New biologics in the treatment of urticaria

Purpose of review Symptomatic management of chronic spontaneous urticaria (CSU) basically depends on second-generation H1 antihistamines and omalizumab. Omalizumab is a game changer in the management, but still there is a need for new targets and new biologics targeting new pathways in the treatment which will provide long-lasting remission, which will be given orally and which will be cheaper. This review will focus on new biologics that are underway of production or are already under use for different disorders but could be beneficial for the treatment of Chronic urticaria. Recent findings In this review, the treatment targets are classified according to the cells which are involved in the pathogenesis of CSU. Those are mast cells/basophils, B cells, T cells and eosinophils. The treatments that are under clinical trials for CSU are anti-IgE treatments such as ligelizumab, molecules targeting intracellular signaling pathways such as spleen tyrosine kinase inhibitors, surface inhibitory molecules such as siglec-8, anti-IL-1s such as canakinumab, Bruton kinase (BTK) inhibitors such as GDC-0853 and anti-IL-5s such as benralizumab and mepolizumab. Summary The ongoing clinical trials on new targets of treatment hold new hopes not only for a better care of the disease but also a better understanding of the pathomechanisms lying underneath. Correspondence to Emek Kocatürk, Department of Dermatology, Okmeydanı Training and Research Hospital, Darulaceze Caddesi, Sisli, Istanbul, Turkey. Tel: +90 2123146300; e-mail: emekozgur@yahoo.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Ocular allergy as a risk factor for dry eye in adults and children

Purpose of review To provide an overview of the pathogenic mechanisms underlying the correlation between ocular allergy and dry eye disease (DED), highlighting how the first condition may be a risk factor for the second one. Recent findings Recent advances in our comprehension of the pathogenesis of ocular allergy and DED allow identifying several pathways of interaction between these two conditions. A growing body of evidence supports the role of ocular allergy as a risk factor for DED. Ocular allergy, particularly the severe forms of keratoconjunctivitis, can impact on different key mechanisms of the DED vicious cycle, including tear film instability, ocular surface inflammation and damage, and neurosensory abnormalities. Summary Ocular allergy and DED are two common, relevant, symptomatic, not mutually exclusive conditions affecting the ocular surface. They share some clinical and biochemical features. To better understand the complex interactions between these two conditions, it's essential to consider the very wide spectrum of clinical conditions included in the term ocular allergy and the still largely unexplored peculiarities of the pediatric ocular surface physio-pathology and DED. Correspondence to Edoardo Villani, MD, FEBO, Clinica Oculistica Ospedale San Giuseppe, via San Vittore 12, 20154 Milan, Italy. Tel: +39 3397859677; e-mail: edoardo.villani@unimi.it Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Precision medicine in food allergy

Purpose of review To familiarize the reader with the concept of precision medicine in food allergy through the most recent insights in the diagnosis, prognosis, and management of the disease. Recent findings With the advent of omics sciences, a new era is commencing. Food protein allergens characterization and quantification together with the immunoglobulin E epitope mapping will contribute to the diagnosis/prognosis of food allergy and will lead to a better safety assessment of foods. The characterization of biomarkers able to identify specific phenotypes and endotypes will improve the diagnostic accuracy. This together with a better understanding of mechanisms of action of the different therapeutic options will allow the accurate selection of the appropriate patient. Summary In the near future, advances in technologies and data interpretation will allow a better understanding of the pathogenesis of food allergy and the development of a personalized treatment tailored on the specific patient' profile. Correspondence to Alessandro Fiocchi, Allergy Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, Rome 00165, Italy. Tel: +39 06 68593570; fax: +39 06 68592218; e-mails: alessandro.fiocchi@allegriallergia.net Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Which Protocol for Milrinone to Treat Cerebral Vasospasm Associated With Subarachnoid Hemorrhage?

