Portable Infrared Pupillometer in Patients With Subarachnoid Hemorrhage: Prognostic Value and Circadian Rhythm of the Neurological Pupil Index (NPi)

Background: Portable automated infrared pupillometry is becoming increasingly popular. To generate an objective reference base, the Neurological Pupil index (NPi) which combines different values of the pupillary light reflex is being introduced into clinical practice. In this explorative study, we examined different aspects of the NPi in relation to clinical severity and outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). Materials and Methods: Patients with serial assessment of the NPi (NeurOptics pupillometer NPi-200, Irvine, CA) starting no later than day 2 after aSAH onset were included in the study. Relative numbers of pathologic NPi's, absolute NPi values, and their variances were compared according to aSAH clinical severity grade, functional outcome, and case fatality. The correlation between NPi and intracranial pressure, and NPi periodicity, were also examined. Results: In total, 18 patients with 4456 NPi values were eligible for inclusion in the analysis. The general trend of the NPi over time reflected the course of the neurological illness. Mean NPi tended to be lower in patients with clinically severe compared with nonsevere aSAH (3.75±0.40 vs. 4.56±0.06; P=0.171), and in patients with unfavorable compared with favorable outcomes (3.64±0.48 vs. 4.50±0.08; P=0.198). The mean variance of the NPi was higher in patients with severe compared with nonsevere aSAH (0.49±0.17 vs. 0.06±0.02; P=0.025). Pathologic NPi values were recorded more frequently in patients with severe compared with nonsevere aSAH (16.3%±8.8% vs. 0.0%±0.0%; P=0.002), and in those with unfavorable compared with favorable outcomes (19.2%±10.6% vs. 0.7%±0.6%; P=0.017). NPi was inversely correlated with intracranial pressure (Spearman r=−0.551, P

https://ift.tt/2A3bT1w

Dexamethasone Is Superior to Dexmedetomidine as a Perineural Adjunct for Supraclavicular Brachial Plexus Block: Systematic Review and Indirect Meta-analysis

BACKGROUND: Both dexamethasone and dexmedetomidine are effective peripheral nerve block (PNB) perineural adjuncts that prolong block duration. However, each is associated with side effects. With paucity of head-to-head comparisons of these adjuncts, the question of the best adjunct to mix with local anesthetics (LA) for PNB is unanswered. This meta-analysis aims to inform current practice and future research by identifying the superior adjunct by comparing dexamethasone and dexmedetomidine. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, trials comparing the combination of perineural dexamethasone or dexmedetomidine with LA to LA alone for PNB were sought. The Cochrane Risk of Bias Tool was used to assess the methodological quality of trials, and indirect or network meta-analyses using random-effects modeling were planned. We designated duration of analgesia as a primary outcome. Secondary outcomes included sensory and motor block durations, sensory and motor block onset times, and the risks of hypotension, sedation, and neurological symptoms. RESULTS: Fifty trials were identified, including only 1 direct comparison, precluding a network meta-analysis. Indirect meta-analysis of 49 trials (3019 patients) was performed. Compared to dexmedetomidine, dexamethasone prolonged the duration of analgesia by a mean difference (95% confidence interval [CI]) of 148 minutes (37–259 minutes) (P = .003), without prolonging sensory/motor blockade. Dexmedetomidine increased rates of hypotension (risk ratio [95% CI], 6.3 [1.5–27.5]; P = .01) and sedation (risk ratio [95% CI], 15.8 [3.9–64.6]; P = .0001). Overall risk of bias was moderate, and publication bias was noted, resulting in downgrading evidence strength. CONCLUSIONS: There is low-quality evidence that both adjuncts similarly prolong sensory/motor blockade. However, dexamethasone may be a superior adjunct; it improves the duration of analgesia by a statistically significant increase, albeit clinically modest, equivalent to 2.5 hours more than dexmedetomidine, without the risks of hypotension or sedation. Future direct comparisons are encouraged. Accepted for publication September 10, 2018. Funding: This work was supported by departmental funding from the Department of Anesthesia, Lausanne University Hospital, Lausanne, Switzerland (E.A.), and also from the Department of Anaesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada (F.W.A.). 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). Reprints will not be available from the authors. Address correspondence to Faraj W. Abdallah, MD, Department of Anesthesiology and Pain Medicine, and Ottawa Hospital Research Institute, University of Ottawa, The Ottawa Hospital General Campus, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada. Address e-mail to FAbdallah@toh.ca. © 2018 International Anesthesia Research Society

https://ift.tt/2A415jz

Airway Management and Clinical Outcomes in External Laryngeal Trauma: A Case Series

External laryngeal trauma is a rare but potentially fatal event that presents several management challenges. This retrospective observational case series conducted at a level-1 trauma center over a 12-year period consists of 62 cases of acute external laryngeal trauma. Patient demographics, mode and mechanisms of injury, presenting signs and symptoms, initial imaging results, airway management, time to surgical management, and 6-month outcomes including airway status, deglutition status, and voice quality were investigated. No difference was found in mortality or 6-month outcomes between patients requiring surgical repair and/or tracheostomy versus patients with less severe injuries managed conservatively. Accepted for publication August 30, 2018. Funding: None. The authors declare no conflicts of interest. Institutional review board Number and Contact Information: HUM00125057. 2800 Plymouth Rd, Bldg 520, Room 3214, Ann Arbor, MI 48109. E-mail: irbmed@umich.edu. Reprints will not be available from the authors. Address correspondence to Alexandra R. DePorre, MD, Department of Anesthesiology, Michigan Medicine, University of Michigan, 1H247 UH, 1500 E Medical Center Dr, Ann Arbor, MI 48109. Address e-mail to adeporre@med.umich.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2QGXCgw

Labor Pain's Relationship With Depression: From Whence, and What Shall be Done?

No abstract available

https://ift.tt/2A4vLRK

Propofol Regulates Neural Stem Cell Proliferation and Differentiation via Calmodulin-Dependent Protein Kinase II/AMPK/ATF5 Signaling Axis

BACKGROUND: Propofol can cause degeneration of developing brain cells and subsequent long-term learning or memory impairment. However, at the early stage of embryonic development, the molecular mechanism of propofol-induced inhibition in neural stem cells (NSCs) neurogenesis is still unclear. The aim of this study was to determine the role of propofol in NSCs neurogenesis and, more importantly, to explore the underlying mechanism. METHODS: First, a single intraperitoneal injection of propofol was performed in pregnant mice, and 6 hours after administration of propofol, the hippocampus RNA and the protein of the embryos' brains was extracted to analyze the expression of neuron-specific markers. Second, the primary NSCs were isolated from the hippocampus of mouse embryonic brain and then treated with propofol for cell viability, immunostaining, and transwell assays; more importantly, we performed RNA sequencing (RNA-seq) and q-reverse transcription polymerase chain reaction assays to identify genes regulated by propofol; the Western blot, small interfering RNA (SiRNA), and luciferase reporter assays were used to study the effects of propofol on calmodulin-dependent protein kinase (CaMk) II/5' adenosine monophosphate-activated protein kinase (AMPK)/activating transcription factor 5 (ATF5) signaling pathway. RESULTS: Our results indicated that propofol treatment could inhibit the proliferation, migration, and differentiation of NSCs. The results of RNA-seq assays showed that propofol treatment resulted in downregulation of a group of Ca2+-dependent genes. The following mechanism studies showed that propofol regulates the proliferation, differentiation, and migration of NSCs through the CaMkII/phosphorylation of serine at amino acid position 485 (pS485)/AMPK/ATF5 signaling pathway. CONCLUSIONS: The results from study demonstrated that propofol inhibits the proliferation, differentiation, and migration of NSCs, and these effects are partially mediated by CaMkII/pS485/AMPK/ATF5 signaling pathway. Accepted for publication August 30, 2018. Funding: This research was supported by National Natural Science Foundation of China (Grant No. 81400930). 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 Jing Cang, MD, Department of Anesthesiology, Zhongshan Hospital, Fudan University, Xuhui Qu, Shanghai Shi 200032, China. Address e-mail to cangjing1998@126.com. © 2018 International Anesthesia Research Society

https://ift.tt/2QNA9dF

Best Practices for Postoperative Brain Health: Recommendations From the Fifth International Perioperative Neurotoxicity Working Group

As part of the American Society of Anesthesiology Brain Health Initiative goal of improving perioperative brain health for older patients, over 30 experts met at the fifth International Perioperative Neurotoxicity Workshop in San Francisco, CA, in May 2016, to discuss best practices for optimizing perioperative brain health in older adults (ie, >65 years of age). The objective of this workshop was to discuss and develop consensus solutions to improve patient management and outcomes and to discuss what older adults should be told (and by whom) about postoperative brain health risks. Thus, the workshop was provider and patient oriented as well as solution focused rather than etiology focused. For those areas in which we determined that there were limited evidence-based recommendations, we identified knowledge gaps and the types of scientific knowledge and investigations needed to direct future best practice. Because concerns about perioperative neurocognitive injury in pediatric patients are already being addressed by the SmartTots initiative, our workshop discussion (and thus this article) focuses specifically on perioperative cognition in older adults. The 2 main perioperative cognitive disorders that have been studied to date are postoperative delirium and cognitive dysfunction. Postoperative delirium is a syndrome of fluctuating changes in attention and level of consciousness that occurs in 20%–40% of patients >60 years of age after major surgery and inpatient hospitalization. Many older surgical patients also develop postoperative cognitive deficits that typically last for weeks to months, thus referred to as postoperative cognitive dysfunction. Because of the heterogeneity of different tools and thresholds used to assess and define these disorders at varying points in time after anesthesia and surgery, a recent article has proposed a new recommended nomenclature for these perioperative neurocognitive disorders. Our discussion about this topic was organized around 4 key issues: preprocedure consent, preoperative cognitive assessment, intraoperative management, and postoperative follow-up. These 4 issues also form the structure of this document. Multiple viewpoints were presented by participants and discussed at this in-person meeting, and the overall group consensus from these discussions was then drafted by a smaller writing group (the 6 primary authors of this article) into this manuscript. Of course, further studies have appeared since the workshop, which the writing group has incorporated where appropriate. All participants from this in-person meeting then had the opportunity to review, edit, and approve this final manuscript; 1 participant did not approve the final manuscript and asked for his/her name to be removed. Accepted for publication August 27, 2018. Funding: This workshop was sponsored by the American Society of Anesthesiology Brain Health Initiative, the Society for Neuroscience in Anesthesiology and Critical Care, Baxter, and Pfizer. M.B. acknowledges receiving private consulting income from a legal case regarding postoperative cognitive function in an older adult and material support (ie, monitors) from Masimo for a research study. C.H.B. has consulted for and has a data share agreement with Medtronic. M.B. acknowledges support from National Institute on Aging (NIA) K76 AG057020 (and additional support from R03-AG050918 and P30AG028716), K.J.S. from National Institutes of Health (NIH) K12 HD043488 and an Alzheimer's Association Clinician Scientist Fellowship, C.H.B. from NIA K76 AG057020, S.G.D. from NIA K23 AG048332 and the American Foundation for Aging Research, R.A.W. from NIH 2R01GM101698, and R.G.E. from National Institute of General Medical Sciences P01 55876. All collaborators participated in the Best Practices Discussion at the 2016 International Perioperative Neurotoxicity Working Group meeting and helped edit the manuscript. The 2016 Perioperative Neurotoxicity Working group are also listed in Appendix. The authors declare no conflicts of interest. Address correspondence to Miles Berger, MD, PhD, Anesthesiology Department, Duke University Medical Center, 4317 Duke S Orange Zone, Durham, NC 27710. Address e-mail to Miles.berger@duke.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2QNA0a7

Effect of Apneic Oxygenation on Tracheal Oxygen Levels, Tracheal Pressure, and Carbon Dioxide Accumulation: A Randomized, Controlled Trial of Buccal Oxygen Administration

