifentanil significantly reduced NRS-max scores, 5.4 (±2.1) compared to placebo, [mean difference −3.1 (95% confidence interval (−4.4 to −1.8)), P 

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Anaesthesiology and ethics: Can the anaesthesiologist ameliorate simply and rapidly the assessment of decision-making capacity in the elderly?

No abstract available

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Standardised noxious stimulation-guided individual adjustment of remifentanil target-controlled infusion to prevent haemodynamic responses to laryngoscopy and surgical incision: A randomised controlled trial

BACKGROUND The surgical plethysmographic index (SPI) is one of the available indexes of the nociception–antinociception (NAN) balance. Individually adjusting the NAN balance to prevent somatic responses to noxious stimulation remains a challenge. OBJECTIVES To assess whether guiding remifentanil administration according to the SPI response to a calibrated noxious stimulus (NANCAL) can blunt the haemodynamic response to tracheal intubation and surgical incision. DESIGN Randomised multicentre study. SETTING Two Belgian university hospitals from January 2014 to April 2015. PATIENTS After ethic review board approval and informed consent, 48 American Society of Anesthesiologists I or II adult patients scheduled for surgery under general anaesthesia were enrolled. INTERVENTIONS Patients were randomly assigned to a SPI group, where remifentanil effect-site concentration was adjusted according to NANCAL, or a control group, where it was fixed at 4 ng ml−1. Propofol concentration was always adjusted to maintain the bispectral index close to 40. NANCAL consisted of a 100 Hz, 60 mA electrical tetanic stimulation during 30 s at the wrist before tracheal intubation and before surgical incision. MAIN OUTCOME MEASURES The primary endpoint was the efficacy of the NANCAL-guided remifentanil administration to prevent the haemodynamic response to tracheal intubation and surgical incision. The secondary aim was to compare the ability of SPI, analgesia nociception index, pupil diameter and mean arterial pressure response to NANCAL to predict the haemodynamic response to tracheal intubation and surgical incision. RESULTS Our SPI response to NANCAL-based correcting scheme for remifentanil administration was not superior to a fixed remifentanil concentration at blunting the haemodynamic response to tracheal intubation or surgical incision. Among all tested NAN balance indices, only mean arterial pressure had significant predictive ability with regard to the haemodynamic response to surgical incision. CONCLUSION Further research is needed to define the best NANCAL stimulus and the best remifentanil correcting scheme to help individualised tailoring of antinociception for each specific subpopulation of surgical patients. TRIAL REGISTRATION Clinicaltrials.gov NCT: 02884310; http://ift.tt/2B2PCiQ.

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Reply to: who takes the lead in critical illness?

No abstract available

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Neostigmine-based reversal of intermediate acting neuromuscular blocking agents to prevent postoperative residual paralysis: A systematic review

BACKGROUND Neostigmine is widely used to antagonise residual paralysis. Over the last decades, the benchmark of acceptable neuromuscular recovery has increased progressively to a train-of-four (TOF) ratio of at least 0.9. Raising this benchmark may impact on the efficacy of neostigmine. OBJECTIVE(S) The systematic review evaluates the efficacy of neostigmine to antagonise neuromuscular block to attain a TOF ratio of at least 0.9. DESIGN We performed a systematic search of the literature from January 1992 to December 2015. DATA SOURCES OR SETTING PubMed, EMBASE and the Cochrane Controlled Clinical Trials database were searched for randomised controlled human studies. Search was performed without language restrictions, using the following free text terms: 'neostigmine', 'sugammadex', 'edrophonium' or 'pyridostigmine' AND 'neuromuscular block', 'reversal' or 'reverse'. ELIGIBILITY CRITERIA Studies were accepted for inclusion if they used quantitative neuromuscular monitoring and neostigmine as the reversal agent. Selected trials were checked by two of the authors for data integrity. Trials relevant for inclusion had to report the number of patients included, the type of anaesthetic maintenance, the type of neuromuscular blocking agent used, the reversal agent and dose used, the depth of neuromuscular block when neostigmine was administered and the reversal time (time from injection of neostigmine until a TOF ratio ≥0.9 was attained). RESULTS 19 trials were eligible for quantitative analysis. In patients with deep residual block [T1 (first twitch height) 25% of baseline), or that a recovery time longer than 15 min be accepted.

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Reply to: collaboration in emergency medical care in Europe the ten principles of CRitical Emergency Medicine (CREM)

No abstract available

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Effects of magnesium chloride on rocuronium-induced neuromuscular blockade and sugammadex reversal in an isolated rat phrenic nerve–hemidiaphragm preparation: An in-vitro study

BACKGROUND Magnesium potentiates the effects of nondepolarising muscle relaxants. However, few studies have used magnesium chloride (MgCl2). Sugammadex reverses neuromuscular block by steroidal nondepolarising muscle relaxants. OBJECTIVES To assess the effects of MgCl2 on rocuronium-induced neuromuscular blockade and its reversal by sugammadex. DESIGN In-vitro experimental study. SETTING Animal laboratory, Asan Medical Center, Seoul, South Korea, from 20 March 2016 to 3 April 2016. ANIMALS Forty male Sprague Dawley rats. INTERVENTION Left phrenic nerve–hemidiaphragms from 40 Sprague Dawley rats were allocated randomly to four groups (1, 2, 3 and 4 mmol l-1 MgCl2 group, n = 10 each). Rocuronium was administered cumulatively until the first twitch of train-of-four (TOF) disappeared completely. Then, equimolar sugammadex was administered. MAIN OUTCOME MEASURES The effective concentration (EC) of rocuronium was obtained in each group. After administering sugammadex, recovery of the first twitch height and the TOF ratio were measured for 30 min. RESULTS EC50, EC90 and EC95 significantly decreased as the concentration of MgCl2 increased (all P ≤ 0.001), except the comparison between the 3 and 4 mmol l–1 MgCl2 groups. After administration of sugammadex, the maximal TOF ratio (%) was lower in the 4 mmol l-1 MgCl2 group than the 1 mmol l–1 MgCl2 group [median 91.7 interquartile range (83.4 to 95.8) vs. 98.3 interquartile range (92.2 to 103.4), P = 0.049]. The mean time (s) from sugammadex injection to achieving maximal first twitch was significantly prolonged in the 4 mmol l–1 MgCl2 group vs. the 1 mmol l–1 MgCl2 and 2 mmol l–1 MgCl2 groups [1483.9 (± 237.0) vs. 1039.0 (± 351.8) and 926.0 (± 278.1), P = 0.022 and 0.002, respectively]. CONCLUSION Increases in MgCl2 concentration reduce the ECs of rocuronium. In addition, administering sugammadex equimolar to the administered rocuronium shows limited efficacy as MgCl2 concentration is increased. TRIAL REGISTRATION The in-vitro study was not registered in a database.

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Emergency medicine is about collaboration, not monopolisation

No abstract available

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Effects of propofol on wound closure and barrier function of cultured endothelial cells: An in vitro experimental study

BACKGROUND Propofol is widely used in routine clinical practice for the induction and maintenance of anaesthesia. Although propofol is regarded as a well tolerated anaesthetic, its effect on intact or damaged endothelial cells has not yet been elucidated. OBJECTIVE The aim of this study was to investigate the effects of different concentrations of propofol on cell damage, metabolic activity, barrier function and wound healing capacity of human endothelial cells. DESIGN An in vitro investigation. SETTING Research Laboratory of the Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Kiel, Germany. MATERIALS In vitro cultures of primary human umbilical vein endothelial cells (HUVECs). INTERVENTIONS Intact HUVEC or wounded HUVEC monolayers were incubated with or without different concentrations of propofol (10, 30 and 100 μmol l-1). MAIN OUTCOME MEASURES Cell damage, metabolic activity, monolayer permeability, wound healing capacity, protein phosphorylation. RESULTS Propofol did not alter the morphology, induce cell damage or influence metabolic activity of intact HUVEC cells. Permeability of a HUVEC monolayer was increased by propofol 100 μmol l-1 (P 

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Who takes the lead in critically ill patients?

No abstract available

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Evaluation of recombinant factor VIIa, tranexamic acid and desmopressin to reduce prasugrel-related bleeding: A randomised, placebo-controlled study in a rabbit model

BACKGROUND Prasugrel is a thienopyridine that inhibits platelet aggregation more rapidly and effectively than clopidogrel, with an increased bleeding risk. OBJECTIVE The current study aimed to evaluate the efficacy of three nonspecific haemostatic drugs – recombinant activated factor VII (rFVIIa), tranexamic acid and desmopressin (DDAVP) – to limit blood loss after administration of prasugrel in a rabbit model of bleeding while also evaluating any prothrombotic effects. DESIGN Randomised, placebo-controlled study. SETTING Faculty of Medicine, University of Geneva, Switzerland, in 2013. ANIMALS Anaesthetised and artificially ventilated rabbits (n=56). INTERVENTIONS Animals were randomly allocated to one of five groups: control (placebo–placebo), prasugrel–placebo, rFVIIa (prasugrel–rFVIIa 150 μg kg−1), tranexamic acid (prasugrel–tranexamic acid 20 mg kg−1) or DDAVP (prasugrel–DDAVP 1 μg kg−1). Two hours after an oral prasugrel loading dose (4 mg kg−1), a stenosis and an injury were inflicted on the carotid artery to induce cyclic flow reductions (CFRs) due to thrombosis. Haemostatic drugs were administered during the ensuing observation period. MAIN OUTCOME MEASURES Standardised hepatosplenic sections were performed to evaluate the primary endpoint of blood loss, monitored for 15 min. Ear-immersion bleeding time and incidence of CFRs were secondary endpoints. RESULTS Prasugrel decreased ADP-induced platelet aggregation (light transmission method) from 66 ± 4% (mean ± SD) to 41 ± 7% (P 

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Professionalisation rather than monopolisation is the future of emergency medicine in Europe

No abstract available

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Impact of pectoral nerve block on postoperative pain and quality of recovery in patients undergoing breast cancer surgery: A randomised controlled trial