Background: Milrinone has emerged as an option to treat delayed cerebral ischemia after subarachnoid hemorrhage. However, substantial variation exists in the administration of this drug. We retrospectively assessed the effectiveness of 2 protocols in patients with angiographically proven cerebral vasospasm. Methods: During 2 successive periods, milrinone was administered using either a combination of intra-arterial milrinone infusion followed by intravenous administration until day 14 after initial bleeding (IA+IV protocol), or a continuous intravenous milrinone infusion for at least 7 days (IV protocol). The primary endpoint was the reversion rate of vasospastic arterial segments following the first IA infusion of milrinone (IA+IV protocol) compared with the reversion rate during the first week of IV infusion (IV protocol). Results: There were 24 and 77 consecutive patients in IA+IV and IV protocols, respectively. The reversion rate was comparable between the 2 protocols: 71% (95% confidence interval [CI], 59%-83%) in the IA+IV protocol versus 64% (95% CI, 58%-71%) in the IV protocol (P=0.36). Rescue procedures for persistence or recurrence of vasospasm, that is, mechanical angioplasty and/or IA milrinone infusion, were similar between the 2 protocols. Patients with a good neurological outcome at 1 year, that is, modified Rankin Scale scores 0-2, were comparable between the 2 protocols. Side effects of milrinone were uncommon and equally distributed within the 2 protocols. Conclusions: These findings indicate that a continuous IV infusion of milrinone was as efficient as combined IA+IV infusion and suggest that this modality could be considered as a first easy-to-use option to treat patients with CVS. The authors have no funding or conflicts of interest to disclose. Address correspondence to: Jean-François Payen, MD, PhD, Pôle Anesthésie Réanimation, CHU Grenoble Alpes, F-38000, Grenoble, France (e-mail: jfpayen@univ-grenoble-alpes.fr). Received April 11, 2018 Accepted June 7, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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JNA Journal Club

No abstract available

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The Effect of Fluid Loading and Hypertonic Saline Solution on Cortical Cerebral Microcirculation and Glycocalyx Integrity

Background: Fluid loading and hyperosmolar solutions can modify the cortical brain microcirculation and the endothelial glycocalyx (EG). This study compared the short-term effects of liberal fluid loading with a restrictive fluid intake followed by osmotherapy with hypertonic saline (HTS) on cerebral cortical microcirculation and EG integrity in a rabbit craniotomy model. Methods: The experimental rabbits were allocated randomly to receive either

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Impact of CPAP on Forehead Near-infrared Spectroscopy Measurements in Patients With Acute Respiratory Failure: Truth or Illusion

Background: Critically ill patients with acute respiratory failure admitted to an intensive care unit are at high risk for cerebral hypoxia. We investigated the impact of continuous positive airway pressure (CPAP) therapy on regional cerebral tissue oxygenation (rSO2). Materials and Methods: In total, 40 extubated surgical intensive care unit patients requiring classic oxygen therapy (COT) for acute respiratory failure were examined. Near-infrared spectroscopy (INVOS 5100C, Covidien) was used for 30 minutes to detect bilateral rSO2 during COT via facemask (6 L/min) and CPAP therapy (40% fraction of inspired oxygen, 8 cm H2O CPAP) using a randomized crossover study design. Patients served as their own control. Continuous hemodynamic routine monitoring and blood gas analysis were performed. The effect of CPAP therapy on rSO2 and influence of assessed covariables were investigated using a mixed linear model. Results: Median rSO2 increased from 57.9% (95% confidence interval [CI], 54.2-61.5) during COT to 62.8% (95% CI, 59.2-66.5) during CPAP therapy (P

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JNA Journal Club

No abstract available

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Multiple lesions of skull and cervical spine: a rare presentation of unicameral bone cysts

A 55-year-old man with a history of Benign Paroxysmal Positional Vertigo unalleviated by Epley manoeuvre presented to an otolaryngologist for dizziness, right ear fullness and headache. MRI of the brain showed numerous marrow-replacing lesions throughout the calvarium, skull base and upper cervical spine which were hypointense on T1-weighted images, hyperintense on T2-weighted images and avidly enhanced following contrast, concerning for a malignant process such as metastatic disease or multiple myeloma (figure 1). Systemic X-ray survey (spine, skull, chest, pelvis, all long bones) and nuclear medicine whole body bone scan were negative except for the lesions seen on MRI. β–2microglobin, immunoglobin and monoclonal protein electrophoresis were negative for myeloma or immunological process. Given the concern for metastatic disease, biopsy of a skull lesion was recommended. Pathological analysis of a calvarial lesion was consistent with unicameral bone cyst (figure 1). No ongoing therapy was offered; however, brain and spine surveillance imaging will continue.

