British Journal of Dermatology, EarlyView.
https://ift.tt/2yIIjQ0
Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Τρίτη 26 Ιουνίου 2018
Multispectral ex vivo photoacoustic imaging of cutaneous melanoma for better selection of the excision margin
Effective anti‐programmed death‐1 therapy in a SUFU‐mutated patient with Gorlin–Goltz syndrome
British Journal of Dermatology, EarlyView.
https://ift.tt/2lAXFgc
Efficacy of oral sirolimus as salvage therapy in refractory lichen planus associated with immune deficiency
British Journal of Dermatology, EarlyView.
https://ift.tt/2yLPAyH
IgE and D‐dimer baseline levels are higher in responders than nonresponders to omalizumab in chronic spontaneous urticaria
British Journal of Dermatology, EarlyView.
https://ift.tt/2lAXC40
Canadian Physician Survey on the Medical Management of Hereditary Angioedema
Publication date: Available online 26 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Lisa Fu, Amin Kanani, Gina Lacuesta, Susan Waserman, Stephen Betsche
BackgroundHereditary angioedema (HAE) is a rare disease that has significant morbidity and may be potentially fatal due to airway obstruction. Our study aimed to determine how Canadian physicians diagnose and treat HAE.ObjectiveTo determine practice patterns in physicians treating HAE.MethodsA survey was designed to determine HAE practice patterns amongst Canadian physicians. These physicians were identified by sending the survey to members of three physician organizations (Canadian Hereditary Angioedema Network, Canadian Society of Clinical Immunology and Allergy, Canadian Hematology Society).ResultsThirty-six physicians responded to the survey. Thirty-four physicians were included in the analysis. The majority of referrals to HAE treating physicians were from family and emergency room physicians. The most common sites of swelling reported by patients to physicians were facial, peripheral and abdominal. A mean of 53.9% of HAE-Type 1 and II patients and 53.4% of HAEnC1INH patients were on long term prophylaxis. A mean of 41.9%, 19.4% and 93.5% of respondents had some patients on danazol, tranexamic acid and C1-inhibitor respectively. The majority of physicians felt severity and frequency of attacks were the most important determinants in deciding when to use prophylaxis. A mean of 88.2% of physicians used C1-inhibitor to treat acute attacks and 79.4% used icatibant. All respondents were aware of HAE guidelines.ConclusionPhysicians are using guidelines to support their practice, and using agents suggested by guidelines with confidence. C1-inhibitor is being used widely for prophylaxis, as well as acute treatment of attacks along with icatibant. However certain special patient populations may require additional focus in future guidelines.
https://ift.tt/2lDAamN
Understanding Caregiver Goals, Benefits, and Acceptable Risks of Peanut Allergy Therapies
Source:Annals of Allergy, Asthma & Immunology
Author(s): Matthew Greenhawt, Rebekah Marsh, Hannah Gilbert, Scott Sicherer, Audrey DunnGalvin, Dan Matlock
https://ift.tt/2tHAt3n
A retrospective study of lichen planus pigmentosus with focus on palmoplantar involvement
Clinical and Experimental Dermatology, EarlyView.
https://ift.tt/2tFHzFG
Does transcutaneous electrical nerve stimulation have an antipruritic effect in lichen planus? A randomized clinical trial
Clinical and Experimental Dermatology, EarlyView.
https://ift.tt/2lFZn01
A young man with necrotic skin lesions
Clinical and Experimental Dermatology, EarlyView.
https://ift.tt/2yLCv8w
Erratum: Der Kontexteffekt bei der Spracherkennung von Sätzen
Laryngo-Rhino-Otol
DOI: 10.1055/a-0642-3621
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
https://ift.tt/2KnpUtC
Point of Care 2.0: Gerinnungsdiagnostik mit ROTEM® sigma und TEG® 6s
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 412-424
DOI: 10.1055/s-0043-107755
TEG® 6s und ROTEM® sigma sind die neueste Generation von 2 häufig perioperativ eingesetzten Point-of-Care-Methoden zur Gerinnungsdiagnostik. Sie basieren auf Systemen zur automatischen Probenvorbereitung und -analyse mit Einweg-Testkassetten – personal- und zeitintensives Pipettieren entfällt größtenteils. Dieser Beitrag beschreibt die Testprinzipien und diskutiert Vor- und Nachteile bei der Integration der Methoden in den klinischen Alltag.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2tuYUlE
Akutes Nierenversagen ist vermeidbar
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 406-407
DOI: 10.1055/a-0633-7284
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
https://ift.tt/2KnhP88
Pflegemangel in Intensivmedizin führt zu Versorgungsengpässen
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 405-405
DOI: 10.1055/a-0597-4562
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
https://ift.tt/2N3nu56
Notfall-Traumatologie: Endexspiratorischer CO2-Wert ist prädiktiv für Überleben
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 406-406
DOI: 10.1055/a-0633-7339
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
https://ift.tt/2Iv5o8w
Point-of-Care-Diagnostik in der Traumatologie – Methoden und Evidenz
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 440-457
DOI: 10.1055/s-0043-107753
Jeder 4. Schwerverletzte weist bereits bei Krankenhausaufnahme eine traumainduzierte Koagulopathie (TIK) auf, die mit einer 4-fach erhöhten Mortalität einhergeht. Rasche und zielgenaue Behandlung kann die TIK-assoziierte Sterblichkeit senken. Point-of-Care-Tests ermöglichen im Vergleich mit herkömmlichen Labormethoden eine zeitnahe und umfassende Bestimmung des Gerinnungsstatus sowie eine zielgerichtete Therapie.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2tuUGdK
Abfall des endexspiratorischen CO2-Partialdrucks kann auf Anaphylaxie hinweisen
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 407-408
DOI: 10.1055/a-0633-7322
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
https://ift.tt/2Itz71P
Point-of-Care-Gerinnungsdiagnostik: neue Methoden, neue Indikationen, neue Studienlage
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 410-411
DOI: 10.1055/a-0597-4581
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
https://ift.tt/2N01h89
Interskalenäre Plexusblockade vs. Supraskapularisblockade in der Schulterchirurgie
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 408-408
DOI: 10.1055/a-0633-7210
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
https://ift.tt/2IyHyZO
Point-of-Care-Gerinnungsdiagnostik in der Neurochirurgie
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 425-439
DOI: 10.1055/s-0043-107754
Gerinnungsstörungen können für neurochirurgische Patienten gravierende Auswirkungen auf den Krankheitsverlauf und das Outcome haben: Blutungskomplikationen können zu intrakraniellem Druckanstieg und Schädigung des Gehirns führen. Somit hat die Gerinnungsdiagnostik und ggf. -therapie hier einen hohen Stellenwert. Dieser Beitrag beleuchtet die Anwendung moderner Point-of-Care-Verfahren zur Gerinnungsdiagnostik bei neurochirurgischen Patienten.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2tuUrzm
Intranasales Ketamin wirksam bei Kindern mit frischen Frakturen
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 408-409
DOI: 10.1055/a-0633-7255
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
https://ift.tt/2IueLVS
Der sichere Gefäßzugang – britisch-irische Leitlinie 2016
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 458-465
DOI: 10.1055/s-0043-104546
Die Etablierung von Gefäßzugängen ist bei der Krankenversorgung die häufigste invasive Prozedur. Sie kann bei unsachgemäßer Durchführung äußerst traumatisierend für die Patientinnen und Patienten sein. Die neue Leitlinie der britisch-irischen Gesellschaft für Anästhesiologie wurde 2016 erstellt, da trotz existierender Handlungsempfehlungen immer noch schwere Komplikationen mit negativem Einfluss auf Morbidität und Mortalität auftreten.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2tuUlYw
Die Rolle der Ernährung beim herzchirurgischen Patienten – eine Übersicht
Anästhesiol Intensivmed Notfallmed Schmerzther 2018; 53: 466-479
DOI: 10.1055/s-0043-121440
Der präoperative Ernährungsstatus und die perioperative Ernährungsstrategie spielen eine wichtige Rolle für das Outcome herzchirurgischer Patienten – dennoch gibt es nur wenige Studien zu Ernährungskonzepten für diese Patientengruppe. In diesem Beitrag werden die Ursachen der Mangelernährung, der Einfluss der Ernährungstherapie auf den herzchirurgischen Patienten und Strategien zur Verbesserung der Ernährung beschrieben.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
https://ift.tt/2KpN3eM
Canadian Physician Survey on the Medical Management of Hereditary Angioedema
Hereditary angioedema (HAE) is a rare disease that has significant morbidity and may be potentially fatal due to airway obstruction. Our study aimed to determine how Canadian physicians diagnose and treat HAE.
https://ift.tt/2KrGR6l
Suicidal jumper’s fracture – sacral fractures and spinopelvic instability: a case series
Sacral fractures with spinopelvic dissociation are rare, and hard to diagnose and treat. Fractures with a H- or U-shaped line are severely unstable, due to a dissociation of the spine and of the upper body of ...
https://ift.tt/2KrAe3X
Intracranial meningeal melanocytoma diagnosed using an interdisciplinary approach: a case report and review of the literature
Meningeal melanocytoma is a rare pigmented tumor arising from leptomeningeal melanocytes. Patients with this tumor might initially consult a dentist because a mass lesion in Meckel's cave could manifest as den...
https://ift.tt/2tuR0Zw
Intrathoracic pressure regulation therapy applied to ventilated patients for treatment of compromised cerebral perfusion from brain injury
Reducing intrathoracic pressure in the setting of compromised cerebral perfusion due to acute brain injury has been associated with reduced intracranial pressure and enhanced cerebral perfusion pressure and bl...
https://ift.tt/2KoxvYQ
Migratory polyarthritis as a paraneoplastic syndrome in a patient with diffuse large B cell lymphoma: a case report
Diffuse large B cell lymphoma is the commonest histological subtype of non-Hodgkin lymphoma and typically presents as a rapidly enlarging lymph node mass and B symptoms. It is unusual for diffuse large B cell ...
https://ift.tt/2K9mpLf
The JAK1/JAK2‐ inhibitor ruxolitinib inhibits mast cell degranulation and cytokine release
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2lBgWOH
Utility of recombinant Aspergillus fumigatus antigens in the diagnosis of allergic bronchopulmonary aspergillosis: a systematic review and diagnostic test accuracy meta‐analysis
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tGTFP0
Animal models of allergen‐specific immunotherapy in food allergy: Overview and opportunities
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2lD99zT
Greater Severity of Peanut Challenge Reactions Using a High fat versus Low Fat Matrix Vehicle
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yNEvNA
Innate immune response reflects disease activity in eosinophilic granulomatosis with polyangiitis
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2lzZTfL
Nasal Cytology: Methodology with application to clinical practice and research
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tHkaUi
A subset of walnut allergic adults is sensitized to walnut 11S globulin Jug r 4
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yI6uy0
The enigmatic role of the neutrophil in asthma: friend, foe or indifferent?
