Eliminating bias and accelerating the clinical translation of oral microbiome research in oral oncology

Publication date: Available online 1 March 2018
Source:Oral Oncology
Author(s): Rohit Kunnath Menon, Divya Gopinath




http://ift.tt/2F8x829

Impact of perioperative hyperglycemia in patients undergoing microvascular reconstruction

Abstract

Background

The effects of perioperative hyperglycemia on complications and outcomes in microvascular reconstruction have not been reported in the literature.

Methods

A retrospective cohort of 203 patients undergoing microvascular reconstruction was generated. Perioperative glucose levels and clinical factors were tested for associations with complications using simple and multivariate analyses.

Results

Hyperglycemia (blood glucose ≥ 180 mg/dL) occurred in 91 patients (44.8%) perioperatively, and was associated with increased rates of surgical complications, medical complications, surgical site infections, fistulas, and wound dehiscence. On univariate analysis, a more strict definition of hyperglycemia (blood glucose ≥ 165 mg/dL) was significantly associated with greater rates of venous thrombosis, although this lost statistical significance on multivariate analysis.

Conclusion

Perioperative hyperglycemia occurs commonly in patients undergoing microvascular reconstruction and is associated with higher rates of complications, independent of a preexisting diagnosis of diabetes mellitus. Further research is needed to define the ideal glycemic target in this population.

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Preimplantation Genetic Diagnosis of Multiple Endocrine Neoplasia Type 2A Using Informative Markers Identified by Targeted Sequencing

Thyroid , Vol. 0, No. 0.


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Issue Information

http://ift.tt/2FdLu4y

Large number of cutaneous neurofibromas beyond age-appropriate incidence in a patient with a large deletion of NF1

http://ift.tt/2CSIxAQ

Preface to Journal of Dermatology special issue: Psoriasis

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Issue Information

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Correlating the Dermatology Life Quality Index and Skin Discoloration Impact Evaluation Questionnaire tools in disorders of hyperpigmentation

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IL1A (-889) gene polymorphism is associated with the effect of diet as a risk factor in Acne Vulgaris

Summary

Background

Despite the several studies suggesting the genetic basis of acne vulgaris, the exact genetic architecture of this very common condition is not yet clear.

Aim of the work

This study aimed to investigate the association between IL-1A (−889) gene polymorphism and acne vulgaris in a sample of patients.

Subjects and Method

Blood samples from 100 patients with acne vulgaris and 100 healthy age, sex, and BMI matched controls were obtained. DNA samples were isolated from blood cells, and the PCR-RFLP method was used for genotyping.

Results

The genotype distributions of IL-1A (−889) polymorphism were as expected under Hardy-Weinberg equilibrium. T allele was predominant in the patients, while C allele predominated in the control subjects (P value < .001). The frequency of TT genotype in patients was significantly higher than in the control subjects (P value < .001). CT genotype was significantly more frequent in the control subjects compared to patients (P value < .001). Among the 47 patients who reported diet as a risk factor for triggering or exacerbating their lesions, 62.5% had TT genotype (P value = .038).

Conclusion

IL-1A (−889) gene polymorphism has a role in the pathogenesis of acne vulgaris. We suggest that the triggering or exacerbating effect of diet on acne may be related to IL-1A (−889) gene polymorphism.

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CME Accreditation Page

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Forthcoming Issues

Global Health in Otolaryngology

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Controversies in the Evaluation and Management of Otosclerosis

Controversies have been associated with the etiology, diagnosis, evaluation, and management of otosclerosis since Valsalva first described stapes fixation as a cause of hearing loss. Although the exact mechanism of the bone remodeling associated with otosclerosis remains uncertain, stapedotomy has been accepted as the surgical treatment of most patients with stapedial otosclerosis. There remains a disparity of opinion, however, regarding the role of preoperative imaging, surgical technique, implant selection, and medical therapy for cochlear otosclerosis. In addition, opinions vary regarding the optimal postoperative care of patients undergoing stapedotomy and a patient's ability to participate in activities that may result in barotrauma.

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Copyright-Page

Elsevier

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Otosclerosis

Over the past several years, with the evolution of genetic and molecular research, several etiologic factors have been implicated in the pathogenesis of otosclerosis. Overall, current evidence suggests that otosclerosis is a complex disease with a variety of potential pathways contributing to the development of abnormal bone remodeling in the otic capsule. These pathways involved in the pathogenesis of otosclerosis are influenced by both genetic and environmental factors.

http://ift.tt/2oLkxL1

Otosclerosis and Stapes Surgery

OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA

http://ift.tt/2HTsDdv

Impact of Imaging in Management of Otosclerosis

The use of imaging in otosclerosis for diagnosis, preoperative assessment, and follow-up has the potential to give the clinician an additional tier of patient evaluation and validation of diagnosis. Before stapes surgery, imaging may help avoid unnecessary middle ear explorations in nonotosclerotic cases, prevent potential complications, and assist in appropriate patient counseling regarding management expectations. Postoperatively, following unsuccessful air-bone gap closure in stapes surgery or conductive hearing deterioration following initial successful closure of the air bone gap, imaging can be used to determine the prosthesis position in the middle ear.

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Advanced Otosclerosis

Diagnosis and treatment of advanced otosclerosis can be controversial. In 1961, House and Sheehy defined advanced otosclerosis as hearing loss in air conduction threshold by 85 dB with nonmeasurable bone conduction. Recently, the definition of advanced otosclerosis is mostly based on the decrease of speech recognition. There are some treatment modalities: stapes surgery and hearing aids, cochlear implantation, or direct acoustic cochlear implant. The authors propose a new algorithm for treatment. If the patient is treated with cochlear implantation, the surgeon should be cautious for facial nerve stimulation after surgery because it is the most prevalent complication.

http://ift.tt/2HZ8i6C

Potential of Robot-Based Surgery for Otosclerosis Surgery

Otosclerosis surgery is performed through a transcanal approach and requires long, thin instruments with submillimetric precision and precise amplitude of motion. The functional outcomes and complications of otosclerosis surgery depend on the experience of the surgeon. Thus, any technological assistance that can enhance the surgeon's dexterity and rapidly reduce the learning curve could yield an even safer surgical procedure. One of the options is to use robotic assistance to achieve this goal. An overview of different robots designed for otosclerosis surgery is presented focusing on the RobOtol system that we have designed as a multitask platform for ear surgery.

http://ift.tt/2HZ8djk

Use of Lasers in Otosclerosis Surgery

Lasers were introduced as an atraumatic modality for accomplishing several of the crucial steps in otosclerosis surgery. Advances in laser technology have spurred coevolution of refinements in the technique of the operation. Several varieties of laser systems are available to suit individual preference and to augment a surgeon's armamentarium; however, a clear advantage in terms of surgical outcome or patient safety remains to be demonstrated.

http://ift.tt/2oJRuaZ

Otosclerosis and Stapes Surgery

The roots of our knowledge about otosclerosis go back to the early eighteenth century. Since then, countless numbers of scientists have studied the pathogenesis and therapy of the disease. The articles in this issue of Otolaryngologic Clinics of North America flow from history to pathophysiology, clinical evaluation, surgical and medical management to future perspectives. As concepts are constantly progressing, timely topics such as genetics and molecular biology, endoscopic ear surgery and robotic surgery are also included in this issue.

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Revision Surgery for Otosclerosis

This article is an overview of the care of patients requiring revision surgery for otosclerosis. Preoperative evaluation of the patient including surgical history, audiologic results, and physical findings is discussed, and the causes of failure of primary surgery are reviewed. A discussion of evidence-based surgical technique and postoperative care then follows.

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Contents

Sujana S. Chandrasekhar

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Contributors

SUJANA S. CHANDRASEKHAR, MD

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Comparative Study of Management of BPPV (Benign Paroxysmal Positional Vertigo) with only Drugs Versus Drugs Plus Epley Manoeuvre

Abstract

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, accounting for 20% of all vertigo cases. Idiopathic BPPV is most common between the ages of 50 and 70, although the condition is found in all age groups. The importance of early diagnosis and treatment can lead to a much improved quality of life for patients afflicted by this ailment. It is presently common for physicians to treat these patients mainly with benzodiazepines, antihistamines, and anticholinergic medications, especially if the history and physical is consistent with BPPV. This method of treatment has had questionable success. Several reviews of the management of vertigo have shown that no medication in current use has well established curative or prophylactic value or is suitable for long-term treatment. Epleys manoeuvre is also used in the treatment of BPPV. This manoeuvre relocates free floating particles from the affected semi-circular canals back into utricle, thus relieving the symptoms of vertigo. The purpose of this study is to compare the efficacy of Epleys manoeuvre with conventional drug therapy versus conventional therapy alone in patients who present with vertigo. The purpose of this study to evaluate and examine two methods of treatment.

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Copyright

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1





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Contributors

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1





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Contents

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1





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Forthcoming Issues

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1





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Improving Perioperative Care: What Are the Tools That Lead to Sustainable Change?

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Lee A. Fleisher




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Quality Improvement and Implementation Science

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Meghan B. Lane-Fall, Lee A. Fleisher




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Quality Improvement and Implementation Science: Different Fields with Aligned Goals

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Meghan B. Lane-Fall, Lee A. Fleisher




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Implementation Science in Perioperative Care

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Meghan B. Lane-Fall, Benjamin T. Cobb, Crystal Wiley Cené, Rinad S. Beidas

Teaser

There is a 17-year gap between the initial publication of scientific evidence and its uptake into widespread practice in health care. The field of implementation science (IS) emerged in the 1990s as an answer to this "evidence-to-practice gap." In this article, we present an overview of implementation science, focusing on the application of IS principles to perioperative care. We describe opportunities for additional training and discuss strategies for funding and publishing IS work. The objective is to demonstrate how IS can improve perioperative patient care, while highlighting perioperative IS studies and identifying areas in need of additional investigation.