BACKGROUND In recent years, thoracic wall nerve blocks, such as the pectoral nerve (PECS) block and the serratus plane block have become popular for peri-operative pain control in patients undergoing breast cancer surgery. The effect of PECS block on quality of recovery (QoR) after breast cancer surgery has not been evaluated. OBJECTIVES To evaluate the ability of PECS block to decrease postoperative pain and anaesthesia and analgesia requirements and to improve postoperative QoR in patients undergoing breast cancer surgery. DESIGN Randomised controlled study. SETTING A tertiary hospital. PATIENTS Sixty women undergoing breast cancer surgery between April 2014 and February 2015. INTERVENTIONS The patients were randomised to receive a PECS block consisting of 30 ml of levobupivacaine 0.25% after induction of anaesthesia (PECS group) or a saline mock block (control group). The patients answered a 40-item QoR questionnaire (QoR-40) before and 1 day after breast cancer surgery. MAIN OUTCOME MEASURES Numeric Rating Scale score for postoperative pain, requirement for intra-operative propofol and remifentanil, and QoR-40 score on postoperative day 1. RESULTS PECS block combined with propofol–remifentanil anaesthesia significantly improved the median [interquartile range] pain score at 6 h postoperatively (PECS group 1 [0 to 2] vs. Control group 1 [0.25 to 2.75]; P = 0.018]. PECS block also reduced propofol mean (± SD) estimated target blood concentration to maintain bispectral index (BIS) between 40 and 50 (PECS group 2.65 (± 0.52) vs. Control group 3.08 (± 0.41) μg ml−1; P 

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Collaboration in emergency medical care in Europe: the patient is the winner

No abstract available

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Ultrasound with neurostimulation compared with ultrasound guidance alone for lumbar plexus block: A randomised single blinded equivalence trial

BACKGROUND Ultrasound-guided lumbar plexus blocks usually require confirmatory neurostimulation. A simpler alternative is to inject local anaesthetic inside the posteromedial quadrant of the psoas muscle under ultrasound guidance. OBJECTIVE We hypothesised that both techniques would result in similar total anaesthesia time, defined as the sum of performance and onset time. DESIGN A randomised, observer-blinded, equivalence trial. SETTING Ramathibodi Hospital and Maharaj Nakorn Chiang Mai Hospital (Thailand) from 12 May 2016 to 10 January 2017. PATIENTS A total of 110 patients undergoing total hip or knee arthroplasty, who required lumbar plexus block for postoperative analgesia. INTERVENTION In the combined ultrasonography-neurostimulation group, quadriceps-evoked motor response was sought at a current between 0.2 and 0.8 mA prior to local anaesthetic injection (30 ml of lidocaine 1% and levobupivacaine 0.25% with epinephrine 5 μg ml−1 and 5 mg of dexamethasone). In the ultrasound guidance alone group, local anaesthetic was simply injected inside the posteromedial quadrant of the psoas muscle. MAIN OUTCOMES MEASURES We measured the total anaesthesia time, the success rate (at 30 min), the number of needle passes, block-related pain, cumulative opioid consumption (at 24 h) and adverse events (vascular puncture, paraesthesia, local anaesthetic spread to the epidural space). The equivalence margin was 7.4 min. RESULTS Compared with ultrasound guidance alone, combined ultrasonography-neurostimulation resulted in decreased mean (±SD) total anaesthesia time [15.3 (±6.5) vs. 20.1 (±9.0) min; mean difference, −4.8; 95% confidence interval, −8.1 to −1.9; P = 0.005] and mean (±SD) onset time [10.2 (±5.6) vs. 15.5 (±9.0) min; P = 0.004). No inter-group differences were observed in terms of success rate, performance time, number of needle passes, block-related pain, opioid consumption or adverse events. CONCLUSION Although the ultrasonography-neurostimulation technique results in a shorter total anaesthesia time compared with ultrasound guidance alone, this difference falls within our accepted equivalence margin (±7.4 min). TRIAL REGISTRATION www.clinicaltrials in the (Study ID: TCTR20160427003).

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Ultrasound in Anesthesia, Critical Care, and Pain Management

No abstract available

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REAL WORLD EVIDENCE - What Is It and Does It Matter for Approval of Drugs?

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Tip to protect the tip: An inexpensive alternative to protect damage to fine instruments during sterilization

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Post-exposure prevention of toxicodendron dermatitis with early forceful unidirectional washing

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Effects of Thyrotropin on Peripheral Thyroid Hormone Metabolism and Serum Lipids

Thyroid , Vol. 0, No. 0.


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The Iconography of Goiter: Five Sculptures in the Sacred Mountains of Varallo, Orta, and Varese in Italy

Thyroid , Vol. 0, No. 0.


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Bacteria Play Critical Role In Driving Colon Cancers

Patients with an inherited form of colon cancer harbor two bacterial species that collaborate to encourage development of the disease, and the same species have been found in people who develop a sporadic form of colon cancer, a study led by a Johns Hopkins Bloomberg~Kimmel Institute for Cancer Immunotherapy research team finds.

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Johns Hopkins and the United Arab Emirates Launch Sheikh Khalifa Stroke Institute

A new institute for stroke research and clinical care was announced today by the United Arab Emirates (UAE) Embassy in Washington, D.C., and Johns Hopkins. The Sheikh Khalifa Stroke Institute, funded by a $50 million gift from the United Arab Emirates, will focus Johns Hopkins' efforts to leverage advances in engineering, artificial intelligence and precision medicine to better diagnose, treat and restore function to stroke patients. The gift is believed to be the largest ever for a stroke-specific initiative.  

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A Pediatric Nasopharyngeal Mass

An otherwise healthy 3-year-old boy presented with symptoms of sleep-disordered breathing, including gasping, apneic episodes at night, and nighttime nasal congestion; intraoperatively he was found to have a nasopharyngeal mass. What is your diagnosis?

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Diagnostic Accuracy of Parallel vs Perpendicular Orientation of the Tuning Fork in the Identification of Conductive Hearing Loss

This study compares patients' responses to the Rinne test when performed with the tuning fork positioned parallel vs perpendicular to the external auditory meatus.

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Primary Palate Trauma in Patients Presenting to US Emergency Departments

This database analysis uses the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample to measure the incidence of primary palate trauma visits to US emergency departments and to determine frequency and factors associated with head and neck imaging.

http://ift.tt/2GzQP3Q

Specific IgE to gelatin as a cause of anaphylaxis to zoster vaccine

Publication date: Available online 1 February 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Maya K.C. Retterer, Lisa J. Workman, John R. Bacon, Thomas A.E. Platts-Mills




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Age-dependent Effect of Ambient Ozone on Emergency Asthma Hospitalizations in Hong Kong

Publication date: Available online 31 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Yuanrong Dai, Hong Qiu, Shengzhi Sun, Yang Yang, Hualiang Lin, Linwei Tian




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CCL19-producing fibroblastic stromal cells restrain lung carcinoma growth by promoting local antitumor T cell responses

Publication date: Available online 31 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Hung-Wei Cheng, Lucas Onder, Jovana Cupovic, Maximilian Boesch, Mario Novkovic, Natalia Pikor, Ignazio Tarantino, Regulo Rodriguez, Tino Schneider, Wolfram Jochum, Martin Brutsche, Burkhard Ludewig
BackgroundA particular characteristic of non-small cell lung cancer (NSCLC) is the composition of the tumor microenvironment with a very high proportion of fibroblastic stromal cells (FSC).ObjectiveLapses in our basic knowledge of fibroblast phenotype and function in the tumor microenvironment make it difficult to define whether FSC subsets exist that exhibit either tumor-promoting or tumor-suppressive properties.MethodsWe employed gene expression profiling of lung versus tumor FSC from NSCLC patients. Moreover, CCL19-expressing FSCs were studied in transgenic mouse models utilizing a lung cancer metastasis model.ResultsCCL19 mRNA expression in human tumor FSC correlates with immune cell infiltration and intratumoral accumulation of CD8⁺ T cells. Mechanistic dissection in murine lung carcinoma models revealed that CCL19-expressing FSC form perivascular niches to promote accumulation of CD8⁺ T cells in the tumor. Targeted ablation of CCL19-expressing tumor FSC reduced immune cell recruitment and resulted in unleashed tumor growth.ConclusionThese data suggest that a distinct population of CCL19-producing FSC fosters the development of an immune-stimulating intratumoral niche for immune cells to control cancer growth.

Graphical abstract

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Mentoring: an art and a responsibility

Publication date: Available online 31 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): K. Frank Austen




http://ift.tt/2DS83ru

Human Th17 cell development requires processing of dendritic cell-derived CXCL8 by neutrophil elastase

Publication date: Available online 31 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Yuri Souwerm, Tom Groot Kormelink, Esther W. Taanman-Kueter, Femke J. Muller, Toni M.M. van Capel, Domonkos V. Varga, Yotam E. Bar-Ephraim, Marcel B.M. Teunissen, S. Marieke van Ham, Taco W. Kuijpers, Diana Wouters, Linde Meyaard, Esther C. de Jong




http://ift.tt/2EutCiO

Incidence and sociodemographic characteristics of eczema diagnosis in children: a cohort study

Publication date: Available online 31 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Lu Ban, Sinéad M. Langan, Katrina Abuabara, Kim S. Thomas, Alyshah Abdul Sultan, Tracey Sach, Emma McManus, Miriam Santer, Sonia Ratib




http://ift.tt/2DRN9sA

Group-2 innate lymphoid cells promote airway hyperresponsiveness through production of VEGFA

Publication date: Available online 31 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Xiaofei Shen, Muhammad Asghar Pasha, Kelsi Hidde, Adil Khan, Mingwei Liang, Wenxian Guan, Yitao Ding, Angela Haczku, Qi Yang




http://ift.tt/2EuUNtU

An unexpected protective role of low affinity allergen-specific IgG via the inhibitory receptor FcγRIIb

Publication date: Available online 31 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Martin Bachmann, Monique Vogel, Lisha Zha, Fabiana Leoratti, Lichun He, Mona O. Mohsen, Federico Storni, Mark Cragg
BackgroundInduction of allergen-specific IgG antibodies is a critical parameter for successful specific immunotherapy (SIT). IgG antibodies may inhibit IgE-mediated mast cell activation by direct allergen-neutralization or via the inhibitory receptor FcγRIIb. The affinity of IgE antibodies to the allergen has been shown to be critical for cellular activation.ObjectiveHere we addressed the question of the affinity thresholds of allergen-specific IgG antibodies for inhibition of mast cell activation by using 2 different monoclonal antibodies against the major cat allergen, Fel d 1, both in vitro and in vivo in mice.MethodsThe sequences of the two high-affinity mAbs were back-mutated to germ-line, resulting in low affinity (10^-7M) antibodies of the exact same specificity.ResultsUsing these newly generated recombinant antibodies, we demonstrate that low affinity antibodies are still able to inhibit mast cell activation via FcγRIIb but fail to neutralize the allergen.ConclusionAntibody affinity dictates the mechanism of mast cell inhibition and IgG antibodies triggering the inhibitory FcγRIIb-pathway may show a broader cross-reactivity pattern than previously thought. This indicates that SIT generates a larger protective umbrella of inhibitory IgG antibodies than previously appreciated.