BACKGROUND: Apneic oxygenation via the oral route using a buccal device extends the safe apnea time in most but not all obese patients. Apneic oxygenation techniques are most effective when tracheal oxygen concentrations are maintained >90%. It remains unclear whether buccal oxygen administration consistently achieves this goal and whether significant risks of hypercarbia or barotrauma exist. METHODS: We conducted a randomized trial of buccal or sham oxygenation in healthy, nonobese patients (n = 20), using prolonged laryngoscopy to maintain apnea with a patent airway until arterial oxygen saturation (SpO2) dropped 90% during apnea. RESULTS: Buccal patients were more likely to achieve the primary outcome (P 94%; 750 seconds (750–750 seconds) vs 447 seconds (405–525 seconds); P

https://ift.tt/2A3CVpk

Preclinical Evaluation of Ropivacaine in 2 Liposomal Modified Systems

BACKGROUND: Our research group has recently developed liposomes with ionic gradient and in a combined manner as donor and acceptor vesicles containing ropivacaine (RVC; at 2% or 0.75%). Looking for applications of such novel formulations for postoperative pain control, we evaluated the duration of anesthesia, pharmacokinetics, and tissue reaction evoked by these new RVC formulations. METHODS: The formulations used in this study were large multivesicular vesicle (LMVV) containing sodium acetate buffer at pH 5.5 or in a combined manner with LMVV as donor and large unilamellar vesicles (LUVs) as acceptor vesicles with an external pH of 7.4. Wistar rats were divided into 6 groups (n = 6) and received sciatic nerve block (0.4 mL) with 6 formulations of RVC (LMVVRVC0.75%, LMVV/LUVRVC0.75%, LMVVRVC2%, LMVV/LUVRVC2%, RVC 0.75%, and RVC 2%). To verify the anesthetic effect, the animals were submitted to the pain pressure test and the motor block was also monitored. Histopathology of the tissues surrounding the sciatic nerve region was also assessed 2 and 7 days after treatment. Rats (n = 6) were submitted to a hind paw incision, and mechanical hypersensitivity was measured via the withdrawal response using von Frey filaments after injection of the 6 formulations. Finally, New Zealand white rabbits (n = 6) received sciatic nerve block (3 mL) with 1 of the 6 formulations of RVC. Blood samples were collected predose (0 minutes) and at 15, 30, 45, 60, 90, 120, 180, 240, 300, 360, 420, 480, and 540 minutes after injection. RVC plasma levels were determined using a triple-stage quadrupole mass spectrometer. RESULTS: Duration and intensity of the sensory block were longer with all liposomal formulations, when compared to the plain RVC solution (P

https://ift.tt/2QGK3gR

The natural history of cutaneous sarcoidosis. Clinical spectrum and histological analysis of 40 cases

International Journal of Dermatology, EarlyView.


https://ift.tt/2IO7wKp

Increasing trends of anaphylaxis-related events: an analysis of anaphylaxis using nationwide data in Taiwan, 2001–2013

Anaphylaxis is a severe, potentially fatal, and systemic allergic reaction. Previous studies document increasing trends in incidence rates of anaphylaxis-related events in Western countries, yet little is know...

https://ift.tt/2Ec7EET

From zero to sixty and back to zero again: the metabolic life of B cells

Munir Akkaya | Susan K Pierce

https://ift.tt/2NxwIpn

Outcomes for patients with second primary malignancy after primary surgical treatment for early‐stage squamous cell carcinoma of the oral cavity

Head &Neck, EarlyView.


https://ift.tt/2QFIvDO

Prognostic role of epiregulin/amphiregulin expression in recurrent/metastatic head and neck cancer treated with cetuximab

Head &Neck, EarlyView.


https://ift.tt/2A3YTbO

Transoral surgery using the Flex Robotic System: Initial experience in the United States

Head &Neck, EarlyView.


https://ift.tt/2QKSbx5

Overexpression of cysteine‐glutamate transporter and CD44 for prediction of recurrence and survival in patients with oral cavity squamous cell carcinoma

Head &Neck, EarlyView.


https://ift.tt/2A39vYp

Deficiency of sun protection advertising exists in consumer magazines across demographic groups and varies by target demographic

https://ift.tt/2A3qHNy

Galeatomy: A Useful Technique Aiding High-Tension Scalp Closures

https://ift.tt/2QHcYkS

Re-evaluating the Need for Routine Laboratory Monitoring in Isotretinoin Patients: A Retrospective Analysis

https://ift.tt/2A32sPC

Eczema Drug Dupilumab Spurs Hair Regrowth in Alopecia Totalis

Shared immune characteristics of alopecia totalis and atopic dermatitis might explain the hair regrowth in a patient with alopecia totalis being treated with dupilumab for persistent eczema.
Medscape Medical News

https://ift.tt/2IOY4Gu

Successful treatment of a traumatic tattoo in a pediatric patient using a 755‐nm picosecond laser

Pediatric Dermatology, EarlyView.


https://ift.tt/2CzaS3y

A comparison of international management guidelines for atopic dermatitis

Pediatric Dermatology, EarlyView.


https://ift.tt/2C843VE

Onychomycosis caused by Scopulariopsis brevicaulis: The third documented case in Japan

The Journal of Dermatology, EarlyView.


https://ift.tt/2QGhTmo

Announcement

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 10, Page 1828-1828, October 2018.


https://ift.tt/2CCnc36

Pioneers in dermatology and venereology: an interview with Prof. Helmut Kerl

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 10, Page 1629-1630, October 2018.


https://ift.tt/2C5OJc2

Issue Information

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 10, Page 1617-1622, October 2018.


https://ift.tt/2CC3d4M

Commentary to “Mogamulizumab‐induced photosensitivity in patients with mycosis fungoides and other T‐cell neoplasms” by Y. Masuda et al.

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 10, Page 1626-1626, October 2018.


https://ift.tt/2C5OFsO

Hidradenitis suppurativa in Korea

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 10, Page 1625-1625, October 2018.


https://ift.tt/2CBbaH5

Forthcoming Events

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 10, Page 1827-1827, October 2018.


https://ift.tt/2C5OCNE

Psoriasis: identifying trends through search engines

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 10, Page 1628-1628, October 2018.


https://ift.tt/2CAa7ar

Assessment of serious infections in pemphigus and pemphigoid by a national registry

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 10, Page 1623-1624, October 2018.


https://ift.tt/2C5Owpg

New attempts to improve in vitro diagnosis of contact allergy are still far from regular clinical practice

Journal of the European Academy of Dermatology and Venereology, Volume 32, Issue 10, Page 1627-1627, October 2018.


https://ift.tt/2CBbaqz

Risk Factors for Dupilumab-Associated Conjunctivitis in Patients With Atopic Dermatitis

This case series evaluates 12 patients with atopic dermatitis who experienced conjunctivitis secondary to injectable dupilumab treatment to investigate severity and common risk factors for secondary conjunctivitis.

https://ift.tt/2MYcybL

Laser Treatment Performed Decades After Napalm Burns

This case report describes the use of laser treatment beginning in 2015 to treat napalm burns sustained by the famous Vietnamese "Napalm Girl" in 1972.

https://ift.tt/2MSEkHx

Myths, Truths, and Clinical Relevance of Comedogenicity Product Labeling

This Viewpoint evaluates the meaning of the noncomedogenic label and the need for an objective assay for assessment of facial products.

https://ift.tt/2KNqRj4

Aprepitant for the Treatment of Pruritus in Sézary Syndrome

This randomized clinical trial assesses whether treatment with the neurokinin 1 receptor antagonist aprepitant decreases pruritus vs placebo in patients with Sézary syndrome.

https://ift.tt/2nEDleN

Increasing Minority Representation in the Dermatology Department

This Viewpoint reviews Johns Hopkins' successful experience in increasing the number of faculty physicians in dermatology from groups underrepresented in medicine and suggests steps that other institutions can take to replicate this success.

https://ift.tt/2OcMYxo

October 2018 Issue Highlights

https://ift.tt/2Pr0spH

Core Outcome Sets for Psoriasis Clinical Trials

Standardized and relevant psoriasis-specific outcome measures would contribute to a better understanding of the benefits of a growing list of highly effective therapies. To this end, in this issue of JAMA Dermatology, Callis Duffin et al present the results of an effort to define core outcome sets (COSs) for clinical trials of psoriasis. Under the auspices of the International Dermatology Outcome Measures group, the authors conducted a Delphi survey and determined that the following 6 domains should be addressed in all psoriasis trials: (1) psoriatic skin manifestations (including location), (2) an investigator global assessment, (3) an evaluation of signs and symptoms of both psoriasis and psoriatic arthritis, (4) a patient global assessment of his or her condition, (5) an assessment of treatment satisfaction, and (6) a measure of health-related quality of life.

https://ift.tt/2HpmFzr

Persistent Malar Erythema With Atrophy in a Young Woman

A young woman had asymptomatic, facial redness that flared in sunlight, previously treated with doxycycline and topical sulfacetamide with no effect; on her cheeks and nasal bridge there were multiple erythematous, annular plaques with focal areas of atrophy. What is your diagnosis?

https://ift.tt/2tpzq86

Identifying a Core Domain Set to Assess Psoriasis in Clinical Trials

This Delphi survey of patients, health care professionals, and other stakeholders identifies a core set of 6 domains that should be measured in all clinical trials for psoriasis therapies.

https://ift.tt/2sCuRrq

Dupilumab for the Treatment of Recalcitrant Bullous Pemphigoid

This case report describes the use of dupilumab to treat recalcitrant bullous pemphigoid.

https://ift.tt/2Ljzf5a

Hair Regrowth Outcomes of Contact Immunotherapy for Patients With Alopecia Areata

This systematic review and meta-analysis uses standardized criteria and prognostic factors to examine the clinical hair regrowth outcomes of contact immunotherapy with diphenylcyclopropenone or squaric acid dibutyl ester for patients with alopecia areata.

https://ift.tt/2vlWQwe

Performance of Dermatology Physician Assistants—Reply

In Reply We thank Marghoob et al for the opportunity to address their concerns regarding our study. Number needed to biopsy (NNB) (or excise) is a well-established measure consistent with prior publications, including studies by Marghoob and colleagues. While NNB can vary with disease prevalence, patients in both cohorts in our study had similar rates of keratinocyte carcinomas and invasive melanomas. Patients were also similarly distributed by age and sex, and our NNB findings remained consistent when patients with a melanoma history were excluded.

https://ift.tt/2mJAyQY

Association of Bullous Pemphigoid With Dipeptidyl-Peptidase 4 Inhibitors in Patients With Diabetes

This case-control study evaluates the association between use of dipeptidyl-peptidase 4 (DPP-4) inhibitors and development of bullous pemphigoid (BP) in patients with diabetes and characterizes those patients who develop DPP-4 inhibitor–associated BP.

https://ift.tt/2OUniGb

Safety Risk of Dermatoscope Magnets in Patients With Cardiovascular Implanted Electronic Devices

This observational cross-sectional study assesses the magnets in 3 different dermatoscopes to determine their ability to disrupt the functionality of pacemakers, defibrillators, and other implanted devices in patients.

https://ift.tt/2MR39iO

Interpretation of Melanocytic Lesions in the Digital Era vs Traditional Microscopy

This study of 87 pathologists compares the use of digital whole-slide imaging vs traditional microscopy in pathologists' ability to accurately interpret melanocytic lesions and reproduce correct diagnoses.

https://ift.tt/2PbZVIg

An Annular Eruption in a Young Child

A young child had a 6-month history of an asymptomatic expanding erythematous eruption on the lower legs, abdomen, and buttocks; clinical examination was significant for faint, nonscaling annular serpiginous, erythematous plaques. What is your diagnosis?

https://ift.tt/2NpjuMn

Self-reported Patient Motivations for Seeking Cosmetic Procedures

This multicenter observational study assesses the importance of self-reported factors that motivate patients to undergo minimally invasive cosmetic surgical procedures.

https://ift.tt/2MORUYf

An Elderly Woman With Painful Buttock and Vulvar Ulcers

A woman in her 80s presented with somnolence, fatigue, lower urinary tract symptoms, and progressively worsening vulvar and buttock pain. What is your diagnosis?

https://ift.tt/2y50QWB

Combined Reflectance Confocal Microscopy–Optical Coherence Tomography for Basal Cell Carcinoma

This pilot study of 85 lesions from 55 patients assesses the accuracy of a handheld imaging device that combines reflective confocal microscopy (RCM) and optical coherence tomography (OCT) to detect, diagnose, and estimate the depth of basal cell carcinoma in adults.

https://ift.tt/2MvL1PG

Program Director and Resident Perspectives on New Parent Leave in Dermatology Residency

This study investigates how new parent leave policies are perceived by dermatology program directors and residents.

https://ift.tt/2BXRQVd

Risk of Melanoma in Moderately Dysplastic Nevi Excisionally Biopsied but With Positive Margins