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Human Factors Applied to Perioperative Process Improvement

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Joseph R. Keebler, Elizabeth H. Lazzara, Elizabeth Blickensderfer, Thomas D. Looke

Teaser

This article discusses some of the major theories of the science of human factors/ergonomics (HF/E) in relation to perioperative medicine, with a focus on safety and errors within these systems. The discussion begins with human limitations based in cognition, decision making, stress, and fatigue. Given these limitations, the importance of measuring human performance is discussed. Finally, using the HF/E perspective on safety, high-level recommendations are provided for increasing safety within the perioperative environment.


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Quality Improvement in Anesthesiology — Leveraging Data and Analytics to Optimize Outcomes

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Elizabeth A. Valentine, Scott A. Falk

Teaser

Quality improvement is at the heart of practice of anesthesiology. Objective data are critical for any quality improvement initiative; when possible, a combination of process, outcome, and balancing metrics should be evaluated to gauge the value of an intervention. Quality improvement is an ongoing process; iterative reevaluation of data is required to maintain interventions, ensure continued effectiveness, and continually improve. Dashboards can facilitate rapid analysis of data and drive decision making. Large data sets can be useful to establish benchmarks and compare performance against other providers, practices, or institutions. Audit and feedback strategies are effective in facilitating positive change.


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Emergency Manuals

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Sara N. Goldhaber-Fiebert, Carl Macrae

Teaser

How can teams manage critical events more effectively? There are commonly gaps in performance during perioperative crises, and emergency manuals are recently available tools that can improve team performance under stress, via multiple mechanisms. This article examines how the principles of implementation science and quality improvement were applied by multiple teams in the development, testing, and systematic implementations of emergency manuals in perioperative care. The core principles of implementation have relevance for future patient safety innovations perioperatively and beyond, and the concepts of emergency manuals and interprofessional teamwork are applicable for diverse fields throughout health care.


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Use of Simulation in Performance Improvement

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Amanda Burden, Erin White Pukenas

Teaser

Human error and system failures continue to play a substantial role in preventable errors that lead to adverse patient outcomes or death. Many of these deaths are not the result of inadequate medical knowledge and skill, but occur because of problems involving communication and team management. Anesthesiologists pioneered the use of simulation for medical education in an effort to improve physician performance and patient safety. This article explores the use of simulation for performance improvement. Educational theories that underlie effective simulation programs are described as driving forces behind the advancement of simulation in performance improvement.


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Developing Multicenter Registries to Advance Quality Science

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Laura E. Schleelein, Kathleen A. Harris, Elizabeth M. Elliott

Teaser

There are several benefits to clinical registries as an information repository tool, ultimately lending itself to the acquisition of new knowledge. Registries have the unique advantage of garnering much data quickly and are, therefore, especially helpful for niche populations or low-prevalence diseases. They can be used to inform on the ideal structure, process, or outcome involving an identified population. The data can be used in many ways, for example, as an observational tool to reveal associations or as a basis for framing future research studies or quality improvement projects.


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Handovers in Perioperative Care

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Atilio Barbeito, Aalok V. Agarwala, Amanda Lorinc

Teaser

Handovers around the time of surgery are common, yet complex and error prone. Interventions aimed at improving handovers have shown increased provider satisfaction and teamwork, improved efficiency, and improved communication and have been shown to reduce errors and improve clinical outcomes in some studies. Common recommendations in the literature include a standardized institutional process that allows flexibility among different units and settings, the completion of urgent tasks before information transfer, the presence of all members of the team for the duration of the handover, a structured conversation that uses a cognitive aid, and education in team skills and communication.


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Rethinking Clinical Workflow

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Joseph J. Schlesinger, Kendall Burdick, Sarah Baum, Melissa Bellomy, Dorothee Mueller, Alistair MacDonald, Alex Chern, Kristin Chrouser, Christie Burger

Teaser

The concept of clinical workflow borrows from management and leadership principles outside of medicine. The only way to rethink clinical workflow is to understand the neuroscience principles that underlie attention and vigilance. With any implementation to improve practice, there are human factors that can promote or impede progress. Modulating the environment and working as a team to take care of patients is paramount. Clinicians must continually rethink clinical workflow, evaluate progress, and understand that other industries have something to offer. Then, novel approaches can be implemented to take the best care of patients.


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Developing Capacity to Do Improvement Science Work

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Irene McGhee, Yehoshua Gleicher

Teaser

Developing capacity to do improvement science starts with prioritizing quality improvement training in all health professions curricula so that a common knowledge base and understanding are created. Educational programs should include opportunities for colearning with patients, health professionals, and leaders. In this way, knowledge translation (also called implementation) is more effective and better coordinated when applied across organizations. Key factors that enable and drive behavior change are reviewed, as is the importance of influence and leadership. A comprehensive approach that accounts for these factors hardwires quality improvement into the health care systems and creates a culture that enables its ongoing development.


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Diffusing Innovation and Best Practice in Health Care

Publication date: March 2018
Source:Anesthesiology Clinics, Volume 36, Issue 1
Author(s): Philip E. Greilich, Mary Eleanor Phelps, William Daniel

Teaser

Diffusing innovation and best practices in healthcare are among the most challenging aspects of advancing patient safety and quality improvement. Recommendations from the Baldrige Foundation, Institute for Healthcare Improvement, and The Joint Commission provide guidance on the principles for successful diffusion. Perioperative leaders are encouraged to applying these principles to high priority areas such as handovers, enhanced recovery and patient blood management. Completing a successful pilot project can be exciting, however, effective diffusion is essential to achieving meaningful and lasting impact on the service line and health system.


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Rhinoplastik

Laryngo-Rhino-Otol 2018; 97: 217-220
DOI: 10.1055/s-0044-100738

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Durch das Cochlea-Implantat zum CODA?

Laryngo-Rhino-Otol 2018; 97: 176-180
DOI: 10.1055/s-0044-100741

Die Cochlea-Implantat-Versorgung gehörloser Kinder mit gehörlosen bzw. hochgradig hörgeschädigten Eltern ist möglich. Bereits vor der Operation muss ein tragfähiges (Re-)Habilitationskonzept zur Entwicklung und Förderung des Hör-Sprachprozesses erarbeitet werden. Der Erfolg der Kinder hängt von Vermittlern ab, die die Eltern unterstützen. Die Kinder wachsen zweisprachig auf: Gebärdensprache und Lautsprache. Sie können Schulen für Hörgeschädigte oder allgemeine Schulen für Hörende besuchen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Dank an die Gutachter

Laryngo-Rhino-Otol 2018; 97: 154-154
DOI: 10.1055/s-0044-101394

Die Laryngo-Rhino-Otologie legt die online eingereichten wissenschaftlichen Manuskripte Experten zur Begutachtung vor. Überwiegend kommen diese Gutachter aus dem Gebiet der Hals-Nasen-Ohrenheilkunde, aber auch aus dem naturwissenschaftlichen Bereich und den klinischen Nachbarfächern. Die Schriftleitung und der Verlag möchten daher den neuen Jahrgang der Zeitschrift nicht beginnen, ohne zuvor allen Gutachtern des letzten Jahres und den Experten, die mit ihren sachkundigen Kommentaren die Rubrik „Referiert und diskutiert" aufwerten, den herzlichsten Dank für ihre Tätigkeit auszusprechen. Zunächst genannt seien die Gutachter, die für ihr besonderes Engagement ausgezeichnet wurden:
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Neues Verfahren zur Liposuktion und Fettaugmentation nach Chordektomie

Laryngo-Rhino-Otol 2018; 97: 163-165
DOI: 10.1055/s-0044-101380

Fettaugmentationen der Stimmlippen sind ein etabliertes Verfahren in der Hals-Nasen-Ohrenheilkunde. Aktuell wird dieses Verfahren auch bei Patienten mit endolaryngealen Defekten nach Laser-Chordektomie diskutiert. Der Artikel beschreibt diesbezüglich ein minimal-invasives Verfahren zur primären Liposuktion und Fettaugmentation bei Patienten nach der Resektion eines pT1a Stimmlippenkarzinoms. Dieses neue Verfahren erwies sich als sichere und technisch einfache Methode zur Rekonstruktion von Stimmlippendefekten. Relevante Komplikationen wurden nicht beobachtet.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Laryngektomie: Rekonstruktion mit dauerhaftem Speichel-Bypass-Tubus effektiver

Laryngo-Rhino-Otol 2018; 97: 155-156
DOI: 10.1055/s-0044-100271

Piazza C et al. Fasciocutaneous free flaps for reconstruction of hypopharyngeal defects. Laryngoscope 2017; 127: 2731–2737 Pharynxdefekte nach totaler Laryngektomie und zirkumferenzieller oder partieller Pharyngektomie können verschiedenartig rekonstruiert werden. In einer Vergleichsstudie untersuchten Ärzte des Zentrums für Kopf-Hals-Chirurgie der Universität von Brescia verschiedene Rekonstruktionsstrategien nach totaler Laryngektomie. Bestimmt wurden der Erfolg der Lappenrekonstruktionen, das Auftreten pharyngokutaner Fisteln sowie die pharyngo-ösophageale Stenose-Rate.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Kopf-Hals-MRT: Was HNO-Ärzte wissen sollten

Laryngo-Rhino-Otol 2018; 97: 206-214
DOI: 10.1055/s-0044-101726

Die Magnetresonanztomografie (MRT) hat sich für die HNO-Heilkunde zu einem wichtigen bildgebenden Verfahren entwickelt. Ziel des vorliegenden CME-Beitrags für HNO-Ärzte ist es, einen Überblick über die Vor- und Nachteile sowie die Möglichkeiten der Kopf-Hals-MRT zu bieten und die wichtigsten klinischen Anwendungsgebiete der verschiedenen MRT-Sequenzen zusammenzufassen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Polysomnographie bei Kindern: nicht nur an obstruktive Schlafapnoe denken

Laryngo-Rhino-Otol 2018; 97: 156-157
DOI: 10.1055/s-0044-100281

Heubi CH et al. Polysomnography in Pediatric Otolaryngology: If Not Obstructive Sleep Apnea, What Is It? Otolaryngol Head Neck Surg 2017; 157: 1053–1059 Ärzte der Abteilung für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie der Universität von Cincinnati überprüften die Polysomnographie- Diagnosen von Kindern mit Verdacht auf schlafbezogene Atmungsstörungen (SBAS) und obstruktiver Schlafapnoe (OSA).
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Durchführung und Interpretation der FEES (Fiberoptic Endoscopic Evaluation of Swallowing)

Laryngo-Rhino-Otol 2018; 97: 160-162
DOI: 10.1055/s-0043-125008

© Georg Thieme Verlag KG Stuttgart · New York

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Präoperative Strahlentherapie bei therapeutischer Neck Dissection vielversprechend

Laryngo-Rhino-Otol 2018; 97: 157-158
DOI: 10.1055/s-0044-100284

Lippert D et al. Lymph Node Yield in Therapeutic Neck Dissection: Impact of Dissection Levels and Prior Radiotherapy. Ann Otol Rhinol Laryngol 2017; 126: 762–767
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Gastroösophageale Refluxkrankheit – was tun, wenn PPI nicht ausreichend wirksam, verträglich oder erwünscht sind?