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Orbitocerebral mucormycosis and intracranial haemorrhage: a role for caution with steroids in suspected giant cell arteritis

A 75-year-old man with type 2 diabetes mellitus presented with complete loss of vision in his right eye and severe headaches for the past 24 hours. He had been treated for suspected giant cell arteritis (GCA) with high-dose corticosteroids which were being tapered to stop after an inconclusive right temporal artery biopsy and an erythrocyte sedimentation rate (ESR) value of 8. His current acute presentation, however, raised further concern for partially treated GCA and precipitated treatment with pulsed methylprednisolone. The patient, taking metformin, developed diabetic ketoacidosis and was transferred to the intensive care unit where a swollen, painful right eye with chemosis and complete ophthalmoplegia was subsequently revealed to be secondary to cavernous sinus thrombosis. Rhino-orbital skin necrosis with positive samples for the organism Rhizopus on eventual orbital exenteration revealed angioinvasive fungal infection, mucormycosis, to be the cause. We discuss here the lessons learnt, and how best to treat a susceptible cohort within our ageing western population.

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Spontaneous migration into the stomach and out of the intestine, as late complication of a gastric band

Description 

A 45-year-old woman with morbid obesity (body mass index 44 kg/m²) presented to the emergency department with severe abdominal pain, nausea, vomiting and no defaecation. She had a laparoscopic adjustable gastric banding (LAGB) inserted elsewhere in 2006. No data or follow-up was performed postoperatively. A CT scan demonstrated a perforated LAGB through the gastric antrum (figure 1). Furthermore the connecting tube perforated the small intestine at the level of the proximal part of the jejunum with a partially intraluminally positioned banding (figure 2), causing prestenotic dilatation of the jejunum (figure 3). An upper gastrointestinal endoscopy confirmed an intact port site with a connected tube and migration and perforation of the band into the jejunum with an erosion of the gastric (figure 4) and duodenal wall. At closer inspection of the port site and connecting tube, we observed a high level...

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Emphysematous Osteomyelitis

Description

A 56-year-old man with a known history of type 2 diabetes mellitus, hypertension, nephrolithiasis and gout presented with fatigue and flank pain for 3 days. The above symptoms were associated with fevers and chills. On admission, the patient's vitals were remarkable for fever with maximum temperature (T max) 39.1°C, hypotension requiring pressor support and tachycardia. On auscultation, he had reduced air entry at lung bases, distended abdomen, bipedal oedema and petechial rash over the upper extremities and the trunks. In addition, there was purplish discolouration over the left medial sacral area. Laboratory work-up was remarkable for elevated white cell count 21.4x10⁹/L (4.0–12.0x10⁹/L), creatinine 7.98 mg/dL (0.60–1.40 mg/dL), anion gap of 25, erythrocyte sedimentation rate of 70 mm/hour (0–20 mm/hour), total bilirubin of 4.9 mg/dL (0.2–1.2 mg/dL) and lipase 422 U/L (0–140 U/L). Platelet count was 31x10³/µL (150–400 10³/µL), aspartate aminotransferase of 71 U/L (10–40 U/L) and alanine aminotransferase of 37 U/L (3–45 U/L). Septic shock was suspected, and the patient was...