This multicenter cohort study examines the outcomes and risk for the development of subsequent cutaneous melanoma in moderately dysplastic nevi excisionally biopsied without residual clinical pigmentation but with positive histologic margins, observed for 3 years or more.

https://ift.tt/2ydrk61

Association Between Psoriasis and Sexual and Erectile Dysfunction in Epidemiologic Studies

This systematic review evaluates the main characteristics of the studies of psoriasis and sexual dysfunction (SD) or erectile dysfunction (ED), including level of evidence, tools used to assess SD or ED, and prevalence and incidence of SD or ED.

https://ift.tt/2Pmqx9c

Hair Regrowth After Long-standing Alopecia Totalis and Atopic Dermatitis Treated With Dupilumab

This case report describes hair regrowth in a patient with long-standing alopecia totalis and atopic dermatitis treated with dupilumab.

https://ift.tt/2yejM2O

Observation of Moderately Dysplastic Nevi With Positive Margins

The management of dysplastic nevi is a quotidian part of the clinical practice of dermatology, yet even directors of pigmented lesion clinics in the United States demonstrate significant practice variation with observation or therapeutic excision of dysplastic nevi. This scenario is particularly true for biopsies of dysplastic nevi that have histologically positive margins. A 2015 consensus statement summarizing this practice gap included a call for further study of this common clinical question. There are several important challenges in establishing evidence-based guidelines for the management of dysplastic nevi, and thus establishing practice consensus for the management of dysplastic nevi, including the lack of definitive evidence that dysplastic nevi are precursor lesions to melanoma, interobserver histopathologic variation in gradation of dysplasia, longitudinal risk of monitoring for clinical recurrence, and variation in diagnostic biopsy procedures (ie, risk of incisional or partial biopsies).

https://ift.tt/2Po52oE

Treatment of Severe Hailey-Hailey Disease With Apremilast

This case series describes 4 adult patients who received apremilast (a phosphodiesterase-4 inhibitor) for treatment-resistant Hailey-Hailey disease.

https://ift.tt/2ybBFzi

Blistering Distal Dactylitis

This case report describes a case of blistering distal dactylitis.

https://ift.tt/2Po4xuF

Clinical manifestations of hydropic ear disease (Menière’s)

Abstract

Introduction

Hydropic ear disease, initially described by and named after Prosper Menière, is one of the most frequent vertigo disorders and one of the most frequent inner ear disorders. It is the syndrome of endolymphatic hydrops which until 2007 could be diagnostically confirmed only by post-mortem histology. In the past, various attempts to formulate clinical diagnostic criteria have been undertaken but were hampered by the inability to ascertain the diagnosis in living patients. With the milestone achievement of endolymphatic hydrops imaging, today the pathology can be ascertained. In this study, we have performed a detailed analysis of the clinical features of hydropic ear disease for the first time by examining a large cohort of patients with morphologically confirmed endolymphatic hydrops using a detailed physician-administered neurotologic face-to-face interview.

Results

During a hydropic vertigo attack, the patients report nausea, vomiting, sweating, urge to defecate, urge to urinate, phosphenes, headache, photophobia, phonophobia and even transient loss of consciousness. A third of the patients does not experience auditory symptoms during the vertigo attacks. Vertigo attacks last less than 20 min in more than one-fourth of the patients. Audiometric hearing loss has its greatest diagnostic value at the frequencies of 1 kHz and below. Cochleovestibular symptom onset simultaneity is associated with a high frequency of drop-attacks. Migraine and autoimmune disorders are not associated with hydropic ear disease.

Conclusion

This study marks the beginning of the clinical characterization of hydropic ear disease. The findings have important implications for the future formulation of clinical diagnostic criteria.

https://ift.tt/2Prmxo0

Möglichkeiten des chirurgischen Zugangs zur Orbita

Zusammenfassung

Zur Entfernung von Tumoren und Fremdkörpern aus der Orbita, zur Behandlung von schweren entzündlichen Erkrankungen und zur Reposition von Knochenfragmenten nach Frakturen bzw. zur Rekonstruktion der knöchernen Strukturen der Orbita stehen unterschiedliche chirurgische Zugangswege zur Verfügung. Die zunehmende Kenntnis über die Pathologie und Pathophysiologie einzelner Erkrankungen, die Weiterentwicklung der Mikroskop- und Endoskoptechnik, die besseren Möglichkeiten der präoperativen bildgebenden Darstellung von pathologischen Prozessen, die modernen Möglichkeiten der Rekonstruktion der Orbita sowie die Weiterentwicklung der adjuvanten Therapie hat zu einer verminderten Invasivität und zur Entwicklung der heute i. d. R. angewandten minimalinvasiven chirurgischen Zugangswege zur Orbita geführt. Hierbei ist die operative Therapie häufig eine interdisziplinäre Aufgabe. Zielsetzung der vorliegenden Übersichtsarbeit ist die Beschreibung von heute gängigen chirurgischen Zugangswegen zur Orbita, ihrer Indikation und den potenziellen Komplikationen. Hierbei wird ein besonderes Augenmerk auf die minimalinvasiven Zugangswege gelegt. Die verschiedenen Zugangswege ermöglichen eine 360°-Exposition der Orbitabinnenstrukturen mit dem N. opticus als Zentrum („round the clock access to the orbit"). Die Beschreibung von Tipps und Tricks sowie eine Übersicht der aktuellen Literatur runden die Darstellungen der einzelnen Zugangswege ab.

https://ift.tt/2yt6bE1

Morphometric properties of the facial nerve in fetal temporal bones

Publication date: Available online 10 October 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Derya Ümit Talas, Orhan Beger, Turan Koç, Vural Hamzaoğlu, Hakan Özalp, Melike Mavruk, Cemre Yıldırım, İrem Güzelyüz, Yusuf Vayisoğlu, Deniz Uzmansel, Mehmet Farsak, Ahmet Dağtekin

Abstract

Objectives

The main aim of the study was to examine the development and course of the facial nerve within fetal temporal bones from an anatomical and neuro-otological perspective.

Methods

The study was conducted on 32 temporal bones from obtained fetuses (7 females, 9 male), on a mean gestational age of 26.75±4.36 (range, 20-34) weeks from the collection of the Anatomy Department of Medicine Faculty. All the measurements were collected with a digital image analysis software.

Results

Neither male/female nor right/left significant differences were observed in relation with the algebraic data of the segment lengths and angles of the facial nerve (p > 0.05). Linear functions for meatal, labyrinthine, tympanic, and mastoid segment lengths of the facial nerve were calculated as: y = -1.206 + 0.200 x Age (weeks), y = -1.868 + 0.153 x Age (weeks), y = -2.327+ 0.325 x Age (weeks), and y = -1.507+ 0.246 x Age (weeks), respectively. In addition, linear functions for first and second genu angles were calculated as: y = 105.475 - 0.117 x Age (weeks) and y = 140.446 - 0.042 x Age (weeks), respectively.

Conclusion

The regression equations and the scatter plot with increment curve, representing the growth dynamics of the facial nerve can be used for estimating its lengths and for understanding its development. The data suggest that there is a dramatic change transition from fetal life to the gathered data of adulthood in the length of meatal and mastoid segments as well as in the second genu angle; in addition, there is a partial change in the length of labyrinthine and tympanic segments as well as in the first genu angle.

https://ift.tt/2C7cSPr

Effect of Collagenase ointment versus Mebo ointment on healing of full‐thickness burns in mice by removing of necrotic tissue

Dermatologic Therapy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2RFz0pt

Trends of oral cavity, oropharyngeal and laryngeal cancer incidence in Scotland (1975-2012) - A socioeconomic perspective

Purkayastha, M; McMahon, AD; Gibson, J; Conway, DI; (2016) Trends of oral cavity, oropharyngeal and laryngeal cancer incidence in Scotland (1975-2012) - A socioeconomic perspective. Oral Oncology , 61 pp. 70-75. 10.1016/j.oraloncology.2016.08.015 . Green open access

https://ift.tt/2Rz4bD3

CORONARY HEART DISEASE MORTALITY IN SEVERE AND NON-SEVERE FAMILIAL HYPERCHOLESTEROLAEMIA: DATA FROM THE UK SIMON BROOME FH REGISTER

Humphries, SE; Cooper, JA; Seed, M; Capps, N; Durrington, PN; Jones, B; McDowell, IFW; ... Neil, HAW; + view all Humphries, SE; Cooper, JA; Seed, M; Capps, N; Durrington, PN; Jones, B; McDowell, IFW; Soran, H; Neil, HAW; - view fewer (2018) CORONARY HEART DISEASE MORTALITY IN SEVERE AND NON-SEVERE FAMILIAL HYPERCHOLESTEROLAEMIA: DATA FROM THE UK SIMON BROOME FH REGISTER. Presented at: HEART UK 32nd Annual Medical and Scientific Conference on Hot Topics in Atheroscloerosis and Cardiovascular Disease, University of Warwick, Coventry, UK.

https://ift.tt/2Ef6qZt

Sixteen diverse laboratory mouse reference genomes define strain-specific haplotypes and novel functional loci

Lilue, J; Doran, AG; Fiddes, IT; Abrudan, M; Armstrong, J; Bennett, R; Chow, W; ... Keane, TM; + view all Lilue, J; Doran, AG; Fiddes, IT; Abrudan, M; Armstrong, J; Bennett, R; Chow, W; Collins, J; Collins, S; Czechanski, A; Danecek, P; Diekhans, M; Dolle, D-D; Dunn, M; Durbin, R; Earl, D; Ferguson-Smith, A; Flicek, P; Flint, J; Frankish, A; Fu, B; Gerstein, M; Gilbert, J; Goodstadt, L; Harrow, J; Howe, K; Ibarra-Soria, X; Kolmogorov, M; Lelliott, CJ; Logan, DW; Loveland, J; Mathews, CE; Mott, R; Muir, P; Nachtweide, S; Navarro, FCP; Odom, DT; Park, N; Pelan, S; Pham, SK; Quail, M; Reinholdt, L; Romoth, L; Shirley, L; Sisu, C; Sjoberg-Herrera, M; Stanke, M; Steward, C; Thomas, M; Threadgold, G; Thybert, D; Torrance, J; Wong, K; Wood, J; Yalcin, B; Yang, F; Adams, DJ; Paten, B; Keane, TM; - view fewer (2018) Sixteen diverse laboratory mouse reference genomes define strain-specific haplotypes and novel functional loci. Nature Genetics 10.1038/s41588-018-0223-8 . (In press). Green open access

https://ift.tt/2Rz41LX

A candidate regulatory variant at the TREM gene cluster associates with decreased Alzheimer's disease risk and increased TREML1 and TREM2 brain gene expression

Carrasquillo, MM; Allen, M; Burgess, JD; Wang, X; Strickland, SL; Aryal, S; Siuda, J; ... Ertekin-Taner, N; + view all Carrasquillo, MM; Allen, M; Burgess, JD; Wang, X; Strickland, SL; Aryal, S; Siuda, J; Kachadoorian, ML; Medway, C; Younkin, CS; Nair, A; Wang, C; Chanana, P; Serie, D; Nguyen, T; Lincoln, S; Malphrus, KG; Morgan, K; Golde, TE; Price, ND; White, CC; De Jager, PL; Bennett, DA; Asmann, YW; Crook, JE; Petersen, RC; Graff-Radford, NR; Dickson, DW; Younkin, SG; Ertekin-Taner, N; - view fewer (2017) A candidate regulatory variant at the TREM gene cluster associates with decreased Alzheimer's disease risk and increased TREML1 and TREM2 brain gene expression. Alzheimer's & Dementia , 13 (6) pp. 663-673. 10.1016/j.jalz.2016.10.005 . Green open access

https://ift.tt/2Ef5EM3

COST-EFFECTIVENESS OF UNIVERSAL SCREENING FOR FAMILIAL HYPERCHOLESTEROLAEMIA (FH) AT AGE 1-2 YEARS

Mckay, AJ; Hogan, H; Humphries, SE; Marks, D; Ray, KK; Miners, A; (2018) COST-EFFECTIVENESS OF UNIVERSAL SCREENING FOR FAMILIAL HYPERCHOLESTEROLAEMIA (FH) AT AGE 1-2 YEARS. In: (Proceedings) HEART UK 32nd Annual Medical and Scientific Conference on Hot Topics in Atheroscloerosis and Cardiovascular Disease. (pp. E3-E3). Elsevier Green open access

https://ift.tt/2RE1hwI

Quick and Simple FRAIL Scale Predicts Incident Activities of Daily Living (ADL) and Instrumental ADL (IADL) Disabilities: A Systematic Review and Meta-analysis