Laryngo-Rhino-Otol 2018; 97: 166-175
DOI: 10.1055/s-0044-100740

Die Standardtherapie der GERD mit PPI ist weniger wirksam als gedacht: Mindestens 30 % der Patienten haben persistierende Symptome und Läsionen (Therapielücke). Bei persistierender Symptomatik oder Wunsch einer alternativen Behandlung ist eine stratifizierte Diagnostik erforderlich. Alginate und neue Operationsverfahren erweitern die Therapieoptionen
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Stephan Remmert - Funktionelle Wiederherstellung der oberen Luft- und Speisewege

Laryngo-Rhino-Otol 2018; 97: 158-159
DOI: 10.1055/s-0043-125338

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Aus der Gutachtenpraxis: Was ist eine Biopsie mit Inzision? Begutachtung der Kodierung im G-DRG-System in der HNO-Heilkunde

Laryngo-Rhino-Otol 2018; 97: 203-205
DOI: 10.1055/s-0044-100737

© Georg Thieme Verlag KG Stuttgart · New York

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Axel Trautmann, Jörg Kleine-Tebbe – Allergologie in Klinik und Praxis

Laryngo-Rhino-Otol 2018; 97: 159-159
DOI: 10.1055/s-0043-125365

© Georg Thieme Verlag KG Stuttgart · New York

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Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2018; 97: 215-216
DOI: 10.1055/s-0044-102258

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Deutschlandweite Umfrage zur Wertigkeit der Ultraschalldiagnostik im Kopf-Hals-Bereich

Laryngo-Rhino-Otol
DOI: 10.1055/a-0573-1785

2013–2014 wurde eine deutschlandweite Umfrage zur aktuellen Anwendung und Wertigkeit der Ultraschalldiagnostik im Kopf-Hals-Bereich durchgeführt. Hier war das Augenmerk insbesondere auf die Integration der Ultraschalldiagnostik im praktischen Alltag des HNO-Arztes im klinischen und im niedergelassenen Bereich gerichtet. Analysiert wurden ferner die aktuell geltenden Standardisierungsprozesse und Ausbildungsrichtlinien.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

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Kommentar der Schriftleitung

Laryngo-Rhino-Otol 2018; 97: 151-152
DOI: 10.1055/a-0547-4493

© Georg Thieme Verlag KG Stuttgart · New York

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Eingeschränkte Schlafqualität als indirekte psychosoziale Folge einer Fazialisparese

Laryngo-Rhino-Otol
DOI: 10.1055/a-0573-2119

Hintergrund Fazialisparese (FP) ist eine Lähmung der Gesichtsmuskulatur und zählt zu den häufigsten motorischen Ausfällen. Sie geht mit einer starken Beeinträchtigung der Lebensqualität und depressiven Symptomen einher. Schlafstörungen in Folge einer FP werden oft auf krankheitsbedingte Beeinträchtigungen zurückgeführt, obwohl auch psychosoziale Belastungen als Ursache in Frage kämen. Diese Studie untersuchte direkte und indirekte Effekte der FP auf die Schlafqualität. Methoden Die Stichprobe der Querschnittsstudie umfasste N = 81 FP-Patienten. Es wurden Symptome der Gesichtsnervenlähmung (FACE), Schlafqualität (PSQI), Lebensqualität (SF36), Depressivität (PHQ9), soziale Ängste (LSAS) und soziodemographische Daten erfasst. Mit Mediationsmodellen wurden Zusammenhänge zwischen Symptomen der FP, sozialen Ängsten, Depressivität und Schlafqualität untersucht. Ergebnisse Die Schlafqualität war bei 33,3 % der Patienten verringert. Die subjektiv eingeschätzte Schwere der FP korrelierte mit der Schlafqualität. Mediationsanalysen legen eine Kausalkette zwischen der Schwere der FP, sozialen Ängsten, depressiven Symptomen und einer eingeschränkten Schlafqualität nahe. Wurden soziale Ängste und Depressivität als Mediatoren in das Modell aufgenommen, gab es keine direkten Effekte der FP auf die Schlafqualität. Schlussfolgerung Schlafprobleme im Kontext einer FP scheinen weniger durch die krankheitsbedingten Beeinträchtigung verursacht, als vielmehr eine indirekte Folge: Die mit einer FP eingehergehende Veränderung des Gesichtes verursacht psychische Beschwerden welche wiederum zu verminderter Schlafqualität führen. Die medizinische Versorgung von FP-Patienten sollte deshalb auch die psychosozialen Folgen in den Blick nehmen, um der Entstehung psychischer Störungen (z. B. Depressionen) und Schlafstörungen vorzubeugen.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
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Mundgesundheitsbezogene Lebensqualität bei Krebspatienten

Laryngo-Rhino-Otol
DOI: 10.1055/a-0573-9741

Hintergrund Bis dato existieren wenige Studien über die mundgesundheitsbezogene Lebensqualität (MLQ) bei Patienten mit Krebserkrankungen. Die European Organisation for Research and Treatment of Cancer (EORTC) hat kürzlich einen Fragebogen zur Erfassung der MLQ erstellt, den Quality of Life Questionnaire – Oral Health Module 15 (EORTC QLQ-OH15). Ziel dieser Arbeit war die Identifizierung möglicher Einschränkungen von MLQ bei Krebspatienten im klinischen Alltag. Patienten und Methoden Die MLQ wurde zu einem nicht näher definierten Zeitpunkt während der Akutbehandlung (t1), 2 Wochen (t2) und 3 Monate (t3) nach dem ersten Befragungszeitpunkt mit dem EORTC QLQ-OH15 gemessen. Als mögliche Prädiktoren der MLQ wurden zu t2 Alter, Geschlecht, Bildung, Krebsentität und Therapie explorativ untersucht. Ergebnisse 40 Patienten nahmen initial an der Studie teil. Im Vergleich zu t1 litten die Patienten zu t2 mehr an klebrigem Speichel und Empfindlichkeit bei Essen und Trinken. Außerdem trugen weniger Patienten eine Zahnprothese. Zu t3 zeigte sich eine Verschlechterung hinsichtlich der Zufriedenheit über die Aufklärung von Problemen im Mundbereich. Über 50-Jährige, Frauen, Patienten mit geringer Bildung, Tumor im Kopf- und Halsbereich, palliativer Therapie, Operation oder zielgerichteter Krebstherapie gaben eine schlechtere MLQ zu t2 an als andere Patienten.Die MLQ ist bei Krebspatienten von klinischer Relevanz. Sie scheint vor allem nach Ende der Therapie eingeschränkt zu sein, und dies nicht nur bei Patienten mit Kopf-Hals-Tumoren. Der EORTC QLQ-OH15 ist trotz seiner Kürze in der Lage, diese Unterschiede abzubilden und wird von den Patienten gut akzeptiert, sodass er für zukünftige Studien in dem Bereich empfohlen werden kann.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Transoral robotic surgery for the treatment of laryngeal chondrosarcoma: A case report

Transoral robotic surgery has revolutionized the practice of head and neck surgery over the past decade, with indications now expanding to include laryngeal pathology. Although laryngeal chondrosarcoma is a rare entity, trends in otolaryngology literature suggest that it can frequently be managed with conservative approaches. We hope to inspire other head and neck surgeons to consider transoral robotic surgery for the treatment of such tumors so that outcomes data can be collected and studied.

http://ift.tt/2HVGpfF

Cytomorphological Spectrum of Thyroiditis: A Review of 110 Cases

Introduction. Different types of thyroiditis may share some parallel clinical and biochemical features. Timely intervention can significantly reduce morbidity and mortality. Aim. Aim of this study is to find the frequency of various thyroiditis, study the cytomorphological features and correlate with clinical findings including radiological findings, thyroid function test, and anti-thyroid peroxidase antibodies (Anti-TPO antibodies). Materials and Methods. The study included consecutive 110 cases of thyroiditis. Detailed cytomorphological features were studied and correlated with ultrasonography findings, thyroid function test, anti-thyroid peroxidase antibodies (anti-TPO) and histopathological features where thyroidectomy specimens were received for histopathological examination. Results. The majority were Hashimoto's thyroiditis () and females (). Other forms of thyroiditis were Hashimoto's thyroiditis with colloid goiter (), De Quervain's thyroiditis (), and one case each of postpartum thyroiditis and Hashimoto's thyroiditis with associated malignancy. The majority of patients were in the age group of 21–40 () and the majority () had diffuse enlargement of thyroid. The majority of patients were hypothyroid (). The serum anti-TPO antibodies were elevated in 47 patients out of 71 patients. In the 48 patients who underwent ultrasonography, 38 were diagnosed as having thyroiditis. The most consistent cytomorphological features seen in fine-needle aspiration smears of Hashimoto's thyroiditis were increased background lymphocytes, lymphocytic infiltration of thyroid follicular cell clusters, and Hurthle cells. Conclusion. The diagnostic cytological features in Hashimoto's thyroiditis are increased background lymphocytes, lymphocytic infiltration of thyroid follicular cell clusters, and Hurthle cells. FNAC remains the "Gold Standard" for diagnosing Hashimoto's thyroiditis. Clinical history, thyroid function, and biochemical parameters are the key for diagnosis of other forms of thyroiditis.