Graphical abstract

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Activation of Protease-Activated Receptor 2 leads to impairment of keratinocyte tight junction integrity

Publication date: Available online 31 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Peter Nadeau, Mason Henehan, Anna De Benedetto




http://ift.tt/2EvlgaN

Home Sweet Home

In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. A 25-year-old woman presented to the emergency…

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'This Mole Looks Strange'

How would you approach a patient who presents to primary care with worries about a changing mole?
Medscape Family Medicine

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When to Buy Organic Foods for Your Child

 

The organic produce section of the grocery story has stared down the best of us. But when is it really worth it? Do I pay double for organic fruit, or will my kid be okay with the regular variety? Here's my advice on when to splurge and when to save.

The post When to Buy Organic Foods for Your Child appeared first on ChildrensMD.

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Autologous Transplantation of the Internal Limiting Membrane for Refractory Macular Hole following Ruptured Retinal Arterial Macroaneurysm: A Case Report

Purpose: To report a case of macular hole (MH) secondary to a retinal arterial macroaneurysm (RAMA) which was successfully treated with an autologous transplantation of internal limiting membrane (ILM). Case Report: An 87-year-old female presented with a sudden decrease in central vision in the right eye. A fundus examination revealed a RAMA in the superonasal macular region, a subretinal hemorrhage (SRH), involving the macula, and a sub-ILM hemorrhage. A pars plana vitrectomy (PPV) was performed. Intraoperatively, an MH filled with coagulum was detected. We tried to blow off and drain the SRH with a current of BSS and a gentle suction with a 27-gauge vitreous cutter from the MH, but some amount of SRH at the bottom of the MH remained. The ILM was peeled off for 2 disc diameters around the MH. The vitreous cavity was filled with air at the end of the operation. Two weeks after the surgery, the MH was not closed. One month following the initial PPV, a second PPV was performed to achieve closure of the MH. Results: An autologous transplantation of ILM was performed as second PPV. Six months after the final surgery, the MH was successfully closed and the best-corrected decimal visual acuity was 0.6. Conclusions: Autologous ILM transplantation can be an effective treatment option for MH closure following RAMA rupture.
Case Rep Ophthalmol 2018;9:113–119

http://ift.tt/2Ewap0s

A Case of Fundus Oculi Albinoticus Diagnosed as Angelman Syndrome by Genetic Testing

Purpose: To report a case of fundus oculi albinoticus diagnosed as Angelman syndrome (AS) via genetic testing. Case Report: This study reports on a 4-year-old boy. Since he had been having respiratory disturbance since birth, he underwent a complete physical examination to investigate the cause. The results indicated that he had various brain congenital abnormalities, such as a thin corpus callosum, as well as hydronephrosis, an atrial septal defect, and skin similar to patients with fundus oculi albinoticus. Examination revealed bilateral fundus oculi albinoticus, mild iridic hypopigmentation, optic atrophy, and poor visual tracking. Genetic testing revealed a deletion in the Prader-Willi syndrome/AS region on chromosome 15, and together with the results of methylation analysis, his condition was diagnosed as AS. Follow-up examinations revealed no change in the fundus oculi albinoticus and optic atrophy, nor did they indicate poor visual tracking. Conclusions: When fundus oculi albinoticus and optic atrophy are observed in patients with multiple malformations, AS should be considered as a differential diagnosis.
Case Rep Ophthalmol 2018;9:102–107

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Alternating Hypotropia with Pseudoptosis: A New Phenotype of Congenital Cranial Dysinnervation Disorder

Congenital cranial dysinnervation disorders, also known as CCDDs, are characterized by aberrant innervation to extraocular and facial muscles resulting in unusual forms of incomitant strabismus. Anomalous innervation to extraocular muscles can result in a wide variety of phenotypes causing various clinical conditions such as Duane syndrome, congenital fibrosis of the extraocular muscles, and Möbius syndrome. We report a case of bilateral dysinnervation disorder causing atypical ocular movements in both eyes as the patient changes fixation from one eye to the other and from right gaze to left gaze that fits with the wider diagnosis of CCDDs.
Case Rep Ophthalmol 2018;9:96–101

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Study Shows Evidence of Severe and Lingering Symptoms in Some after Treatment for Lyme Disease

In a study of 61 people treated for the bacteria that causes Lyme disease, Johns Hopkins researchers conclude that fatigue, pain, insomnia and depression do indeed persist over long periods of time for some people, despite largely normal physical exams and clinical laboratory testing.

http://ift.tt/2DVOoXH

Bill Burgwinkle and Cary Howie, Sanctity and Pornography in Medieval Culture: On the Verge. (Manchester: Manchester University Press, 2010) ISBN 9780719080296 (hardcover); xii + 216 pages; £55

Spencer-Hall, A; (2012) Bill Burgwinkle and Cary Howie, Sanctity and Pornography in Medieval Culture: On the Verge. (Manchester: Manchester University Press, 2010) ISBN 9780719080296 (hardcover); xii + 216 pages; £55. Marginalia , 16 pp. 23-26.

http://ift.tt/2EwGDIR

Review of Living Saints of the Thirteenth Century: The Lives of Yvette, Anchoress of Huy; Juliana of Cornillon, Author of the Corpus Christi Feast; and Margaret the Lame,Anchoress of Magdeburg, ed. by Anneke B. Mulder-Bakker. (Turnhout: Brepols, 2011)

Spencer-Hall, A; (2013) Review of Living Saints of the Thirteenth Century: The Lives of Yvette, Anchoress of Huy; Juliana of Cornillon, Author of the Corpus Christi Feast; and Margaret the Lame,Anchoress of Magdeburg, ed. by Anneke B. Mulder-Bakker. (Turnhout: Brepols, 2011). Marginalia , 17 pp. 54-57.

http://ift.tt/2DStg4D

Evidence for Eccentric, Precessing Gaseous Debris in the Circumstellar Absorption toward WD 1145 + 017

Cauley, PW; Farihi, J; Redfield, S; Bachman, S; Parsons, SG; Gänsicke, BT; (2018) Evidence for Eccentric, Precessing Gaseous Debris in the Circumstellar Absorption toward WD 1145 + 017. The Astrophysical Journal Letters , 852 (2) , Article L22. 10.3847/2041-8213/aaa3d9 . Green open access

http://ift.tt/2EwFReV

Relationship between speech-evoked neural responses and perception of speech in noise in older adults

Mai, G; Tuomainen, J; Howell, P; (2018) Relationship between speech-evoked neural responses and perception of speech in noise in older adults. Journal of the Acoustical Society of America (In press). Green open access

http://ift.tt/2DQhnMt

Os neofalantes galegos no contexto europeo: A produción e a percepción da fala

Tomé Lourido, G; Evans, BG; (2016) Os neofalantes galegos no contexto europeo: A produción e a percepción da fala. In: Regueria, XL and Fernandez Rei, E, (eds.) Cambio lingüístico no galego actual. Instituto da Lingua Galega / Consello da Cultura: Santiago de Compostela, Spain.

http://ift.tt/2Eu0yIe

Raising girls’ participation in A-level mathematics: initial findings from ‘good practice’ case studies

Smith, C; Golding, J; (2015) Raising girls' participation in A-level mathematics: initial findings from 'good practice' case studies. In: Proceedings of the British Society for Research into Learning Mathematics - Feb 2015. (pp. pp. 72-77). British Society for Research in to Learning Mathematics: Dublin, Ireland.

http://ift.tt/2DTn9gv

Plasma neurofilament light chain concentration in the inherited peripheral neuropathies

Sandelius, Å; Zetterberg, H; Blennow, K; Adiutori, R; Malaspina, A; Laura, M; Reilly, MM; Sandelius, Å; Zetterberg, H; Blennow, K; Adiutori, R; Malaspina, A; Laura, M; Reilly, MM; Rossor, AM; - view fewer (2018) Plasma neurofilament light chain concentration in the inherited peripheral neuropathies. Neurology , 90 e1-e7. 10.1212/WNL.0000000000004932 . Green open access

http://ift.tt/2Eu0nN4

'It's Reducing a Human Being to a Percentage'; Perceptions of Procedural Justice in Algorithmic Decisions

Binns, R; Van Kleek, M; Veale, M; Lyngs, U; Zhao, J; Shadbolt, N; (2018) 'It's Reducing a Human Being to a Percentage'; Perceptions of Procedural Justice in Algorithmic Decisions. In: Proceedings of the CHI'18: ACM Conference on Human Factors in Computing Systems. ACM (In press).

http://ift.tt/2DSK7UZ

The distribution and composition of Campylobacter jejuni plasmid pan-genome

Gori, A; (2015) The distribution and composition of Campylobacter jejuni plasmid pan-genome. In: Proceedings UK 2015 Genome Science meeting. University of Birmingham: Birmingham, United Kingdom. (In press).

http://ift.tt/2DUtqIv

Objective Measures and Subjective Reports: Examining Optometric Practice

vom Lehn, D; Webb, H; Heath, C; Gibson, W; (2017) Objective Measures and Subjective Reports: Examining Optometric Practice. International Review of Qualitative Research , 10 (2) pp. 128-148. 10.1525/irqr.2017.10.2.128 .

http://ift.tt/2Ew7uF2

Is prevalence of e-cigarette and nicotine replacement therapy use among smokers associated with average cigarette consumption in England? A time-series analysis

