Hybrid method with explorative laparoscopy and anterior open approach for re-recurrent inguinal hernia

Abstract

The new guidelines of the HerniaSurge group recommend that only an expert hernia surgeon should repair a re-recurrent inguinal hernia. We report the efficacy of the hybrid method with explorative laparoscopy and anterior open approach for re-recurrent inguinal hernia repair. A 61-year-old man underwent anterior open preperitoneal mesh repair for right inguinal direct hernia and laparoscopic transabdominal preperitoneal repair for recurrence. Two years after the second surgery, re-recurrent inguinal hernia was confirmed. We carried out explorative laparoscopy for the re-recurrent inguinal hernia, which revealed a re-recurrent hernia orifice. We performed the anterior open approach while observing from the abdominal cavity. Explorative laparoscopy can help in accurately determining the orifice of the re-recurrent inguinal hernia. Based on that information, the hernia sac can be reached through the shortest route using the anterior open approach.

https://ift.tt/2qLIIdD

Right external iliac artery thrombus following the use of resuscitative endovascular balloon occlusion of the aorta for placenta accreta

Abstract

A 33-year-old female, 32 weeks and 1 day gestation, with known placenta accreta who presented to the emergency department with 2 h of severe abdominal pain, nausea and vomiting. She became hypotensive and underwent emergency cesarean section. Emergency general surgery was consulted for placement of a resuscitative endovascular balloon for aortic occlusion (REBOA). After successful delivery, the balloon was inflated in zone 3 and systolic blood pressure rose from 70 to 170 mmHg. The patient underwent hysterectomy for ongoing hemorrhage. The patient was taken to the surgical intensive care unit. The patient was noted to have pulses following removal of the sheath. Arterial brachial indices and arterial duplex was performed 48 h after sheath removal. The patient was found to have complete occlusion of the right external iliac artery. Vascular surgery was consulted and cut-down performed with thrombus removal via fogarty catheter. The patient was discharged 2 days later without further complication.

https://ift.tt/2FlevfU

Additional unloading of the left ventricle using the Impella LP 2.5 during extracorporeal life support in cases of pulmonary congestion

Abstract

Extracorporeal life support (ECLS) is used for the treatment of severe cardiogenic shock. However, pulmonary congestion can progress to a severe problem with ECLS therapy. We report our experience with the Impella system for severe pulmonary congestion with ECLS therapy. We used the Impella system for two patients, which led to successful unloading of the left ventricle. Impella implantation during ECLS support appears to be a promising concept. However, more evidence is required for further evaluation.

https://ift.tt/2qLIDXn

Necrotizing fasciitis caused by Kocuria rosea in an immunocompromised patient

Abstract

This case report describes an immunocompromised patient with a skin boil that progressed to necrotizing fasciitis. The aim of this brief report is to raise awareness regarding necrotizing soft tissue infections caused by an unusual organism, Kocuria rosea, a typically non-pathogenic organism, and outline the course of treatment currently considered to be the standard of care.

https://ift.tt/2Fw6Ds7

Colonic perforation due to amebiasis, a rare and lethal complication

Abstract

Amebiasis is still a major healthcare concern, especially in developing countries like Ecuador. The lack of sanitary control and hygiene measures make parasites infections still a burden for patients and physicians. Despite infections due to this parasites are usually mild, severe infections and fatal outcomes although rare still occur. Bowel perforation is a rare complication of amebiasis, and unfortunately, it continues to be almost fatal. We present a case of an Ecuadorian patient who presented to the emergency room with an acute abdomen, despite adequate surgery and critical care, the patient regrettably died. Bowel perforation due to Entamoeba histolytica was the final diagnosis.

https://ift.tt/2qRdmmh

Two cases of intestinal injuries due to seat belt without seat belt sign

Abstract

Although seat belts save lives after motor vehicle accidents, they may cause different types of injuries such as abdominal wall, intra-abdominal, neck and spine or vascular injuries. Seat belt sign indicates the severity of injuries, and usually the risk of intra-abdominal injuries is high when the seat belt sign exists. Here, we present two cases of intra-abdominal injuries caused by seat belts without seat belt sign.