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Book Review: Dermatology: Visual Recognition and Case Reviews by Christine J. Ko

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The C-MAC® Video-assisted Nasoendoscopy vs Traditional Direct Flexible Nasoendoscopy: A Pilot Randomised controlled study

Abstract

The C-MAC^® video monitor attachment is suitable for all otolaryngological scenarios, including post-operative follow up and difficult airway examination.

Currently, there are no studies looking at the effectiveness of C-MAC^® portable monitor with portable flexible nasoendoscopy.

Our study demonstrates that the C-MAC^® monitor with portable flexible nasoendoscopy is an excellent tool in terms of medical education, improving patient-doctor communication, efficiency of ward rounds and for medico-legal documentation, with distinct advantages over traditional direct flexible nasoendoscopy.

This article is protected by copyright. All rights reserved.

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Does otitis media in early childhood affect later behavioural development? Results from the Western Australian Pregnancy Cohort (Raine) Study

Abstract

Objectives

To examine the relationship between early life episodes of otitis media and later behavioural development with adjustment for confounders.

Design

Longitudinal cohort study.

Setting: The Western Australian Pregnancy Cohort (Raine) Study recruited 2900 pregnant women from King Edward Memorial Hospital (KEMH) in Perth, Western Australia, between 1989 and 1991.

Participants

Data from the children born were collected at both the Year 3 and Year 5 follow up. At Year 3, n = 611 were diagnosed with recurrent otitis media through parent-report and clinical examination. At Year 5, n = 299 were considered exposed to otitis media based upon tympanometry results.

Main Outcome Measures

Performance in the Child Behaviour Checklist (CBCL), a questionnaire completed by the primary caregiver at Year 10.

Results

Significant associations were found between recurrent otitis media at Year 3 and internalising behaviours (P = 0.011), and the somatic (P = 0.011), withdrawn (P = 0.014), attention (P = 0.003) and thought problems domains (P = 0.021), and the total CBCL score (P = 0.010). A significant association was also found between exposure to otitis media at Year 5 and externalising behaviours (P = 0.026).

Conclusions

A modest association was seen between recurrent otitis media at Year 3 and exposure to otitis media at Year 5 and a number of behaviour domains at Year 10.

This article is protected by copyright. All rights reserved.

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Decreasing cytokeratin 17 expression in head and neck cancer predicts nodal metastasis and poor prognosis: the first evidence

Abstract

Objectives

Cytokeratins (CKs) are mainly expressed in epithelial carcinomas and are valuable for making diagnoses and identifying metastatic status. Changes in the expression of individual CKs in certain carcinoma may be relevant to establishing a prognosis. However, the prognostic significance of CKs in head and neck squamous cell carcinoma (HNSCC) remains elusive. Herein, we investigated the diverse and unique expression patterns of Cytokeratin 13 (CK13) and Cytokeratin 17 (CK17) and assessed the role of CK17 as a predictor for HNSCC metastasis and prognosis.

Methods

CK13 and CK17 expressions were evaluated by using immunohistochemical tissue microarray (TMA) analysis with 106 patients of HNSCC. To clarify the characterization of CK17 expression with respect to its ability in predicting metastatic disease, an in-vitro study of cells migration/invasion assays was conducted. Furthermore, the correlation of CK17 expression to clinicopathologic variables and prognosis was analyzed by using a serial statistical method.

Results

CK13 was predominately expressed in noncancerous tissues and was lost in HNSCC. Decreasing expression of CK17 correlated with cancerous cell migration and invasion (P<0.0001) in an in-vitro study. CK17 expression was lower in the N1 and N2 nodal metastases category compared to the N0 stage. Moreover, Kaplan-Meier survival analyses showed that a lower CK17 expression was associated with a poorer survival connotation in HNSCC patients (P<0.05) with 10-year follow-up.

Conclusion

Our findings provide the first evidence that CK17 under-expression might be a potential predictor of nodal metastasis and adverse prognosis.

This article is protected by copyright. All rights reserved.

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Effects of sumatriptan nasal spray (Imigran) on human nasal mucosa

Abstract

Objectives

Sumatriptan (Imigran) is a potent and highly selective 5-HT₁ receptor agonist often used in treating acute migraine. Intranasal sumatriptan is well absorbed and is generally effective in relieving headache. However, the effects of Imigran on human nasal mucosa have rarely been well explored. To verify the effect of Imigran, which act on human nasal mucosa directly in vitro.

Design and participants

We examined the effectiveness of Imigran on human nasal mucosa by testing: 1) effect on human nasal mucosa resting tension; 2) effect on contraction caused by 10^-6 M methoxamine as a sympathetic mimetic; 3) effect of the drugs on electrically induced on human nasal mucosa contractions.

Results

The results indicated that addition of methoxamine to the incubation medium caused the nasal mucosa to contract in a dose-dependent manner. Addition of Imigran at doses of 10 ⁻⁴ M elicited a significant relaxation response to 10^–6 M methoxamine -induced contraction. Imigran couldn't inhibit electrical field stimulation-induced spike contraction. It also had a minimal effect on the basal tension of nasal mucosa as the concentration increased.

Conclusions

The study indicated that high concentrations of Imigran had a significant spasmolytic effect by antagonizing α-adreoceptors and nasal obstruction couldn't be released in the patient combined with acute migraine and stuffy nose by concomitant α-adrenergic agonist nasal spray plus Imigran nasal spray.

This article is protected by copyright. All rights reserved.

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Punctate palmoplantar keratoderma: an unusual mutation causing an unusual phenotype

Abstract

Palmoplantar keratodermas (PPKs, OMIM #144200) refers to a large phenotypically and genetically heterogeneous group of keratinization disorders characterized by marked hyperkeratosis on the surface of palms and soles. Punctate PPK (PPKP) features multiple hyperkeratotic papules that develop in early adolescence or later and are irregularly distributed on the palms and soles. The disease is clinically classified into three autosomal dominant subtypes: PPKP1 (OMIM #148600, 614936) characterized by multiple tiny punctate keratoses and caused by mutations in the AAGAB or COL14A1 genes; PPKP2 (OMIM #175860) which features tiny hyperkeratotic spinous papules and PPKP3 or acrokeratoelastoidosis (AKE, OMIM # 101850) which manifests with small hyperkeratotic papules located over the peripheral margins of the palms and soles and is typically associated with degeneration of elastic fibers on histology. The molecular etiology of PPKP2 and AKE remains unknown.

This article is protected by copyright. All rights reserved.

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Evaluation of treatment results in multifocal primary cutaneous anaplastic large cell lymphoma: Report of the Dutch Cutaneous Lymphoma Group

Abstract

Background

There is no consensus on the treatment of multifocal primary cutaneous anaplastic large cell lymphoma (C-ALCL). Radiotherapy (RT) and methotrexate (MTX) are the current treatment options, but their efficacy is unknown. Recently, targeted therapies showed promising results in C-ALCL, and may therefore be an attractive first choice of treatment.

Objectives

To assess the efficacy of conventional treatment strategies for patients with multifocal C-ALCL, and to define which patients may require novel targeted therapies.

Methods

In this multicenter study, treatment was evaluated in patients initially presenting (n=24) or relapsing with multifocal C-ALCL (n=17; 23 relapses). Distinction was made between cases with ≤ 5 (n=36) and >5 lesions (n=11).

Results

Treatments most commonly used were radiotherapy (n=21), systemic chemotherapy (n=9) and low-dose methotrexate (MTX; n=7) with complete response rates of 100%, 78% and 43%, respectively, and an overall response rate of 100%, 100%, and 57%, respectively. Four patients showed a complete spontaneous regression. Sixteen of 24 patients (67%) first presenting with multifocal C-ALCL relapsed, including all five patients initially treated with CHOP. Compared with patients presenting with 2-5 skin lesions, patients presenting with >5 lesions had a higher chance of developing extracutaneous relapse (56 vs 20%) and more often died of lymphoma (44% vs 7%).

Conclusion

Patients with ≤5 lesions should be treated with low-dose RT (2x4 Gy). Maintenance low-dose MTX (20 mg/week) is a suitable option in patients with >5 lesions. Targeted therapies may be considered in rare patients refractory to MTX or patients developing extracutaneous disease.

This article is protected by copyright. All rights reserved.

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Genome-wide association study identifies three novel susceptibility loci for systemic lupus erythematosus in Han Chinese

Abstract

Systemic lupus erythematosus (SLE) is a common prototypic autoimmune disease with substantial genetic predispositions. It is more prevalent in Asians than in Caucasians. Genome wide association studies (GWAS) have discovered more than 80 genetic loci for the risk of SLE¹, which improve the understanding of SLE etiology and provide potential therapeutic targets. However, each GWAS finding only confers a relatively small effect, and they in total cannot fully explain SLE heritability, suggesting more genetic variants are yet to be discovered.

This article is protected by copyright. All rights reserved.

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Itch in dermatomyositis: the role of increased skin interleukin-31

Summary

Background

Interleukin-31 (IL-31) is implicated in pruritus associated with pruritic skin diseases like atopic dermatitis. Although pruritus is a prominent feature in dermatomyositis (DM), few studies have evaluated the pathogenesis of DM-associated itch.

Objectives

Our goals were to establish the prevalence of itch in DM, and to investigate the role of IL-31 in DM-related itch.

Methods

Pruritus and disease activity of DM were evaluated by a visual analog scale (VAS) and the Cutaneous Disease and Activity Severity Index (CDASI), respectively. Expression of IL-31 and IL-31 receptor alpha (IL-31RA) in lesional DM, non-lesional DM and healthy control (HC) skin was evaluated by qRT-PCR and immunofluorescence. Flow cytometry was performed on skin cells isolated from lesional DM skin to identify cellular sources of IL-31 in DM.

Results

Among 191 DM patients, 50.8% had moderate to severe itch, and itch was correlated with increased cutaneous severity (r= 0.34). In itchy DM patients, gene expression of IL-31 and IL-31RA in lesional skin was upregulated compared to non-lesional skin and HC skin. IL-31 mRNA expression positively correlated with VAS itch score (r= 0.67). On immunofluorescence, immunoreactivity for IL-31 and IL31RA was stronger in lesional skin. Flow cytometry showed lesional DM skin contained significantly more IL-31-producing cells and CD4+ cells were the most common cell type. Lenabasum, an emerging treatment for DM, significantly downregulated IL-31 from CpG-stimulated PBMCs.