Kojima, G; (2018) Quick and Simple FRAIL Scale Predicts Incident Activities of Daily Living (ADL) and Instrumental ADL (IADL) Disabilities: A Systematic Review and Meta-analysis. Journal of the American Medical Directors Association 10.1016/j.jamda.2018.07.019 . (In press).

https://ift.tt/2Ef64lB

Association of Changes in Plasma Neurofilament Light and Tau Levels With Anesthesia and Surgery Results From the CAPACITY and ARCADIAN Studies

Evered, L; Silbert, B; Scott, DA; Zetterberg, H; Blennow, K; (2018) Association of Changes in Plasma Neurofilament Light and Tau Levels With Anesthesia and Surgery Results From the CAPACITY and ARCADIAN Studies. JAMA Neurology , 75 (5) pp. 542-547. 10.1001/jamaneurol.2017.4913 .

https://ift.tt/2RCCoS6

Coping-Style Behavior Identified by a Survey of Parent-of-Origin Effects in the Rat

Mont, C; Hernandez Pilego, P; Cañete, T; Oliveras, I; Río-Álamos, C; Blázquez, G; López-Aumatell, R; ... Mott, R; + view all Mont, C; Hernandez Pilego, P; Cañete, T; Oliveras, I; Río-Álamos, C; Blázquez, G; López-Aumatell, R; Martínez-Membrives, E; Tobeña, A; Flint, J; Fernández-Teruel, A; Mott, R; - view fewer (2018) Coping-Style Behavior Identified by a Survey of Parent-of-Origin Effects in the Rat. G3: Genes, Genomes, Genetics , 8 (10) pp. 3283-3291. 10.1534/g3.118.200489 . Green open access

https://ift.tt/2E7GKhk

Climate variability impacts on coastal dune slack ecohydrology

varandas martins, S; Burningham, H; pinto-cruz, C; (2018) Climate variability impacts on coastal dune slack ecohydrology. Irish Geography (In press).

https://ift.tt/2RB0eO2

Evolving Relevance of Neuroproteomics in Alzheimer's Disease

Lista, S; Zetterberg, H; O'Bryant, SE; Blennow, K; Hampel, H; (2017) Evolving Relevance of Neuroproteomics in Alzheimer's Disease. Neuroproteomics, Methods in Molecular Biology , 1598 pp. 101-115. 10.1007/978-1-4939-6952-4_5 . Green open access

https://ift.tt/2EaN2wF

Impacts of climate change and hydrological management on a coastal lake and wetland system

Gardner, EA; Burningham, H; Thompson, JR; (2018) Impacts of climate change and hydrological management on a coastal lake and wetland system. Irish Geography (In press).

https://ift.tt/2RHPQnZ

Are the Kihon Checklist and the Kaigo-Yobo Checklist Compatible With the Frailty Index?

Kojima, G; Taniguchi, Y; Kitamura, A; Shinkai, S; (2018) Are the Kihon Checklist and the Kaigo-Yobo Checklist Compatible With the Frailty Index? Journal of the American Medical Directors Association , 19 (9) 797-800.e2. 10.1016/j.jamda.2018.05.012 .

https://ift.tt/2E9nn7O

Fluid biomarkers for disease activity in multiple sclerosis

Zetterberg, H; Teunissen, C; (2017) Fluid biomarkers for disease activity in multiple sclerosis. [Editorial comment]. Multiple Sclerosis Journal , 23 (13) pp. 1660-1661. 10.1177/1352458517736151 . Green open access

https://ift.tt/2RHvkDA

Dotty triangles: two different approaches to analysing young children’s responses to a pattern replication activity

Thouless, H; Gifford, S; (2018) Dotty triangles: two different approaches to analysing young children's responses to a pattern replication activity. In: Proceedings of the 9th British Congress of Mathematics Education 2018. BSRLM: University of Warwick, UK. (In press).

https://ift.tt/2EbGJJq

Fluid biomarkers for microglial activation and axonal injury in multiple sclerosis

Zetterberg, H; (2017) Fluid biomarkers for microglial activation and axonal injury in multiple sclerosis. Acta Neurologica Scandinavica , 136 (s201) pp. 15-17. 10.1111/ane.12845 .

https://ift.tt/2RLeDaG

Alzheimer's disease biomarker-guided diagnostic workflow using the added value of six combined cerebrospinal fluid candidates: A beta(1-42), total-tau, phosphorylated-tau, NFL, neurogranin, and YKL-40

Hampel, H; Toschi, N; Baldacci, F; Zetterberg, H; Blennow, K; Kilimann, I; Teipel, SJ; ... Lista, S; + view all Hampel, H; Toschi, N; Baldacci, F; Zetterberg, H; Blennow, K; Kilimann, I; Teipel, SJ; Cavedo, E; dos Santos, AM; Epelbaum, S; Lamari, F; Genthon, R; Dubois, B; Floris, R; Garaci, F; Lista, S; - view fewer (2018) Alzheimer's disease biomarker-guided diagnostic workflow using the added value of six combined cerebrospinal fluid candidates: A beta(1-42), total-tau, phosphorylated-tau, NFL, neurogranin, and YKL-40. Alzheimer's & Dementia , 14 (4) pp. 492-501. 10.1016/j.jalz.2017.11.015 .

https://ift.tt/2Ec6Z6q

From Cerebrospinal Fluid to Blood: The Third Wave of Fluid Biomarkers for Alzheimer's Disease

Zetterberg, H; Blennow, K; (2018) From Cerebrospinal Fluid to Blood: The Third Wave of Fluid Biomarkers for Alzheimer's Disease. Journal of Alzheimer's Disease , 64 (s1) S271-S279. 10.3233/JAD-179926 . Green open access

https://ift.tt/2RLekg2

Endovascular baroreflex amplification for resistant hypertension: a safety and proof-of-principle clinical study

Spiering, W; Williams, B; Van der Heyden, J; van Kleef, M; Lo, R; Versmissen, J; Moelker, A; ... Bates, M; + view all Spiering, W; Williams, B; Van der Heyden, J; van Kleef, M; Lo, R; Versmissen, J; Moelker, A; Kroon, A; Reuter, H; Ansel, G; Stone, GW; Bates, M; - view fewer (2017) Endovascular baroreflex amplification for resistant hypertension: a safety and proof-of-principle clinical study. The Lancet , 390 (10113) pp. 2655-2661. 10.1016/S0140-6736(17)32337-1 . Green open access

https://ift.tt/2E7FN8K

Impact of Zostavax Vaccination on T-Cell Accumulation and Cutaneous Gene Expression in the Skin of Older Humans After Varicella Zoster Virus Antigen-Specific Challenge

Patel, NP; Vukmanovic-Stejic, M; Suarez-Farinas, M; Chambers, ES; Sandhu, D; Fuentes-Duculan, J; Mabbott, NA; ... Akbar, AN; + view all Patel, NP; Vukmanovic-Stejic, M; Suarez-Farinas, M; Chambers, ES; Sandhu, D; Fuentes-Duculan, J; Mabbott, NA; Rustin, MHA; Krueger, J; Akbar, AN; - view fewer (2018) Impact of Zostavax Vaccination on T-Cell Accumulation and Cutaneous Gene Expression in the Skin of Older Humans After Varicella Zoster Virus Antigen-Specific Challenge. The Journal of Infectious Diseases , 218 (suppl_2) S88-S98. 10.1093/infdis/jiy420 . Green open access

https://ift.tt/2RLea8q

Internet freedom, human rights and power

Carr, M; (2013) Internet freedom, human rights and power. Australian Journal of International Affairs , 67 (5) pp. 621-637. 10.1080/10357718.2013.817525 . Green open access

https://ift.tt/2EdPJO6

Transcriptome analysis of differentially expressed genes involved in innate immunity following Bacillus thuringiensis challenge in Bombyx mori larvae

Publication date: November 2018

Source: Molecular Immunology, Volume 103

Author(s): Gongqing Wu, Yunhong Yi

Abstract

In this study, we describe RNA-seq expression profiling of larval Bombyx mori response to hemocoel injection of Bacillus thuringiensis (Bt). Two transcriptomes were generated from the hemocytes of the PBS- and Bt-injected B. mori larvae. More than 49 million 100-bp paired-end reads, encompassing over 7.3 Gb of sequence data, were generated for each library. After filtering the raw reads and removing the rRNA mapped reads, more than 89% of the reads in each library could be mapped to the silkworm genome reference sequence. Comparison of gene expression levels revealed that a total of 133 unigenes were upregulated while 84 unigenes were downregulated in PBS vs Bt. To further investigate the biological functions of different expression genes (DEGs), gene ontology (GO) and functional enrichment analysis were performed to map all the DEGs to terms in the GO, euKaryotic Ortholog Groups of proteins (KOG) and Kyoto Encyclopedia of Genes and Genomes Pathway (KEGG) database. Among these DEGs, many genes involved in immunity against Bt challenge were identified. These included genes participated in pattern recognition, antimicrobial peptides, insecticide resistance or detoxification, immune melanization, cytoskeleton reorganization and many other immune effectors. To confirm the gene expression patterns identified by the RNA-seq data, the transcript levels of 10 immune related DEGs were examined by quantitative real-time PCR (qRT-PCR). The results showed that the DEGs obtained from the deep sequencing data were accurate and gene expression profiles from RNA-Seq data were reliable. Our studies provide insights into the to immune response of B. mori underling the stress of Bt, which is valuable to understand how Bt affects the innate immune system of silkworm and provide new approaches to control insect pests by using Bt as a biological insecticide.

https://ift.tt/2NuhYrf

Usefulness of OLGA and OLGIM system not only for intestinal type but also for diffuse type of gastric cancer, and no interaction among the gastric cancer risk factors

Helicobacter, EarlyView.


https://ift.tt/2A34C1B

Comparison of bleach, acetic acid, and other topical anti‐infective treatments in pediatric atopic dermatitis: A retrospective cohort study on antibiotic exposure

Pediatric Dermatology, EarlyView.


https://ift.tt/2yrEgV9

Upregulated P-Rex1 exacerbates human airway smooth muscle hyperplasia in asthma

Publication date: Available online 10 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Yapei Huang, Yan Xie, Haihong Jiang, Peter W. Abel, Reynold A. Panettieri, Thomas B. Casale, Yaping Tu

https://ift.tt/2E7zZvY

Intestinal dysbiosis in Inflammatory Bowel Disease associated with primary immunodeficiency.

Publication date: Available online 10 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Harry Sokol, Nizar Mahlaoui, Claire Aguilar, Perrine Bach, Olivier Join-Lambert, Aurélie Garraffo, Philippe Seksik, François Danion, Sarah Jegou, Marjolene Straube, Christelle Lenoir, Bénédicte Neven, Despina Moshous, Stéphane Blanche, Bénédicte Pigneur, Olivier Goulet, Frank Ruemmele, Felipe Suarez, Laurent Beaugerie, Stéphanie Pannier

https://ift.tt/2RFFftm

Hsa-mir-144-3p is increased in umbilical cord serum of infants developing atopic dermatitis

Publication date: Available online 9 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Eishika Dissanayake, Yuzaburo Inoue, Shingo Ochiai, Akifumi Eguchi, Taiji Nakano, Fumiya Yamaide, Satomi Hasegawa, Hiroyuki Kojima, Hiroko Suzuki, Chisato Mori, Yoichi Kohno, Masaru Taniguchi, Naoki Shimojo

https://ift.tt/2E9dOWg

EROS mutations: decreased NADPH oxidase function and chronic granulomatous disease

Publication date: Available online 9 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): David C. Thomas, Louis-Marie Charbonnier, Andrea Schejtman, Hasan Aldhekri, Eve L. Coomber, Elizabeth R. Dufficy, Anne E. Beenken, James C. Lee, Simon Clare, Anneliese O. Speak, Adrian J. Thrasher, Giorgia Santilli, Hamoud Al-Mousa, Fowzan S. Alkuraya, Talal A. Chatila, Kenneth G.C. Smith

Short Summary

The phagocyte respiratory burst is mediated by the phagocyte NADPH oxidase, a multi-protein subunit complex that facilitates production of reactive oxygen species and which is essential for host defence. Monogenic deficiency of individual subunits leads to chronic granulomatous disease (CGD), which is characterized by an inability to make reactive oxygen species, leading to severe opportunistic infections and auto-inflammation. However, not all cases of CGD are due to mutations in previously identified subunits. We recently showed that Eros, a novel and highly conserved ER-resident transmembrane protein, is essential for the phagocyte respiratory burst in mice because it is required for expression of gp91phox-p22phox heterodimer, which are the membrane bound components of the phagocyte NADPH oxidase. Eros has a human orthologue, CYBC1/EROS. We now show that the function of CYBC1/EROS is conserved in human cells and describe a case of CGD secondary to a homozygous CYBC1/EROS mutation that abolishes EROS protein expression. This work demonstrates the fundamental importance of CYBC1/EROS in human immunity and describes a novel cause of CGD.

https://ift.tt/2RDhYIF

Real life treatment of Cholinergic Urticaria with Omalizumab

Publication date: Available online 9 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): S. Altrichter, M. Chuamanochan, H. Knoth, A. Asady, T. Ohanyan, M. Metz, M. Maurer

Abstract

Background

Cholinergic urticaria (CholU), a frequent type of chronic inducible urticaria, presents with small itchy wheals upon physical exercise or passive warming. Omalizumab has been shown to be very effective in patients with chronic spontaneous urticaria. Whether or not omalizumab is also effective in CholU is largely unknown.