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2lzZOst
NLRP3 inflammasome: a likely target for the treatment of allergic diseases
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yNJRZe
Diagnosis of concomitant inducible laryngeal obstruction and asthma
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2lD8U7X
Vaccines and atopic/allergic children: a survey among private pediatricians
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yNJFcs
Plasma Metabolite Profiles in Children with Current Asthma
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2lD8OgB
Helicobacter pylori infection reduces the risk of Barrett's esophagus: A meta‐analysis and systematic review
Helicobacter, EarlyView.
https://ift.tt/2tFYdVB
Family‐based study reveals decreased abundance of sputum Granulicatella in asthmatics
Allergy, EarlyView.
https://ift.tt/2N0R4YV
Association of mast cells with clinical, endoscopic, and histologic findings in adults with eosinophilic esophagitis
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tFOIFX
A marked shift in innate and adaptive immune response in chinese immigrants living in a western environment
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tx7dx4
Mucosal Zinc Deficiency in Chronic Rhinosinusitis with Nasal Polyposis Contributes to Barrier Disruption and Decreases ZO‐1
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tIgCBa
Adult farming exposure does not protect against sensitization to the storage mite Lepidoglyphus destructor (Lep d)
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2txgkho
RAGE‐dependent VCAM‐1 expression in the lung endothelium mediates IL‐33 induced allergic airway inflammation
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yNCmS2
Reply to Allergen‐Specific IgG Responses Preceding Allergic Sensitization
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tvUlr6
Intranasal administration of probiotic Lactobacillus rhamnosus GG prevents birch pollen‐induced allergic asthma in a murine model
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tGNVEZ
17q21 variant increases the risk of exacerbations in asthmatic children despite inhaled corticosteroids use
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2txSP7Y
Glucocorticoid‐induced eosinopenia in humans can be linked to early transcriptional events
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yNHZja
Major hazelnut and peanut allergens are potent in basophil activation and cross‐react at T cell level
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2N0yf8h
Precision medicine in united airways disease: a “treatable traits” approach
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yLbKRF
Updosing of bilastine is effective in moderate to severe chronic spontaneous urticaria: a real life study
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tyoGFn
Probiotics for the Airways: potential to improve epithelial and immune homeostasis
Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tGS9wi
Poromas with large lumens histopathologically mimicking syringocystadenoma papilliferum: Report of three cases
Australasian Journal of Dermatology, EarlyView.
https://ift.tt/2tFSZJt
Fire in the theatre: A cautionary tale
Australasian Journal of Dermatology, EarlyView.
https://ift.tt/2lDsSiU
Hospital‐based phototherapy: What is the cost to our patients?
Australasian Journal of Dermatology, EarlyView.
https://ift.tt/2yL6ldl
Protective effect of skin‐derived precursors on photoaging in nude mice
Australasian Journal of Dermatology, EarlyView.
https://ift.tt/2lCV8Co
Fragrance exposure in the UK: has there been a change in the last decade?
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yNzhkY
Relationship and probabilistic stratification of EASI and oSCORAD severity scores for atopic dermatitis
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2lytGpg
Therapeutic equivalence of two formulations of calcipotriol‐betamethasone ointment: a multi‐centre, randomized, double‐blind study in adult patients with chronic plaque psoriasis
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tNeoAP
Identification of a recurrent mutation in ATP2C1 demonstrates that papular acantholytic dyskeratosis and Hailey‐Hailey disease are allelic disorders
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2lB8oqP
A case of disseminated follicular spicules in HIV‐associated follicular syndrome in the absence of the seven known human polyomaviruses, suggesting that this disorder is distinct from trichodysplasia spinulosa
British Journal of Dermatology, EarlyView.
https://ift.tt/2tHJ5Hg
Standardized reporting of the Eczema Area and Severity Index (EASI) and the Patient‐Oriented Eczema Measure (POEM): a recommendation by the Harmonising Outcome Measures for Eczema (HOME) Initiative
British Journal of Dermatology, EarlyView.
https://ift.tt/2lAnAVd
Expression profile of the amino acid transporters SLC7A5, SLC7A7, SLC7A8 and the enzyme TDO2 in basal cell carcinoma
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yNeFJI
Short‐term exposure of human sebocytes to 13‐cis retinoic acid induces acnegenic changes
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2lAq9qo
Validation of a short form FLQA‐LS quality of life instrument for lymphedema
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2lBbGdV
Epidermolysis bullosa simplex generalized severe induces a Th17 response and is improved by Apremilast treatment
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yKlxau
Vesicular variant of Dowling‐Degos disease
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2lCoCQP
Prospective evaluation of frequency of genital lichen sclerosus in 79 patients with systemic sclerosis
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yNedv0
Merkel Cell Polyomavirus is uncommon in New Zealand Merkel Cell Carcinomas
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2lzTCRf
Omalizumab in chronic spontaneous urticaria patients nonresponsive to H1‐antihistamine treatment: Results of the phase IV open‐label SUNRISE study
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yNyArS
Needs and preferences of patients regarding basal cell carcinoma and cutaneous squamous cell carcinoma care: a qualitative focus group study
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yNyfFC
Hydroxyurea and Acitretin as a novel combination therapy in severe plaque psoriasis
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2lCoC3h
Secukinumab in pregnancy: outcomes in psoriasis, psoriatic arthritis and ankylosing spondylitis from the global safety database
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tIhTbt
Autosomal dominant progressive hyperpigmentation and lentigines in a Japanese pedigree due to a missense mutation near the C‐terminus of KIT
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2lA4KgV
Keratinocytes derived from late‐onset psoriasis skin do not impair Langerhans cell migration
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yNugsC
The new 8th edition of TNM staging and its implications for skin cancer: a review by the British Association of Dermatologists and the Royal College of Pathologists, United Kingdom
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2lA4Epz
ESTIMation of the ABiLity of Prophylactic Central Compartment Neck Dissection to Modify Outcomes in Low-risk Differentiated Thyroid Cancer
Condition: Thyroid Cancer
Interventions: Procedure: total thyroidectomy with bilateral prophylactic central compartment (level VI) neck dissection; Procedure: total thyroidectomy alone without neck dissection
Sponsor: Gustave Roussy, Cancer Campus, Grand Paris
Not yet recruiting
https://ift.tt/2MrfdH6
Interventions: Procedure: total thyroidectomy with bilateral prophylactic central compartment (level VI) neck dissection; Procedure: total thyroidectomy alone without neck dissection
Sponsor: Gustave Roussy, Cancer Campus, Grand Paris
Not yet recruiting
https://ift.tt/2MrfdH6
Effectiveness and Safety of Nivolumab in Participants That Have Head and Neck Cancer That Has Come Back or Has Spread.
Conditions: Cancer of Head and Neck; Cancer of the Head; Cancer of the Neck
Intervention: Other: Non-Interventional
Sponsors: Bristol-Myers Squibb; Ono Pharma USA Inc
Recruiting
https://ift.tt/2K882qq
Intervention: Other: Non-Interventional
Sponsors: Bristol-Myers Squibb; Ono Pharma USA Inc
Recruiting
https://ift.tt/2K882qq
Integrative Care and Acupuncture in MOHS Surgery
Condition: Quality of Life
Intervention: Other: Integrative medicine care
Sponsor: Carmel Medical Center
Not yet recruiting
https://ift.tt/2IykR7M
Intervention: Other: Integrative medicine care
Sponsor: Carmel Medical Center
Not yet recruiting
https://ift.tt/2IykR7M
Radiation-associated Carotid Artery Disease in Patients With Nasopharyngeal Carcinoma
Conditions: Nasopharyngeal Carcinoma; Carotid Artery Diseases
Interventions: Diagnostic Test: Measurement of intima media thickness of carotid artery; Diagnostic Test: Detection and measurement of carotid plaques; Diagnostic Test: Carotid Color Flow Duplex Testing; Diagnostic Test: Montreal Cognitive Assessment; Other: Medical history of cardiovascular risk factors and cardiovascular diseases
Sponsor: Fudan University
Not yet recruiting
https://ift.tt/2Kkto3l
Interventions: Diagnostic Test: Measurement of intima media thickness of carotid artery; Diagnostic Test: Detection and measurement of carotid plaques; Diagnostic Test: Carotid Color Flow Duplex Testing; Diagnostic Test: Montreal Cognitive Assessment; Other: Medical history of cardiovascular risk factors and cardiovascular diseases
Sponsor: Fudan University
Not yet recruiting
https://ift.tt/2Kkto3l
Effect of Benralizumab in Atopic Dermatitis
Conditions: Dermatitis, Atopic; Dermatitis; Eczema; Skin Diseases; Skin Diseases, Genetic; Genetic Diseases, Inborn; Skin Diseases, Eczematous; Hypersensitivity; Hypersensitivity, Immediate; Immune System Diseases
Interventions: Drug: Benralizumab; Drug: Placebo Control
Sponsors: McMaster University; AstraZeneca
Not yet recruiting
https://ift.tt/2MtALTB
Interventions: Drug: Benralizumab; Drug: Placebo Control
Sponsors: McMaster University; AstraZeneca
Not yet recruiting
https://ift.tt/2MtALTB
The history of dermatology helps to understand debates of today
Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 7, Page 1053-1053, July 2018.
https://ift.tt/2N3zxz9
Issue Information
Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 7, Page 1047-1052, July 2018.
https://ift.tt/2tFJzO7
Reflectance confocal microscopy: a crucial role for actinic keratosis treatment monitoring
Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 7, Page 1055-1055, July 2018.
https://ift.tt/2N2XRkU
Pioneers in dermatology and venereology: an interview with Prof. Otto Braun‐Falco
Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 7, Page 1056-1058, July 2018.
https://ift.tt/2tFJkmb
Biosimilars
Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 7, Page 1054-1054, July 2018.
https://ift.tt/2tx99ps
Forthcoming Events
Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 7, Page 1222-1222, July 2018.
https://ift.tt/2tFJcTJ
Announcement
Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 7, Page 1223-1223, July 2018.
https://ift.tt/2tx91pY
Patient expectations and determinants of patient satisfaction in a dermatology outpatient clinic
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tN8UWL
The self‐assessed psychological comorbidities of prurigo in European patients: A multi‐centre study in 13 countries
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2txKeSF
Facial Dermatitis: Epidemiological Retrospective Study and Patch Test
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yKpRqb
Should we be testing for urogenital Mycoplasma hominis, Ureaplasma parvum and U. urealyticum in men and women? – a Position Statement from the European STI Guidelines Editorial Board
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2twVKxw
Autoantibody profile and clinical patterns in 619 Italian patients with cutaneous lupus erythematosus
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yKpxaX
Evaluation of large clinically atypical vulvar pigmentation with RCM: atypical melanosis or early melanoma?