Beard, E; Brown, J; Michie, S; West, R; (2018) Is prevalence of e-cigarette and nicotine replacement therapy use among smokers associated with average cigarette consumption in England? A time-series analysis. BMJ Open (In press). Green open access

http://ift.tt/2DU76Pg

Legal Marriage, Unequal Recognition, and Mental Health Among Same-Sex Couples

LeBlanc, AJ; Frost, DM; Bowen, K; (2018) Legal Marriage, Unequal Recognition, and Mental Health Among Same-Sex Couples. Journal of Marriage and Family 10.1111/jomf.12460 . (In press).

http://ift.tt/2Euqd3F

Synthesis of a novel HER2 targeted aza-BODIPY-antibody conjugate: synthesis, photophysical characterisation and in vitro evaluation

Cheng, MHY; Maruani, A; Savoie, H; Chudasama, V; Boyle, RW; (2018) Synthesis of a novel HER2 targeted aza-BODIPY-antibody conjugate: synthesis, photophysical characterisation and in vitro evaluation. Organic & Biomolecular Chemistry 10.1039/c7ob02957h . (In press).

http://ift.tt/2DVcmm0

Lessons learnt from a deep excavation for future application of the Observational Method

Ferreira, PMV; Fuentes, R; Pillai, A; (2018) Lessons learnt from a deep excavation for future application of the Observational Method. Journal of Rock Mechanics and Geotechnical Engineering (In press).

http://ift.tt/2Ew7t3W

In vivo and ex vivo analyses of amyloid toxicity in the Tc1 mouse model of Down syndrome

Naert, G; Ferré, V; Keller, E; Slender, A; Gibbins, D; Fisher, EM; Tybulewicz, VL; Naert, G; Ferré, V; Keller, E; Slender, A; Gibbins, D; Fisher, EM; Tybulewicz, VL; Maurice, T; - view fewer (2017) In vivo and ex vivo analyses of amyloid toxicity in the Tc1 mouse model of Down syndrome. Journal of Psychopharmacology 10.1177/0269881117743484 . (In press). Green open access

http://ift.tt/2EtPkU4

Assessing uncertainty in the burden of Hepatitis C Virus: comparison of estimated disease burden and treatment costs in the UK

Gubay, F; Staunton, R; Metzig, C; Abubakar, I; White, PJ; (2017) Assessing uncertainty in the burden of Hepatitis C Virus: comparison of estimated disease burden and treatment costs in the UK. Journal of Viral Hepatitis 10.1111/jvh.12847 . (In press). Green open access

http://ift.tt/2DTd6b8

A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in opiate substitution treatment services

Day, E; Copello, A; Seddon, JL; Christie, M; Bamber, D; Powell, C; Bennett, C; ... Freemantle, N; + view all Day, E; Copello, A; Seddon, JL; Christie, M; Bamber, D; Powell, C; Bennett, C; Akhtar, S; George, S; Ball, A; Frew, E; Goranitis, I; Freemantle, N; - view fewer (2018) A pilot feasibility randomised controlled trial of an adjunct brief social network intervention in opiate substitution treatment services. BMC Psychiatry , 18 , Article 8. 10.1186/s12888-018-1600-7 . Green open access

http://ift.tt/2EtPlY8

Journal article reporting standards for qualitative primary, qualitative meta-analytic, and mixed methods research in psychology: The APA Publications and Communications Board task force report

Levitt, HM; Bamberg, M; Creswell, JW; Frost, DM; Josselson, R; Suárez-Orozco, C; (2018) Journal article reporting standards for qualitative primary, qualitative meta-analytic, and mixed methods research in psychology: The APA Publications and Communications Board task force report. American Psychologist , 73 (1) pp. 26-46. 10.1037/amp0000151 .

http://ift.tt/2BJBkTj

Meta-analysis of Gaussian individual patient data: two-stage or not two-stage?

Morris, TP; Fisher, DJ; Kenward, MG; Carpenter, JR; (2018) Meta-analysis of Gaussian individual patient data: two-stage or not two-stage? Statistics in Medicine 10.1002/sim.7589 . (In press). Green open access

http://ift.tt/2nwDrWv

The Taste of Others: Soviet Adventures in Cosmopolitan Cuisines

Koenker, DP; (2018) The Taste of Others: Soviet Adventures in Cosmopolitan Cuisines. Kritika (In press).

http://ift.tt/2DSJLS5

Tracheal advancement with myomucosal island flap for partial laryngopharyngectomy defect reconstruction

Abstract

Background

Restoring the anatomy and function of a partial laryngopharyngectomy with hemicricoid defect is an extremely challenging area in head and neck cancer surgery. Procedures such as tracheal autotransplantation described for these defects are complex and attempted in very few centers. Therefore, the purpose of this article was to share our technique of reconstructing such defects with tracheal advancement with myomucosal island flap for laryngopharyngeal defect (TAMMIL), which allows functional reconstruction of the larynx.

Method

A 49-year-old man with carcinoma of the right pyriform sinus, postneoadjuvant chemotherapy with progressive disease underwent vertical partial laryngopharyngectomy. The resultant defect was reconstructed with tracheal advancement and islanded facial artery myomucosal (FAMM) flap.

Result

The patient is 1-year postsurgery, free of disease, decannulated, and taking oral feeds. Video fluoroscopy showed no evidence of aspiration.

Conclusion

This technique is single-staged, easier compared to existing techniques, aids "like-for-like" reconstruction, and allows surgical organ preservation in selected laryngeal and hypopharyngeal cancers.

http://ift.tt/2nvTFhq

Validation of nomograms for overall survival, cancer-specific survival, and recurrence in carcinoma of the major salivary glands

Abstract

Background

The purpose of this study was to investigate the performance of the Memorial Sloan Kettering Cancer Center salivary carcinoma nomograms predicting overall survival, cancer-specific survival, and recurrence with an external validation dataset.

Methods

The validation dataset comprised 123 patients treated between 2010 and 2015 at our institution. They were evaluated by assessing discrimination (concordance index [C-index]) and calibration (plotting predicted vs actual probabilities for quintiles).

Results

The validation cohort (n = 123) showed some differences to the original cohort (n = 301). The validation cohort had less high-grade cancers (P = .006), less lymphovascular invasion (LVI; P < .001) and shorter follow-up of 19 months versus 45.6 months. Validation showed a C-index of 0.833 (95% confidence interval [CI] 0.758-0.908), 0.807 (95% CI 0.717-0.898), and 0.844 (95% CI 0.768-0.920) for overall survival, cancer-specific survival, and recurrence, respectively.

Conclusion

The 3 salivary gland nomograms performed well using a contemporary validation dataset, despite limitations related to sample size, follow-up, and differences in clinical and pathology characteristics between the original and validation cohorts.

http://ift.tt/2DUPzuF

Comparison the clinical outcomes with altered versus conventional fractionated radiotherapy plus concurrent chemotherapy for advanced nasopharyngeal carcinoma

Abstract

Background

The purpose of this study was to compare the long-term survivals between altered fractionated and conventional fractionated radiotherapy with the same concurrent chemoradiotherapy (concurrent CRT) for patients with advanced nasopharyngeal carcinoma (NPC).

Methods

We retrospectively reviewed 203 patients with NPC who received radiotherapy (RT) by either a conventional fractionated (70-74 Gy/35-37 fractions/7-8 weeks) or altered fractionated (72-75 Gy/45 fractions/6 weeks) schedule plus the same concurrent CRT.

Results

The patient characteristics between conventional fractionated and altered fractionated groups showed similar distribution. The 5-year rates of nasopharyngeal failure-free, neck failure-free, and distant metastasis failure-free survival between conventional fractionated and altered fractionated groups were 88% versus 86% (P = .7781), 95% versus 93% (P = .4176), and 76% versus 73% (P = .4029), respectively. The overall survival (OS; 5-year rates were 64% versus 62%; P = .4812) and progression-free survival (PFS; 5-year rates were 67% versus 63%; P = .3829) rates also showed no significant differences. The acute and late toxicities were similar between both groups.

Conclusion

Altered fractionated and conventional fractionated RT achieved similar survival outcome when concurrent CRT strategy was used for advanced NPC.

http://ift.tt/2nwSMFn

Intraoperative monitoring of marginal mandibular nerve during neck dissection

Abstract

Background

The purpose of this study was to assess the efficacy of intraoperative nerve integrity monitoring (NIM) to prevent marginal mandibular nerve injuries during neck dissection.

Methods

This prospective study compared 36 patients undergoing NIM-assisted neck dissection from July 2014 to March 2015 to a cohort of 35 patients subjected to neck dissection over an identical period of time before the technique was introduced. We also assessed possible correlations between marginal mandibular nerve injuries and other factors, such as anthropometric measurements, presence of clinical neck metastases, type of neck dissection, and site of primary tumor.

Results

The incidence of marginal mandibular nerve paralyses was significantly lower among the group of patients undergoing NIM-assisted neck dissection (P = .021). There was no significant difference in the duration of the procedure, and the technique resulted in a limited increase of cost. No other factor seemed to influence the onset of marginal mandibular nerve palsy.

Conclusion

In our opinion, NIM is a valuable aid for preventing marginal mandibular nerve injuries during neck dissection.

http://ift.tt/2DSpo7x

Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy

Abstract

Background

Hypocalcaemia is a common and serious complication after thyroidectomy. The purpose of this study is to assess the effectiveness of first postoperative day parathyroid hormone (PTH) measurement in order to predict the presence and severity of postthyroidectomy hypocalcaemia.

Methods

One hundred consecutive cases undergoing total thyroidectomy in a tertiary referral center were prospectively assessed. Preoperative measurements of PTH were compared with postoperative levels in the first morning after surgery. All cases of hypocalcaemia were recorded and evaluated with regard to preoperative and postoperative levels of PTH.

Results

A decrease of 56% of PTH levels on the first postoperative day could accurately predict postoperative hypocalcaemia with a sensitivity and specificity of 80%.