Conclusion

Increased skin IL-31 may play a role in DM-associated itch, and ongoing trials will evaluate the effects of systemic treatment on IL-31 and itch in DM.

This article is protected by copyright. All rights reserved.

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A rare BRAF T599dup mutation conferring sensitivity to BRAF inhibitor in a patient with metastatic melanoma

Abstract

Treatment for patients with V600 mutation of the B-Raf protooncogene BRAF (BRAF-V600) and metastatic stage IV or unresectable stage III melanoma has greatly advanced with the introduction of selective BRAF inhibitors (BRAFi), such as vemurafenib and dabrafenib, combined with mitogen-activated protein kinase kinase inhibitors (MEKi), such as cobimetinib and trametinib, as first-line therapy [1,2]. Two mutations, V600E and V600K, are routinely searched in patients with stage IV and unresectable stage III cancer. The presence of the V600 mutation allows for prescribing BRAFi combined with MEKi according to the European Medicine Agency. Other non– BRAF-V600 mutations have been increasingly found by next-generation sequencing (NGS) and question the possible efficiency of BRAFi associated with MEKi with these mutations [3]. Here we report a case of metastatic melanoma in a patient with a non–BRAF-V600 mutation responding to combined BRAFi and MEKi treatment.

This article is protected by copyright. All rights reserved.

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Should You Get Genetic Testing During Your Pregnancy?

As an expecting mom, you will be given the opportunity to get genetic testing. Many new moms are full of questions concerning this topic. Should I get genetic testing? What does it test for? What type of tests are available? How accurate are the test? The list goes on and on so here is my advice to help you in making your decision.

The post Should You Get Genetic Testing During Your Pregnancy? appeared first on ChildrensMD.

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Johns Hopkins Researchers Invent New Technology for Cancer Immunotherapy

Johns Hopkins researchers have invented a new class of cancer immunotherapy drugs that are more effective at harnessing the power of the immune system to fight cancer. This new approach, which was reported in Nature Communications, results in a significant decrease of tumor growth, even against cancers that do not respond to existing immunotherapy.

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Lymph Node Yield as Quality Metric for Clinically N0 Oral Cancer—Reply

In Reply We thank Dr Judson for his comments on our article. Dr Judson claimed that we selected the median number as our lymph node threshold and suggested that the cutoff was chosen arbitrarily. However, this was incorrect. As described in the article, we used restricted cubic spline, in particular, maximally selected rank statistics to choose the cutoff value. Therefore, the threshold 24 was selected objectively, not arbitrarily or based on the median lymph node count. We also examined model discriminative ability using bootstrapping bias-adjusted concordance probability (c-index) and calibration against the Kaplan-Meier estimated survival. Internal validation was performed using bootstrapping with 200 replications. The study by no means implied that half of the neck dissections in the cohort were inadequate; rather, it indicated that the cutoff of 24 could best differentiate the patient survival in the data set.

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Lymph Node Yield as Quality Metric for Clinically N0 Oral Cancer

To the Editor In their research letter, Tsai et al evaluated lymph node yield in a cohort of patients with clinically N0 oral cavity cancer from the National Cancer Database (NCDB). They found an association of lymph node yield with survival. With a median node count of 23, they used neck dissections with 24 or more nodes as a variable in a multivariable analysis and found 24 or more nodes to be associated with improved survival.

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Fall With e-Cigarette Resulting in Pharyngeal and Esophageal Burns

This Observation describes the case of a man who presented to the emergency department with stridor, increased work of breathing, and supplement oxygen requirement after falling with an e-cigarette in his mouth several hours earlier.

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Association of Reduced Delay in Care With a Dedicated Operating Room in Pediatric Otolaryngology

This study evaluates an otolaryngology-specific operating room time block for unscheduled cases to determine time from initial consultation to surgery and utilization of the dedicated block of time.

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Preoperative Aspirin Use and Bleeding Complications in Thyroid Surgery

This cohort study assesses whether continued preoperative aspirin use preoperatively is associated with increased bleeding complications among patients undergoing thyroid surgery.

http://ift.tt/2t9ulEa

The central venous pressure, and ‘a plea for some common-sense’

No abstract available

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Obstructive sleep apnoea in adults: peri-operative considerationsA narrative review

Obstructive sleep apnoea (OSA) is a common breathing disorder of sleep with a prevalence increasing in parallel with the worldwide rise in obesity. Alterations in sleep duration and architecture, hypersomnolence, abnormal gas exchange and also associated comorbidities may all feature in affected patients. The peri-operative period poses a special challenge for surgical patients with OSA who are often undiagnosed, and are at an increased risk for complications including pulmonary and cardiovascular, during that time. In order to ensure the best peri-operative management, anaesthetists caring for these patients should have a thorough understanding of the disorder, and be aware of the individual's peri-operative risk constellation, which depends on the severity and phenotype of OSA, the invasiveness of the surgical procedure, anaesthesia and also the requirement for postoperative opioids. The objective of this review is to educate clinicians in the epidemiology, pathogenesis and diagnosis of OSA in adults and also to highlight specific tasks in the preoperative assessment, namely to select a suitable intra-operative anaesthesia regimen, and manage the extent and duration of postoperative care to facilitate the best peri-operative outcome.

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Is the dose and mode of administration of dipyrone associated with acute kidney injury?

No abstract available

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Effect of various durations of smoking cessation on postoperative outcomes: A retrospective cohort analysis

BACKGROUND Preoperative smoking cessation is commonly advised in an effort to improve postoperative outcomes. However, it remains unclear for how long smoking cessation is necessary, and even whether a brief preoperative period of abstinence is helpful and well tolerated. OBJECTIVE We evaluated associations between various periods of preoperative smoking cessation and major morbidity and death. DESIGN Retrospective cohort analysis. SETTING Adults who had noncardiac surgery at the Cleveland Clinic Main Campus between May 2007 and December 2013. PATIENTS A total of 37 511 patients whose smoking history was identified from a preoperative Health Quest questionnaire. Of these patients, 26 269 (70%) were former smokers and 11 242 (30%) were current smokers. Of the current smokers, 9482 (84%) were propensity matched with 9482 former smokers (36%). We excluded patients with American Society of Anesthesiologists' physical status exceeding four, patients who did not have general anaesthesia, and patients with missing outcomes and/or covariables. When multiple procedures were performed within the study period, only the first operation for each patient was included in the analysis. MAIN OUTCOME MEASURES The relationship between smoking cessation and in-hospital morbidity/mortality. RESULTS The incidence of the primary composite of in-hospital morbidity/mortality was 6.9% (656/9482) for all former smokers; the incidence was 7.8% (152/1951) for patients who stopped smoking less than 1 year before surgery, 6.3% (118/1977) for 1 to 5 years, 7.2% (115/1596) for 5 to 10 years and 6.9% (271/3457) for more than 10 years. CONCLUSION Smoking cessation was associated with reduced in-hospital morbidity and mortality which was independent of cessation interval.

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About anaesthetists and artists

No abstract available

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Incidence and risk factors of anaesthesia-related perioperative cardiac arrest: A 6-year observational study from a tertiary care university hospital

BACKGROUND In recent decades, the incidences of anaesthesia-related perioperative mortality and adverse outcomes have decreased drastically. However, to date, data on perioperative cardiac arrest and risk factors of perioperative cardiac arrest from European countries are scarce. OBJECTIVES To determine the incidences of perioperative cardiac arrest and rates of anaesthesia-related and anaesthesia-contributory cardiac arrest. Identification of pre-existing risk factors leading to perioperative cardiac arrest. DESIGN Retrospective cohort study. SETTING Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Germany. INTERVENTIONS Perioperative critical incident reports between 2007 and 2012 were screened, and reports on cardiac arrest within 24 h postoperatively were identified. Cardiac arrests were classified as 'anaesthesia-related', 'anaesthesia-contributory' or 'anaesthesia-unrelated' by two reviewers independently. Univariate and multi-variate logistic regression analysis was used to identify risk factors associated with perioperative cardiac arrest. RESULTS Analysis of 318 critical incidents from 169 500 anaesthetics revealed 99 perioperative cardiac arrests. This is an overall incidence of perioperative cardiac arrest of 5.8/10 000 anaesthetics [95% confidence interval (CI), 4.7 to 7.0]. The rate of anaesthesia-related cardiac arrest was 0.7/10 000 (95% CI, 0.3 to 1.1), and the rate of anaesthesia-contributory cardiac arrest was 1.7/10 000 (95% CI, 1.1 to 2.3). Most cardiac arrests related to anaesthesia were due to respiratory events. From the multi-variate analysis, American Society of Anesthesiologists physical status grade at least 3 [P = 0.007, odds ratio (OR) 2.59 (95% CI, 1.29 to 5.19)], emergency surgery [P 

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Does the technique of two-hand mask ventilation matter?

No abstract available

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Intraoperative hypotension is associated with acute kidney injury in noncardiac surgery: An observational study

BACKGROUND Perioperative acute kidney injury (AKI) is common and increases the risk of morbidity and mortality. OBJECTIVES To determine the association between intraoperative hypotension, defined as an individual decrease from baseline and the risk of perioperative AKI. DESIGN Observational cohort study. SETTING Karolinska University Hospital, Stockholm, Sweden, from October 2012 to May 2013 and October 2015 and April 2016. PATIENTS All adult patients undergoing major elective noncardiac surgery who were scheduled for an overnight admission in the postoperative unit were included. Patients undergoing phaeochromocytoma surgery were excluded. DATA COLLECTION Preoperative risk factors (comorbidities), intraoperative events (hypotension defined as a more than 40 or 50% decrease in SBP relative to each patient's baseline and lasting more than 5 min) and postoperative data were collected from medical records. MAIN OUTCOME MEASURES AKI within the first two postoperative days. RESULTS Of the final cohort of 470 patients, 127 (27%) developed AKI in the perioperative period. AKI was associated with male sex [(66 vs. 48%) P 40%, 70 vs. 57%, P = 0.013; >50%, 20 vs. 12%, P = 0.024) and greater blood loss (800 vs. 400 ml, P 

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Is the Arné risk index a valid predictor for difficult intubation with indirect laryngoscopy?