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2N2ldqY
Allergic contact reaction to antiseptics in very young children
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yLuuAr
Physician‐Patient Communication and Patient‐Reported Outcomes in the Actinic Keratosis TReatment‐Adherence INitiative (AK‐TRAIN): A Multicenter, Prospective, Real‐Life study of Treatment Satisfaction, Quality of Life and Adherence to topical field‐directed therapy for the treatment of Actinic Keratosis in Italy
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2N4dvfE
Chronic subcutaneous infection due to Lichtheimia ramosa
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tN86Bd
Elderly psoriatic patients under biological therapies: an Italian experience
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tsHwhh
Evolution of pigmented Spitz nevi with starburst pattern during childhood
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tFaeLe
In Situ Nail Unit Melanoma: epidemiological and clinic‐pathologic features with conservative treatment and long term follow up
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tw3PlZ
Evaluation of Antimicrobial Textiles for Atopic Dermatitis
Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tCxPMg
Barriers to improving tracheostomy care in low‐ and middle‐income countries: Our experience of a 23 patient closed loop audit cycle
Clinical Otolaryngology, EarlyView.
https://ift.tt/2lB9jrx
How to improve the endoscopic view of the hypopharynx: Validation of our novel modified Killian's Method to expose the hypopharynx in 20 subjects
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tFakCA
Anatomical Variants Of The Paranasal Sinuses In Patients With Mid‐facial Segment Pain: Our Experience Of A Cohort Of Twenty‐Three Patients
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2lzMZ1l
Healing criteria: how should be defined an episode of benign paroxistic positional vertigo of posterior semicircular canal′s resolution? Prospective observational study
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tCxUj2
Outpatient Management and Surgeon Specialty for Thyroglossal Duct Cyst Excision: A Retrospective Analysis of 377 Patients and 30‐Day Outcomes in the American College of Surgeons NSQIP‐P Database
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2lAUt48
Pre‐treatment CD8+ tumor‐infiltrating lymphocyte density predicts distant metastasis after definitive treatment in patients with stage III/IV hypopharyngeal squamous cell carcinoma
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tHHeSO
Modeling the dependence of the distortion product otoacoustic emission response on primary frequency ratio
Abstract
When measured as a function of primary frequency ratio r = f2/f1, using a constant f2, distortion product otoacoustic emission (DPOAE) response demonstrates a bandpass shape, previously interpreted as the evidence for a cochlear "second filter." In this study, an alternate, interference-based explanation, previously advanced in variants, is forwarded on the basis of experimental data along with numerical and analytical solutions of nonlinear and linear cochlear models. The decrease of the DPOAE response with increasing and decreasing ratios is explained by a diminishing "overlap" generation region and the onset of negative interference among wavelets of different phase, respectively. In this paper, the additional quantitative hypothesis is made that negative interference becomes the dominant effect when the spatial width of the generation (overlap) region exceeds half a wavelength of the DPOAE wavelets. Therefore, r is predicted to be optimal when this condition is matched. Additionally, the minimum on the low-ratio side of the DPOAE curve is predicted to occur as the overlap region width equals one wavelength. As the width of the overlap region depends on both tuning and ratio, while wavelength depends on tuning only, an experimental method for estimating tuning from either the width of the pass band or the optimal ratio of the DPOAE vs. ratio curve has been theoretically formulated and evaluated using numerical simulations. A linear model without the possibility of nonlinear suppression is shown to reasonably approximate data from human subjects at low ratios reinforcing the relevance of the proposed negative interference effect. The different dependence of the distortion and reflection DPOAE components on r as well as the nonmonotonic behavior of the distortion component observed at very low ratios are also in agreement with this interpretation.
https://ift.tt/2ItXXhU
Kelch-like protein 14 promotes B-1a but suppresses B-1b cell development
Abstract
B-1 cells are innate-like B-cell population and produce natural antibodies that contribute to the first line of host defense. There are two subsets of B-1 cells: B-1a and B-1b. B-1a cells are the main producer of poly-reactive and autoreactive natural IgM antibodies, whereas B-1b cells can respond specifically to T-cell-independent antigens. Despite the functional significance of B-1a and B-1b cells, little information is available about what regulates the development of these two subsets. We found that Kelch-like protein 14 (KLHL14) was expressed at high levels in B cells but only at low levels in a few non-lymphoid tissues. Although mice lacking KLHL14 died right after birth, the heterozygotes developed normally with no gross abnormalities by appearance. B-cell development in the bone marrow and maturation and activation in the spleen were not affected in the heterozygous mice. However, the number of peritoneal B-1a cells was significantly reduced while B-1b cells were increased in Klhl14 heterozygous mice compared with wild-type (WT) mice. Consistently, Rag1−/− mice reconstituted with Klhl14−/− fetal liver cells had a more severe reduction of B-1a and an increase of B-1b cells in the peritoneal cavity. KLHL14 did not affect the turnover or apoptosis of B-1a and B-1b cells in vivo. Moreover, Klhl14−/− fetal liver contained a similar proportion and absolute numbers of the B-1 progenitor cells as did WT fetal liver. These results suggest that KLHL14 promotes B-1a development in mice.https://ift.tt/2yNpGL2
Onychomycosis in children: Safety and efficacy of antifungal agents
Pediatric Dermatology, EarlyView.
https://ift.tt/2Msj72u
Cutaneous manifestations in Egyptian children with beta‐thalassemia major: Relationship with serum ferritin, thyroid profile, and treatment modalities
Pediatric Dermatology, EarlyView.
https://ift.tt/2Kp5xiR
Bier anaemic spots, cyanosis with urticaria‐like eruption (BASCULE) syndrome on trunk and upper limbs
Pediatric Dermatology, EarlyView.
https://ift.tt/2Moh3sk
Multiple Spitz nevi after allogeneic hematopoietic stem cell transplantation
Pediatric Dermatology, EarlyView.
https://ift.tt/2Kp5tQ9
Usefulness of high‐frequency ultrasonography in the assessment of cutaneous lesions in children with hematologic malignancies
Pediatric Dermatology, EarlyView.
https://ift.tt/2MsiK86
Methotrexate for severe nummular eczema in children: Efficacy and tolerability in a retrospective study of 28 patients
Pediatric Dermatology, EarlyView.
https://ift.tt/2K8D95n
Pediatric “pet consort dermatitis”—Allergic contact dermatitis from transfer of bronopol from a pet cat
Pediatric Dermatology, EarlyView.
https://ift.tt/2IvBUHH
The human IL‐17A/F heterodimer regulates psoriasis‐associated genes through IκBζ
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yJMefv
Measurement of the Biomechanical Function and Structure of Ex Vivo Drying Skin Using Raman Spectral Analysis and its Modulation with Emollient Mixtures
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tuwqZg
Mild electrical stimulation with heat shock reduces the inflammatory symptoms in imiquimod‐induced psoriasis mouse model
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yHPxDS
Topical silver and gold nanoparticles complexed with Cornus Mas suppress inflammation in human plaques psoriasis by inhibiting NF‐κB activity
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2N0Z6RG
Gromwell (Lithospermum erythrorhizon) root extract protects against glycation and related inflammatory and oxidative stress while offering UV absorption capability
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yNmOxK
Possible Roles of Basophils in Chronic Itch
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tx5O9U
The role of skin barrier in occupational contact dermatitis
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yNp8om
Increased expression of IL‐33 in rosacea skin and UVB‐irradiated and LL‐37‐treated HaCaT cells
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tzC4sQ
Control of cell death‐associated danger signals during cornification prevents autoinflammation of the skin
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tGZ6gz
Molecular pathogenesis of cutaneous lymphomas
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2N3wIOz
Toll‐like receptor 4 attenuates a murine model of atopic dermatitis through inhibition of langerin‐positive DCs migration
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yJLRBD
Effects of a ceramide containing water‐in‐oil ointment on skin barrier function and allergen penetration in an IL‐31 treated 3D model of the disrupted skin barrier
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tvRPRE
Generalized pustular psoriasis – A model disease for specific targeted immunotherapy, systematic review
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tCvdhq
Protein kinases involved in epidermal barrier formation: The AKT family and other animals
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2tzBY4s
Analysis of Gene Expression Profiles of Multiple Skin Diseases Identifies a Conserved Signature of Disrupted Homeostasis
Experimental Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2yLpTyb
Topical proline therapy in prolidase deficiency
Clinical and Experimental Dermatology, EarlyView.