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Campylobacter fetus spondylodiscitis in a patient with HIV infection and restored CD4 count

Campylobacter fetus (C. fetus) is a rare condition and mostly seen in elderly or immunocompromised patients. We present the first case of C. fetus spondylodiscitis in a virologically suppressed HIV seropositive patient with low back pain. MRI was performed and showed spondylodiscitis of the L4–L5 region. Empirical antibiotic therapy with flucloxacillin was started after blood cultures were drawn and an image-guided disc biopsy was performed. Blood cultures remained negative. The anaerobic culture of the puncture biopsy of the disc revealed presence of C. fetus after which the antibiotic treatment was switched to ceftriaxone. Guided by the susceptibility results, the therapy was switched to ciprofloxacin orally for 6 weeks after which the patient made full clinical, biochemical and radiographic recovery. Since no other immune-deficient conditions were noted, it is important to highlight that patients with HIV infection with restored CD4 counts and complete virological suppression can still be susceptible for infections caused by rare pathogens. Low back pain should raise suspicion for these conditions and should be examined properly.

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Case of fatal familial insomnia caused by a d178n mutation with phenotypic similarity to Hashimotos encephalopathy

Fatal familial insomnia (FFI) is a rare prion disease commonly inherited in an autosomal dominant pattern from a mutation in the PRioN Protein (PRNP) gene. Hashimoto's encephalopathy (HE) is characterised by encephalopathy associated with antithyroid peroxidase (TPO) or antithyroglobulin (Tg) antibodies. These two conditions characteristically have differing clinical presentations with dramatically different clinical course and outcomes. Here, we present a case of FFI mimicking HE. A woman in her 50s presented with worsening confusion, hallucinations, tremor and leg jerks. Several maternal relatives had been diagnosed with FFI, but the patient had had negative genetic testing for PRNP. MRI of brain, cervical and thoracic spine were unremarkable except for evidence of prior cervical transverse myelitis. Cerebrospinal fluid analysis was normal. Anti-TPO and anti-Tg antibodies were elevated. She was started on steroids for possible HE and showed improvement in symptoms. Following discharge, the results of her PRNP gene test returned positive for variant p.Asp178Asn.

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The treatment of trismus with Ativan: a 3-year-old with difficulty opening her mouth

Description

A 3-year-old healthy girl presented with intermittent spells of difficulty opening her mouth, talking and swallowing.

Episodes began 3 weeks prior without any inciting incident. Initially occurring weekly, episodes were brief and self-resolving, but had begun increasing in frequency. Symptoms were typically worse later in the day. The presenting episode started 36 hours earlier. The child was eating when her jaw unexpectedly clenched tightly, preventing her from chewing, swallowing or opening her mouth. She had no other neurological symptoms. Family denied any new exposures or trauma. She had no other systemic symptoms. Her father had severe blepharospasms in youth that resolved without treatment.

Her mouth was pursed and jaw tightly clenched (figures 1 and 2). She was drooling and appeared unable to swallow secretions or speak, though was whining and appeared frustrated. Temporomandibular joint (TMJ) was non-tender with symmetrical jaw musculature. She had fasciculations over...

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Rare cause of voiding dysfunction in an adult man: urethral diverticulum compressing the anterior urethra

Description 

A 46-year-old man presented to us with lower urinary tract symptoms that include severe voiding symptoms. He had a history of injury to the perineum 3 years back. A smooth cystic swelling was palpable in the perineum in midline. Uroflowmetry was done and was suggestive of poor urinary flow (Q_avg: 2 mL/s and Q_max: 6 mL/s), with significant postvoid residual urine (PVR). A micturating cystourethrogram (MCU) with retrograde urethrography (RUG) was done and was suggestive of an anterior urethral diverticulum, which was compressing the urethra, along with significant PVR (figure 1). The patient was planned for open excision of the urethral diverticulum. A cystourethroscopy was done preoperatively and clearly showed a normal anterior urethra and the opening of the diverticulum on the ventral aspect of the urethra (figure 2). The patient was operated in lithotomy position and a midline perineal incision was done. The diverticulum was dissected free and then excised,...