https://ift.tt/2FhyGew

Compound volvulus: a case report and literature review

Abstract

Compound volvulus is an uncommon cause of acute abdomen and involves the twisting of the loops of ileum around the base of the sigmoid or vice versa. It is a surgical emergency that is often missed pre-operatively. We are reporting this case and reviewing the relevant literature to increase the awareness of this condition. A 37-year-old female presented at the Emergency Unit of our hospital with features thought to be acute peritonitis secondary to typhoid perforation and a differential of rupture appendix. She had laparotomy with the finding of a gangrenous twisted terminal ileum around the base of the sigmoid for which a right hemicolectomy and sigmoidopexy were done. Compound volvulus, though rare, can still be encountered in our environment. Prompt identification, adequate resuscitation and expedient intervention will reduce morbidity and mortality.

https://ift.tt/2qRdhyZ

A nutrition problem solved by a two-step endoscopic removal of a non-adjustable gastric band

Abstract

Bariatric surgery is an effective approach for weight loss and short-term improvement in metabolic disorders. Stenosis is a common complication of gastric banding. Balloon dilatation or gastrotomy has been employed in this setting. Few studies have indicated endoscopic removal of the band a feasible procedure. We present a 60-year-old female who underwent gastric banding in 1985 and suffered from late stenosis and malnutrition. Endoscopy revealed a severe stenosis. A two-step procedure was performed. Initially a coated stent was placed into the stenosis to achieve pressure necrosis. Two weeks later, the stent was removed and the band was removed endoscopically. The procedure was performed without any complications. The patient was discharged the next day. A follow-up after 2 months revealed no problems with stenosis or malnutrition. The procedure was a safe, efficient and convenient way of handling late stenosis after gastric banding.

https://ift.tt/2FhyCvi

Elective cholecystectomy as a rare presentation of metastatic breast cancer

Abstract

Cholecystectomy leads, occasionally, to the diagnosis of subclinical primary carcinomas and rarely metastatic tumors. The authors report the diagnosis of gallbladder metastasis after an elective cholecystectomy for symptomatic cholelithiasis. Histological examination disclosed a metastasis from a lobular breast carcinoma. Authors found no more than 25 case reports of breast cancer metastasis in English literature. Of those, only one reports first diagnosis after elective cholecystectomy with no radiological or macroscopic signs of malignancy. Rare clinical presentations, as in this case, should always be kept in mind specially in high volume centers. These rare presentations lack good quality evidence and challenge the best standard treatment regimen available. Multidisciplinary assessment is the key to maximize the risk/benefit of different treatment modalities. In this case report, although curative surgery was attempted, progression disease was typical of an advance staged disease.

https://ift.tt/2qIfxbH

Objective demonstration of improvement of neurogenic bowel dysfunction in a case of spinal cord injury following stem cell therapy

Abstract

Constipation in spinal cord injury patients is a frequent complication that leads to a reduction of quality of life, extensive psychological and economic strain on patients and healthcare systems. We report a 58-year-old man with an incomplete SCI secondary to L1 vertebral fracture, presented gait disorder with neurogenic bowel and bladder dysfunction. He received 300 million autologous mesenchymal stromal cells (MSC) in the subarachnoid space by lumbar puncture. After the third administration of MSC the patient had an important improvement in almost every functional scale of spinal cord injury, especially in the Krogh's Neurogenic Bowel Dysfunction scale. Our present observation supports recent clinical findings about the benefit of autologous stem cell therapy for the improvement of bowel dysfunction in patients suffering spinal cord injury.

https://ift.tt/2FhypZ2

Hemorrhagic necrosis of small bowel following small bowel obstruction as a late complication of sex reassignment surgery—a gap in transgender care

Abstract

For decades, Thailand has been at the forefront of sex reassignment surgeries. The neovagina created by recto-sigmoid vaginoplasty is much more complex procedure when compared with penile skin version technique, but yielded more satisfactory functional outcomes. We reported an unusual case of life-threatening small bowel obstruction following previously successful recto-sigmoid vaginoplasty in a transgender woman. Transgender individuals have unique healthcare needs. However, various gaps still exist to provide multi-disciplinary care for these patients. The rate of adhesive small bowel obstruction is highest in the early period of any intra-abdominal post-operative surgeries, but the risk remains life-long. Transgender women receiving complicated vaginoplasty should be instructed to continue long-term follow-up to ensure early detection and management of post-operative complications.