https://ift.tt/2tuw30O
Implication of Highly Cytotoxic Natural Killer Cells for Esophageal Squamous Cell Carcinoma Treatment
Esophageal squamous cell carcinoma (ESCC) is an aggressive upper gastrointestinal cancer and effective treatments are limited. Previous studies reported that natural killer (NK) cells expanded by coculturing with K562-mb15-41BBL feeder cells, a genetically modified K562 leukemia cell line that expresses membrane-bound interleukin (IL)-15 and 41BBL ligand, were highly proliferative and highly cytotoxic. Here, we investigated the potential of expanded NK cells for ESCC treatment. We analyzed both genetic and surface expression levels of NKG2D ligands (NKG2DLs) in ESCC using publicly available microarray data sets and ESCC cell lines. The cytotoxicity of resting and of IL-2-activated NK cells against ESCC cell lines was compared with that of expanded NK cells. We then also investigated the effect of epithelial mesenchymal transition (EMT) inducers, GSK3β inhibitor and epidermal growth factor, on NKG2DLs expressions. As a result, MICA and MICB were significantly overexpressed in ESCC compared with adjacent normal tissues and surface NKG2DLs were expressed in ESCC cell lines. Expanded NK cells were much potent than IL-2-activated and resting NK cells against ESCC cell lines. Blocking of NKG2D with anti-NKG2D monoclonal antibody dampened expanded NK cell cytotoxicity, suggesting that the NKG2DLs-NKG2D interaction is crucial for NK cells to eliminate ESCC cells. EMT inducers concurrently induced EMT and NKG2DLs expression in ESCC cell lines rendering transitioned cells more sensitive to expanded NK cells. In conclusion, expanded NK cells were highly cytotoxic against NKG2DLs-expressing ESCC cells, particularly the EMT phenotype. These results provide a strong rationale for clinical use of these NK cells in ESCC patients.https://ift.tt/2ty7Wy1
Evidence for Efficacy of Treatment With the Anti-PD-1 Mab Nivolumab in Radiation and Multichemorefractory Advanced Penile Squamous Cell Carcinoma
Penile squamous cell carcinoma (PeSCC) is a rare tumor and advanced PeSCC is associated with poor survival due to the aggressiveness of the disease and lack of effective systemic therapies. We describe for the first time a case with advanced chemoradiation refractory PeSCC who had documented response to active immunotherapy with the immune checkpoint inhibitor, anti-programmed death-1 monoclonal antibody Nivolumab. The patient suffered from a poor prognosis human papillomavirus-negative PeSCC, with a somatic inactivation mutation of cyclin-dependent kinase inhibitor 2A (CDKN2A) gene in tumor cells, and treatment with Nivolumab resulted in a partial response to therapy and significant tumor shrinkage. Histology transitions and alterations in tumor-infiltrating cytotoxic CD8+ T-cell lymphocytes, programmed death ligand-1 expression on tumor cells and immune cells in tumor lesion biopsies pretreatment and posttreatment with Nivolumab were observed and described. In conclusion, in patients with metastatic PeSCC active immunotherapy combinations with an anti-programmed death-1/programmed death ligand-1 agent may be beneficial and further relative clinical studies are required.https://ift.tt/2KorL1d
Adoptive Transfer of Interleukin-21-stimulated Human CD8+ T Memory Stem Cells Efficiently Inhibits Tumor Growth
Memory stem T (TSCM) cells, a new subset of memory T cells with self-renewal and multipotent capacities, are considered as a promising candidates for adoptive cellular therapy. However, the low proportion of human TSCM cells in total CD8+ T cells limits their utility. Here, we aimed to induce human CD8+ TSCM cells by stimulating naive precursors with interleukin-21 (IL-21). We found that IL-21 promoted the generation of TSCM cells, described as CD45RA+CD45RO−CD62L+CCR7+CD122+CD95+ cells, with a higher efficiency than that observed with other common γ-chain cytokines. Upon adoptive transfer into an A375 melanoma mouse model, these lymphocytes mediated much stronger antitumor responses. Further mechanistic analysis revealed that IL-21 activated the Janus kinase signal transducer and activator of transcription 3 pathway by upregulating signal transducer and activator of transcription 3 phosphorylation and consequently promoting the expression of T-bet and suppressor of cytokine signaling 1, but decreasing the expression of eomesodermin and GATA binding protein 3. Our findings provide novel insights into the generation of human CD8+ TSCM cells and reveal a novel potential clinical application of IL-21.https://ift.tt/2N1C4Kd
Characteristics and Predictive Value of PD-L1 Status in Real-World Non–Small Cell Lung Cancer Patients
Immunotherapy targeting the programmed cell death-1 (PD-1) and programmed cell death-ligand 1 (PD-L1) pathway has emerged as an effective treatment for lung cancer patients. It is important to evaluate the practicality of PD-L1 testing in real-world practice. A total of 211 non–small cell lung cancer patients were enrolled to detect 5 driver mutations and PD-L1 status (22C3 and SP263 assays) and to evaluate the characteristics of PD-L1 expression and its predictive value of immunotherapy. The PD-L1 positive (≥1%) and strong positive (≥50%) rate by SP263 assay was 27.0% and 12.8%. The concordance rates between 2 PD-L1 assays while using 1%, 10%, 25%, and 50% positive tumor cells as the cutoffs were 76.8%, 81.5%, 90.5%, and 94.3%, respectively. Smokers and patients without known actionable driver mutation were more likely to present strong positive PD-L1 [adjusted hazard ratio, 5.00 (95% confidence interval—CI, 1.60-15.64); P=0.006 and 3.59 (95% CI, 1.25-10.33); P=0.018, respectively]. Higher levels of smoking were associated with higher PD-L1 expressions. None of the EGFR, ALK, HER2, or BRAFV600E-mutant nonsmokers displayed strong positive PD-L1 expression by SP263 assay. Among patients undergoing PD-1 checkpoint inhibitors therapy, high PD-L1 expression by SP263 was associated with a longer progression-free survival [adjusted hazard ratio, 0.15 (95% CI, 0.03-0.71); P=0.017]. In conclusion, our results suggest that PD-L1 status remains an important predictor of immunotherapy efficacy. The concordance between 22C3 and SP263 assays was greater at a higher cutoff level of positivity. Patients without known actionable driver mutation, along with smokers, particularly those having high smoking pack-years, were more likely to have strong PD-L1 expression.https://ift.tt/2ItSMOQ
Evaluating for Pseudoprogression in Colorectal and Pancreatic Tumors Treated With Immunotherapy
Pseudoprogression has been observed in patients with various tumor types treated with immunotherapy. However, the frequency of pseudoprogression is unknown in gastrointestinal malignancies. Metastatic colorectal cancer (mCRC) and advanced pancreatic ductal adenocarcinoma (PDAC) patients who progressed on treatment with immunotherapy beyond RECIST version 1.1 criteria were analyzed. Degree of progression, tumor markers, time to progression, overall survival, Eastern Cooperative Oncology Group Performance Status (ECOG PS), and costs were analyzed for patients treated beyond progression (TBP) and not treated beyond progression. Fifty-nine of 159 (37%) patients with mCRC or PDAC were TBP (31 mCRC, 28 PDAC). Fifty-four of 59 (92%) patients were microsatellite stable. Zero of these 59 patients with initial treatment beyond progression demonstrated subsequent radiographic tumor shrinkage at a median 42 days from first scan documenting progression. A pseudoprogression rate of >6% could be excluded with 95% confidence. Compared with baseline, median growth on the first and second scan that showed progression was 29.8% and 43%, respectively. In those not treated beyond progression, median growth at first restaging was 31.2%. The trend in change in tumor size positively correlated with the trend in tumor markers in all patients TBP. Fifteen patients (25%) experienced grade 3/4 adverse events by continuing treatment beyond progression, whereas 19 (32%) experienced deterioration in ECOG PS. Pseudoprogression was not seen in microsatellite stable patients with mCRC or PDAC treated with immunotherapy. Changes in tumor markers correlated with changes in tumor volume. This data may help inform future treatment decisions and/or trial design in patients with mCRC or advanced PDAC treated with immunotherapy.https://ift.tt/2N0eb5S
Donor-derived CAR-T Cells Serve as a Reduced-intensity Conditioning Regimen for Haploidentical Stem Cell Transplantation in Treatment of Relapsed/Refractory Acute Lymphoblastic Leukemia: Case Report and Review of the Literature
Background: Reduced-intensity conditioning (RIC) regimens with low tolerable toxicities have been used for allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, the relapse rate by this treatment is high. Treatment of CD19+ B-cell relapsed/refractory acute lymphoblastic leukemia (r/r ALL) with allogeneic chimeric antigen receptor-modified T (CAR-T) cells is safe and effective. Use of allogeneic CD19-CAR-T cells as a part of RIC regimens for treatment of r/r ALL patients with haploidentical HSCT has not been investigated yet. Case Presentation: A 12-year-old girl with CD19+ r/r ALL underwent haploidentical HSCT. The patient received fludarabine, busulfan, and cyclophosphamide combined with haploidentical donor-derived CD19-CAR-T cells as the conditioning regimen. Granulocyte colony-stimulating factor–mobilized peripheral blood stem cells and granulocyte colony-stimulating factor–mobilized bone marrow were infused on days 1 and 2, respectively. Mycophenolate mofetil and tacrolimus were administered on day 1, antithymocyte globulin was administered on days +14 and +15, and a short course of methotrexate was administered to prevent graft-versus-host disease. The time of peak CAR-T cell proliferation was detected after the first infusion of CAR-T cells on day 7. The patient's engraftment and full-donor cell engraftment were established. The disease was in complete remission with minimal residual disease, which was undetectable by flow cytometry. No graft-versus-host disease or serious cytokine-release syndrome was found. Conclusions: Treatment of r/r ALL with RIC including CD19-CAR-T cells followed by allo-HSCT was safe and effective, which suggest that CAR-T cells can be used as a part of RIC regimens in the treatment of r/r ALL in haploidentical HSCT.https://ift.tt/2IsapyM
Is My Child Ready for Toilet Training?
Thinking about toilet training your child? Before starting the process, it's important to make sure your child is developmentally ready. Although you may be eager to discontinue the seemingly endless cycle of diaper changes, there is no benefit to early toilet training. Most children are ready to start between age 2 and 3. By this age, they are neurologically capable of containing stool and urine.
Signs Indicating When to Start Toilet Training
- Staying dry for extended periods of time (2 hours or more)
- Bowel movements are more predictable
- Can walk to and from the bathroom and pull down pants independently
- Demonstrates awareness of wet or soiled diaper
- Demonstrates signs of the urge to defecate or urinate
- Ex: facial expressions, doing the "potty dance," going off to the corner to use the bathroom
- Able to follow simple directions
- Ex: flush the toilet, wash your hands
- Interested in how others use the restroom and may imitate their behavior
- Understands cause and effect
- Ex: When I flush, my poop goes away.
- Shows a desire to please caregivers
Remember, toilet training is not a contest! While some may be ready to train at age 2, others may not be developmentally ready until closer to age 3. If you have additional questions, your pediatrician can help!