No abstract available

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Comparing peri-operative complications of paediatric and adult anaesthesia: A retrospective cohort study of 81 267 cases

BACKGROUND Comparisons of peri-operative complications associated with paediatric (≤16 years) and adult anaesthesia are poorly available, especially in which cardiac surgery, organ transplantation and neurosurgery are involved. OBJECTIVE The aim of this study was to evaluate the nature and incidence of peri-operative complications that might be due to anaesthesia and to identify independent risk factors for complications in children and adults, including those undergoing cardiac surgery, organ transplantation and neurosurgery. DESIGN Retrospective cohort study. SETTING The study was performed at the University Medical Centre Groningen in the 4 years between 1 January 2010 and the 31 December 2013. MAIN OUTCOME MEASURES Complications and their severity were graded according to the standard complication score (20 items) of the Dutch Society of Anaesthesia. Univariate and multivariate regression analysis was used to identify independent risk factors for the reported complications. RESULTS A total of 81 267 anaesthetic cases were included. In the paediatric cohort, there were 410 (2.9%) complications and 1675 (2.5%) in the adults. In both cohorts age, American Society of Anaesthesiologists classification and emergency treatment were independent risk factors for complications. With respect to age, infants less than 1 year were at the highest risk, whereas in the adult cohort, increased age was related to a greater number of complications. The incidences of the specific complications were different between both cohorts. Upper airway obstruction was more frequently observed in paediatric patients (26%), whereas in the adults, complications with the highest incidence concerned conversion of regional-to-general anaesthesia (25%) and hypotension (17%). CONCLUSION Risk factors for all peri-operative complications were similar for paediatric and adult anaesthesia. However, the incidence of specific complications differed between both age categories.

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Reply to: maternal anaemia - the story behind the number

No abstract available

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The efficacy of pre-operative preparation with intravenous iron and/or erythropoietin in anaemic patients undergoing orthopaedic surgery: An observational study

BACKGROUND Pre-operative anaemia and transfusion are common among patients undergoing elective orthopaedic surgery. Application of 'patient blood management' might be the most effective way to reduce both anaemia and transfusion. Pre-operative administration of iron and/or erythropoietin (EPO) is one of the cornerstones of the first pillar of patient blood management, but in a daily clinical setting, efficacy and long-term safety of this measure have not been analysed thoroughly to date. OBJECTIVE To investigate the influence of pre-operative preparation (PREP) of patients with iron and/or EPO on peri-operative transfusion needs and long-term survival. DESIGN Single-centre, retrospective study. SETTING Anaesthesia department, University hospital. INTERVENTIONS Pre-operative preparation with iron and/or EPO versus no preparation. METHODS After approval of our local ethics committee, data of 5518 patients who received total hip or total knee replacement between 2008 and 2014 were included. Patients receiving iron and/or EPO were included in the PREP group, whereas patients without iron and/or EPO were included in the no preparation group. From the full data set, a bias-reduced subset of 662 patients was obtained by means of propensity score-matching to compare peri-operative red blood cell utilisation and long-term survival of patients between groups. RESULTS Patients in the PREP group needed a lower number of units of red blood cells than patients in the no preparation group (0.2 ± 0.8 vs. 0.5 ± 1.3, P 

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Reply to: is the dose and mode of administration of dipyrone associated with acute kidney injury?

No abstract available

http://ift.tt/2HUZxu1

Effects of pressure support ventilation on ventilator-induced lung injury in mild acute respiratory distress syndrome depend on level of positive end-expiratory pressure: A randomised animal study

BACKGROUND Harmful effects of spontaneous breathing have been shown in experimental severe acute respiratory distress syndrome (ARDS). However, in the clinical setting, spontaneous respiration has been indicated only in mild ARDS. To date, no study has compared the effects of spontaneous assisted breathing with those of fully controlled mechanical ventilation at different levels of positive end-expiratory pressure (PEEP) on lung injury in ARDS. OBJECTIVE To compare the effects of assisted pressure support ventilation (PSV) with pressure-controlled ventilation (PCV) on lung function, histology and biological markers at two different PEEP levels in mild ARDS in rats. DESIGN Randomised controlled experimental study. SETTING Basic science laboratory. PARTICIPANTS Thirty-five Wistar rats (weight ± SD, 310 ± 19) g received Escherichia coli lipopolysaccharide (LPS) intratracheally. After 24 h, the animals were anaesthetised and randomly allocated to either PCV (n=14) or PSV (n=14) groups. Each group was further assigned to PEEP = 2 cmH2O or PEEP = 5 cmH2O. Tidal volume was kept constant (≈6 ml kg−1). Additional nonventilated animals (n=7) were used as a control for postmortem analysis. MAIN OUTCOME MEASURES Ventilatory and mechanical parameters, arterial blood gases, diffuse alveolar damage score, epithelial integrity measured by E-cadherin tissue expression, and biological markers associated with inflammation (IL-6 and cytokine-induced neutrophil chemoattractant, CINC-1) and type II epithelial cell damage (surfactant protein-B) were evaluated. RESULTS In both PCV and PSV, peak transpulmonary pressure was lower, whereas E-cadherin tissue expression, which is related to epithelial integrity, was higher at PEEP = 5 cmH2O than at PEEP = 2 cmH2O. In PSV, PEEP = 5 cmH2O compared with PEEP = 2 cmH2O was associated with significantly reduced diffuse alveolar damage score [median (interquartile range), 11 (8.5 to 13.5) vs. 23 (19 to 26), P = 0.005] and expressions of IL-6 and CINC-1 (P = 0.02 for both), whereas surfactant protein-B mRNA expression increased (P = 0.03). These changes suggested less type II epithelial cell damage at a PEEP of 5 cmH2O. Peak transpulmonary pressure correlated positively with IL-6 [Spearman's rho (ρ) = 0.62, P = 0.0007] and CINC-1 expressions (ρ = 0.50, P = 0.01) and negatively with E-cadherin expression (ρ = −0.67, P = 0.0002). CONCLUSION During PSV, PEEP of 5 cmH2O, but not a PEEP of 2 cmH2O, reduced lung damage and inflammatory markers while maintaining epithelial cell integrity.

http://ift.tt/2oG1YYA

Reply to: does the technique of two-hand mask ventilation matter?

No abstract available

http://ift.tt/2HXvxOq

Effect of pressure-controlled inverse ratio ventilation on dead space during robot-assisted laparoscopic radical prostatectomy: A randomised crossover study of three different ventilator modes

BACKGROUND Pressure-controlled inverse inspiratory to expiratory ratio ventilation (PC-IRV) is thought to be beneficial for reducing the dead space volume. OBJECTIVE To investigate the effects of PC-IRV on the components of dead space during robot-assisted laparoscopic radical prostatectomy (RLRP). DESIGN A randomised crossover study of three different ventilator modes. SETTING A single university hospital from September 2014 to April 2015. PATIENTS Twenty consecutive study participants undergoing RLRP. INTERVENTIONS Patients were ventilated sequentially with three different modes in random order for 30 min: volume control ventilation (VCV; inspiratory to expiratory ratio 0.5), pressure control ventilation (PCV; inspiratory to expiratory ratio 0.5) and PC-IRV. Inverse inspiratory to expiratory ratio was adjusted individually by observing the expiratory flow-time wave to prevent the risk of dynamic pulmonary hyperinflation. MAIN OUTCOME MEASURES The primary outcome included physiological dead space (VDphys), airway dead space (VDaw), alveolar dead space (VDalv) and shunt dead space (VDshunt). VDphys was calculated by Enghoff's method. We also analysed respiratory dead space (VDresp) and VDaw using a novel analytical method. Then, VDalv and VDshunt were calculated by VDalv = VDresp − VDaw and VDshunt = VDphys − VDresp, respectively. RESULTS The VDphys/expired tidal volume (VTE) ratio in PC-IRV (29.2 ± 4.7%) was significantly reduced compared with that in VCV (43 ± 8.5%) and in PCV (35.9 ± 3.9%). The VDshunt/VTE in PC-IRV was significantly smaller than that in VCV and PCV. VDaw/VTE in PC-IRV was also significantly smaller than that in VCV but not that in PCV. There was no significant change in VDalv/VTE. CONCLUSION PC-IRV with the inspiratory to expiratory ratio individually adjusted by the expiratory flow-time wave decreased VDphys/VTE in patients undergoing RLRP. TRIAL REGISTRATION University Hospital Medical Information Network in Japan 000014004.

http://ift.tt/2oGPH6v

Reply to: the central venous pressure, and ‘a plea for some common-sense’

No abstract available

http://ift.tt/2HXZ9v6

Maternal anaemia - the story behind the number

No abstract available

http://ift.tt/2oInaNG

Reply to: is the Arné risk index a valid predictor for difficult intubation with indirect laryngoscopy?

No abstract available

http://ift.tt/2HUZnTr

Detailed analysis of inflammatory cell infiltration and the prognostic impact on nasopharyngeal carcinoma

Abstract

Background

One of the most striking characteristics of nasopharyngeal carcinoma (NPC) is the presence of a very abundant immune cells infiltrate containing mainly T-lymphocytes. The purpose of this study was to present our analysis providing a comprehensive characterization of antitumor inflammatory response in NPC.

Methods

The densities of 9 types of inflammatory cells were assessed in 197 patients with NPC, including CD3 + T-lymphocytes, CD8 + cytotoxic T-lymphocytes, CD20 + B-lymphocytes, CD56 + natural killer (NK) cells, FOXP3 + regulatory T-lymphocytes, CD1a + immature dendritic cells, CD83 + mature dendritic cells, neutrophil elastase + neutrophils, and tryptase + mast cells. We characterized the inflammatory infiltrate in relation to clinical stage and patient survival. The expression of programmed death-1 (PD-1) on tumor-infiltrating lymphocytes (TILs) was also detected. The correlations between PD-1 expression and clinical characteristics and posttreatment outcome were analyzed.