Aim

To assess the effectiveness of omalizumab treatment in CholU

Method

We assessed the effects of real life omalizumab treatment at standard and higher than standard doses in CholU patients including their time to response, the effects on concomitant urticaria forms and links to clinical features.

Results

Of 16 CholU patients treated with omalizumab, 11 (68%) reported a major or complete response, 2 patients reported a minor effect (13 %) and 3 patients (19%) showed no benefit. Omalizumab updosing led to complete response in 4 of 6 patients, who did not achieve controlled disease on standard dosed omalizumab therapy, i.e. 300 mg/4wks. Time to onset of benefit was fast, and concomitant urticaria forms showed similar response patterns. Treatment effects were linked to patient gender, with better responses in female patients (p < 0.05), but not patient age, age at onset of disease, duration of disease, or total IgE serum levels.

Conclusion

Omalizumab treatment is effective in the majority of CholU patients, especially in female patients. Most non-responders to standard-dosed omalizumab benefit from updosing. Our findings call for controlled clinical trials of omalizumab and other IgE-targeted treatments in CholU.

https://ift.tt/2E9dI0Q

CSF3R/CD114 mediates infection-dependent transition to severe asthma

Publication date: Available online 9 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Hao Wang, Meaghan FitzPatrick, Nicholas J. Wilson, Desiree Anthony, Patrick C. Reading, Catherine Satzke, Eileen M. Dunne, Paul V. Licciardi, Huei Jiunn Seow, Kristy Nichol, Ian M. Adcock, Kian Fan Chung, Gary P. Anderson, Ross Vlahos, Peter Wark, Steven Bozinovski

https://ift.tt/2RDh9zz

Maintained thymic output of conventional and regulatory T cells during human pregnancy

Publication date: Available online 9 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Sandra Hellberg, Ratnesh B. Mehta, Anna Forsberg, Göran Berg, Jan Brynhildsen, Ola Winqvist, Maria C. Jenmalm, Jan Ernerudh

https://ift.tt/2E9dzdO

Neutropenia as a sign of immunodeficiency

Publication date: Available online 9 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Kathleen E. Sullivan

https://ift.tt/2RDgYnT

A Personal Perspective on Mentoring

Publication date: Available online 9 October 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Dean D. Metcalfe

https://ift.tt/2E9hM1i

Métastases cutanées des extrémités

Publication date: Available online 10 October 2018

Source: Annales de Dermatologie et de Vénéréologie

Author(s): H. Martin, M. Mariano-Bourin, L. Antunes, A. Bonhomme, J.-F. Cuny, L. Dubouis, F. Truchetet, A. Schoeffler

Résumé

Introduction

Les métastases cutanées (MC) localisées aux extrémités sont des complications exceptionnelles des cancers solides, au pronostic sévère. Dans la majorité des cas, elles simulent une infection. Nous en rapportons deux nouvelles observations de présentation originale.

Observations

Cas n^o 1 : un homme de 71 ans consultait pour suspicion de botryomycomes de la main gauche évoluant depuis 3 mois. Il avait pour antécédent deux carcinomes épidermoïdes (lingual et pulmonaire) en rémission. L'examen clinique objectivait trois lésions bourgeonnantes de la main gauche. La biopsie d'une des lésions concluait à une métastase de carcinome épidermoïde. Au bilan d'extension, on notait l'apparition de micronodules pulmonaires disséminés suspects de localisations secondaires. Cas n^o 2 : un homme de 68 ans consultait pour un œdème du membre inférieur droit infiltré, dur, mal limité, qui évoluait depuis plusieurs mois. Six mois auparavant, il avait eu un adénocarcinome bronchique traité par lobectomie supérieure gauche et dont le bilan d'extension ne révélait pas de lésion secondaire. Cliniquement, on notait un œdème induré prédominant au pied. La biopsie cutanée objectivait une métastase d'adénocarcinome. Le bilan d'extension montrait des lésions ostéolytiques du tarse droit ainsi que des adénomégalies.

Discussion

Nous rapportons deux cas originaux de MC des extrémités ayant permis de diagnostiquer une évolution tumorale. Il s'agit d'une complication rare, de présentation clinique variable, ayant un impact sur la prise en charge du cancer et sur le pronostic vital du patient. Ces observations illustrent l'importance d'évoquer le diagnostic en cas de lésions cutanées distales persistantes, a fortiori en cas d'antécédents néoplasiques.

Summary

Background

Cutaneous metastases (CM) on the extremities are rare complication of cancer with poor prognosis. In general, lesions simulate an infection. Herein, we report two new cases with atypical presentation.

Patients and methods

Case no 1: a 71-year-old man consulted for suspicion of left hand pyogenic granuloma present for 3 months. His history revealed two treated squamous-cell carcinomas (tongue and lung). On physical examination, he presented three budding and foul-smelling lesions on his left hand. Histopathology showed metastasis of squamous-cell carcinoma. Radiographic examination revealed spread of pulmonary nodules with suspicion of metastasis. Case no 2: a 68-year-old man was hospitalized for indurated edema of the right leg present for several months. Six months earlier, he had undergone surgery for left pulmonary adenocarcinoma without metastasis. Physical examination revealed an indurated edema on the right foot. Histopathology showed metastasis from adenocarcinoma. A scan revealed several osteolytic lesions in the right foot as well as lymphadenopathy.

Discussion

Herein, we report two original cases of CM of the extremities diagnosed as tumor progression. This is a rare complication of variable clinical presentation and impacts both cancer management and prognosis. It is important to consider the diagnosis when distal cutaneous lesions persist, particularly where there is a history of cancer.

https://ift.tt/2Pqt1Dv

The effect of human serum and dentin powder alone or in combination on the antibacterial activity of sodium hypochlorite against Enterococcus faecalis

Publication date: Available online 9 October 2018

Source: Archives of Oral Biology

Author(s): Zhongchun Tong, Yanqing Zhang, Xi Wei

Abstract

Objective

Dentin debris and organic components may affect the properties of intracanal irrigants. This study aimed to evaluate the effect of dentin powder (DP) and human serum (HS) on the antibacterial and antibiofilm activity of sodium hypochlorite (NaOCl) against Enterococcus faecalis.

Design

DP from 100 to 6.25 mg/mL and HS from 10% to 0.3125% were interactively mixed and added into E. faecalis and 1% NaOCl solution. The live E. faecalis were counted after 1 min of contact. For biofilm testing, 7 days of E. faecalis biofilms were treated by 100 mg/mL DP and 10% HS alone or combination with 1% NaOCl solution for 1 min. Furthermore, after challenges, E. faecalis biofilms were stained with SYTO 9 and propidium iodide, and confocal laser scanning microscopy (CLSM) was used to determine the proportion of dead and live cells in the biofilm.

Results

One hundred mg/mL DP or 10% HS alone showed the excellent inhibition of 1% NaOCl against planktonic E. faecalis, and the low concentration of DP and HS presented an additive inhibitory effect. The number of live bacteria in biofilms were significantly higher in the 1% NaOCl-treated group with DP or HS than without DP and HS (p <  0.05), and a higher percentage of dead bacteria was found in the challenge of NaOCl in the absence of DP and HS than in the presence of DP and HS.

Conclusion

DP and HS generated the inhibition of antibacterial and antibiofilm activities of NaOCl, whereas the effect of HS was greater than DP.

https://ift.tt/2RCtIeu

Demethylated Drug in the Treatment of Nasopharyngeal Carcinoma

Condition:   Nasopharyngeal Carcinoma
Intervention:   Drug: Demethylated drug decitabine
Sponsors:   Wei Jiang;   Guilin Hospital of Traditional Chinese Medicine
Recruiting

https://ift.tt/2yxK7bg

The protective effect of metformin against the noise-induced hearing loss

Abstract

Objective

To test the protective effect of metformin against noise-induced hearing loss.

Methods

24 rats were included in the study. The first group was exposed to noise only, the second group took metformin, the third group was exposed to noise and took metformin, and the fourth group was neither exposed to noise nor took metformin as control group. After measurement of baseline DPOAE and ABR of rats, the metformin group and the metformin + noise group received 300 mg/kg/day metformin via gavage for 10 days. On the 11th day, group 1 and group 3 were exposured to white noise at 105 dB SPL for 15 h. After noise exposure, DPOAE and ABR measurements of all rats were repeated on days 1st, 7th, and 21st. At the end of the study, all animals were sacrificed and cochlear tissues were separated for immunohistochemical assessments.

Results

ABR threshold values and DPAOE measurements of groups 1 and 3 were deteriorated on the 1st day after noise, while deterioration in group 1 continued on 7th and 21st days, but normalized on 7th day in group 3. After immune staining, a significant immunoreaction was observed in the noise group, while the reaction in the noise + metformin group was close to the control group.

Conclusion

Metformin has a protective effect on noise-induced hearing loss in rats. As a conclusion, it is determined that metformin protects from permanent threshold shift in rats. It can be considered a good alternative for protecting noise-induced hearing loss.

https://ift.tt/2pNmFTC

Nachruf auf Herrn Prof. Dr. med. Joachim Heermann

https://ift.tt/2C79NyW

Tinnitus is multicausal and may not only be related to DNA variants

https://ift.tt/2OfSYJE

Macrophage-microbe interaction: lessons learned from the pathogen Mycobacterium tuberculosis

Abstract

Macrophages, being the cornerstone of the immune system, have adapted the ancient nutrient acquisition mechanism of phagocytosis to engulf various infectious organisms thereby helping to orchestrate an appropriate host response. Phagocytosis refers to the process of internalization and degradation of particulate material, damaged and senescent cells and microorganisms by specialized cells, after which the vesicle containing the ingested particle, the phagosome, matures into acidic phagolysosomes upon fusion with hydrolytic enzyme-containing lysosomes. The destructive power of the macrophage is further exacerbated through the induction of macrophage activation upon a variety of inflammatory stimuli. Despite being the end-point for many phagocytosed microbes, the macrophage can also serve as an intracellular survival niche for a number of intracellular microorganisms. One microbe that is particularly successful at surviving within macrophages is the pathogen Mycobacterium tuberculosis, which can efficiently manipulate the macrophage at several levels, including modulation of the phagocytic pathway as well as interfering with a number of immune activation pathways that normally would lead to eradication of the internalized bacilli. M. tuberculosis excels at circumventing destruction within macrophages, thus establishing itself successfully for prolonged times within the macrophage. In this contribution, we describe a number of general features of macrophages in the context of their function to clear an infection, and highlight the strategies employed by M. tuberculosis to counter macrophage attack. Interestingly, research on the evasion tactics employed by M. tuberculosis within macrophages not only helps to design strategies to curb tuberculosis, but also allows a better understanding of host cell biology.

https://ift.tt/2Cy2nWJ

Extension of the Clinical Significance of the “Cog”

Objective: To study the clinical anatomy of the epitympanum, the attic, and its medial wall, to try to discover a new clinical operation-related anatomical landmark, and to investigate the adjacent anatomical relationship with this landmark. Materials and Methods: Eight donor temporal bone specimens were dissected endoscopically. For 29 healthy persons (17 males and 12 females), CT images of the temporal bone (57 ears) were taken, 3-dimensional (3-D) reconstruction and multidimensional plane reconstruction were performed, and identification and assessment of 3-D spatial relationships between any 2 of these complex structures were done. Results: 3-D images of the temporal bone structures including the facial nerve, the cochlea, the semicircular canal, and the brain plate were reconstructed and shown in detail. We discovered a new clinical surgery-related anatomical landmark (the "cog" tangent and the trailing edge of the cog). Based on the tangent and the trailing edge of the cog, we quantified the anatomical relationship between it and its neighboring important structures. Conclusion: Based on endoscopic anatomy and the temporal bone spiral CT 3-D structure reconstruction of the epitympanum, the attic, and the adjacent structures, we found an extension of the clinical significance the cog. Quantification of the adjacent anatomical relationship of this landmark is very important for otology microsurgical operation.
ORL

https://ift.tt/2A2KtZu

Actions Speak Louder than Words: Examining the Relationship Between Violent Behaviors and Bullying Victimization Among Adolescents

Violence and Gender, Ahead of Print.


https://ift.tt/2yqiPni

Sequential bilateral cochlear implants in children and adolescents: Outcomes and prognostic factors

Publication date: Available online 9 October 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): S. Baron, M. Blanchard, M. Parodi, I. Rouillon, N. Loundon

Abstract

Objectives

Cochlear implants (CI) have enabled an increasing proportion of deaf children to develop oral communication. Despite the well-known benefits of bilateral implantation, many of these children and teenagers have only a unilateral implant. The aim of this study was to evaluate the benefits of sequential bilateral CI and the influence of relevant factors on outcome.