The post Is My Child Ready for Toilet Training? appeared first on ChildrensMD.
https://ift.tt/2KnWD1R
Correction to Supporting Information for Zheng et al., How electrostatic networks modulate specificity and stability of collagen [SI Corrections]
BIOPHYSICS AND COMPUTATIONAL BIOLOGY Correction to Supporting Information for "How electrostatic networks modulate specificity and stability of collagen," by Hongning Zheng, Cheng Lu, Jun Lan, Shilong Fan, Vikas Nanda, and Fei Xu, which was first published May 29, 2018; 10.1073/pnas.1802171115 (Proc Natl Acad Sci USA 115:6207–6212). The authors note that...
https://ift.tt/2tG29pj
Correction to Supporting Information for Smith et al., Direct measurements of meltwater runoff on the Greenland ice sheet surface [SI Corrections]
EARTH, ATMOSPHERIC, AND PLANETARY SCIENCES Correction to Supporting Information for "Direct measurements of meltwater runoff on the Greenland ice sheet surface," by Laurence C. Smith, Kang Yang, Lincoln H Pitcher, Brandon T. Overstreet, Vena W. Chu, Åsa K. Rennermalm, Jonathan C. Ryan, Matthew G. Cooper, Colin J. Gleason, Marco Tedesco,...
https://ift.tt/2txo8Q7
No evidence that extinction risk increases in the largest and smallest vertebrates [Biological Sciences]
Extinction risk is widespread across the tree of life (1, 2). Therefore, a key goal of conservation biology is to identify predictors of species endangerment. The prevailing consensus that larger species are more likely to be threatened (3) was recently overturned by Ripple et al. (4), who demonstrate instead a...
https://ift.tt/2tG270F
History by the numbers? [Social Sciences]
Turchin et al.'s (1) "Global History Databank" is an exciting project. However, we are not convinced that their principal component analysis (PCA) succeeds in discriminating between competing historical hypotheses. We also have concerns about their missing data imputation strategy. Turchin et al. ran PCA on nine "complexity characteristics" (CCs), and...
https://ift.tt/2txo7vx
Reply to Tosh et al.: Quantitative analyses of cultural evolution require engagement with historical and archaeological research [Social Sciences]
We thank Tosh et al. (1) for their interest in our research (2) but note that their analyses do not undermine the main findings of our article. Their suggestion that polity population divided by polity area should be one of the social complexity dimensions raises a number of issues. What...
https://ift.tt/2yJxOvQ
Reply to Pincheira-Donoso and Hodgson: Both the largest and smallest vertebrates have elevated extinction risk [Biological Sciences]
Pincheira-Donoso and Hodgson (1) discuss vertebrate endangerment patterns in their response to our recent article (2). They reassessed our conclusion of a bimodal body size distribution of endangerment for all vertebrates but did so using only data on body mass for amphibians. In our study, we collectively analyzed patterns of...
https://ift.tt/2txo3fh
Expansion of the IL1B gene family in the pig [Biological Sciences]
In the pig, the blastocyst becomes ovoid and then tubular before rapidly elongating into a filamentous shape on day 11 of pregnancy. This morphological change is believed to maximize contact between the embryo and the uterine surface for fetal–maternal nutrient exchange, as well as to inhibit the endometrial production of...
https://ift.tt/2txNTjc
Structure and mutagenic analysis of the lipid II flippase MurJ from Escherichia coli [Biophysics and Computational Biology]
The peptidoglycan cell wall provides an essential protective barrier in almost all bacteria, defining cellular morphology and conferring resistance to osmotic stress and other environmental hazards. The precursor to peptidoglycan, lipid II, is assembled on the inner leaflet of the plasma membrane. However, peptidoglycan polymerization occurs on the outer face...
https://ift.tt/2tuR2jS
Bright quantum dots emitting at ~1,600 nm in the NIR-IIb window for deep tissue fluorescence imaging [Chemistry]
With suppressed photon scattering and diminished autofluorescence, in vivo fluorescence imaging in the 1,500- to 1,700-nm range of the near-IR (NIR) spectrum (NIR-IIb window) can afford high clarity and deep tissue penetration. However, there has been a lack of NIR-IIb fluorescent probes with sufficient brightness and aqueous stability. Here, we...
https://ift.tt/2yI4NRt
Roles of Gag-RNA interactions in HIV-1 virus assembly deciphered by single-molecule localization microscopy [Cell Biology]
During HIV-1 assembly, the retroviral structural protein Gag forms an immature capsid, containing thousands of Gag molecules, at the plasma membrane (PM). Interactions between Gag nucleocapsid (NC) and viral RNA (vRNA) are thought to drive assembly, but the exact roles of these interactions have remained poorly understood. Since previous studies...
https://ift.tt/2MZZcsw
Distinct human circulating NKp30+FcϵRI{gamma}+CD8+ T cell population exhibiting high natural killer-like antitumor potential [Immunology and Inflammation]
CD8+ T cells are considered prototypical cells of adaptive immunity. Here, we uncovered a distinct CD8+ T cell population expressing the activating natural killer (NK) receptor NKp30 in the peripheral blood of healthy individuals. We revealed that IL-15 could de novo induce NKp30 expression in a population of CD8+ T...
https://ift.tt/2tHnY80
On the role of sidechain size and charge in the aggregation of A{beta}42 with familial mutations [Biophysics and Computational Biology]
The aggregation of the amyloid-β (Aβ) peptide is linked to the pathogenesis of Alzheimer's disease (AD). In particular, some point mutations within Aβ are associated with early-onset familial Alzheimer's disease. Here we set out to explore how the physical properties of the altered side chains, including their sizes and charges,...
https://ift.tt/2tMp02T
Neural network retuning and neural predictors of learning success associated with cello training [Neuroscience]
The auditory and motor neural systems are closely intertwined, enabling people to carry out tasks such as playing a musical instrument whose mapping between action and sound is extremely sophisticated. While the dorsal auditory stream has been shown to mediate these audio–motor transformations, little is known about how such mapping...
https://ift.tt/2yJDqWT
Enhanced mRNA delivery into lymphocytes enabled by lipid-varied libraries of charge-altering releasable transporters [Chemistry]
We report a strategy for generating a combinatorial library of oligonucleotide transporters with varied lipid domains and their use in the efficient transfection of lymphocytes with mRNA in vitro and in vivo. This library is based on amphiphilic charge-altering releasable transporters (CARTs) that contain a lipophilic block functionalized with various...
https://ift.tt/2txNRb4
A disordered acidic domain in GPIHBP1 harboring a sulfated tyrosine regulates lipoprotein lipase [Medical Sciences]
The intravascular processing of triglyceride-rich lipoproteins depends on lipoprotein lipase (LPL) and GPIHBP1, a membrane protein of endothelial cells that binds LPL within the subendothelial spaces and shuttles it to the capillary lumen. In the absence of GPIHBP1, LPL remains mislocalized within the subendothelial spaces, causing severe hypertriglyceridemia (chylomicronemia). The...
https://ift.tt/2yJxXzo
NMR chemical shift analysis decodes olefin oligo- and polymerization activity of d0 group 4 metal complexes [Chemistry]
d0 metal-alkyl complexes (M = Ti, Zr, and Hf) show specific activity and selectivity in olefin polymerization and oligomerization depending on their ligand set and charge. Here, we show by a combined experimental and computational study that the 13C NMR chemical shift tensors of the α-carbon of metal alkyls that...
https://ift.tt/2yQMR7k
Genomic and environmental determinants and their interplay underlying phenotypic plasticity [Agricultural Sciences]
Observed phenotypic variation in living organisms is shaped by genomes, environment, and their interactions. Flowering time under natural conditions can showcase the diverse outcome of the gene–environment interplay. However, identifying hidden patterns and specific factors underlying phenotypic plasticity under natural field conditions remains challenging. With a genetic population showing dynamic...
https://ift.tt/2yJ8c2d
Direct observation and rational design of nucleation behavior in addressable self-assembly [Chemistry]
To optimize a self-assembly reaction, it is essential to understand the factors that govern its pathway. Here, we examine the influence of nucleation pathways in a model system for addressable, multicomponent self-assembly based on a prototypical "DNA-brick" structure. By combining temperature-dependent dynamic light scattering and atomic force microscopy with coarse-grained...
https://ift.tt/2N3Aojk
Glycosylation-dependent galectin-receptor interactions promote Chlamydia trachomatis infection [Medical Sciences]
Chlamydia trachomatis (Ct) constitutes the most prevalent sexually transmitted bacterium worldwide. Chlamydial infections can lead to severe clinical sequelae including pelvic inflammatory disease, ectopic pregnancy, and tubal infertility. As an obligate intracellular pathogen, Ct has evolved multiple strategies to promote adhesion and invasion of host cells, including those involving both...
https://ift.tt/2yJxZHw
High-speed microjets issue from bursting oil gland reservoirs of citrus fruit [Engineering]
The rupture of oil gland reservoirs housed near the outer surface of the citrus exocarp is a common experience to the discerning citrus consumer and bartenders the world over. These reservoirs often rupture outwardly in response to bending the peel, which compresses the soft material surrounding the reservoirs, the albedo,...
https://ift.tt/2tGEuoT
Maximizing Utilization in Pancreas Transplantation: Phenotypic Characteristics Differentiating Aggressive from Nonaggressive Transplant Centers
Background Maximizing pancreas utilization requires a balance between judicious donor selection and transplant center aggressiveness. We sought to determine how such aggressiveness affects transplant outcomes. Methods Using the Scientific Registry of Transplant Recipients, we studied 28 487 deceased-donor adult pancreas transplants. Donor and recipient demographic factors indicative of aggressiveness were used to score center aggressiveness. We compared outcomes of low (> 1 SD below mean), medium (+/- 1 SD from mean), and high (> 1 SD above mean) aggressiveness centers using bivariate and multivariable regression. Results Donor and recipient aggressiveness demonstrated a roughly linear relationship (R2 = 0.20). Center volume correlated moderately with donor (rs = 0.433) and recipient (rs = 0.270) aggressiveness. In bivariate analysis, there was little impact of donor selection aggressiveness on graft survival. Further, for simultaneous pancreas and kidney transplants, centers with greater recipient aggressiveness selection had better graft survival. High volume centers had better graft survival than low volume centers. In multivariable analysis, donor aggressiveness did not have an effect on graft survival; whereas graft survival for medium (HR 0. 66, CI 0.53-0.83) and high (HR 0.67, CI 0.51-0.86) recipient aggressiveness performed better than low aggressiveness centers. There was a clear volume effect, with high volume centers (>20 transplants/year, HR 0.69, CI 0.61-0.79) performing better than low volume centers. Conclusions Center practice patterns using higher risk donors and recipients did not negatively affect outcomes. This effect is likely mediated through efficiencies gained with the increased transplant volumes at these centers. Received 26 February 2018. Revision received 23 May 2018. Accepted 12 June 2018. Presented at the 16th International Congress of the International Pancreas and Islet Transplant Association (Oxford, United Kingdom), June 21-24, 2017. Correspondence: Oscar K. Serrano, MD, MBA, University of Minnesota, Division of Transplantation, Department of Surgery, Mayo Mail Code 195, 420 Delaware Street SE, Minneapolis, MN 55455. Email: serra061@umn.edu 1. Authorship: •Participated in research design: Serrano, Vock, Finger. •Participated in the writing of the paper: Serrano, Finger. •Participated in the editing of the paper: Serrano, Vock, Dunn, Kandaswamy, Finger. •Participated in the performance of the research: Serrano, Vock, Dunn, Kandaswamy, Finger. •Contributed new reagents or analytic tools: Vock, Finger •Participated in data analysis: Serrano, Vock, Finger. 2. Disclosure: The authors declare no conflicts of interest. 3. Funding: The authors declare no funding received for this work. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2IsG57c
https://ift.tt/2IsG57c
Preoperative autologous blood collection in adult living liver donors: Are we wasting donor blood and increasing exposure to risk?