https://ift.tt/2qJHEaw

Synchronous volvulus of the sigmoid and transverse colon in a 26-year-old male

Abstract

We present a 26-year-old male patient who presented with complete bowel obstruction and peritonitis. His abdominal X-rays showed grossly distended large bowels with air–fluid levels. A differential diagnosis of sigmoid volvulus was entertained and the patient was taken for an exploratory laparotomy. Intraoperatively, we found a sigmoid volvulus and a concurrent transverse colon volvulus. A subtotal colectomy and colostomy was performed. The histopathology results showed mucosal and submucosal congestion, chronic inflammation, and no malignancy or dysplasia. Synchronous volvulus of the sigmoid and transverse colon is an extremely rare. Management includes endoscopic derotation and decompression followed by semi-elective surgery in non-complicated cases. When endoscopic decompression has failed or there is suspicion of necrosis or perforation, surgery is mandatory.

https://ift.tt/2FiG3lZ

Large intra-abdominal desmoid tumour posing diagnostic and therapeutic challenges, a case report

Abstract

We present the case of a 46-year-old gentleman originally from China who presented to the acute surgical assessment unit complaining of upper abdominal discomfort, dyspepsia and early satiety ongoing for the previous 6 months. On exam he had a palpable mass in the left upper quadrant. He underwent an esophagogastroduodenoscopy which was normal and later received a CT abdomen which identified a well-circumscribed soft tissue mass in the mesenteric fat and lying adjacent to the transverse colon with no obvious cleavage plane between them. Colonoscopy was then performed which was normal. After discussion at MDT he was taken for laparotomy. At laparotomy the mass was found to be adherent to major vessels, small bowel and large bowel necessitating an extended right hemicolectomy and small bowel resection. The mass itself could not be completely excised. Histology from the resected specimen confirmed desmoid tumour.

https://ift.tt/2qGgzos

Effects of oral ısotretinoin on normal and wounded nasal mucosa: an experimental study

Abstract

Background

We aimed to investigate the effect of systemic isotretinoin therapy on normal and wounded nasal septal mucosa histopathologically in an experimental rabbit model.

Methods

Circular mucosal defect with a 7 mm diameter was made in the left septum of 12 New Zealand white rabbits. The rabbits were divided into two groups (six rabbits in each group) oral isotretinoin was given with olive oil at the operation day to the first group. The control group was only oil given group. The harvested septum mucosas were divided into four groups (1—wounded-drug given side, 2—unwounded and drug-given side, 3—wounded-control and 4—unwounded-control side). The diameter of the defect, mucosal thickness, epithelial thickness, ciliated cell level, goblet cell level and inflammation were evaluated every week for 4 weeks.

Results

At both wounded and normal side, thinning of normal respiratory ciliated epithelium was observed in the postoperative period. In study group at the wounded side; mean mucosal thickness was measured 139.66 µ (± 26.24), and in the control group, mean mucosal thickness was 238.33 µ (± 39.7) at the wounded side. (p < 0.001). The difference between the groups in thickness of normal septal mucosa was also statistically significant (p = 0.016) [190 µ (± 14.6) and 256.66 µ (± 44.66)]. The average cilia level was observed 1.16 in the wounded study group, while the average level was 2.33 in the wounded control group (p = 0.012). Average score measurements of the regenerated mucosa suggested that isotretinoin–given wounded animals have reduced goblet cell recovery, compared to the control both on the regenerated and unwounded mucosas (p = 0.007, p = 0.002, respectively). Inflammation was significantly higher in the wounded isotretinoin group (p = 0.018).