Material and methods

A single-center retrospective study included 109 children and adolescents who received a second sequential CI between 2008 and 2016. Subjects were evaluated before sequential implantation and subsequently at 3, 12 and 24 months, on Speech Intelligibility Rating and speech perception tests: Categories of Auditory Performance, word and sentence recognition in silence and in noise. The influence of inter-implant interval and performance with the first CI were analyzed.

Results

In the majority of patients, sequential CI provided significant improvement in speech and intelligibility perception. These benefits were seen not only for short but also for long inter-implant intervals. Some subjects with poor performance with their first implant showed significant progression after sequential bilateral implantation.

Conclusion

In view of the benefits of sequential bilateral CI, we suggest that a second CI should be proposed to all unilaterally implanted children and adolescents, regardless of inter-implant interval and initial performance with the first CI. Further studies need to be conducted to identify prognostic factors for success in sequential contralateral implantation.

https://ift.tt/2C44BMp

Comparison of outcomes between hemithyroidectomy alone and hemithyroidectomy with elective unilateral central neck dissection in patients with papillary thyroid microcarcinoma

Head &Neck, EarlyView.


https://ift.tt/2C6IyV6

Evaluation of training on palliative care for staff working within a homeless hostel

Shulman, C; Hudson, BF; Kennedy, P; Brophy, N; Stone, P; (2018) Evaluation of training on palliative care for staff working within a homeless hostel. Nurse Education Today , 71 pp. 135-144. 10.1016/j.nedt.2018.09.022 . Green open access

https://ift.tt/2A2IHYB

Commentary on Al Hussona et al. 'New-onset seizures as a sole clinical presentation of multiple sclerosis'

Chard, DT; (2018) Commentary on Al Hussona et al. 'New-onset seizures as a sole clinical presentation of multiple sclerosis'. Multiple Sclerosis Journal 10.1177/1352458518781978 . (In press). Green open access

https://ift.tt/2QGrGc6

Alzheimer's Disease-Associated Cerebrospinal Fluid (CSF) Biomarkers do not Correlate with CSF Volumes or CSF Production Rate

Edsbagge, M; Andreasson, U; Ambarki, K; Wikkelso, C; Eklund, A; Blennow, K; Zetterberg, H; Edsbagge, M; Andreasson, U; Ambarki, K; Wikkelso, C; Eklund, A; Blennow, K; Zetterberg, H; Tullberg, M; - view fewer (2017) Alzheimer's Disease-Associated Cerebrospinal Fluid (CSF) Biomarkers do not Correlate with CSF Volumes or CSF Production Rate. Journal of Alzheimer's Disease , 58 (3) pp. 821-828. 10.3233/JAD-161257 . Green open access

https://ift.tt/2A2vu1P

Sacroiliac Joint Ankylosis In Young Spondyloarthritis Patients Receiving Biologic Therapy: Observation of Serial MRI scans

Bray, TJP; Lopes, A; Fisher, C; Ciurtin, C; Sen, D; Hall-Craggs, MA; (2018) Sacroiliac Joint Ankylosis In Young Spondyloarthritis Patients Receiving Biologic Therapy: Observation of Serial MRI scans. Arthritis and Rheumatology 10.1002/art.40750 . (In press). Green open access

https://ift.tt/2QFDR8O

Go-with-the-flow: A smartphone app for realtime tracking and sonification of physical activity in CP

Newbold, JW; Singh, A; Bianchi-Berthouze, N; (2016) Go-with-the-flow: A smartphone app for realtime tracking and sonification of physical activity in CP. In: Proceedings of 10th EAI International Conference on Pervasive Computing Technologies for Healthcare - 2016. EAI: Cancun, Mexico.

https://ift.tt/2A2OkWv

Differential Nanoscale Topography and Functional Role of GluN2-NMDA Receptor Subtypes at Glutamatergic Synapses

Kellermayer, B; Ferreira, JS; Dupuis, J; Levet, F; Grillo-Bosch, D; Bard, L; Linarès-Loyez, J; ... Groc, L; + view all Kellermayer, B; Ferreira, JS; Dupuis, J; Levet, F; Grillo-Bosch, D; Bard, L; Linarès-Loyez, J; Bouchet, D; Choquet, D; Rusakov, DA; Bon, P; Sibarita, J-B; Cognet, L; Sainlos, M; Carvalho, AL; Groc, L; - view fewer (2018) Differential Nanoscale Topography and Functional Role of GluN2-NMDA Receptor Subtypes at Glutamatergic Synapses. Neuron , 100 pp. 1-14. 10.1016/j.neuron.2018.09.012 . (In press).

https://ift.tt/2QFDEm2

Conceptualising production, productivity and technology in pharmacy practice: a novel framework for policy, education and research

Baines, D; Bates, I; Bader, L; Hale, C; Schneider, P; (2018) Conceptualising production, productivity and technology in pharmacy practice: a novel framework for policy, education and research. Human Resources for Health , 16 , Article 51. 10.1186/s12960-018-0317-5 . Green open access

https://ift.tt/2A2mBFr

Service user experiences of specialist mental health supported accommodation: A systematic review of qualitative studies and narrative synthesis

Krotofil, J; McPherson, P; Killaspy, H; (2018) Service user experiences of specialist mental health supported accommodation: A systematic review of qualitative studies and narrative synthesis. Health and Social Care in the Community , 26 (6) pp. 787-800. 10.1111/hsc.12570 .

https://ift.tt/2QGIU8Z

Analysis of wild macaque stone tools used to crack oil palm nuts

Proffitt, T; Luncz, VL; Malaivijitnond, S; Gumert, M; Svensson, MS; Haslam, M; (2018) Analysis of wild macaque stone tools used to crack oil palm nuts. Royal Society Open Science , 5 (3) , Article 171904. 10.1098/rsos.171904 . Green open access

https://ift.tt/2A2vpex

Short acquisition time PET/MR pharmacokinetic modelling using CNNs

Scott, CJ; Jiao, J; Cardoso, MJ; Kläser, K; Melbourne, A; Markiewicz, PJ; Schott, JM; ... Ourselin, S; + view all Scott, CJ; Jiao, J; Cardoso, MJ; Kläser, K; Melbourne, A; Markiewicz, PJ; Schott, JM; Hutton, BF; Ourselin, S; - view fewer (2018) Short acquisition time PET/MR pharmacokinetic modelling using CNNs. In: Proceedings of the International Conference on Medical Image Computing and Computer-Assisted Intervention: MICCAI 2018. (pp. pp. 48-56). Springer, Cham: Granada, Spain.

https://ift.tt/2QGr3PM

Evolution of dynamic, biochemical, and morphological parameters in hypothermic machine perfusion of human livers: A proof-of-concept study

Abudhaise, H; Davidson, BR; DeMuylder, P; Luong, T; Fuller, B; (2018) Evolution of dynamic, biochemical, and morphological parameters in hypothermic machine perfusion of human livers: A proof-of-concept study. PLoS ONE , 13 (9) , Article e0203803. 10.1371/journal.pone.0203803 . Green open access

https://ift.tt/2A2x2sp

Annual Research Review: Developmental computational psychiatry

Hauser, TU; Will, G-J; Dubois, M; Dolan, RJ; (2018) Annual Research Review: Developmental computational psychiatry. Journal of Child Psychology and Psychiatry 10.1111/jcpp.12964 . (In press).

https://ift.tt/2QEWTfO

Fine details in complex environments: the power of cryo-electron tomography

Hutchings, J; Zanetti, G; (2018) Fine details in complex environments: the power of cryo-electron tomography. Biochemical Society Transactions , 46 pp. 807-816. 10.1042/BST20170351 . Green open access

https://ift.tt/2A3NdG2

Relationship between endotoxin core, staphylococcal and varicella antibody levels and outcome following aortic valve replacement surgery: a prospective observational study

Smith, A; Moravcova, S; Treibel, TA; Colque-Navarro, P; Mollby, R; Moon, JC; Hamilton-Davies, C; (2018) Relationship between endotoxin core, staphylococcal and varicella antibody levels and outcome following aortic valve replacement surgery: a prospective observational study. Perioperative Medicine , 7 , Article 20. 10.1186/s13741-018-0101-z . Green open access

https://ift.tt/2QEWIkE

Multi-organ quantitative MRI for the assessment of liver disease - A whole much more than the sum of its parts

Chouhan, MD; Taylor, SA; Mookerjee, RP; (2018) Multi-organ quantitative MRI for the assessment of liver disease - A whole much more than the sum of its parts. [Editorial comment]. Journal of Hepatology 10.1016/j.jhep.2018.09.004 . (In press).

https://ift.tt/2A2fHzQ

Evaluation of CA 19-9, a predictive biomarker of response and survival in patients undergoing chemotherapy for metastatic pancreatic ductal adenocarcinoma

Alrifai, D; (2017) Evaluation of CA 19-9, a predictive biomarker of response and survival in patients undergoing chemotherapy for metastatic pancreatic ductal adenocarcinoma. Presented at: ESMO World Congress on Gastrointestinal Cancer 2018, Barcelona, Spain.

https://ift.tt/2QEWzO8

The frail patient with heart disease: Please handle with care!

Hausenloy, D; (2018) The frail patient with heart disease: Please handle with care! Heart and Metabolism , 76 pp. 2-3.

https://ift.tt/2A1EF2y

The effectiveness of universal parenting programmes: the CANparent trial

Lindsay, G; Totsika, V; (2017) The effectiveness of universal parenting programmes: the CANparent trial. BMC Psychology , 5 , Article 35. 10.1186/s40359-017-0204-1 . Green open access

https://ift.tt/2QEMBfu

Review: The Fantastic Worlds of Yuri Vynnychuk (2016)

Kernan, Helena; Review: The Fantastic Worlds of Yuri Vynnychuk (2016). [Review]. Slovo , 31 (2) , Article 4. 10.14324/111.0954-6839.082 . Green open access

https://ift.tt/2A3N6KC

The Discourse on Humour in the Romanian Press between 1948-1965

Ignat, Eugen Constantin; The Discourse on Humour in the Romanian Press between 1948-1965. Slovo , 31 (2) , Article 3. 10.14324/111.0954-6839.081 . Green open access

https://ift.tt/2QGIQpL

Endovascular Management of a Refractory Pseudoaneurysm of the Sternocleidomastoid Artery Caused by Attempted Internal Jugular Central Line Placement with Long-Term Follow-Up: A Case Report and Review

Introduction. This case report shows successful treatment of a refractory sternocleidomastoid branch of the superior thyroid artery (SBSTA) pseudoaneurysm using endovascular glue embolization in a patient who refused surgery. Case Presentation. A 63-year-old female with multiple comorbidities presented with a firm 7 cm tender mass located in the right neck. Ultrasound showed pseudoaneurysm and a 7 × 3.3 × 4 cm multilobular hematoma in the location of the previous central line. CTA showed a corresponding heterogeneous mass. Serial imaging demonstrated enlargement over 2 weeks. Angiogram showed contrast blush off of the SBSTA. Management and Outcome. SBSTA was embolized using glue. Repeat angiogram showed embolization and no contrast blush. One month later, the mass was no longer pulsatile but present on physical exam. CTA showed decreased size. 8 months later, her neck was soft without mass. Discussion. Pseudoaneurysms of the external carotid artery are rare and usually due to trauma. Pseudoaneurysms after central line placement are documented, but most are complications of femoral central lines. A handful of cases of superior thyroid artery pseudoaneurysms due to several etiologies are reported, but none involving the SBSTA. Therapeutic options include surveillance, compression, thrombin injection, embolization, and surgery. Endovascular management offers an alternative for patients unwilling or unable to undergo open surgery.

https://ift.tt/2C6BZSs

The Comorbidity Burden of Hidradenitis Suppurativa in the United States: A Claims Data Analysis

Abstract

Introduction

Prior studies have reported that hidradenitis suppurativa (HS) is accompanied by a myriad of physical and mental conditions. However, given the small sample sizes and the limited number of pre-selected comorbidities, these studies do not provide a complete picture of the comorbidity burden of HS in the USA. Moreover, the relationship between HS severity and comorbidity burden has yet to be characterized. Using a large US claims database, we estimated the comorbidity burden associated with HS, stratified by disease severity.