Background Despite waning indications in the general population for preoperative autologous blood donation (PABD), it is a procedure that continues to be offered to healthy living liver donors (LLD). In this study we sought to understand the impact of PABD on the LLD population. Methods We retrospectively reviewed charts of one institution's LLDs over a 2-year period. Per institutional protocol, all accepted LLD donated 1 unit of autologous blood prior to living donor hepatectomy (LDH). Results Sixty-six LLDs underwent PABD and 59 of these donors underwent LDH. In this cohort, there was a significant 1.2 g/dL drop in HB from baseline (prior to PABD) to the evening before surgery. Mean (SD) procedure estimated blood loss was 260 mL (±100), mean (SD) resected graft weight was 592 g (±174). No allogeneic blood was transfused. 42% of LLD received autologous transfusion. Mean (SD) pretransfusion HB of transfused LLDs was 11.7 g/dL (± 1.2). All LLDs had negative antibody screens. 63% of donated autologous units were discarded. Conclusions PABD in our population is associated with decreased preoperative HB, increased exposure of healthy LLD to unnecessary transfusion-related risks, and high rates of discarded blood product. We encourage further investigation and reconsideration of the practice of PABD and autologous transfusion in LLDs. Received 12 April 2018. Revision received 23 May 2018. Accepted 17 June 2018. Corresponding author: Solmaz P. Manuel, M.D., Department of Anesthesia and Perioperative Care, University of California San Francisco, 500 Parnassus Avenue, MU West 4th Floor, Box 0648, San Francisco, CA 94143. Phn: (415) 476-9043. Solmaz.Manuel@ucsf.edu AUTHORSHIP Solmaz Manuel: Participated in research design, collection of data, statistical analysis, and manuscript writing and preparation. John Roberts: Participated in review of data, manuscript preparation and review. Sara Bakhtary: Participated in research design, collection of data, data analysis, and manuscript writing and preparation. Disclosure: The authors declare no conflicts of interest. Funding: Support received from our own academic departments only: no external funding. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2K9jW3f
https://ift.tt/2K9jW3f
Efficacy of IgM-Enriched Immunoglobulin for Vasopressor-Resistant Vasoplegic Shock After Liver Transplantation
Background Vasoplegia is a clinical condition typically manifested by cardiovascular instability unresponsive to usual doses of inotropes or vasopressors. It can occur in a variety of clinical settings including liver transplantation (LT). Immunoglobulins have been used to treat sepsis-related vasoplegia. We performed a retrospective study to evaluate the efficacy of IgM-enriched immunoglobulin (IgMIg) on 30-day mortality and its ability to reverse vasoplegia in patients undergoing LT. Methods Between 5/2013 and 11/2017, 473 LT were performed at our institution. We identified 21 patients who received IgMIg for 3 days to treat vasoplegia. Patients included in the study met the criteria for having vasoplegia and required noradrenaline administration greater than 1 μg/kg/min for more than 24 h to maintain a mean arterial pressure (MAP) ≥ 70 mmHg. Procalcitonin (PCT) and interleukin-6 (IL-6) levels were used as surrogate markers for inflammation and were measured at the beginning and end of IgM treatment. Results After IgMIg administration, median noradrenaline infusion rates could be significantly reduced from 1.6 (1.3-2) μg/kg/min to 0.16 (0.08-0.34) μg/kg/min (P
https://ift.tt/2MsiB4f
https://ift.tt/2MsiB4f
Incidence, Outcomes, and Long-Term Immune Response to Tuberculosis in Organ Transplant Recipients
Background Tuberculosis (TB) is a significant opportunistic infection in solid organ transplant recipients (SOTR). There are limited data on TB incidence in transplantation from low prevalence countries as well as on long-term TB specific immune responses. Methods We performed a single-center retrospective review of SOTR diagnosed with active TB between 2000 and 2015 and further contacted the available patients for a study of long-term T cell responses using an interferon-gamma (IFN-γ) release assay and a flow cytometry-based assay. Results We identified 31 SOTR with active TB for an incidence of 62 cases/100,000 patient-years. 19/31 (61.3%) patients were diagnosed within the first year after transplant. Nineteen (61.3%) were born in countries with high TB prevalence and disseminated disease occurred in 22.6%. No patient had been screened for latent TB infection pretransplant. The majority of patients received isoniazid and a rifamycin as part of multidrug regimen. In addition, 13/29 (44.8%) patients received quinolones. One-year mortality in this population was 19.4%. Eight patients were available for long-term immune responses. Of these, all had detectable IFN-γ response by interferon-gamma release assay testing and 7/8 had detectable TB-specific T cells, primarily central and effector T cell responses in the CD4+ compartment and terminally differentiated T cells in the CD8+ compartment. Conclusions TB has high incidence in SOTR even in low-prevalence regions but especially targets patients who originated from TB-endemic countries. Long-term TB-specific T cell responses were found in the majority of patients. Received 26 March 2018. Revision received 22 May 2018. Accepted 16 June 2018. *denotes joint senior authorship CORRESPONDENCE Deepali Kumar MD, Associate Professor of Medicine, Transplant Infectious Diseases & Multi Organ Transplant Program, University Health Network, 585 University Ave., 11-PMB-174, Toronto ON M5G 2N2. Email: deepali.kumar@uhn.ca AUTHOR CONTRIBUTIONS Y.N., A.H. and D.K participated in research design, the writing of the paper, performance of the research and data analysis. V.H.F and S.N. participated in the data analysis and interpretation. S.H., C.R. participated in writing of the paper. DISCLOSURE D.K. has received research funding from Qiagen, and Oxford Immunotec as well as consultancy fees from Qiagen and Oxford Immunotec. A.H. has received research funding from Qiagen. The remaining authors have no conflicts of interest. FUNDING The authors declare no funding for this study. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2IsqBjB
https://ift.tt/2IsqBjB
Perioperative Blood Management, Red Cell Recovery (Cell Salvage) Practice in an Australian Tertiary Hospital: A Hospital District Clinical Audit
BACKGROUND: Data on red cell recovery (cell salvage) utilization in Australia are limited and national guidance is based on a single Australian audit conducted at a hospital that excludes cardiothoracic surgery. This clinical audit aimed to analyze the utility of red cell recovery at a tertiary health care facility which includes cardiothoracic surgery. Secondary aims of this study were to identify specific surgical procedures in which red cell recovery is most beneficial and to quantify this benefit. METHODS: Data were collected retrospectively on all adult red cell recovery surgical cases conducted at a 2-campus health care facility over a 2-year period. Case demographic data, including surgical procedure, red blood cell return, and hematocrit levels, were collated and analyzed against national cell salvage guidelines. Average return per procedure was collated into a red cell recovery benefit analysis. RESULTS: A total of 471 red cell recovery cases for 85 surgical procedures met inclusion criteria. Of the 7 surgical subspecialties utilizing red cell recovery, orthopedics utilized the most cases (22.9%, n = 108), followed by urology (19.1%, n = 90) and cardiothoracic surgery (18.3%, n = 86). Radical retropubic prostatectomy (11.7%), revision (7.6%), and primary (6.6%) total hip replacement were the most utilized procedures. Red cell recovery use had a 79% compliance rate with national guidelines. Vascular surgery and urology had the highest average return at 699 mL (interquartile range, 351–1127; CI, 449–852) and 654 mL (interquartile range, 363–860; CI, 465–773), respectively. CONCLUSIONS: Overall, our center demonstrated good compliance with national red cell recovery guidelines. This audit adds to the existing data on red cell recovery practice in Australia and provides a benefit-specific surgical procedure guideline that includes cardiothoracic surgery. Accepted for publication May 5, 2018. Funding: None. The authors declare no conflicts of interest. Gold Coast Health Human Research Ethics Committee number: HREC/17/QGC/130. Reprints will not be available from the authors. Address correspondence to Elizabeth A. Forrest, MD, Department of Anaesthetics, Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4214, Australia. Address e-mail to elizabeth.forrest3@health.qld.gov.au. © 2018 International Anesthesia Research Society
https://ift.tt/2N0GZLr
https://ift.tt/2N0GZLr
Treating Anemia in the Preanesthesia Assessment Clinic: Results of a Retrospective Evaluation
BACKGROUND: Perioperative anemia is challenging during hospital stay because anemia and red blood cell (RBC) transfusions are associated with an increased morbidity and mortality. With the implementation of patient blood management (PBM), a preanesthesia assessment clinic to screen and treat anemia before elective surgery was institutionalized at Muenster University Hospital, Germany. The main objective of this study was to evaluate the association between treating preoperative anemic patients with intravenous iron (IVI) and (primarily) presurgical hemoglobin levels and (secondarily) use of RBCs and mortality. METHODS: Between April 1, 2014, and July 4, 2016, patients scheduled for elective surgery with a risk for RBC transfusions >10% in 2013 were screened for preoperative anemia and, if indicated, treated with IVI. Patients' data, time span between visit in the anesthesia/PBM clinic and surgery, demographic data, type of surgery, the difference of hemoglobin levels between visit and surgery, RBC transfusion, infectious-related International Classification of Disease codes during hospital stay, and 1-year survival were determined retrospectively by screening electronic data files. In addition, patients were interviewed about adverse events, health-related events, and infections via telephone 30, 90, and 365 days after visiting the anesthesia/PBM clinic. RESULTS: A total of 1101 patients were seen in the anesthesia/PBM clinic between days −28 and −1 (median [Q1–Q3], −3 days [−1, −9 days]) before elective surgery. Approximately 29% of patients presented with anemia, 46.8% of these anemic patients were treated with ferric carboxymaltose (500–1000 mg). In the primary analysis, hemoglobin levels at median were associated with a reduction between the visit in the anesthesia/PBM clinic and the surgery in all nonanemic patients on beginning of medical treatment (nonanemic patients at median −2.8 g/dL [−4, −0.9 g/dL], while anemic patients without IVI presented with median differences of −0.8 g/dL [−2, 0 g/dL] and anemic patients with IVI of 0 g/dL [−1.0, 0.5 g/dL]). Hemoglobin levels raised best at substitution 22–28 days before surgery (0.95 g/dL [−0.35, 1.18 g/dL]). Due to the selection criteria, transfusion rates