Conclusion

Oral isotretinoin has negative effects on epithelial and ciliary regeneration, significantly reduces mucosal thickness and goblet cell counts of the normal and regenerated mucosa, causes severe inflammation and significant reactive changes.

https://ift.tt/2DgCJoS

Cervical inlet patch: an important cause of Globus pharyngeus

https://ift.tt/2PScnQS

Reply to: Angulation of the ossified stylohyoid complex and Eagle syndrome

https://ift.tt/2Di9xh7

Commentary to: Predictable prosthesis length on a high-resolution CT scan before a stapedotomy

https://ift.tt/2PScmfM

Angulation of the ossified stylohyoid complex and Eagle syndrome

https://ift.tt/2DgYK6Y

Evaluation of saccular and inferior vestibular nerve function in children with auditory neuropathy spectrum disorder

Abstract

Purpose

The aim of the current work was to evaluate the function of the saccule and inferior vestibular nerve in children with auditory neuropathy spectrum disorder (ANSD) by recording the cervical-evoked myogenic potentials (C-VEMP) on those children and to compare C-VEMP results in ANSD children of pre-lingual onset to those in ANSD children of post-lingual onset.

Methods

The study included 38 ANSD children of pre-lingual onset, 16 ANSD children of post-lingual onset, and 20 control children. All participant children were subjected to C-VEMP testing using 500 Hz tone burst stimuli.

Results

The vast majority of ANSD children of pre-lingual onset (35 out of 38; 92.1%) had bilateral intact C-VEMP response with C-VEMP parameters (amplitude, asymmetric ratio, latency, and inter-aural latency difference) that were not statistically different than those in the control children. Only three children had bilateral absent C-VEMP response. On the other hand, the majority of ANSD children of post-lingual onset (11 out of 16; 68.75%) had bilateral absent C-VEMP response. The remaining five children had bilateral intact C-VEMP response with C-VEMP parameters that were not statistically different than those in the control children.

Conclusions

The pathology of ANSD spares the saccule and inferior vestibular nerve in the vast majority of ANSD children of pre-lingual onset, while it involves them in the majority of ANSD of post-lingual onset reflecting different site(s) of lesion between the two ANSD categories. Such results have important clinical implications as regards to the management of ANSD in children.

https://ift.tt/2PSchZw

Authors’ response to Commentary on “Role of barium swallow pharyngoesophagography in the management of globus pharyngeus”

https://ift.tt/2DisYq9

Role of barium swallow pharyngoesophagography in the management of globus pharyngeus

https://ift.tt/2PQd7G7

Clinical classification of cervical necrotizing fasciitis

Abstract

Purpose

Necrotizing fasciitis of the craniofacial region is a rare and potentially life-threatening bacterial infectious disease. Odontogenic infections primarily spread along facial fascia and subcutaneous tissues, resulting in upper chest skin or thoracic necrosis. The purpose of this clinical classification was to demonstrate clinically important guidelines for early diagnosis and prompt management of CNF.

Methods

Although the incidence of cervical necrotizing fasciitis (CNF) is very rare in many developed countries, prompt management with appropriate initial diagnosis is essential, especially in tropical low-economic rural regions of African countries. Over the last 12 years, our charitable team in West Africa made clinical classifications of CNF according to onset time and spreading pattern to thoracic extension.

Results

CNF patients could be divided into two primary types, limited to neck type and extended to upper chest type. We also further categorized from each type into three different groups according to the CNF onset and clinical characteristics, including acute type with hematogenous spread within 2 weeks, subacute type with suppuration over 2 to 4 weeks, chronic type without suppuration over 4 weeks, multiple type with partial skin necrosis, island type with necrotic skin coverage, and broad type with whole skin necrosis.

Conclusions

These classifications will help decrease the mortality rate in severely infected patients.

https://ift.tt/2DhSNXm

Activations of group 2 innate lymphoid cells depend on endotypes of chronic rhinosinusitis

Abstract

Objective

Chronic rhinosinusitis (CRS) is a complicated disease with several variants caused by different cellular and molecular mechanisms. The characterization of this heterogeneity supports the definition that the disease consists of many endotypes, such as eosinophilic and neutrophilic CRS, and so on. This study aimed to explore group 2 innate lymphoid cells (ILC2s) in neutrophilic CRS without nasal polyps (CRSsNP) and with nasal polyps (CRSwNP), and evaluate ILC2s across characteristics of the disease.