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Dekubitus erkennen und richtig klassifizieren: ein Positionspapier

Zusammenfassung

Hintergrund

Dekubitalulzera sind schwerwiegende Haut- und Gewebeschäden. Die korrekte Diagnose und Einteilung in verschiedene Kategorien gestaltet sich in der Praxis oft schwierig.

Fragestellung

Welches Vorgehen kann empfohlen werden, um Dekubitalulzera in der Praxis richtig zu diagnostizieren und zu klassifizieren?

Material und Methoden

Die Initiative Chronische Wunden (ICW) e. V. berief eine Expertengruppe ein, die, basierend auf der aktuellen Literatur und eigener Expertise, praktische Empfehlungen für die Diagnostik und Klassifikation von Dekubitalulzera entwickelte.

Ergebnisse

Die Diagnose Dekubitus soll nur dann gestellt werden, wenn Haut- und/oder Gewebeschäden mit hoher Wahrscheinlichkeit infolge von länger andauerndem Druck oder Druck in Verbindung mit Scherkräften entstanden sind. Es muss eine vollständige Anamnese durchgeführt werden, um Phasen von vorhergehender längerer Immobilität zu erfassen. Dekubitalulzera befinden sich in der Regel an typischen Prädilektionsstellen. Bei der Kategorie I und „vermuteter tiefer Gewebeschädigung" liegen Gewebeschäden unter (zunächst) intakter Haut vor. Die Diagnose ist jedoch unsicher, und die Klassifikation soll erst im weiteren Verlauf vorgenommen werden. Ein Kategorie-II-Dekubitus ist in der Regel eine Ausschlussdiagnose. Die Kategorien III und IV sind Dekubitalulzera im eigentlichen Sinn. Solange die Abgrenzung zwischen Kategorie III und IV nicht möglich ist, soll die niedrigere Kategorie kodiert werden.

Schlussfolgerungen

Derzeit soll passend für das jeweilige Setting einheitlich eine relevante Klassifikation verwendet werden. Die am besten dem klinischen Bild entsprechende Diagnose kann dann gestellt werden. Dabei ist es unerheblich, welches Klassifikationssystem verwendet wird. Mithilfe der zukünftig zu erwartenden Version des ICD-11 der WHO können Dekubitalulzera dann besser klassifiziert werden.

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Interactions of zearalenone and its reduced metabolites α-zearalenol and β-zearalenol with serum albumins: species differences, binding sites, and thermodynamics

Abstract

Zearalenone (ZEN) is a mycotoxin produced by Fusarium species. ZEN mainly appears in cereals and related foodstuffs, causing reproductive disorders in animals, due to its xenoestrogenic effects. The main reduced metabolites of ZEN are α-zearalenol (α-ZEL) and β-zearalenol (β-ZEL). Similarly to ZEN, ZELs can also activate estrogen receptors; moreover, α-ZEL is the most potent endocrine disruptor among these three compounds. Serum albumin is the most abundant plasma protein in the circulation; it affects the tissue distribution and elimination of several drugs and xenobiotics. Although ZEN binds to albumin with high affinity, albumin-binding of α-ZEL and β-ZEL has not been investigated. In this study, the complex formation of ZEN, α-ZEL, and β-ZEL with human (HSA), bovine (BSA), porcine (PSA), and rat serum albumins (RSA) was investigated by fluorescence spectroscopy, affinity chromatography, thermodynamic studies, and molecular modeling. Our main observations are as follows: (1) ZEN binds with higher affinity to albumins than α-ZEL and β-ZEL. (2) The low binding affinity of β-ZEL toward albumin may result from its different binding position or binding site. (3) The binding constants of the mycotoxin-albumin complexes significantly vary with the species. (4) From the thermodynamic point of view, the formation of ZEN-HSA and ZEN-RSA complexes are similar, while the formation of ZEN-BSA and ZEN-PSA complexes are markedly different. These results suggest that the toxicological relevance of ZEN-albumin and ZEL-albumin interactions may also be species-dependent.

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Penile lymphoedema: approach to investigation and management

Clinical and Experimental Dermatology, EarlyView.