were high in the cohort. Overall, there was no association between IVI treatment and the use of RBC transfusions (odds ratio for use of RBCs in anemic patients, no IVI versus IVI: 1.14; 95% confidence interval, 0.72–1.82). Patients treated with or without IVI presented a comparable range of International Classification of Disease codes related to infections. Telephone interviews indicated similar adverse events, health-related events, and infections. Cox regression analysis showed an association between anemia and reduced survival, regardless of IVI. CONCLUSIONS: An anemia clinic within the preanesthesia assessment clinic is a feasible and effective approach to treat preoperative anemia. The IVI supplementation was safe but was associated with decreased RBC transfusions in gynecology/obstetric patients only. The conclusions from this retrospective analysis have to be tested in prospective, controlled trials. Accepted for publication May 8, 2018. Funding: This work was supported by an industrial grant for the implementation of patient blood management to H.V.A. (AF 700501). A.U.S. receives funding from the German Research Foundation (DFG-STE1895-4/1). The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Clinical trial number: The implementation of Patient Blood Management and treatment of anemia was registered at clinicaltrial.gov NCT01820949. I. Ellermann and A. Bueckmann contributed equally and share first authorship. Reprints will not be available from the authors. Address correspondence to Andrea U. Steinbicker, MD, PD, MPH, Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Albert-Schweitzer Campus 1, Bldg A1, Muenster 48149, Germany. Address e-mail to andrea.steinbicker@ukmuenster.de. © 2018 International Anesthesia Research Society
https://ift.tt/2Mrm17o
https://ift.tt/2Mrm17o
Usefulness of the Korean Version of the CAGE-Adapted to Include Drugs Combined With Clinical Predictors to Screen for Opioid-Related Aberrant Behavior
BACKGROUND: As national opioid consumption in South Korea has soared, well-validated screening tools for opioid use disorder (OUD) have become indispensable. The aims of our study were to evaluate OUD using the Korean version of the CAGE-Adapted to Include Drugs (CAGE-AID) and the CAGE-Opioid (an alternative version of the CAGE-AID), and to investigate clinical predictors that might be useful to screen for OUD in conjunction with the CAGE-AID/Opioid questionnaires. METHODS: A single-center, prospective, observational study was performed. After linguistic validation of the Korean version of the CAGE-AID/Opioid questionnaires, we assessed OUD in patients with chronic opioid treatment. Multivariable logistic models of the CAGE-AID/Opioid questionnaires combined with relevant clinical predictors were established. Then, the receiver operating characteristic curve analysis of the multivariable CAGE-AID/Opioid models was conducted to assess diagnostic accuracy to screen for OUD. Next, we calculated predicted probability with >85% sensitivity and >50% specificity in each CAGE-AID and CAGE-Opioid model. Using the optimal value of the predicted probability, a cutoff score of the CAGE-AID/Opioid questionnaires combined with the relevant clinical factors was suggested to screen for OUD. RESULTS: Among 201 participants, 51 patients showed ≥1 OUDs. In the multivariable regression model, male sex, comorbid neuropsychiatric disorder, and current heavy drinking significantly remained as clinical variables to predict OUD combined with the scores of the Korean CAGE-AID/Opioid questionnaire. The area under the curve was 0.77 (95% confidence interval, 0.71–0.83) for the CAGE-AID model and 0.78 (95% confidence interval, 0.71–0.83) for the CAGE-Opioid model. The optimal predicted probability values to screen for OUD in the CAGE-AID/Opioid models were >0.135 (sensitivity, 0.86; specificity, 0.52) and >0.142 (sensitivity, 0.86; specificity, 0.53), respectively. When we used these predictive probabilities, the cutoff score of the CAGE-AID/Opioid questionnaires ranged from 0 to 3, which was dependent on the presence of the relevant clinical variables in each model. CONCLUSIONS: In this study, one fourth of the total participants with chronic opioid treatment showed OUD in the Korean population. The multivariable models of the CAGE-AID/Opioid with sex, comorbid neuropsychiatric disorder, and current heavy drinking are valid parameters to screen for OUD, with the cutoff scores of the CAGE-AID/Opioid questionnaires ranging from 0 to 3 depending on the presence of the clinical variables. Accepted for publication May 8, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Jee Youn Moon, MD, PhD, FIPP, CIPS, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital College of Medicine, 110 Daehang-ro, Jongno-gu, Seoul 110–744, Korea. Address e-mail to jymoon0901@gmail.com. © 2018 International Anesthesia Research Society
https://ift.tt/2N2tfjh
https://ift.tt/2N2tfjh
Incidence and Epidemiology of Perioperative Transfusion-Related Pulmonary Complications in Pediatric Noncardiac Surgical Patients: A Single-Center, 5-Year Experience
BACKGROUND: Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are the leading causes of transfusion-related fatalities. While these transfusion-related pulmonary complications (TRPCs) have been well detailed in adults, their burden in pediatric subsets remains poorly defined. We sought to delineate the incidence and epidemiology of pediatric TRPCs after intraoperative blood product transfusion. METHODS: In this retrospective cohort study, we evaluated all consecutive pediatric patients receiving intraoperative blood product transfusions during noncardiac surgeries between January 2010 and December 2014. Exclusion criteria were cyanotic heart disease, preoperative respiratory insufficiency, extracorporeal membrane oxygenation, and American Society of Anesthesiologists physical status VI. Medical records were electronically screened to identify those with evidence of hypoxemia, and in whom a chest x-ray was obtained within 24 hours of surgery. Records were then manually reviewed by 2 physicians to determine whether they met diagnostic criteria for TACO or TRALI. Disagreements were adjudicated by a third senior physician. RESULTS: Of 19,288 unique pediatric surgical patients, 411 were eligible for inclusion. The incidence of TRPCs was 3.6% (95% confidence interval [CI], 2.2–5.9). TACO occurred in 3.4% (95% CI, 2.0–5.6) of patients, TRALI was identified in 1.2% (95% CI, 0.5–2.8), and 1.0% (95% CI, 0.4–2.5) had evidence for both TRALI and TACO. Incidence was not different between males (3.4%) and females (3.8%; P = .815). Although a trend toward an increased incidence of TRPCs was observed in younger patients, this did not reach statistical significance (P = .109). Incidence was comparable across subsets of transfusion volume (P = .184) and surgical specialties (P = .088). Among the 15 patients experiencing TRPCs, red blood cells were administered to 13 subjects, plasma to 3, platelets to 3, cryoprecipitate to 2, and autologous blood to 3. Three patients with TRCPs were transfused mixed blood components. CONCLUSIONS: TRPCs occurred in 3.6% of transfused pediatric surgical patients, with the majority of cases attributable to TACO, congruent with adult literature. The frequency of TRPCs was comparable between genders and across surgical procedures and transfusion volumes. The observed trend toward increased TRPCs in younger children warrants further consideration in future investigations. Red blood cell administration was the associated component for the majority of TRPCs, although platelets demonstrated the highest risk per component transfused. Mitigation of perioperative risk associated with TRPCs in pediatric patients is reliant on further multiinstitutional studies powered to examine patterns and predictors of this highly morbid entity. Accepted for publication May 8, 2018. Funding: D.J.K. receives funding via National Institutes of Health grant R01-HL121232. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Leanne Thalji, BM, MSc, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905. Address e-mail to thalji.leanne@mayo.edu. © 2018 International Anesthesia Research Society
https://ift.tt/2ttBoW8
https://ift.tt/2ttBoW8
US Food and Drug Administration Disruption of Generic Drug Market Increases Hospital Costs
BACKGROUND: The purpose of the US Food and Drug Administration's Marketed Unapproved Drugs Initiative is to decrease marketing of older unapproved medications. The administration has recently extended its rulings by including sterile injectable drugs administered in the inpatient environment. The impact of this initiative on the inpatient environment has been minimally studied. METHODS: Consecutive retrospective purchase data of vasopressin for injection (vasopressin) and neostigmine methylsulfate for injection (neostigmine) from 720 hospitals and 746 hospitals, respectively, were included. Purchases occurred from January 1, 2010 to December 31, 2016. The average noncontract drug price was calculated and compared to the purchase data during the impact of the initiative. Comparison was made of hospital purchases made before and after the initiative. The year 2014 was considered a washout transition year due to the large amounts of discontinued unapproved formulations that were still available and purchased by hospitals. The analysis was completed using a matched paired t test. RESULTS: The noncontract price for vasopressin increased from $12.83 per vial to $158.83 per vial (1138% increase) and for neostigmine from $27.74 per vial to $175.14 per vial (531% increase) across the pre- and postinitiative intervals; however, purchase volumes after the price increases were not found to have a statistically significant difference compared to purchases before the price increases (P = .98 and P = .4, respectively). CONCLUSIONS: Health systems have experienced a significant cost increase of vasopressin and neostigmine and are absorbing price increases for these older, generic sterile injectable drugs. Accepted for publication May 21, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Philip J. Almeter, PharmD, Department of Pharmacy Services, University of Kentucky HealthCare, 800 Rose St, H110, Lexington, KY 40536. Address e-mail to philip.almeter@uky.edu. © 2018 International Anesthesia Research Society
https://ift.tt/2KkSz2d
https://ift.tt/2KkSz2d
Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea
The purpose of the Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea (OSA) is to present recommendations based on current scientific evidence. This guideline seeks to address questions regarding the intraoperative care of patients with OSA, including airway management, anesthetic drug and agent effects, and choice of anesthesia type. Given the paucity of high-quality studies with regard to study design and execution in this perioperative field, recommendations were to a large part developed by subject-matter experts through consensus processes, taking into account the current scientific knowledge base and quality of evidence. This guideline may not be suitable for all clinical settings and patients and is not intended to define standards of care or absolute requirements for patient care; thus, assessment of appropriateness should be made on an individualized basis. Adherence to this guideline cannot guarantee successful outcomes, but recommendations should rather aid health care professionals and institutions to formulate plans and develop protocols for the improvement of the perioperative care of patients with OSA, considering patient-related factors, interventions, and resource availability. Given the groundwork of a comprehensive systematic literature review, these recommendations reflect the current state of knowledge and its interpretation by a group of experts at the time of publication. While periodic reevaluations of literature are needed, novel scientific evidence between updates should be taken into account. Deviations in practice from the guideline may be justifiable and should not be interpreted as a basis for claims of negligence. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Accepted for publication March 27, 2018. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). LMA Unique is a registered trademark of Teleflex Incorporated or its affiliates. Reprints will not be available from the authors. Address correspondence to Stavros G. Memtsoudis, MD, PhD, Departments of Anesthesiology, Critical Care & Pain Management and Public Health, Weill Cornell Medical College and Hospital for Special Surgery, 535 E 70th St, New York, NY 10021. Address e-mail to memtsoudiss@hss.edu. © 2018 International Anesthesia Research Society
https://ift.tt/2N1MSYY
https://ift.tt/2N1MSYY
Use of Earlier-Reported Rotational Thromboelastometry Parameters to Evaluate Clotting Status, Fibrinogen, and Platelet Activities in Postpartum Hemorrhage Compared to Surgery and Intensive Care Patients
BACKGROUND: Rotational thromboelastometry (ROTEM) can provide clinical information in 10–20 minutes for guiding administration of fibrinogen, platelets, and fresh frozen plasma products. While ROTEM testing is well established for cardiac and other surgeries, it is less characterized for use in postpartum hemorrhage (PPH) patients. We wanted to determine if the earlier-measured ROTEM parameters (α-angle and amplitude at 10 minutes [A10]) could replace the later parameters (amplitude at 20 minutes and maximum amplitude [maximum clot firmness {MCF}]) in all patient groups studied. We also correlated the A10 and α-angle of the EXTEM and FIBTEM tests to the fibrinogen levels and platelet counts in these patients. METHODS: We retrospectively analyzed 100 sets of EXTEM and FIBTEM results ordered on patients undergoing operations for PPH, patients in intensive care units (ICU), and those undergoing cardiothoracic surgery (cardiothoracic operating room [C/T OR]). We determined if the correlations among the various parameters were similar among the PPH, ICU, and C/T OR patients. RESULTS: As expected, the EXTEM A10 (A10EX) and FIBTEM A10 (A10FIB) correlated highly to the EXTEM MCF and FIBTEM MCF in all patient groups. The A10EX parameter correlated significantly to both fibrinogen and platelet levels, and the A10FIB correlated to the fibrinogen levels. The difference between the A10EX and the A10FIB (PLTEM) is related to platelet activity, and we found that the PLTEM and platelet count correlated highly for all 100 PPH patients (r = 0.80), C/T OR patients (r = 0.70), and ICU patients (r = 0.66), despite 4 high platelet counts with relatively low PLTEM values in the ICU group. The earlier-reported parameter EXTEM α angle (α-EX) is an excellent indicator of the A10EX, with an α-EX ≥65° (ie, normal) giving a >96% probability that the A10EX was ≥44 mm, and an α-EX value below 65 mm giving an 86% probability that the A10EX was
https://ift.tt/2MpwVuF
https://ift.tt/2MpwVuF
Ketamine as a Rapid Sequence Induction Agent in the Trauma Population: A Systematic Review
The choice of drug used to facilitate endotracheal intubation in trauma patients during rapid sequence induction (RSI) may have an impact on survival. Ketamine is commonly used in the hemodynamically unstable trauma patient although it has been associated with side effects. This review sought to investigate whether ketamine should be preferred over other induction agents for RSI in trauma patients. PubMed, Embase, and the Cochrane Library were systematically searched on September 19, 2016 for studies reporting RSI of adult trauma patients with ketamine compared with another induction agent (etomidate, propofol, thiopental, or midazolam). No language restrictions were applied. The primary outcome was 30-day mortality, and secondary outcomes included information on blood transfusions, length of hospital stay, and hospital mortality. Risk of bias was assessed using the Cochrane Risk of Bias assessment tool for randomized trials and the Risk of Bias in Non-Randomized Studies of Interventions for nonrandomized studies of intervention. A total of 4 studies were included. A cohort study from 1976 compared thiopental (n = 26) with ketamine (n = 14) for RSI in trauma patients. The primary outcome was number of blood transfusions, and no significant difference was found. Risk of bias was judged to be serious. A randomized controlled trial from 2009 compared etomidate (n = 57) with ketamine (n = 47) and found no significant difference in 28-day mortality (odds ratio [OR], 0.8 [0.4–2.0]). The trial was judged to have a low risk of bias. Two cohort studies from 2015 and 2017 also compared etomidate (n = 116 and n = 526) with ketamine (n = 145 and n = 442). No significant difference in hospital mortality between the groups was observed (OR, 1.11 [0.38–3.27] and OR, 1.41 [0.91–2.16], respectively). Both studies were judged to have a moderate risk of bias, thus excluding the possibility of a meaningful meta-analysis. The study from 2017 also reported number of units of blood transfused during the first 48 hours after trauma and length of hospital stay. No significant differences were observed (OR, 1.14 [0.87–1.49] and OR, 1.1 [0.95–1.27], respectively). Extremely few studies have compared induction agents for RSI in trauma patients. No significant differences have been found in mortality, length of hospital stay, or number of blood transfusions after induction with ketamine compared to other induction agents, but a clinically relevant benefit or harm cannot be excluded. Accepted for publication February 27, 2018. Funding: The study group received funding from "Tryg Foundation." However, Tryg Foundation was not involved in any steps undertaken for this study. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Josefine S. Baekgaard, MD, Department of Anaesthesia, Center of Head and Orthopedics, Rigshospitalet, University of Copenhagen, Section 4231, Rigshospitalet, Juliane Maries Vej 10, DK-2100 Copenhagen, Denmark. Address e-mail to josefine.stokholm.baekgaard.01@regionh.dk. © 2018 International Anesthesia Research Society
https://ift.tt/2MZlY3X
https://ift.tt/2MZlY3X
Hydroxyapatite implantation for the repair of a congenital nasal anomaly: 10 years follow-up
Abstract
Frontonasal dysplasia is a rare congenital anomaly characterized by ocular hypertelorism, a broad nasal root, and vertical median cleft of the nose and/or upper lip and palate. We report a case of frontonasal dysplasia in which hydroxyapatite was used to treat a nasal deformity in early childhood. In the 10 years of follow-up of our case, there were no complications such as infection, malpositioning, or exposure, and computed tomography revealed no resorption or malpositioning of the implant. Hydroxyapatite implants may be a viable alternative to autologous bone/cartilage grafts for the repair of congenital nasal anomalies until nasal development is completed.https://ift.tt/2yITOXF
Breakthrough Treatment for Chronic Rhinitis & Postnasal Drip
As he grew older, 42-year-old Jon Balter developed severe chronic rhinitis and sought help from allergists and ENTs for nearly...https://ift.tt/2lyWz4t
Memorial Hermann-Texas Medical Center Opens the First Dedicated ENT ICU in Houston
Otorhinolaryngologists, pulmonary intensivists and critical care nurses work hand in hand to treat adult patients with complex conditions in the...https://ift.tt/2tGHEJa
Itching at night: A review on reducing nocturnal pruritus in children
Pediatric Dermatology, EarlyView.
https://ift.tt/2KdbLTF
Editorial Board
Source:Clinical Immunology, Volume 193
https://ift.tt/2K8Zgsv
Thymopoiesis following HSCT; a retrospective review comparing interventions for aGVHD in a pediatric cohort
Publication date: August 2018
Source:Clinical Immunology, Volume 193
Author(s): A.M. Flinn, C.F. Roberts, M.A. Slatter, R. Skinner, H. Robson, J. Lawrence, J. Guest, A.R. Gennery
Acute graft-versus-host disease (aGVHD) complicates allogeneic hematopoietic stem cell transplantation (HSCT), and is treated with topical and/or systemic corticosteroids. Systemic corticosteroids and aGVHD damage thymic tissue. We compared thymopoietic effect of topical steroid therapy, corticosteroids and extracorporeal photopheresis (ECP) in 102 pediatric allogeneic HSCT patients.We categorized patients into 4 groups: - no aGVHD, aGVHD treated with topical or systemic steroid, or ECP. Naïve CD4+CD45RA+CD27+ T-lymphocyte values at 3, 6, 9, 12months post-HSCT were recorded: for ECP patients, values were recorded at 3, 6, 9, 12months during ECP. Differences were compared using the Kruskal-Wallis test.41 patients had no aGVHD, 23 had aGVHD treated topically or systemically (25), 13 received ECP. Rate of thymopoiesis was significantly different between all groups at all time-points post-transplant (p=0.002, p<0.001, p<0.001, p=0.001 respectively).Even mild aGVHD impairs thymopoiesis. Worst recovery was in ECP patients. Earlier institution of ECP may speed thymic recovery.
https://ift.tt/2KlyMzP
Citrullinated fibrinogen impairs immunomodulatory function of bone marrow mesenchymal stem cells by triggering toll-like receptor
Source:Clinical Immunology, Volume 193
Author(s): Yue Sun, Wei Deng, Genhong Yao, Weiwei Chen, Xiaojun Tang, Xuebing Feng, Liwei Lu, Lingyun Sun
Bone marrow mesenchymal stem cells (BMSC) have been shown to possess immunomodulatory activities, while its role in rheumatoid arthritis (RA) remains unknown. Citrullinated fibrinogen (cfb) has been considered as a specific autoantigen in RA pathogenesis. Our study aims to determine the role of cfb on immunomodulatory function of BMSC. We demonstrated the specific role of toll-like receptor 4 (TLR4)-NFκB pathway in the pro-inflammatory response of BMSC to cfb with increased production of interleukin (IL)-6, IL-8 and chemokine CC motif ligand 2 (CCL2). Moreover, cfb impaired BMSC-mediated suppression of peripheral blood mononuclear cells (PBMC) proliferation and reduced the production of the key immunomodulatory molecule indoleamine 2,3-dioxygenase (IDO) in BMSC. We have uncovered a previously unrecognized role of cfb in interfering BMSC-mediated immunoregulation in RA. Cfb could act as a damage-associated molecule pattern (DAMP) for BMSC and thereby contribute to the propagation of inflammation in RA.
https://ift.tt/2K8Z5NR
Εγγραφή σε:
Αναρτήσεις (Atom)