Conclusion

Serum PTH levels on the first postoperative day may be used as a reliable predictive marker for calcium supplementation need and even prolonged hospitalization in cases undergoing total thyroidectomy.

http://ift.tt/2ny3Hih

Clinical Evaluation of the Patient with Otosclerosis

Otosclerosis is a disorder presenting most commonly with unilateral conductive hearing loss. It can present as a mixed hearing loss also. Evaluation for otosclerosis relies on a specific history and physical examination, including tuning fork assessment and audiometric testing. Otosclerosis differs from other etiologies in that symptoms of imbalance are rare, and the ear most commonly appears normal on otoscopy.

http://ift.tt/2BI2Osl

Ectopic Intratracheal Thyroid Tissue Leading to Stridor

Abstract

Ectopic thyroid is a condition in which the thyroid tissue is present outside its normal anatomical position. Usually the ectopic thyroid is present along the line of its migration. The presence of ectopic thyroid tissue within the trachea is a very rare condition. Surgery is appropriate treatment for patients with ectopic thyroid tissue with clinical signs of upper airway obstruction. Here we present such a case where an ectopic intratracheal thyroid was causing airway obstruction.

http://ift.tt/2E7Bjhk

Functional Outcome After Treatment for Oropharyngeal Squamous Cell Carcinoma

Conditions:   Oropharynx Cancer;   Pain;   Swallowing Disorder;   Quality of Life;   Saliva Altered;   Human Papilloma Virus
Intervention:  
Sponsor:   Rigshospitalet, Denmark
Recruiting

http://ift.tt/2rZbQ4D

HPV Anti-CD40 RNA Vaccine

Conditions:   Carcinoma, Squamous Cell;   Head and Neck Neoplasm;   Cervical Neoplasm;   Penile Neoplasms Malignant
Intervention:   Drug: HPV vaccine
Sponsors:   University of Southampton;   Biontech AG
Recruiting

http://ift.tt/2GEtNJg

Functional Sparing of Salivary Glands Using MRI Sialography for Patients Undergoing Definitive Radiation Therapy for Head and Neck Cancers of the Oropharynx

Conditions:   Head and Neck Cancer;   Oropharynx Cancer;   Xerostomia Due to Radiotherapy
Intervention:   Other: MRI Sialogram
Sponsor:   UNC Lineberger Comprehensive Cancer Center
Not yet recruiting

http://ift.tt/2rYqB7Z

The Vertebral Vector in a Horizontal Plane. A Simple Way to See in 3D.

Condition:   Scoliosis
Intervention:   Other: Medical File data analysis
Sponsor:   Tamas Illes
Not yet recruiting

http://ift.tt/2GEtIFs

Prehabilitation in Patients With Esophageal or Gastric Cancers

Conditions:   Esophageal Cancer;   Gastric Cancer
Intervention:   Behavioral: Prehabilitation group
Sponsor:   Cliniques universitaires Saint-Luc- Université Catholique de Louvain
Not yet recruiting

http://ift.tt/2rXyDhl

The Oral Microbiome as a Prognostic Tool in Oral Malignant and Premalignant Lesions and in Medication Related Osteonecrosis of the Jaw

Conditions:   Oral Squamous Cell Carcinoma;   Medication Related Osteonecrosis of the Jaw;   Oral Epithelial Dysplasia
Intervention:   Diagnostic Test: Buccal mucosa samples for Extraction of BACTERIAL DNA
Sponsor:   Barzilai Medical Center
Recruiting

http://ift.tt/2GEtBtw

Ectopic Intratracheal Thyroid Tissue Leading to Stridor

Abstract

Ectopic thyroid is a condition in which the thyroid tissue is present outside its normal anatomical position. Usually the ectopic thyroid is present along the line of its migration. The presence of ectopic thyroid tissue within the trachea is a very rare condition. Surgery is appropriate treatment for patients with ectopic thyroid tissue with clinical signs of upper airway obstruction. Here we present such a case where an ectopic intratracheal thyroid was causing airway obstruction.

http://ift.tt/2E7Bjhk

Robustness and invariance in the generalization error of deep neural networks

Sokolić, Jure; (2017) Robustness and invariance in the generalization error of deep neural networks. Doctoral thesis (Ph.D), UCL (University College London). Green open access

http://ift.tt/2FCe8c7

The role of PI3Kα in cardioprotection

Rossello Lozano, Francisco Javier; (2017) The role of PI3Kα in cardioprotection. Doctoral thesis (Ph.D), UCL (University College London). Green open access

http://ift.tt/2FAdfAM

The impact of rural residence and HIV infection on poor tuberculosis treatment outcomes in a large urban hospital: a retrospective cohort analysis

Adamu, AL; Aliyu, MH; Galadanci, NA; Musa, BM; Lawan, UM; Bashir, U; Abubakar, I; (2018) The impact of rural residence and HIV infection on poor tuberculosis treatment outcomes in a large urban hospital: a retrospective cohort analysis. International Journal for Equity in Health , 17 , Article 4. 10.1186/s12939-017-0714-8 . Green open access

http://ift.tt/2E2NETU

Adolescent drinking in Chile: the role of school socioeconomic environment in relation to parental and peer influences.

Roman Mella, MF; (2017) Adolescent drinking in Chile: the role of school socioeconomic environment in relation to parental and peer influences. Doctoral thesis (Ph.D), UCL (University College London).

http://ift.tt/2E2URmZ

Unravelling the Role of an Aqueous Environment on the Electronic Structure and Ionisation of Phenol Using Photoelectron Spectroscopy

Riley, J; Wang, B; Woodhouse, J; Assmann, M; Worth, GA; Fielding, HH; (2018) Unravelling the Role of an Aqueous Environment on the Electronic Structure and Ionisation of Phenol Using Photoelectron Spectroscopy. The Journal of Physical Chemistry Letters , 9 pp. 678-682. 10.1021/acs.jpclett.7b03310 .

http://ift.tt/2E6SM9G

Reconstructing the strontium isotopic composition of Neoproterozoic seawater

Zhou, Y; (2017) Reconstructing the strontium isotopic composition of Neoproterozoic seawater. Doctoral thesis (Ph.D), UCL (University College London).

http://ift.tt/2FAgiJa

Investigating relationships between cost and CO2 emissions in reinforced concrete structures using a BIM-based design optimisation approach

Eleftheriadis, E; Duffour, P; Greening, P; James, J; Stephenson, B; Mumovic, D; (2018) Investigating relationships between cost and CO2 emissions in reinforced concrete structures using a BIM-based design optimisation approach. Energy and Buildings (In press).

http://ift.tt/2E6SzmU

‘A Taster of Political Insult’: The Case of Novi Sad’s Youth Tribune, 1968-71

Ilic, M; (2018) 'A Taster of Political Insult': The Case of Novi Sad's Youth Tribune, 1968-71. Third Text (In press).

http://ift.tt/2FAxOwK

How to Make a Past: Painting since Reinhardt

Sheleg, Moran; (2017) How to Make a Past: Painting since Reinhardt. Doctoral thesis (Ph.D), UCL (University College London).

http://ift.tt/2E3guU3

Intertextual Masculinities and the Struggle for Self-Reflexivity: A Quixotic Investigation of the Novels of J. M. Coetzee, Milan Kundera, Philip Roth and Mario Vargas Llosa

Rossoni, Stefano; (2017) Intertextual Masculinities and the Struggle for Self-Reflexivity: A Quixotic Investigation of the Novels of J. M. Coetzee, Milan Kundera, Philip Roth and Mario Vargas Llosa. Doctoral thesis (Ph.D), UCL (University College London).

http://ift.tt/2FAxE8C

Spring assisted cranioplasty: A patient specific computational model

Borghi, A; Rodriguez-Florez, N; Rodgers, W; James, G; Hayward, R; Dunaway, D; Jeelani, O; Borghi, A; Rodriguez-Florez, N; Rodgers, W; James, G; Hayward, R; Dunaway, D; Jeelani, O; Schievano, S; - view fewer (2018) Spring assisted cranioplasty: A patient specific computational model. Medical Engineering & Physics 10.1016/j.medengphy.2018.01.001 . (In press).

http://ift.tt/2E2NI66

Regularity and optimisation practice in steel structural frames in real design cases

Dunant, C; Drewniok, M; Eleftheriadis, E; Cullen, J; Allwood, J; (2018) Regularity and optimisation practice in steel structural frames in real design cases. Resources, Conservation and Recycling (In press).

http://ift.tt/2FCatLn

Response

Borghi, A; Schievano, S; Dunaway, D; Owase Jeelani, NU; (2017) Response. [Editorial comment]. Journal of Neurosurgery: Pediatrics , 20 (5) p. 399. 10.3171/2017.3.PEDS1725 .

http://ift.tt/2FxPqJW

Rebeldes or luchadores por la libertad? Los amotinados de Flandes

Samson, Alexander; (2016) Rebeldes or luchadores por la libertad? Los amotinados de Flandes. In: Rodriguez Perez, Y and Sanchez Jimenez, A, (eds.) La leyenda negra en el crisol de la comedia: El teatro del Siglo de Oro frente a los estereotipos antihispanicos. (pp. 121-139). Iberoamericana Vervuert: Madrid, Spain.

http://ift.tt/2E3gtzt

Do goals facilitate conscious awareness of goal-related information?