Methods

Nasal biopsy samples were obtained from normal subjects or subjects with CRSsNP or CRSwNP during surgery. ILC2s were sorted and purified as CD45⁺Lin⁻CD127⁺CD4⁻CD8⁻CRTH2⁺CD161⁺ cells through flow cytometry, and were compared among three groups of subjects. Then, these samples were cultured in vitro, and inflammatory factors were assessed in tissue cultures. After that, human recombinant (rm) interleukin (IL)-33 or IL-17 were administered into the cultures, and we again examined relevant inflammatory substances.

Results

ILC2s were upregulated in neutrophilic CRSsNP and CRSwNP patients, and there were no statistical differences between them. Eosinophil cation protein (ECP), myeloperoxidase (MPO), IL-25, IL-33, IL-5, IL-13, interferon (IFN)-γ and IL-17 were increased in the cultures, however, only concentrations of MPO, IFN-γ and IL-17 were enhanced in CRSwNP tissues compared to CRSsNP ones. After administration of rmIL-33, ECP, IL-5 and IL-13 were all increased in tissues from CRSsNP and CRSwNP patients, however, there were no significant differences between them. Finally, we evaluated concentrations of several above inflammatory factors after the treatment of rmIL-17, and found that MPO and IFN-γ were enhanced in these two phenotypes of patients, and were elevated significantly in CRSwNP tissue cultures.

Conclusion

These findings show that ILC2s might be inactivated in neutrophilic CRSsNP and CRSwNP based on this pilot study.

https://ift.tt/2PXluiU

Expression of matrix metalloproteinases (MMPs-2, -7, -9, and -26) and tissue inhibitors of metalloproteinases (TIMPs-1 and -2) in pleomorphic adenomas and adenoid cystic carcinomas

Abstract

Purpose

To compare the immunohistochemical expression of matrix metalloproteinases-2, -7, -9 and -26 and tissue inhibitors of metalloproteinases-1 and -2 in pleomorphic adenomas and adenoid cystic carcinomas of the minor salivary glands.

Methods

Twenty cases of pleomorphic adenomas and 20 cases of adenoid cystic carcinomas were evaluated for the immunohistochemical expression of matrix metalloproteinases-2, -7, -9, and -26 and tissue inhibitors-1 and -2 in tumor parenchyma.

Results

Most pleomorphic adenomas and adenoid cystic carcinomas showed high expression of matrix metalloproteinases and tissue inhibitors, predominantly located in the tumor cells. There was no statistically significant difference in the expression of the metalloproteinases-2 (p = 0.359), -7 (p = 0.081), and -26 (p = 0 553), as well as the tissue inhibitors-1 (p = 0.657), and -2 (p = 0.248) between the parenchyma of the studied tumors. Only matrix metalloproteinase-9 showed a significant difference in expression between the two tumors, with adenoid cystic carcinoma showing a more intense staining for this gelatinase (p = 0.041).

Conclusions

The expression of the studied metalloproteinases suggests the involvement of these enzymes in the tissue remodeling process in pleomorphic adenomas and adenoid cystic carcinomas, but only MMP-9, significantly expressed in the adenoid cystic carcinomas, appears to be involved in the process of invasiveness and more aggressive behavior of these tumors. Additionally, results point that TIMPs-1 and -2 may have more complex functions besides metalloproteinase inhibition, which may be related to the pathogenesis and biological behavior of salivary gland tumors.

https://ift.tt/2DhSD2c

The effect of ectodermal dysplasia on volume and surface area of maxillary sinus

Abstract

Purpose

Ectodermal dysplasia (ED) is a congenital syndrome characterized by abnormal development of ectodermal structures, such as skin, hair, nails, teeth, or salivary glands. Patients with ED demonstrate craniofacial dysmorphology, midfacial hypoplasia and hypodontia. The aim of this study is to evaluate volume and surface area of maxillary sinus and craniofacial structures in patients with ectodermal dysplasia (ED) using cone-beam computed tomography (CBCT) images.