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Regulation of neutrophils in type 2 immune responses

Lukas E M Heeb | Cecilie Egholm | Daniela Impellizzieri | Frederike Ridder | Onur Boyman

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Autonomous Driving and Perverse Incentives

Abstract

This paper discusses the ethical implications of perverse incentives with regard to autonomous driving. We define perverse incentives as a feature of an action, technology, or social policy that invites behavior which negates the primary goal of the actors initiating the action, introducing a certain technology, or implementing a social policy. As a special form of means-end-irrationality, perverse incentives are to be avoided from a prudential standpoint, as they prove to be directly self-defeating: They are not just a form of unintended side effect that must be balanced against the main goal or value to be realized by an action, technology, or policy. Instead, they directly cause the primary goals of the actors—i.e., the goals that they ultimately pursue with the action, technology, or policy—to be "worse achieved" (Parfit). In this paper, we elaborate on this definition and distinguish three ideal-typical phases of adverse incentives, where only in the last one the threshold for a perverse incentive is crossed. In addition, we discuss different possible relevant actors and their goals in implementing autonomous vehicles. We conclude that even if some actors do not pursue traffic safety as their primary goal, as part of a responsibility network they incur the responsibility to act on the common primary goal of the network, which we argue to be traffic safety.

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Urea cycle disorder presenting as bilateral mesial temporal sclerosis – an unusual cause of seizures: a case report and review of the literature

Urea cycle disorders are secondary to defects in the system converting ammonia into urea, causing accumulation of ammonia and other byproducts which are neurotoxic. Ornithine transcarbamylase deficiency is the...

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Closing the Gap: Understanding African-American Asthma Knowledge and Beliefs

Asthma remains a common and serious public health problem affecting 24 million people in the United States (US). The disease accounts for 1.6 million emergency department visits and 10.5 million physician's office visits each year in the US [3]. Asthma prevalence rates are higher among specific populations such as children, females, ethnic minorities, and those living below the poverty level; many of these groups also have higher rates of asthma related morbidity and mortality [4]. African-Americans with asthma experience disproportionate rates of morbidity and mortality compared to Caucasians [5].

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Resolution of Eosinophilia and Elevated Immunoglobulin E with Ibrutinib for Chronic Lymphocytic Leukemia

Eosinophilia can be categorized as mild (500-1500 eosinophils/µL), moderate (1500-5000 eosinophils/µL), or severe (≥5000 eosinophils/µL) with hypereosinophilia referring to an eosinophil count ≥1500 eosinophils/µL.1 Rarely, eosinophilia is associated with hematologic disorders that produce eosinophilopoietic cytokines.2 We describe a case of eosinophilia and elevated IgE in a 61-year-old gentleman who was subsequently diagnosed with B-cell chronic lymphocytic leukemia (B-CLL). His eosinophilia and immunoglobulin E (IgE) levels declined significantly after initiating ibrutinib therapy for B-CLL.

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Intralymphatic allergen immunotherapy against pollen allergy. A 3-year open follow-up study of 10 patients

To date, allergen immunotherapy (AIT) is the only treatment that affects the long-term development of allergic rhinoconjunctivitis and induces clinical tolerance primarily by stimulating regulatory T (Treg) cells, attenuating T helper 2 (Th2) responses and synthesis of blocking antibodies1. Conventional AIT with subcutaneous injections, sublingual tablets or drops is effective, but consumes time and resources 2.

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Moisturizers vs. Barrier Repair in the Management of Atopic Dermatitis

Current guidelines recommend the use of anti-inflammatory agents along with moisturizers for the management of atopic dermatitis (AD).1 This approach is prudent, since co-applications of moisturizers under nursing supervision reduce reliance upon topical steroids in AD management.2,3 Yet, some commonly employed moisturizers could harm the skin, if deployed in settings where the barrier already is compromised,3 as in AD. Here, we will compare the key differences between ubiquitous, over-the-counter moisturizers and preparations formulated specifically to correct the biochemical abnormalities in AD.