Rochal, Irina; (2017) Do goals facilitate conscious awareness of goal-related information? Doctoral thesis (Ph.D), UCL (University College London). Green open access

http://ift.tt/2FAxhLg

Tissue stiffening coordinates morphogenesis by triggering collective cell migration in vivo

Mayor, R; Barriga, E; Franze, K; Charras, G; (2018) Tissue stiffening coordinates morphogenesis by triggering collective cell migration in vivo. Nature (In press).

http://ift.tt/2E2UQ2p

Causes of decline of common scoter (Melanitta nigra) in north Scotland: evidence from palaeolimnology

Robson, HJ; (2017) Causes of decline of common scoter (Melanitta nigra) in north Scotland: evidence from palaeolimnology. Doctoral thesis (Ph.D), UCL (University College London).

http://ift.tt/2FCrPYp

Comparing Proxy Rated Quality of Life of People with Dementia in Care Homes

Robertson, Sarah; (2017) Comparing Proxy Rated Quality of Life of People with Dementia in Care Homes. Doctoral thesis (Ph.D), UCL (University College London).

http://ift.tt/2E86wAX

A multi-objective GA-based optimisation for holistic Manufacturing, transportation and Assembly of precast construction

Anvari, B; Angeloudis, P; Ochieng, WY; (2016) A multi-objective GA-based optimisation for holistic Manufacturing, transportation and Assembly of precast construction. Automation in Construction , 71 (Part 2) pp. 226-241. 10.1016/j.autcon.2016.08.007 . Green open access

http://ift.tt/2FzhrRa

Molecular approaches for studying the evolution of the Xenacoelomorpha

Robertson, Helen Elizabeth; (2017) Molecular approaches for studying the evolution of the Xenacoelomorpha. Doctoral thesis (Ph.D), UCL (University College London).

http://ift.tt/2E2caEN

An IL-15 superagonist/IL-15Rα fusion complex protects and rescues NK cell-cytotoxic function from TGF-β1-mediated immunosuppression

Abstract

Natural killer (NK) cells are innate cytotoxic lymphocytes that play a fundamental role in the immunosurveillance of cancers. NK cells of cancer patients exhibit impaired function mediated by immunosuppressive factors released from the tumor microenvironment (TME), such as transforming growth factor (TGF)-β1. An interleukin (IL)-15 superagonist/IL-15 receptor α fusion complex (IL-15SA/IL-15RA; ALT-803) activates the IL-15 receptor on CD8 T cells and NK cells, and has shown significant anti-tumor activity in several in vivo studies. This in vitro study investigated the efficacy of IL-15SA/IL-15RA on TGF-β1-induced suppression of NK cell-cytotoxic function. IL-15SA/IL-15RA inhibited TGF-β1 from decreasing NK cell lysis of four of four tumor cell lines (H460, LNCap, MCF7, MDA-MB-231). IL-15SA/IL-15RA rescued healthy donor and cancer patient NK cell-cytotoxicity, which had previously been suppressed by culture with TGF-β1. TGF-β1 downregulated expression of NK cell-activating markers and cytotoxic granules, such as CD226, NKG2D, NKp30, granzyme B, and perforin. Smad2/3 signaling was responsible for this TGF-β1-induced downregulation of NK cell-activating markers and cytotoxic granules. IL-15SA/IL-15RA blocked Smad2/3-induced transcription, resulting in the rescue of NK cell-cytotoxic function from TGF-β1-induced suppression. These findings suggest that in addition to increasing NK cell function via promoting the IL-15 signaling pathway, IL-15SA/IL-15RA can function as an inhibitor of TGF-β1 signaling, providing a potential remedy for NK cell dysfunction in the immunosuppressive tumor microenvironment.

http://ift.tt/2FAQX1z

Correction to: Total analysis of clinical factors for surgical success of adenotonsillectomy in pediatric OSAS

Abstract

The authors would like to publish this erratum to indicate Dr Rayleigh Ping-Ying Chiang as the corresponding author of this article.

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Biomarkers and asthma management: analysis and potential applications

Purpose of review Asthma features a high degree of heterogeneity in both pathophysiology and therapeutic response, resulting in many asthma patients being treated inadequately. Biomarkers indicative of underlying pathological processes could be used to identify disease subtypes, determine prognosis and to predict or monitor treatment response. However, the newly identified as well as more established biomarkers have different applications and limitations. Recent findings Conventional markers for type 2-high asthma, such as blood eosinophils, fraction of exhaled nitric oxide, serum IgE and periostin, feature limited sensitivity and specificity despite their significant correlations. More distinctive models have been developed by combining biomarkers and/or using omics techniques. Recently, a model with a positive predictive value of 100% for identification of type 2-high asthma based on a combination of minimally invasive biomarkers was developed. Summary Individualisation of asthma treatment regimens on the basis of biomarkers is necessary to improve asthma control. However, the suboptimal properties of currently available conventional biomarkers limit its clinical utility. Newly identified biomarkers and models based on combinations and/or omics analysis must be validated and standardised before they can be routinely applied in clinical practice. The development of robust biomarkers will allow development of more efficacious precision medicine-based treatment approaches for asthma. Correspondence to Anke H. Maitland-van der Zee, Department of Respiratory Medicine, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Tel: +31 20 566 4356; e-mail: a.h.maitland@amc.nl Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2rYFhE4

Role of epigenetics in the development of childhood asthma

Purpose of review Epigenetic marks are emerging as mediators of genetics and the environment on complex disease phenotypes, including childhood asthma and allergy. Recent findings Epigenome-wide association studies over the past year have added to the growing body of evidence supporting significant associations of epigenetic regulation of gene expression and asthma and allergy. Studies in children have identified signatures of eosinophils in peripheral blood, Th2 cell transcription factors and cytokines in peripheral blood mononuclear cells, and epithelial dysfunction in the respiratory epithelium. Importantly, studies at birth have begun to decipher the contribution of epigenetic marks to asthma inception. Few studies have also begun to address the contribution of genetics and the environment to these associations. Summary Next generation of epigenome-wide association studies that will deal with confounders, study the influence of the genetics and environment, and incorporate multiple datasets to provide better interpretation of the findings are on the horizon. Identification of key epigenetic marks that are shaped by genetics and the environment, and impact transcription of specific genes will help us have a better understanding of etiology, heterogeneity and severity of asthma, and will also empower us to develop biologically driven therapeutics and biomarkers for secondary prevention of this disease. Correspondence to Ivana V. Yang, University of Colorado Denver 12700 East 19th Avenue, 8611 Aurora, CO 80045. E-mail: ivana.yang@ucdenver.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Development of allergic sensitization and its relevance to paediatric asthma

Purpose of review The purpose of this review is to summarize the recent evidence on the distinct atopic phenotypes and their relationship with childhood asthma. We start by considering definitions and phenotypic classification of atopy and then review evidence on its association with asthma in children. Recent findings It is now well recognized that both asthma and atopy are complex entities encompassing various different sub-groups that also differ in the way they interconnect. The lack of gold standards for diagnostic markers of atopy and asthma further adds to the existing complexity over diagnostic accuracy and definitions. Although recent statistical phenotyping studies contributed significantly to our understanding of these heterogeneous disorders, translating these findings into meaningful information and effective therapies requires further work on understanding underpinning biological mechanisms. Summary The disaggregation of allergic sensitization may help predict how the allergic disease is likely to progress. One of the important questions is how best to incorporate tests for the assessment of allergic sensitization into diagnostic algorithms for asthma, both in terms of confirming asthma diagnosis, and the assessment of future risk. Correspondence to Adnan Custovic, MD, PhD, Department of Paediatrics, Imperial College London, St Mary's Campus Medical School, Room 244, Norfolk Place, London W2 1PG, UK. Tel: +44 20 7594 3274; fax: +44 20 7594 3984; e-mail: a.custovic@imperial.ac.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2rX2mXF

Assessing the impact of air pollution on childhood asthma morbidity: how, when, and what to do

Purpose of review Exposure to air pollutants is linked with poor asthma control in children and represents a potentially modifiable risk factor for impaired lung function, rescue medication use, and increased asthma-related healthcare utilization. Identification of the most relevant pollutants to asthma as well as susceptibility factors and strategies to reduce exposure are needed to improve child health. Recent findings The current available literature supports the association between pollutants and negative asthma outcomes. Ethnicity, socioeconomic status, and presence of certain gene polymorphisms may impact susceptibility to the negative health effects of air pollution. Improved air quality standards were associated with better asthma outcomes. Summary The link between air pollution and pediatric asthma morbidity is supported by the recent relevant literature. Continued efforts are needed to identify the most vulnerable populations and develop strategies to reduce exposures and improve air quality. Correspondence to Allison J. Burbank, MD, Department of Pediatrics, Division of Allergy, Immunology, & Rheumatology, 104 Mason Farm Road, CB #7310, Chapel Hill, NC 27599-7310, USA. Tel: +1 919 843 2714; fax: +1 919 962 4421; e-mail: allison_burbank@med.unc.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2Gy8Nnf

How to prevent a tragus piercing becoming infected

A look at infected tragus piercings, a condition where a small part of the ear develops an infection. Included is detail on avoiding infection and risks.

http://ift.tt/2EtilPQ

A Narrative Review of Cardiovascular Abnormalities After Spontaneous Intracerebral Hemorrhage

Background: The recommended cardiac workup of patients with spontaneous intracerebral hemorrhage (ICH) includes an electrocardiogram (ECG) and cardiac troponin. However, abnormalities in other cardiovascular domains may occur. We reviewed the literature to examine the spectrum of observed cardiovascular abnormalities in patients with ICH. Methods: A narrative review of cardiovascular abnormalities in ECG, cardiac biomarkers, echocardiogram, and hemodynamic domains was conducted on patients with ICH. Results: We searched PubMed for articles using MeSH Terms "heart," "cardiac," hypertension," "hypotension," "blood pressure," "electro," "echocardio," "troponin," "beta natriuretic peptide," "adverse events," "arrhythmi," "donor," "ICH," "intracerebral hemorrhage." Using Covidence software, 670 articles were screened for title and abstracts, 482 articles for full-text review, and 310 extracted. A total of 161 articles met inclusion and exclusion criteria, and, included in the manuscript. Cardiovascular abnormalities reported after ICH include electrocardiographic abnormalities (56% to 81%) in form of prolonged QT interval (19% to 67%), and ST-T changes (19% to 41%), elevation in cardiac troponin (>0.04 ng/mL), and beta-natriuretic peptide (BNP) (>156.6 pg/mL, up to 78%), echocardiographic abnormalities in form of regional wall motion abnormalities (14%) and reduced ejection fraction. Location and volume of ICH affect the prevalence of cardiovascular abnormalities. Prolonged QT interval, elevated troponin-I, and BNP associated with increased in-hospital mortality after ICH. Blood pressure control after ICH aims to preserve cerebral perfusion pressure and maintain systolic blood pressure between 140 and 179 mm Hg, and avoid intensive blood pressure reduction (110 to 140 mm Hg). The recipients of ICH donor hearts especially those with reduced ejection fraction experience increased early mortality and graft rejection. Conclusions: Various cardiovascular abnormalities are common after spontaneous ICH. The workup of patients with spontaneous ICH should involve 12-lead ECG, cardiac troponin-I, as well as BNP, and echocardiogram to evaluate for heart failure. Blood pressure control with preservation of cerebral perfusion pressure is a cornerstone of hemodynamic management after ICH. The perioperative implications of hemodynamic perturbations after ICH warrant urgent further examination. A.L. has received research support from Edge Therapeutics for NEWTON-2 study, Aqueduct Critical Care for the ASSESSED clinical trial, and from NIH/NINDS for the ATACH-II clinical trial, none of which are relevant to this study. The remaining authors have no funding or conflicts of interest to disclose. Address correspondence to: Abhijit Lele, MBBS, MD, MS, Department of Anesthesiology, Harborview Medical Center, University of Washington, 325, 9th Avenue, P.O. Box 356540, Seattle, WA 98104 (e-mail: abhijit2@uw.edu). Received October 17, 2017 Accepted December 31, 2017 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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Issue Information