Results

The patients with NPC with a low density of tumor-infiltrating FOXP3+, CD8 + T-lymphocytes, neutrophils, and mast cells showed a significantly longer overall survival (OS) and progression-free survival (PFS). However, patients with a high density of NK cells showed a better OS and PFS. The densities of NK cells and mast cells could be served as biomarkers for predicting recurrence or distant metastasis in patients with NPC. Moreover, PD-1 positivity predicted poor prognosis in patients with NPC.

Conclusion

The densities of inflammatory cells are correlated with the prognosis of patients with NPC.

http://ift.tt/2t6uvfx

Thirty-day readmission in patients undergoing head and neck microvascular reconstruction

Abstract

Background

Characteristics of 30-day unplanned readmissions after head and neck microvascular reconstruction remain poorly understood.

Methods

We conducted a retrospective cohort of patients who underwent head and neck microvascular reconstruction between 2010 and 2015.

Results

The 30-day unplanned readmission rate was 13.0% (64/493). The most common readmission diagnoses were dehiscence, surgical site infection, or fistula (45.3%; n = 29). Of the readmissions, 46.9% (30/64) occurred within 7 days of discharge from the hospital. Risk factors for readmission on multivariable analysis included body mass index (BMI) < 21 kg/m² (odds ratio [OR] 2.47; 95% confidence interval [CI] 1.36-4.47), primary site of oropharynx (OR 1.66; 95% CI 1.17-6.06), hypopharynx/larynx (OR 3.66; 95% CI 1.70-7.88), or sinonasal/skull base (OR 4.07; 95% CI 1.43-11.55), and fistula during the index hospitalization (OR 2.98; 95% CI 1.22-7.24).

Conclusion

More than 1 in 10 patients undergoing head and neck microvascular reconstruction has a 30-day unplanned readmission, most commonly related to wound complications. Further efforts are needed to determine optimal 30-day unplanned readmission reduction strategies.

http://ift.tt/2FGWKE6

Oral Contraceptives and Cancer Risk

A fact sheet about research on the association of oral contraceptive use with risk of various cancers.

http://ift.tt/2dJ5jiE

Fitbit, Really?

When I glanced at my 7 and 10 year-old son and daughter's Christmas lists back in December and saw  they both included a Fitbit, my initial thought was those were completely unnecessary gifts.  After all, my kids seem to have ample energy from the moment they rise to the moment I remind them it's time to wind down at night.

The American Academy of Pediatrics recommends at least 60 minutes of active play per day for school-aged children.  As a psychologist and parent, I am increasingly aware of the time limit placed on children during the school day on physical activity, with shortened recess (or non-existent for middle and high schoolers) and physical education often not incorporated into every school day.  Of course cold, winter months and hot, summer days often also result in children being indoors more often than when the weather is nice.  And of course, increased use of media can interfere with children achieving that 60 minutes.  This got me thinking about whether my children really are physically active for the recommended time on a daily basis.

As I thought more about my kids' lists, I started to consider whether this might be just the perfect gift – not just for them, but for the whole family.  Not only is physical activity important for physical health, it also promotes good mental health, including stress relief.  Teaching children healthy habits when they're young really helps set them up for success as adults.

Despite my initial hesitation, I went ahead and bought activity trackers for both of my children, and it has been a great decision.  I'm back to wearing my Fitbit and my husband wears his Garmin, and between the four of us, we have daily competitions about who was most active. Our dog is even getting in on the action as she agrees to walk around the neighborhood if one of us needs to increase our activity level that day.  While having an activity tracker is certainly not a necessity, the emphasis on physical activity is, and this goal is always easier to accomplish if it is shared by the entire family.

The post Fitbit, Really? appeared first on ChildrensMD.

http://ift.tt/2CRr1No

Inhibition of EGFR, HER2, and HER3 signalling in patients with colorectal cancer wild-type for BRAF, PIK3CA, KRAS, and NRAS (FOCUS4-D): a phase 2–3 randomised trial

Adams, R; Brown, E; Brown, L; Butler, R; Falk, S; Fisher, D; Kaplan, R; ... FOCUS4 Trial Investigators, ; + view all Adams, R; Brown, E; Brown, L; Butler, R; Falk, S; Fisher, D; Kaplan, R; Quirke, P; Richman, S; Samuel, L; Seligmann, J; Seymour, M; Shiu, KK; Wasan, H; Wilson, R; Maughan, T; FOCUS4 Trial Investigators, ; - view fewer (2018) Inhibition of EGFR, HER2, and HER3 signalling in patients with colorectal cancer wild-type for BRAF, PIK3CA, KRAS, and NRAS (FOCUS4-D): a phase 2–3 randomised trial. The Lancet Gastroenterology & Hepatology , 3 (3) pp. 162-171. 10.1016/S2468-1253(17)30394-1 . Green open access

http://ift.tt/2FJmmAw

The use of reinforcement learning algorithms to meet the challenges of an artificial pancreas

Bothe, MK; Dickens, L; Reichel, K; Tellmann, A; Ellger, B; Westphal, M; Faisal, AA; (2013) The use of reinforcement learning algorithms to meet the challenges of an artificial pancreas. Expert Review of Medical Devices , 10 (5) pp. 661-673. 10.1586/17434440.2013.827515 . Green open access

http://ift.tt/2t7vEmT

Experiences and concerns of patients with recurrent attacks of acute hepatic porphyria: A qualitative study

Naik, H; Stoecker, M; Sanderson, SC; Balwani, M; Desnick, RJ; (2016) Experiences and concerns of patients with recurrent attacks of acute hepatic porphyria: A qualitative study. Molecular Genetics and Metabolism , 119 (3) pp. 278-283. 10.1016/j.ymgme.2016.08.006 . Green open access

http://ift.tt/2FGR0u6

Calorie Restriction Attenuates Terminal Differentiation of Immune Cells

White, MJ; Beaver, CM; Goodier, MR; Bottomley, C; Nielsen, CM; Wolf, A-SFM; Boldrin, L; ... Riley, EM; + view all White, MJ; Beaver, CM; Goodier, MR; Bottomley, C; Nielsen, CM; Wolf, A-SFM; Boldrin, L; Whitmore, C; Morgan, J; Pearce, DJ; Riley, EM; - view fewer (2017) Calorie Restriction Attenuates Terminal Differentiation of Immune Cells. Frontiers in Immunology , 7 , Article 667. 10.3389/fimmu.2016.00667 . Green open access

http://ift.tt/2t794uJ

Machine learning for identifying Randomized Controlled Trials: An evaluation and practitioner's guide

Marshall, IJ; Noel-Storr, A; Kuiper, J; Thomas, J; Wallace, BC; (2018) Machine learning for identifying Randomized Controlled Trials: An evaluation and practitioner's guide. Research Synthesis Methods 10.1002/jrsm.1287 . Green open access

http://ift.tt/2FLxw7T

De novo HNF1 homeobox B mutation as a cause for chronic, treatment-resistant hypomagnesaemia

Bockenhauer, D; Stiles, CE; Thursaisingham, R; Platts, L; Kumar, A; Korbonits, M; (2018) De novo HNF1 homeobox B mutation as a cause for chronic, treatment-resistant hypomagnesaemia. Endocrinology, Diabetes and Metabolism Case Reports (In press).

http://ift.tt/2F6fTyg

Bodiam: Research Prior to 2010

Pope, MI; Johnson, M; Martin, D; James, R; Whittock, C; Johnson, C; (2017) Bodiam: Research Prior to 2010. In: Johnson, M, (ed.) Lived Experience in the Later Middle Ages Studies of Bodiam and Other Elite Landscapes in South-Eastern England. Highfield Press: Southampton, United Kingdom.

http://ift.tt/2FEWTrD

A novel mutation in HSD11B2 causes apparent mineralocorticoid excess in an Omani kindred

Yau, M; Al Azkawi, HS; Haider, S; Khattab, A; Al Badi, M; Abdullah, W; Al Senani, A; ... New, MI; + view all Yau, M; Al Azkawi, HS; Haider, S; Khattab, A; Al Badi, M; Abdullah, W; Al Senani, A; Wilson, RC; Yuen, T; Zaidi, M; New, MI; - view fewer (2016) A novel mutation in HSD11B2 causes apparent mineralocorticoid excess in an Omani kindred. Annals of the New York Academy of Sciences , 1376 pp. 65-71. 10.1111/nyas.13162 . Green open access

http://ift.tt/2t50IUF

Mosaic RAS/MAPK variants cause sporadic vascular malformations which respond to targeted therapy

Al-Olabi, L; Polubothu, S; Dowsett, K; Andrews, KA; Stadnik, P; Joseph, AP; Knox, R; ... Kinsler, VA; + view all Al-Olabi, L; Polubothu, S; Dowsett, K; Andrews, KA; Stadnik, P; Joseph, AP; Knox, R; Pittman, A; Clark, G; Baird, W; Bulstrode, N; Glover, M; Gordon, K; Hargrave, D; Huson, SM; Jacques, TS; James, G; Kondolf, H; Kangesu, L; Keppler-Noreuil, KM; Khan, A; Lindhurst, MJ; Lipson, M; Mansour, S; O'Hara, J; Mahon, C; Mosica, A; Moss, C; Murthy, A; Ong, J; Parker, VE; Rivière, J-B; Sapp, JC; Sebire, NJ; Shah, R; Sivakumar, B; Thomas, A; Virasami, A; Waelchli, R; Zeng, Z; Biesecker, LG; Barnacle, A; Topf, M; Semple, RK; Patton, EE; Kinsler, VA; - view fewer (2018) Mosaic RAS/MAPK variants cause sporadic vascular malformations which respond to targeted therapy. Journal of Clinical Investigation 10.1172/JCI98589 . (In press). Green open access

http://ift.tt/2FHkNTv

Magnetism, X-rays and accretion rates in WD 1145+017 and other polluted white dwarf systems