Methods

A retrospective matched cohort design was used. Patients with HS were classified into two severity cohorts (milder and more severe) using an empirical algorithm based on treatments received. The comorbidity burden was compared between each HS cohort and their matched HS-free cohort, and between patients with milder vs. those with more severe forms of HS.

Results

Several physical and mental comorbidities were found to be more prevalent in both cohorts of patients with milder and more severe forms of HS than in their matched HS-free cohorts. The comorbidity burden also increased greatly as the disease progressed to more severe forms.

Conclusions

The results of this study highlight the complexity of the comorbidity burden of HS patients and the need for a multidisciplinary approach to optimize the management of HS and its numerous associated comorbidities.

Funding

AbbVie, Inc.

https://ift.tt/2NwcZWR

From the Pages of AllergyWatch : January 2019

Publication date: Available online 10 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): John J Oppenheimer, Vivian Hernandez-Trujillio, Stanley M. Fineman

https://ift.tt/2A1DFeM

Flow mediated vasodilation assay indicates no endothelial dysfunction in hereditary angioedema patients with C1-inhibitor deficiency

Publication date: Available online 10 October 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Zsuzsa Nebenführer, Erika Szabó, Erika Kajdácsi, Kinga Viktória Kőhalmi, István Karádi, András Zsáry, Henriette Farkas, László Cervenak

Abstract

Background

Hereditary angioedema with C1 inhibitor deficiency (C1-INH-HAE) is a rare, potentially life-threatening disorder characterized by recurrent edematous attacks. The edema formation is the consequence of interaction of bradykinin and various vasoactive peptides with endothelium. Besides these agents, danazol, a modified testosterone derivative used in these patients to prevent edematous attacks, can also affect the function of the endothelium, since it shifts the blood lipid profile to a pro-atherogenic phenotype.

Objective

To assess the endothelial function in C1-INH-HAE patients and in healthy matched controls.

Methods

To evaluate the endothelial function, we used the flow mediated dilation method measured in the region of the brachial artery in 33 C1- INH-HAE patients and in 30 healthy matched controls. Laboratory measurements of standard biochemical parameters were performed on computerized laboratory analyzers.

Results

There was no difference in endothelial function (reactive hyperaemia, RH) between patients (median 9.0, 25-75% percentile 6.3-12.9) and controls (median 7.37, 25-75% percentile 4.52-9.93). Although we found elevated cardiovascular risk (high BMI and LDL/HDL ratio) in danazol treated C1-INH-HAE patients, RH values did not differ between danazol treated and non-treated patients. Furthermore, risk factors correlated with the endothelial function only in healthy controls and patients not treated with danazol.

Conclusion

In summary, our results did not indicate any signs of endothelial dysfunction in C1-INH-HAE patients. Moreover, the normal endothelial function in danazol treated patients with pro-atherogenic lipid profile suggests that elevated bradykinin level or other factor(s) involved in the pathogenesis of edematous attacks may have a protective role against endothelial dysfunction and atherosclerosis.

https://ift.tt/2QFLlc1

Adalimumab treatment in Japanese patients with generalized pustular psoriasis: Results of an open‐label phase 3 study

The Journal of Dermatology, EarlyView.


https://ift.tt/2ORjiJn

Unique dermoscopic feature of a long‐standing pencil core granuloma on the head

The Journal of Dermatology, EarlyView.


https://ift.tt/2NycLyI

Compound heterozygous missense mutations p.Leu207Pro and p.Tyr544Cys in TGM1 cause a severe form of lamellar ichthyosis

The Journal of Dermatology, EarlyView.


https://ift.tt/2ONwnDr

Macrophages express βKlotho in skin lesions of psoriatic patients and the skin of imiquimod‐treated mice

The Journal of Dermatology, EarlyView.


https://ift.tt/2NzgRXf

Polymorphous light eruption with complication of solar urticaria revealed by phototesting

The Journal of Dermatology, EarlyView.


https://ift.tt/2ORb8km

Linearly distributed multiple lipomas: An unusual case report

The Journal of Dermatology, EarlyView.


https://ift.tt/2NAKDLr

Correction to: Gastrointestinal juvenile-like (inflammatory/hyperplastic) mucosal polyps in neurofibromatosis type 1 with no concurrent genetic or clinical evidence of other syndromes

The authors regret that the original version of this article, unfortunately, contained an error. The values "1/3 (33%)" reported in the second to last sentence of the Discussion are wrong; the correct values are "2/2 (100%)". These are presented correctly in this article.

https://ift.tt/2yvsuJa

Contemporary Academic Contributions From Anesthesiologists in Adult Critical Care Medicine

BACKGROUND: Anesthesiology has a long relationship with critical care medicine (CCM). However, US anesthesiologists are less likely to practice CCM than non-US anesthesiologists. To date, no studies have compared academic contributions in CCM between US anesthesiologists and non-US anesthesiologists. The objective of our study was to use recent trends in critical care publications as a surrogate for academic contribution among US and non-US anesthesiologists. METHODS: Research articles published between 2010 and 2015 in 3 anesthesiology journals (Anesthesiology, Anesthesia & Analgesia, and British Journal of Anaesthesia) and 3 multidisciplinary CCM journals (Critical Care Medicine, Intensive Care Medicine, and Journal of Critical Care) were reviewed. Author information, including the primary department appointment and geographic location for the first and senior author(s), and article details, including topic and publication type, were collected. Odds ratios for having a first or senior author from the United States were calculated. Anesthesiologists' contributions in individual journals were summarized, as were trends in anesthesiology CCM publications during the 6-year study period. RESULTS: A total of 3831 articles were reviewed, with 1050 (27.4%) having US authors. Eighty-two and one-half percent of CCM articles in anesthesiology journals had a US anesthesiologist as first author, and 81% had a US anesthesiologist as senior author, while fewer CCM articles in multidisciplinary journals had a US anesthesiologist as first (12.1%) or senior (12.3%) author. When considering all publications, 16.3% and 16.4% of articles had a US anesthesiologist as the first or senior author compared with articles for which non-US anesthesiologists were first (23.8%) or senior (20.9%) authors. The odds of having a US anesthesiologist as first or senior author compared to a non-US anesthesiologist for all publications were 0.6 (0.5–0.7) and 0.7 (0.6–0.9). The number of publications trended downward for both US anesthesiologists and non-US anesthesiologists during the study period. CONCLUSIONS: When compared to non-US anesthesiologists, US anesthesiologists had more CCM publications in anesthesiology journals and fewer publications in multidisciplinary CCM journals. The number of anesthesiology CCM publications decreased for both US and non-US anesthesiologists throughout the study period. Accepted for publication September 5, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Jesse J. Kiefer, MD, Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, 3400 Spruce St, Silverstein #5036, Philadelphia, PA 19104. Address e-mail to jesse.kiefer@uphs.upenn.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2pL30n7

Mild Perioperative Hypothermia and Myocardial Injury: A Retrospective Cohort Analysis

BACKGROUND: We tested the primary hypothesis that final intraoperative esophageal temperature is associated with increased odds of a composite of in-hospital all-cause mortality and myocardial injury within 7 days after noncardiac surgery. Secondary exposures were time-weighted average intraoperative temperature and area

https://ift.tt/2IO9FG7

Intensive Care Unit Readmission After Left Ventricular Assist Device Implantation: Causes, Associated Factors, and Association With Patient Mortality

BACKGROUND: Previous studies on readmissions after left ventricular assist device (LVAD) implantation have focused on hospital readmissions after dismissal from the index hospitalization. Because few data exist, the purpose of this study was to examine intensive care unit (ICU) readmissions in patients during their initial hospitalization for LVAD implantation to determine reasons for, factors associated with, and incidence of mortality after ICU readmission. METHODS: A retrospective analysis was performed from February 2007 to March 2015 of patients at our institution receiving first-time LVAD implantation. After LVAD implantation, patients dismissed from the ICU who then required ICU readmission before hospital dismissal were compared to those not requiring ICU readmission before hospital dismissal with respect to preoperative, intraoperative, and postoperative factors. RESULTS: Among 287 LVAD patients, 266 survived their initial ICU admission, of which 49 (18.4%) required ICU readmission. The most common reasons for readmission were bleeding and respiratory failure. Factors found to be univariably associated with ICU readmission were preoperative hemoglobin, preoperative aspartate aminotransferase, preoperative atrial fibrillation, preoperative dialysis, longer cardiopulmonary bypass times, and higher intraoperative allogeneic blood transfusion requirements. Multivariable analysis revealed ICU readmission to be independently associated with preoperative dialysis (odds ratio, 12.86; 95% confidence interval, 3.16–52.28; P

https://ift.tt/2pKAT7C

Recognizing the Chinese Pioneer of Neuraxial Labor Analgesia: Dr Guang-Bo Zhang and Her Unpublished Manuscript From More Than a Half-Century Ago

Dr Guang-Bo Zhang was the first anesthesiologist to administer and study the effects of labor epidural analgesia in China. Between September 1963 and March 1964, she conducted an observational study evaluating the effects of neuraxial analgesia for laboring women. She presented her research and prepared an article; however, due to the Great Proletarian Cultural Revolution (Cultural Revolution), which began in 1966, her work went unpublished. She successfully preserved her unpublished article, notes, and slides throughout the Cultural Revolution by hiding them in a countryside location near Beijing. These 54-year-old, previously unpublished documents represent the first known clinical trial of neuraxial labor analgesia conducted in China. Accepted for publication Septermber 5, 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). LMA is a registered trademark of Teleflex Incorporated or its affiliates. Reprints will not be available from the authors. Address correspondence to Ling-Qun Hu, MD, Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 E Huron St F4-701, Chicago, IL 60611. Address e-mail to l-hu2@northwestern.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2IMiOip