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Oral condyloma acuminatum in a 75-year-old geriatric patient

Condyloma acuminatum (CA) is a human papillomavirus-induced sexually transmitted disease which is characterised by epithelial proliferation in the genital region, perianal region, oral cavity and larynx. It was first reported by Knapp and Uohara in 1967. The disease is more common in children and teenagers and appears as solitary or multiple, pinkish, sessile papules or plaques with pebbled surface or as pedunculated papillary lesions. Oral lesions commonly affect the lips, floor of the mouth, lateral and ventral surfaces of tongue, buccal mucosa, soft palate and rarely gingiva. The present report deals with a case of CA affecting a 75-year-old male patient with emphasis on clinical presentation, histological features and importance of PCR for establishment of definitive diagnosis. This case is unique because CA is extremely rare in geriatric age group.

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Wave of renal impairment

We present a case of a 51-year-old man who went to the emergency department after an almost-drowning episode, presenting with muscular weakness, myalgia and dark urine. Laboratory data showed a severe rhabdomyolysis (creatine kinase 497 510 U/L). Despite aggressive fluid therapy, an oliguric acute kidney injury was established with temporary need of haemodialysis. The patient had a longtime history of exercise intolerance and family history of a metabolic myopathy, namely a sister with McArdle's disease. The genetic test was positive. McArdle's disease is an autosomal recessive disorder caused by mutations in the muscle glycogen phosphorylase gene that encodes the myophosphorylase. The main symptom consists in exercise intolerance and the most severe complication is rhabdomyolysis with acute renal failure. Metabolic myopathies, such as McArdle's disease, should be considered in patients with acute renal failure due to unexplained severe rhabdomyolysis, especially if there are chronic complaints of exercise intolerance and positive family history.

http://ift.tt/2EuZHr2

Simultaneous endoscopic full-thickness resection of two synchronous colonic granular cell tumours

Granular cell tumours (GCTs) are rare soft tissue tumours originating from Schwann cells. Due to potential malignant transformation, complete endoscopic resection should be aimed for. We report on a 49-year-old patient with two synchronous GCTs found in the caecum and the ascending colon, respectively. Synchronous endoscopic full-thickness resection (EFTR) using an all-in-one full-thickness resection device (FTRD) was performed under propofol sedation. Completeness of resection was proven histologically. No adverse events occurred. We report safe and complete simultaneous EFTR of two synchronous colonic GCTs.

http://ift.tt/2DSnBeX

Prostatic abscess: a rare complication of staghorn calculi

A staghorn calculus is a calculus accommodating the majority of a renal calyx extending into the renal pelvis. A conservative approach to its treatment may lead to high morbidity and mortality rates. Such morbidity usually manifests with renal failure, obstructed upper urinary tractand/or life-threatening sepsis. Prostatic abscesses have never been associated with staghorn calculi in the literature. We report a case of a 70-year-old man who presented with sepsis, which was found to originate from a complex prostatic abscess. The patient had no history of urinary tract infections or risk factors. The authors believe that the incidentally identified staghorn calculi promoted the growth of Proteus mirabilis which led to the development of the prostatic abscess. The patient underwent a transurethral resection and drainage of the abscess following a failed course of antibiotic therapy. This case also highlights the paucity of guidelines available in treating prostatic abscesses.

http://ift.tt/2EuYCPE

Treating chronic hepatitis E: when is enough enough?

We present a 38-year-old white British man who was taking long-term immunosuppressive medication following kidney transplantation. On routine review, he was noted to have an isolated and asymptomatic rise in alanine aminotransferase. After thorough investigation, he was found to have positive IgM and IgG serology to hepatitis E virus—and given the duration of his transaminitis, he was determined to have chronic hepatitis E infection. Treatment options were complicated by the presence of his kidney transplant, by chronic anaemia and by his wish for concomitant fertility treatment. Ribavirin therapy was instituted with a dramatic and immediate drop in serum viral load, although stool viraemia persisted. No clear protocols guide duration of treatment in chronic hepatitis E infection, but protracted faecal virus shedding predicts viral recrudescence, and treatment should continue at least until the stool is clear of virus.

http://ift.tt/2DRRls4

Metformin-associated lactic acidosis mimicking ischaemic bowel

Metformin-associated lactic acidosis (MALA) is a rare complication among patients who are diabetic, commonly presenting with non-specific findings, and developing mostly among those with other risk factors for lactic acidosis. We report the development of MALA in a 67-year-old man with diabetes who presented with progressive abdominal pain and bloody diarrhoea. On presentation the patient was in shock, with signs suggestive of peritonitis, and with severe lactic acidosis, renal failure and non-specific findings on abdominal CT. Neither the patient nor family could provide details of his home pharmaceuticals. Circulatory resuscitation with intravenous crystalloids and vasopressors was commenced, along with empiric broad-spectrum antibiotics. Emergent laparotomy did not show pathological findings. Emergent haemodialysis, initiated postoperatively, resulted in rapid resolution of shock and lactic acidosis. A list of patient's medications, provided afterwards by the family, included metformin. Microbiological studies remained negative and renal function normalised by the time of patient's hospital discharge after 9 days.

http://ift.tt/2Evyl43

Spread of Quadratus Lumborum Block to the Paravertebral Space Via Intramuscular Injection: A Volunteer Study

Background and Objectives Several types of quadratus lumborum block (QLB) are used for postoperative analgesia and are believed to be effective against both somatic and visceral pain via a local anesthetic (LA) effect in the paravertebral space (PVS). However, it remains unclear whether all QLB techniques result in LA spread into the PVS. We hypothesized that LA administered via intramuscular QLB would spread into the paravertebral space and investigated the spread and sensory block area of LA in intramuscular QLB. Methods This volunteer study included 5 healthy men and 1 woman, with no previous medical history. Intramuscular QLB and lateral transversus abdominis plane block were performed under real-time ultrasound guidance for comparison of sensory deprivation range. Two days later, the same procedure was performed on the contralateral side of the body. The spread of LA via intramuscular QLB spread to the PVS was assessed 1 hour after the first injections using magnetic resonance imaging. Sensory perception was also evaluated by the pinprick test at 90 minutes after injection. Results In total, we performed 11 intramuscular QLBs and 11 lateral transversus abdominis plane blocks. Magnetic resonance imaging showed that LA did not spread into the PVS after ultrasound-guided intramuscular QLB. The analgesic area corresponded to the side of the body that was ipsilateral to the block. Conclusions Ultrasound-guided intramuscular QLBs are not clinically useful for procedures requiring LA spread into the PVS but do result in an ipsilateral analgesic effect in healthy volunteers. Clinical Trial Registration This study was registered at University Hospital Medical Information Network Clinical Trials Registry, UMIN 000019149. Accepted for publication October 4, 2017. Address correspondence to: Takahiro Tamura, MD, PhD, Department of Anesthesiology, Nagoya University Graduate School of Medicine, Tsurumai-cho 65, Showa-Ku, Nagoya 466-8550, Japan (e-mail: takahiro@med.nagoya-u.ac.jp). Nagoya University Graduate School of Medicine and Japanese Red Cross Nagoya Daiichi Hospital funded this study by providing funding to the Department of Anesthesiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. This work was presented in part at the American Society of Anesthesiologists' Anesthesiology 2016 meeting; Chicago, IL; October 22 to 26, 2016. The authors declare no conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.rapm.org). Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Aberrant breast tissue in complete androgen insensitivity syndrome

http://ift.tt/2E1OY9H

Trauma and transfusion in the geriatric patient

Purpose of review The percentage of people over the age of 65 is growing rapidly and anesthesiologists must develop a medical understanding that is comprehensive to meet the unique medical needs of this population. The changing physiology of an elderly population makes them extremely vulnerable to trauma and the administration of blood products. Although most of these cases involve orthopedic attention, it is not less dangerous as a blunt trauma case. Recent findings This article addresses some of the main concerns for the anesthesiologists of providing a hemostatic resuscitation in the geriatric population. Should blood that is new lead to better outcomes than blood that was collected more than 14 days from the injury? What role does patient frailty have in trauma and transfusion outcomes? Is the massive transfusion protocol safe for the geriatric population? As this subset of the population grows, the number of patients on anticoagulation therapy will grow. Knowledge of the bone marrow plays an important role in geriatric trauma. How does head trauma in the elderly differ from the younger patient? Summary The information in this article is by no means comprehensive. Nongeriatric trauma protocols are far from being validated. Applying these protocols to the geriatric protocols must be investigated in terms of safety and benefits. Correspondence to Corey Scott Scher, Clinical Professor of Anesthesiology, New York University School of Medicine, Bellevue Hospital, 560 First Ave, New York City, NY 10016, USA. Tel: +1 646 753 2791; fax: +1 212 787 2721; e-mail: coreyscher@gmail.com;Corey.Scher@nyumc.org Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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For beginners in anaesthesia, self-training with an audiovisual checklist improves safety during anaesthesia induction: A prospective, randomised, controlled two-centre study