Farihi, J; Fossati, L; Wheatley, PJ; Metzger, BD; Mauerhan, J; Bachman, S; Gansicke, BT; ... Stone, N; + view all Farihi, J; Fossati, L; Wheatley, PJ; Metzger, BD; Mauerhan, J; Bachman, S; Gansicke, BT; Redfield, S; Cauley, PW; Kochukhov, O; Achilleos, N; Stone, N; - view fewer (2018) Magnetism, X-rays and accretion rates in WD 1145+017 and other polluted white dwarf systems. Monthly Notices of the Royal Astronomical Society , 474 (1) pp. 947-960. 10.1093/mnras/stx2664 . Green open access

http://ift.tt/2t6f8Ur

Oligosaccharide model of the vascular endothelial glycocalyx in physiological flow

Pikoula, M; Tessier, MB; Woods, RJ; Ventikos, Y; (2018) Oligosaccharide model of the vascular endothelial glycocalyx in physiological flow. Microfluidics and Nanofluidics , 22 (2) , Article 21. 10.1007/s10404-018-2037-5 . Green open access

http://ift.tt/2FH6sXh

Clinical round-up

Herbert, S; Haddow, L; (2016) Clinical round-up. Sexually Transmitted Infections , 92 (3) p. 246. 10.1136/sextrans-2016-052565 . Green open access

http://ift.tt/2t7vegj

Clinical round up

Herbert, S; Haddow, L; (2016) Clinical round up. Sexually Transmitted Infections , 92 (5) p. 402. 10.1136/sextrans-2016-052654 . Green open access

http://ift.tt/2FHLSGc

On the Accuracy and Scalability of Probabilistic Data Linkage over the Brazilian 114 Million Cohort

Pita, RD; Pinto, C; Sena, S; Fiaccone, R; Amorim, L; Reis, S; Barreto, M; ... Barreto, ME; + view all Pita, RD; Pinto, C; Sena, S; Fiaccone, R; Amorim, L; Reis, S; Barreto, M; Denaxas, S; Barreto, ME; - view fewer (2018) On the Accuracy and Scalability of Probabilistic Data Linkage over the Brazilian 114 Million Cohort. IEEE Journal of Biomedical and Health Informatics 10.1109/JBHI.2018.2796941 . (In press). Green open access

http://ift.tt/2t5ALEa

Calling for help: the role of telephone helplines in child protection

Statham, J; Carlisle, J; (2004) Calling for help: the role of telephone helplines in child protection. Thomas Coram Research Unit, UCL Institute of Education: London, UK. Green open access

http://ift.tt/2FHLCac

Phase 1-3 of the cross-cultural development of an EORTC questionnaire for the assessment of sexual health in cancer patients: The EORTC SHQ-22

Oberguggenberger, AS; Nagele, E; Inwald, EC; Tomaszewski, K; Lanceley, A; Nordin, A; Creutzberg, CL; ... Greimel, E; + view all Oberguggenberger, AS; Nagele, E; Inwald, EC; Tomaszewski, K; Lanceley, A; Nordin, A; Creutzberg, CL; Kuljanic, K; Kardamakis, D; Schmalz, C; Arraras, J; Costantini, A; Almont, T; Wei-Chu, C; Dehandschutter, S; Winters, Z; Greimel, E; - view fewer (2018) Phase 1-3 of the cross-cultural development of an EORTC questionnaire for the assessment of sexual health in cancer patients: The EORTC SHQ-22. Cancer Medicine 10.1002/cam4.1338 . (In press). Green open access

http://ift.tt/2taDL2k

Clinical round-up

Haddow, LJ; Herbert, S; (2016) Clinical round-up. Sexually Transmitted Infections , 92 (2) p. 168. 10.1136/sextrans-2015-052366 . Green open access

http://ift.tt/2FIOx2j

How distributed processing produces false negatives in voxel-based lesion-deficit analyses

Gajardo-Vidal, A; Lorca-Puls, DL; Crinion, JT; White, J; Seghier, ML; Leff, A; Hope, TMH; ... Price, CJ; + view all Gajardo-Vidal, A; Lorca-Puls, DL; Crinion, JT; White, J; Seghier, ML; Leff, A; Hope, TMH; Ludersdorfer, P; Green, DW; Bowman, H; Price, CJ; - view fewer (2018) How distributed processing produces false negatives in voxel-based lesion-deficit analyses. Neuropsychologia (In press).

http://ift.tt/2taDmgk

Overexpression of BLM promotes DNA damage and increased sensitivity to platinum salts in triple negative breast and serous ovarian cancers

Birkbak, NJ; Li, Y; Pathania, S; Greene-Colozzi, A; Dreze, M; Bowman-Colin, C; Sztupinszki, Z; ... Richardson, AL; + view all Birkbak, NJ; Li, Y; Pathania, S; Greene-Colozzi, A; Dreze, M; Bowman-Colin, C; Sztupinszki, Z; Krzystanek, M; Diossy, M; Tung, N; Ryan, PD; Garber, JE; Silver, DP; Iglehart, JD; Wang, ZC; Szuts, D; Szallasi, Z; Richardson, AL; - view fewer (2018) Overexpression of BLM promotes DNA damage and increased sensitivity to platinum salts in triple negative breast and serous ovarian cancers. Annals of Oncology , Article mdy049. 10.1093/annonc/mdy049 . (In press). Green open access

http://ift.tt/2FI9YAv

Socioeconomic, religious, spiritual and health factors associated with symptoms of common mental disorders: a cross-sectional secondary analysis of data from Bhutan's Gross National Happiness Study, 2015

Sithey, G; Li, M; Wen, LM; Kelly, PJ; Clarke, K; (2018) Socioeconomic, religious, spiritual and health factors associated with symptoms of common mental disorders: a cross-sectional secondary analysis of data from Bhutan's Gross National Happiness Study, 2015. BMJ Open , 8 (2) , Article e018202. 10.1136/bmjopen-2017-018202 . Green open access

http://ift.tt/2F3G5JR

Corrigendum to “Assessment of 105 Patients with Angiotensin Converting Enzyme-Inhibitor Induced Angioedema”

http://ift.tt/2t4EHVP

Early detection of hepatocellular carcinoma using autoantibody profiles from a panel of tumor-associated antigens

Abstract

Background

Multiple antigen miniarrays used for detecting autoantibodies to tumor-associated antigens (TAAs) can be a useful approach for cancer detection and diagnosis. We here address a very specific question: might there be autoimmune responses to TAAs which precede clinical detection of hepatocellular carcinoma (HCC) in HBV and HCV chronic liver disease patients under continuous medical surveillance, and if so, could these anti-TAAs be added to the armamentarium of diagnostic tests?

Methods

We here examine the utility of a panel of 12 TAAs for the diagnosis of hepatocellular carcinoma (HCC). We derived a predictive rule for the presence of HCC based on the panel, from a cohort comprising 160 HCC patients and 90 normals. We then applied this rule to sequential anti-TAA data from a cohort of 17 HCC patients, from whom this information was available prior to diagnosis.

Results

The predictors (autoantibodies to HCC1, P16, P53, P90, and survivin) indicated the presence of HCC prior to diagnosis in 16 of the 17 patients, at a median lead time of 0.75 year.

Conclusions

We believe these findings warrant further study of anti-TAA profiles as biomarkers for primary or early diagnosis of HCC.

http://ift.tt/2HUFEn3

Wright Medical Technology Metal-on-Metal 522 Post-Market Surveillance Study

Conditions:   Osteoarthritis, Hip;   Hip Disease;   Hip Osteoarthritis;   Joint Pain
Intervention:   Device: Wright Medical Technology Metal-on-Metal Total Hip System
Sponsor:   MicroPort Orthopedics Inc.
Not yet recruiting

http://ift.tt/2oFMXpO

Durvalumab Plus Tremelimumab Combined With Proton Therapy for HNSCC

Condition:   Head and Neck Squamous Cell Carcinoma
Intervention:   Drug: Durvalumab Plus Tremelimumab
Sponsor:   Samsung Medical Center
Not yet recruiting

http://ift.tt/2HWQ3hR

Outcomes of A Novel Treatment Decision of Patients With Esophageal and Head and Neck Carcinoma Synchronously

Conditions:   Head and Neck Cancer;   Esophageal Cancer Stage
Intervention:  
Sponsor:   Yanqing Li
Not yet recruiting

http://ift.tt/2oHLTSe

Stellate Ganglion Block in Beating Heart Surgery

Condition:   Cardiac Arrythmias
Intervention:   Drug: stellate ganglion block
Sponsor:   Assiut University
Not yet recruiting

http://ift.tt/2HUKeS5

Centralising specialist cancer surgery services in England: survey of factors that matter to patients and carers and health professionals

Melnychuk, M; Vindrola, C; Aitchison, M; CLARKE, C; Fulop, N; Levermore, C; Madinneni, S; ... Morris, S; + view all Melnychuk, M; Vindrola, C; Aitchison, M; CLARKE, C; Fulop, N; Levermore, C; Madinneni, S; Moore, C; Mughal, M; Perry, C; Pritchard-Jones, K; Ramsay, A; Shackley, D; Vickers, J; Morris, S; - view fewer (2018) Centralising specialist cancer surgery services in England: survey of factors that matter to patients and carers and health professionals. BMC Cancer , 18 , Article 226. 10.1186/s12885-018-4137-8 . Green open access

http://ift.tt/2F68sY5

Ezh2 and Runx1 Mutations Collaborate to Initiate Lympho-Myeloid Leukemia in Early Thymic Progenitors

Booth, CAG; Barkas, N; Neo, WH; Boukarabila, H; Soilleux, EJ; Giotopoulos, G; Farnoud, N; ... Mead, AJ; + view all Booth, CAG; Barkas, N; Neo, WH; Boukarabila, H; Soilleux, EJ; Giotopoulos, G; Farnoud, N; Giustacchini, A; Ashley, N; Carrelha, J; Jamieson, L; Atkinson, D; Bouriez-Jones, T; Prinjha, RK; Milne, TA; Teachey, DT; Papaemmanuil, E; Huntly, BJP; Jacobsen, SEW; Mead, AJ; - view fewer (2018) Ezh2 and Runx1 Mutations Collaborate to Initiate Lympho-Myeloid Leukemia in Early Thymic Progenitors. Cancer Cell , 33 (2) 274-291.e8. 10.1016/j.ccell.2018.01.006 .

http://ift.tt/2FGlufM