Emergency Department Airway Management Responsibilities in the United States

BACKGROUND: In the 1990s, emergency medicine (EM) physicians were responsible for intubating about half of the patients requiring airway management in emergency rooms. Since then, no studies have characterized the airway management responsibilities in the emergency room. METHODS: A survey was sent via the Eastern Association for Surgery and Trauma and the Trauma Anesthesiology Society listservs, as well as by direct solicitation. Information was collected on trauma center level, geographical location, department responsible for intubation in the emergency room, department responsible for intubation in the trauma bay, whether these roles differed for pediatrics, whether an anesthesiologist was available "in-house" 24 hours a day, and whether there was a protocol for anesthesiologists to assist as backup during intubations. Responses were collected, reviewed, linked by city, and mapped using Python. RESULTS: The majority of the responses came from the Eastern Association for Surgery of Trauma (84.6%). Of the respondents, 72.6% were from level-1 trauma centers, and most were located in the eastern half of the United States. In the emergency room, EM physicians were primarily responsible for intubations at 81% of the surveyed institutions. In trauma bays, EM physicians were primarily responsible for 61.4% of intubations. There did not appear to be a geographical pattern for personnel responsible for managing the airway at the institutions surveyed. CONCLUSIONS: The majority of institutions have EM physicians managing their airways in both emergency rooms and trauma bays. This may support the observations of an increased percentage of airway management in the emergency room and trauma bay setting by EM physicians compared to 20 years ago. Accepted for publication September 5, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Joshua W. Sappenfield, MD, Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Rd, PO Box 100254, Gainesville, FL 32610. Address e-mail to jsappenfield@anest.ufl.edu. © 2018 International Anesthesia Research Society

https://ift.tt/2pK2nub

Fluid Challenge During Anesthesia: A Systematic Review and Meta-analysis

BACKGROUND: Assessing the volemic status of patients undergoing surgery is part of the routine management for the anesthesiologist. This assessment is commonly performed by means of dynamic indexes based on the cardiopulmonary interaction during mechanical ventilation (if available) or by administering a fluid challenge (FC). The FC is used during surgery to optimize predefined hemodynamic targets, the so-called Goal-Directed Therapy (GDT), or to correct hemodynamic instability (non-GDT). METHODS: In this systematic review, we considered the FC components in studies adopting either GDT or non-GDT, to assess whether differences exist between the 2 approaches. In addition, we performed a meta-analysis to ascertain the effectiveness of dynamic indexes pulse pressure variation (PPV) and stroke volume (SV) variation (SVV), in predicting fluid responsiveness. RESULTS: Thirty-five non-GDT and 33 GDT studies met inclusion criteria, including 5017 patients. In the vast majority of non-GDT and GDT studies, the FC consisted in the administration of colloids (85.7% and 90.9%, respectively). In 29 non-GDT studies, the colloid infused was the 6% hydroxyethyl starch (6% HES; 96.6% of this subgroup). In 20 GDT studies, the colloid infused was the 6% HES (66.7% of this subgroup), while in 5 studies was a gelatin (16.7% of this subgroup), in 3 studies an unspecified colloid (10.0% of this subgroup), and in 1 study albumin (3.3%) or, in another study, both HES 6% and gelatin (3.3%). In non-GDT studies, the median volume infused was 500 mL; the time of infusion and hemodynamic target to assess fluid responsiveness lacked standardization. In GDT studies, FC usually consisted in the administration of 250 mL of colloids (48.8%) in 10 minutes (45.4%) targeting an SV increase >10% (57.5%). Only in 60.6% of GDT studies, a safety limit was adopted. PPV pooled area under the curve (95% confidence interval [CI]) was 0.86 (0.80–0.92). The mean (standard deviation) PPV threshold predicting fluid responsiveness was 10.5% (3.2) (range, 8%–15%), while the pooled (95% CI) sensitivity and specificity were 0.80 (0.74–0.85) and 0.83 (0.73–0.91), respectively. SVV pooled area under the curve (95% CI) was 0.87 (0.81–0.93). The mean (standard deviation) SVV threshold predicting fluid responsiveness was 11.3% (3.1) (range, 7.5%–15.5%), while the pooled (95% CI) sensitivity and specificity were 0.82 (0.75–0.89) and 0.77 (0.71–0.82), respectively. CONCLUSIONS: The key components of FC including type of fluid (colloids, often 6% HES), volume (500 and 250 mL in non-GDT studies and GDT studies, respectively), and time of infusion (10 minutes) are quite standardized in operating room. However, pooled sensitivity and specificity of both PPV and SVV are limited. Accepted for publication August 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). Reprints will not be available from the authors. Address correspondence to Antonio Messina, PhD, Department of Anesthesia and Intensive Care Medicine, IRCCS Humanitas, Humanitas University, Via Alessandro Manzoni, 56, 20089 Rozzano, Milano, Italy. Address e-mail to mess81rc@gmail.com. © 2018 International Anesthesia Research Society

https://ift.tt/2INAxpw

Regional Analgesia Added to General Anesthesia Compared With General Anesthesia Plus Systemic Analgesia for Cardiac Surgery in Children: A Systematic Review and Meta-analysis of Randomized Clinical Trials

BACKGROUND: The aim of this systematic review was to compare the effects of regional analgesic (RA) techniques with systemic analgesia on postoperative pain, nausea and vomiting, resources utilization, reoperation, death, and complications of the analgesic techniques in children undergoing cardiac surgery. METHODS: A search was done in May 2018 in PubMed, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials comparing RA techniques with systemic analgesia. Risks of bias of included trials were judged with the Cochrane tool. Data were analyzed with fixed- (I2

https://ift.tt/2IRurVn

The Importance of Differentiating Charges and Cost

No abstract available

https://ift.tt/2pJl80D

Use of the Bougie Endotracheal Tube Introducer in Unstable Cervical Spine Airway Management?

No abstract available

https://ift.tt/2ILdRpN

Resting Hemodynamics and Response to Exercise Using the 6-Minute Walk Test in Late Pregnancy: An International Prospective Multicentre Study

BACKGROUND: Cardiac disease is the leading cause of maternal death. Assessment of cardiovascular fitness is important in pregnant women because it is linked to increased risk of cardiac disease but is rarely undertaken or studied. The 6-Minute Walk Test (6MWT) is a safe exercise test but is not used in pregnancy. We determined the 95% reference interval for resting heart rate (HR) and distance walked for the 6MWT, as well as hemodynamic recovery variables, and quantified expectations and actual experiences of exertion and breathlessness with exercise in late pregnancy. METHODS: After institutional research board approval (Australian and New Zealand Clinical Trials Registry Number: 12615000964516), 300 healthy term nulliparous pregnant women performed the 6MWT at 3 tertiary referral obstetric hospitals using a standardized protocol. Each woman underwent two 6MWT with maximum 15-minute recovery period after each test. Hemodynamic variables were measured at rest and after exercise. Participants were asked 4 questions, 2 regarding expectation and 2 regarding actual experience, using the Rating of Perceived Exertion scale and Modified Borg Dyspnea scale. RESULTS: Participant characteristics and resting variables were mean (standard deviation [SD]); age, 31 years (4.2 years); body mass index, 27 kg/m2 (2.9 kg/m2); gestational age, 37 weeks (1.3 weeks); HR, 85 bpm (10.8 bpm) with 95% reference interval 64–106 bpm; systolic blood pressure, 112 mm Hg (10.2 mm Hg); diastolic blood pressure, 72 mm Hg (8.6 mm Hg); oxygen saturation, 98% (0.9%); and respiratory rate, 18 breaths/min (5.7 breaths/min). The mean (SD) average distance walked was 488 m (94.9 m) with a speed of 3.0 mph (0.64 mph) with a 95% reference interval of 302–674 m. The mean (SD) HR increase with exercise was 12 bpm (11.0 bpm) with a median [quartile] recovery time of 5.0 minutes [1–8 minutes]. A lower resting HR was associated with increased distance walked (r = −0.207; 95% confidence interval, −0.313 to −0.096; P

https://ift.tt/2pMv3Ts

Implementing a Pediatric Perioperative Surgical Home Integrated Care Coordination Pathway for Laryngeal Cleft Repair

BACKGROUND: The Pediatric Perioperative Surgical Home (PPSH) model is an integrative care model designed to provide better patient care and value by shifting focus from the patient encounter level to the overarching surgical episode of care. So far, no PPSH model has targeted a complex airway disorder. It was hypothesized that the development of a PPSH for laryngeal cleft repair would reduce the high rates of postoperative resource utilization observed in this population. METHODS: Institutional review board approval was obtained for the purpose of data collection and analysis. A multidisciplinary team of anesthesiologists, surgeons, nursing staff, information technology specialists, and finance administrators was gathered during the PPSH development phase. Standardized perioperative (preoperative, intraoperative, and postoperative) protocols were developed, with a focus on preoperative risk stratification. Patients presenting before surgery with ≥1 predefined medical comorbidity were triaged to the intensive care unit (ICU) postoperatively, while patients without severe systemic disease were triaged to a lower-acuity floor for overnight observation. The success of the PPSH protocol was defined by quality outcome and value measurements. RESULTS: The PPSH initiative included 120 patients, and the pre-PPSH period included 115 patients who underwent laryngeal cleft repair before implementation of the new process. Patients in the pre-PPSH period were reviewed and classified as ICU candidates or lower acuity floor candidates had they presented in the post-PPSH period. Among the 79 patients in the pre-PPSH period who were identified as candidates for the lower-acuity floor transfer, 70 patients (89%) were transferred to the ICU (P

https://ift.tt/2ILcyY4

In Response

No abstract available

https://ift.tt/2pM42PG

Predicting the Depth of the Lumbar Plexus in Pediatric Patients: A Retrospective Magnetic Resonance Imaging Study

BACKGROUND: The lumbar plexus (LP) block is commonly used for analgesia for lower extremities. If the depth of the LP (LPD) can be predicted, the performance time and procedure-related complications could be reduced. METHODS: Three hundred sixty-one magnetic resonance images of pediatric patients (

https://ift.tt/2A1xPtS

Update on sinus disease in children with cystic fibrosis: advances in treatment modalities, microbiology, and health-related quality-of-life instruments

Purpose of review There is a lack of consensus with regards to the diagnosis and treatment of sinus disease in children with cystic fibrosis. Here, we review literature from the past 18 months in order to highlight the way forward in this contentious field. Recent findings Most of the literature (from the past 18 months) on sinus disease in pediatric cystic fibrosis focused on treatment approaches, bacteriology and immunology, and health-related quality-of-life (HRQOL) instruments. Quality studies have demonstrated that functional endoscopic sinus surgery (FESS) is as safe in children with or without cystic fibrosis; that the microbiology of the paranasal sinus in children with cystic fibrosis is different than that of their lungs; and, that HRQOL instruments may prove useful in determining sinonasal disease severity in children with cystic fibrosis. Summary Medical and surgical approaches appear to be viable in the treatment of sinonasal disease in pediatric cystic fibrosis; the microbiology and immunology of pediatric cystic fibrosis is proving more complex and nuanced than initially believed; and, HRQOL instruments show promise in reconciling differences between observable and clinically relevant sinus disease in pediatric cystic fibrosis patients. Correspondence to Frank W. Virgin, MD, Assistant Professor of Pediatric Otolaryngology, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, 7224 Doctors' Office Tower, Nashville, TN 37232, USA. Tel: +1 615 936 8176; fax: +1 615 875 0101; e-mail: frank.w.virgin@vumc.org Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2QGLlZt

Velopharyngeal incompetence: role in paediatric swallowing deficits

Purpose of review The purpose of this manuscript is to highlight the latest advances in diagnosis and management of velopharyngeal incompetence (VPI) as it pertains to swallowing deficits in children. This is timely and relevant as otolaryngologists are often amongst the first to diagnose and treat VPI. Although nasal regurgitation of a bolus is frequently transient, persistent problems can be associated with other swallowing problems and other significant medical problems. Furthermore, velopharyngeal incompetence has implications for speech production. Recent findings Persistent VPI associated with a swallowing deficit can be an isolated anomaly with or without a cleft palate or submucous cleft palate. VPI may be secondary to a cranial neuropathy, esophageal abnormality or associated with another airway anomaly, any of which may further contribute to dysphagia. Findings of additional anomalies may be suggestive of a syndrome. Workup should explore these potential causes. When velopharyngeal incompetence is associated with dysphagia, fiberoptic endoscopic evaluation of swallow (FEES) and videofluoroscopic swallow study (VFSS) can be helpful in diagnosis and management. The advantages and disadvantages of FEES and VFSS have been well delineated over the past few years. Similarly, nasopharyngoscopy and fluoroscopy are increasingly used in diagnosis and management of VPI that is associated with hypernasal resonance disorders. Summary Concurrent medical diagnoses or syndrome manifestations are often associated with or contribute significantly to the cause of dysphagia in children with VPI. As VPI can be a sign of brainstem vagal neuropathy, the clinician should investigate by imaging the CNS if other correlative symptoms of dysphagia and examination findings are present. Endoscopy is advocated for evaluation of vocal fold function. Fluoroscopy is best for further assessment of airway protection or safety of swallow. And, whenever indicated, additional workup is recommended to determine an underlying cause of the swallowing disorder. Correspondence to Laura H. Swibel Rosenthal, MD, 225 E. Chicago Avenue, Box 25, Chicago, IL 60611, USA. Tel: +1 312 227 6230; fax: +1 312 227 9414; e-mail: lrosenthal@luriechildrens.org Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2A0qFWT