BACKGROUND Beginners in residency programmes in anaesthesia are challenged because working environment is complex, and they cannot rely on experience to meet challenges. During this early stage, residents need rules and structures to guide their actions and ensure patient safety. OBJECTIVE We investigated whether self-training with an electronic audiovisual checklist app on a mobile phone would produce a long-term improvement in the safety-relevant actions during induction of general anaesthesia. DESIGN, SETTING AND PARTICIPANTS During the first month of their anaesthesia residency, we randomised 26 residents to the intervention and control groups. The study was performed between August 2013 and December 2014 in two university hospitals in Germany. INTERVENTION In addition to normal training, the residents of the intervention group trained themselves on well tolerated induction using the electronic checklist for at least 60 consecutive general anaesthesia inductions. MAIN OUTCOME MEASURES After an initial learning phase, all residents were observed during one induction of general anaesthesia. The primary outcome was the number of safety items completed during this anaesthesia induction. Secondary outcomes were similar observations 4 and 8 weeks later. RESULTS Immediately, and 4 weeks after the first learning phase, residents in the intervention group completed a significantly greater number of safety checks than residents in the control group 2.8 [95% confidence interval (CI) 0.4 to 5.1, P = 0.021, Cohen's d = 0.47] and 3.7 (95% CI 1.3 to 6.1, P = 0.003, Cohen's d = 0.61), respectively. The difference between the groups had disappeared by 8 weeks: mean difference in the number of safety checks at 8 weeks was 0.4, 95% CI −2.0 to 2.8, P = 0.736, Cohen's d = 0.07). CONCLUSION The use of an audiovisual self-training checklists improves safety-relevant behaviour in the early stages of a residency training programme in anaesthesia. Correspondence to Dr Stefanie Beck, Department of Anaesthesiology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany E-mail: st.beck@uke.de © 2018 European Society of Anaesthesiology

http://ift.tt/2DQAzd2

Cross currents in genetics and ethics around the millennium 1999-2001: final report to the Wellcome Trust

Alderson, P; Farsides, B; Williams, C; (2001) Cross currents in genetics and ethics around the millennium 1999-2001: final report to the Wellcome Trust. Social Science Research Unit, Institute of Education, University of London: London, UK. Green open access

http://ift.tt/2E0Ax5N

The role of negative cognitions, emotion regulation strategies, and attachment style in complex post-traumatic stress disorder: Implications for new and existing therapies

Karatzias, T; Shevlin, M; Hyland, P; Brewin, CR; Cloitre, M; Bradley, A; Kitchiner, NJ; ... Roberts, NP; + view all Karatzias, T; Shevlin, M; Hyland, P; Brewin, CR; Cloitre, M; Bradley, A; Kitchiner, NJ; Jumbe, S; Bisson, JI; Roberts, NP; - view fewer (2018) The role of negative cognitions, emotion regulation strategies, and attachment style in complex post-traumatic stress disorder: Implications for new and existing therapies. British Journal of Clinical Psychology 10.1111/bjc.12172 . (In press).

http://ift.tt/2Fy8nvQ

Geography Education (K-12)

Lambert, DM; (2018) Geography Education (K-12). Oxford Bibliographies 10.1093/OBO/97801998740020028 . (In press).

http://ift.tt/2E5RADg

Raman spectroscopic investigation of Friedel's salt

Yue, Y; Wang, JJ; Basheer, PAM; Bai, Y; (2018) Raman spectroscopic investigation of Friedel's salt. Cement and Concrete Composites , 86 pp. 306-314. 10.1016/j.cemconcomp.2017.11.023 .

http://ift.tt/2FBF2AT

Retardation mechanism of anionic asphalt emulsion on the hydration of Portland cement

Li, W; Hong, J; Zhu, X; Yang, D; Bai, Y; Liu, J; Miao, C; (2018) Retardation mechanism of anionic asphalt emulsion on the hydration of Portland cement. Construction and Building Materials , 163 pp. 714-723. 10.1016/j.conbuildmat.2017.12.150 .

http://ift.tt/2E1BYAV

Children as partners in their diabetes care: An exploratory research study September-December 2003

Sutcliff, K; Alderson, P; Curtis, K; (2004) Children as partners in their diabetes care: An exploratory research study September-December 2003. Social Science Research Unit, Institute of Education, University of London: London, UK. Green open access

http://ift.tt/2FztsGc

Global Trends in CD4 Cell Count at the Start of Antiretroviral Therapy: Collaborative Study of Treatment Programs

Collins, J; (2018) Global Trends in CD4 Cell Count at the Start of Antiretroviral Therapy: Collaborative Study of Treatment Programs. Clinical Infectious Diseases 10.1093/cid/cix915 . (In press). Green open access

http://ift.tt/2E78od2

Flipping social determinants on its head: Medical student perspectives on the flipped classroom and simulated patients to teach social determinants of health

Gostelow, N; Barber, J; Gishen, FS; Berlin, A; (2018) Flipping social determinants on its head: Medical student perspectives on the flipped classroom and simulated patients to teach social determinants of health. Medical Teacher (In press).

http://ift.tt/2FBC6nP

Kids just wanna have fun: Children's experiences of a weight management programme

Watson, LA; Baker, MC; Chadwick, PM; (2016) Kids just wanna have fun: Children's experiences of a weight management programme. British Journal of Health Psychology , 21 (2) pp. 407-420. 10.1111/bjhp.12175 . Green open access

http://ift.tt/2E77LQI

An emerging opportunistic infection: fatal animal-astrovirus encephalitis in a paediatric stem cell transplant recipient

Lum, SH; Turner, A; Bonney, D; Guiver, M; Breuer, J; Wynn, R; (2016) An emerging opportunistic infection: fatal animal-astrovirus encephalitis in a paediatric stem cell transplant recipient. Presented at: 42nd Annual Meeting of the European Society for Blood and Marrow Transplantation, Valencia, Spain. Green open access

http://ift.tt/2FzxWwI

Hospital and home teachers' views about teaching students who have medically defined mental health needs

Perera, M; Alderson, P; (2007) Hospital and home teachers' views about teaching students who have medically defined mental health needs. NAHHT (National Association of Hospital and Home Teaching)

http://ift.tt/2E6hsz6

Introduzione. L'uomo, lo storico, il maestro

Ferrara Degli Uberti, C; (2015) Introduzione. L'uomo, lo storico, il maestro. In: Ferrara degli Uberti, C, (ed.) Michele Rosi. Appunti personali (1901-1933). (VII-XLIV). Edizioni della Normale: Pisa, Italy.

http://ift.tt/2Fz8o2O

JOHN PHILLIP SHORT. Magic Lantern Empire: Colonialism and Society in Germany

Bowersox, J; (2013) JOHN PHILLIP SHORT. Magic Lantern Empire: Colonialism and Society in Germany. The American Historical Review , 118 (5) pp. 1619-1620. 10.1093/ahr/118.5.1619 . Green open access

http://ift.tt/2E3oIvl

Thomas A. Kohut. A German Generation: An Experiential History of the Twentieth Century. New Haven: Yale University Press, 2012. 335 pp. $38.00 (cloth). ISBN-10: 0-300-17003-3. $25.00 (paper). ISBN-10: 0-300-17003-0.

Bowersox, J; (2013) Thomas A. Kohut. A German Generation: An Experiential History of the Twentieth Century. New Haven: Yale University Press, 2012. 335 pp. $38.00 (cloth). ISBN-10: 0-300-17003-3. $25.00 (paper). ISBN-10: 0-300-17003-0. Journal of the History of the Behavioral Sciences , 49 (4) pp. 428-429. 10.1002/jhbs.21619 . Green open access

http://ift.tt/2Fyj29P

EERI Earthquake Reconnaissance Team Report: M7.8 Muisne, Ecuador Earthquake on April 16, 2016

Lanning, F; Haro, AG; Liu, MK; Monzón, A; Monzón-Despang, H; Schultz, A; Tola, A; ... Lopez, J; + view all Lanning, F; Haro, AG; Liu, MK; Monzón, A; Monzón-Despang, H; Schultz, A; Tola, A; Diaz-Fanas, G; Antonaki, N; Nikolaou, S; Vera-Grunauer, X; Gilsanz, R; Diaz, V; Franco, G; Stone, H; Ahmed, B; Chian, SC; Hughes, F; Jirouskova, N; Kaminski, S; Lopez, J; - view fewer (2016) EERI Earthquake Reconnaissance Team Report: M7.8 Muisne, Ecuador Earthquake on April 16, 2016. Earthquake Engineering Research Institute (EERI): Oakland, California, USA.

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Deh, quando rivedrò il dolce paese: considerazioni tematiche e formali sulla satira ciniana

Keen, C; (2016) Deh, quando rivedrò il dolce paese: considerazioni tematiche e formali sulla satira ciniana. In: Arqués Corominas, R and Tranfaglia, S, (eds.) Cino da Pistoia nella storia della poesia italiana. (pp. 143-152). Franco Cesati Editore: Florence, Italy.

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Intestinal-type adenocarcinoma of the sinonasal tract: an update

Purpose of review Intestinal-type adenocarcinoma (ITAC) is one of the most frequent sinonasal tumors, especially in European countries. The purpose of this article is to review the most recent literature, with special emphasis on biological and genetic profile and treatment guidelines. Recent findings Results on large series support transnasal endoscopic surgery as the technique of choice in the large majority of patients with ITAC. Adjuvant radiotherapy is recommended in advanced-stage and high-grade lesions. More robust data are required to confirm that early-stage, low-grade lesions can be treated with exclusive surgery. The efficacy of new chemotherapy and biotherapy regimens and the added value of heavy particle radiotherapy are currently under evaluation. With a 5-year overall survival ranging between 53 and 83%, which is mainly impacted by local recurrences, ITAC requires a more detailed understanding of its biology. Genetic and biological studies have identified alterations in the molecular pathways of EGFR, MET, and H-RAS which might be considered as potential targets for biotherapy. Summary Surgery still plays a key role in the treatment of ITAC, but multidisciplinary management is mandatory. Although further validation is needed, the role of nonsurgical treatment strategies is rising, in agreement with the progresses made in the biological profiling of the disease. Correspondence to Piero Nicolai, MD, Unit of Otorhinolaryngology, Spedali Civili of Brescia, University of Brescia, Piazza Spedali Civili, 1, 25123 Brescia, Italy. Tel: +39 0303995319; fax: +39 030395212; e-mail: pieronicolai@virgilio.it Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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