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Unnecessary food allergy testing by primary care providers: ethical implications for the specialist

After completing her fellowship in allergy and immunology, Dr. X accepted an appointment in an academic position at a tertiary care pediatric hospital. Many of the patients Dr. X sees for evaluation of food allergy have undergone serum specific IgE testing prior to their allergy consultation. As time goes on, Dr. X begins to notice a concerning trend in patients referred from Dr. Y, a primary care provider who has been practicing in the community for over twenty years. Dr. X is worried that many of Dr.

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Response to YAJOT_2018_288 “Letter to the Editor: T2-weighted MRI screening algorithm for patients with asymmetric sensorineural hearing loss”

We thank Drs. O'Bryant and Woo for their thoughtful commentary on our recent publication. We agree that any screening protocol for vestibular schwannoma (VS) or intralabyrinthine schwannoma (ILS) must heavily prioritize asymmetric audiovestibular findings in order to reduce the risk of not scanning a patient with a tumor and scanning too many patients that do not have a lesion. In addition, thin slice image acquisition is critical to identify small, often subtle intracanalicular and intralabyrinthine lesions.

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T2-weighted MRI screening algorithm for patients with asymmetric sensorineural hearing loss

We read with interest the article by Valesano et al. [1]. As noted in the article, gadolinium-enhanced T1-weighted MRI (GdT1WI) has been the "gold standard" imaging study for many years in the diagnosis of vestibular schwannoma in asymmetric sensorineural hearing loss (ASNHL). In recent years, with improved imaging technology, a push toward non-contrast T2-weighted MRI (T2WI) for screening of patients with ASNHL has been made in an effort to decrease patient exposure to gadolinium, acquisition time, and cost.

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Sun protection behaviour after diagnosis of high-risk primary melanoma and risk of a subsequent primary

Melanoma survivors are at high risk of further primary melanomas.

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The Role of Sunscreen in the Prevention of Cutaneous Melanoma and Non-Melanoma Skin Cancer

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Second Primary Melanomas: Increased Risk and Decreased Time to Presentation in Patients exposed to Tanning Beds

Melanoma incidence has increased; the primary modifiable risk factor is ultraviolet radiation (UVR) from the sun or artificial (arUVR) from tanning beds.

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Office-Based Procedures for Nasal Airway Obstruction

Treatment of common rhinologic problems with in-office surgical procedures has increased dramatically in response to patient preference, evolving insurance patterns, and changes in coding and reimbursement. Because this is an emerging practice, there is not a lot of evidence published about how to best perform these techniques. This article provides practical advice from experienced surgeons related to logistics and anesthetic techniques for conducting in-office surgical treatment of nasal airway obstruction; an overview of office set-up and necessary equipment; and specific procedural considerations. Attention also is paid to pharmacologic issues. Logistics and clinical considerations for common office-based procedures for obstructive pathology are reviewed.

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Surgical Management of Nasal Valve Collapse

Nasal valve collapse has multiple causes, including congenital, traumatic, and, unfortunately, iatrogenic. Recognition of the causes of nasal valve collapse and the methodology for treatment is paramount not only for the otolaryngologist but also for any physician managing the nasal airway. This article focuses on the cause and surgical management of internal and external nasal valve collapse.

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Nasal Obstruction Considerations in Cosmetic Rhinoplasty

Cosmetic rhinoplasty is an increasingly popular procedure in the United States. There are critical aspects of preoperative planning and intraoperative execution that facilitate successful rhinoplasty. Thorough preoperative assessment of the structures comprising the internal and external nasal valves and identification of potential at-risk areas for static or dynamic compromise must be done before surgery. Thoughtful maneuvers and meticulous surgical technique must be used. Postoperative counseling ranges from simple reassurance to medical therapy to procedural efforts to alleviate a patient's concerns. It is important to establish rapport with the patient and dutifully address all cosmetic and functional concerns.

https://ift.tt/2Jpo8qu

Comparison of clinical outcomes between butterfly inlay cartilage tympanoplasty and conventional underlay cartilage tympanoplasty

To assess the efficacy of butterfly inlay cartilage tympanoplasty and compare it with conventional underlay cartilage tympanoplasty in terms of success rate and hearing outcomes.

https://ift.tt/2uomfpv

Management of retrosternal goiter: Retrospective study of 72 patients at two secondary care centers

Data pertaining to the outcomes of retrosternal goiter surgeries performed at secondary care centers, where thoracic surgery expertise is not readily available, is infrequently reported. Careful patient selection is crucial to avoid an unexpected need for a sternotomy during surgery. We sought to evaluate the surgical management of patients with retrosternal goiters treated at two secondary care centers.

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A Rare Case of Vascular Leiomyosarcoma Originating from a Branch Vessel of the External Iliac Vein

Leiomyosarcoma arising from the external iliac vein is uncommon. This is a report of a 51-year-old Japanese man with venous leiomyosarcoma originating from a branch vessel of the left external iliac vein. The tumor was found during a medical examination, and the patient had no symptoms. Computed tomography showed a 72 × 49 mm mass adjacent to the left external iliac vein. The tumor was resected en-block along with ligation of the external iliac vein due to strong adhesion with the tumor. Histological examination showed venous leiomyosarcoma, and its origin was thought to be a branch vessel of the left external iliac vein. The patient has remained free from recurrence at 30 months after surgery.

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A Comparative Analysis of Tooth Size Discrepancy between Male and Female Subjects Presenting with a Class I Malocclusion

Objectives. To evaluate the tooth size discrepancy and Bolton's ratios between male and female subjects with a Class I malocclusion. Materials and Methods. The digital e-models of 100 male and 100 female 12-year-old southern Chinese children with a Class I malocclusion were selected. The mesiodistal widths from permanent first molar to the contralateral side first molar of the upper and lower dentitions were measured. Differences between the tooth size discrepancy, together with the anterior and overall Bolton's ratios between male and female subjects, were assessed using a two-sample t-test. A paired t-test was used to determine differences between antimetric pairs of teeth within the same arch. Results. Females had statistically significant smaller teeth than males (P 0.05), while the mean values of overall Bolton's ratios of male and female are 90.48 and 90.65, respectively (P 0.2) for contralateral tooth size were shown on the maxillary canines, lateral incisors, and central incisors of males; and mandibular canines and lateral incisors of females. Conclusions. Southern Chinese females presenting with Class I malocclusions have smaller mesiodistal tooth dimensions compared to males. Both males and females presented several tooth size asymmetries. There are no statistical differences in anterior and overall Bolton's ratios between the genders.

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Growth Responses and Photosynthetic Indices of Bamboo Plant (Indocalamus latifolius) under Heavy Metal Stress

Investigating factors involved in the alleviation of the toxic effects of heavy metals (HMs) on plants is regarded as one of the important research concerns in the environmental field. The southern regions of China are severely impacted by human-induced heavy metal (HM) contamination, which poses an impediment to growth and productivity of bamboo (Indocalamus latifolius) plants. This necessitates the investigation of the effects of HMs on growth and physiological properties of bamboo. Therefore, the aim of the study was to evaluate some gas exchange and growth parameters in two-year-old bamboo species under HMs stress. A greenhouse-based experiment was conducted at Nanjing Forestry University, where the bamboo plant was treated with three HMs (Cu, Pb, and Zn) at four different concentrations (0, 500, 1000, and 2000 mg kg-1). The results illustrated that excessive HMs (1000 and 2000 mg kg−1) triggered a decline in a number of photosynthetic-related indices including the rate of photosynthesis (μmol CO2 m−2 s−1), intercellular CO2 concentration (μmol CO2 mol−1), conductance to H2O (mol H2O m−2 s−1), and net assimilation as well as transpiration. Morphological indices were also depressed as a result of the adverse influence of HMs, leading to decreased shoot length (10 to 73%) and reduced number of emerged plants (6 to 57%). Also, the results indicated that Pb had the greatest harmful impact on the growth indices.

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