Methods

The CBCT images of 20 patients with ED (study group) and 20 healthy individuals (control) which are equal in terms of age and gender were evaluated. After a three-dimensional analysis and segmentation of each maxillary sinus, the volume and surface area were calculated. Craniofacial dimensions were measured on the sagittal planes of the CBCT images. The results of the ED and control groups were statistically compared.

Results

The right and left sinus volumes and surface areas were significantly lower in the ED group than in the control group (p < 0.05) while the SNA was significantly higher (p < 0.05). ANB and SN-GoMe were also lower in patients with ED than in controls (p < 0.05). The difference in SNB values between the two groups was not significant (p > 0.05).

Conclusions

The volumes and surface areas of both maxillary sinuses were found to be smaller in patients with ED compared to healthy individuals. Class III malocclusion with maxillary retrusion is a characteristic craniofacial feature of these patients.

https://ift.tt/2PX46uN

Evaluation of upper esophageal sphincter in benign vocal lesions

Abstract

Purpose

To evaluate upper esophageal sphincter (UES) activity in patients with benign glottic lesions.

Methods

Twenty-three patients with benign vocal fold (VF) lesions scheduled for manometric evaluation were enrolled as the study group (SG); 20 healthy subjects without vocal pathology or dysphagia were included as the control group (CG). UES residual, basal, relaxation time and peak pharyngeal pressures were evaluated by manometry. The reflux symptom index (RSI) and reflux finding score (RFS) were used to estimate the clinical findings of laryngopharyngeal reflux, and the voice handicap index (VHI) was measured in both groups. The patients' data were compared using the Mann–Whitney test and t test.

Results

The diagnoses in the SG were vocal nodules, vocal polyps, vocal cysts, sulcus vocalis, or Reinke's edema. The evaluation scores (RSI, RFS, and VHI) were significantly higher in the SG than in the CG (P < 0.05). UES basal and relaxation pressures, relaxation time, and peak pharyngeal pressures did not differ between the SG and the CG (P > 0.05).

Conclusion

UES manometric pressure was similar in patients with VF mucosal lesions and controls. Studies involving larger populations are necessary to confirm the manometric changes in the UES and to elucidate the pathogenesis of benign VF lesions.

https://ift.tt/2Dj65mv

Brain-Derived Neurotrophic Factor and Its Associations with Metabolism and Physical Activity in a Latino Sample

Metabolic Syndrome and Related Disorders, Ahead of Print.


https://ift.tt/2qKG7ku

Both Bupivacaine and Levobupivacaine inhibit colon cancer cell growth but not melanoma cells in vitro

Abstract

Background

Retrospective studies indicate that the use of regional anaesthesia causes a reduction in cancer recurrence after oncological surgery, which could be due to anaesthetic's negating effect on immunosuppression related to the surgical stress response. Local anaesthetics may also exert direct suppressive effects on malignant cells, an area where further investigation is urgently needed.

Methods

Human colon cancer cells and human melanoma cells were cultured and then treated with 1 mM bupivacaine or levobupivacaine for up to 24 or 48 h. Their migratory ability was measured by scratch assay, proliferation determined with Ki67 immunofluorescence staining, and apoptosis accessed with annexin V and PI staining on flow cytometry. The effects of bupivacaine and levobupivacaine on cellular signaling and molecular response, specifically, on endoplasmic reticulum stress (ERS), were studied with immunostaining and western blot.

Results

In colon cancer cells, treatment with bupivacaine and levobupivacaine significantly inhibited cell migration (**p < 0.01, ***p < 0.001; n = 4) and proliferation (**p < 0.01; n = 4), while increasing the expression of CHOP (***p < 0.001; n = 4) and decreased the expression of Grp78 (*p < 0.05; n = 4). These effects were not mirrored by melanoma cells, such that no significant increase in apoptosis was seen in either melanoma cell lines following treatment.

Conclusion

These in vitro data suggested that both bupivacaine and levobupivacaine suppress colorectal adenocarcinoma cell proliferation and migration, which are concurrent with increased endoplasmic reticulum stress. Conversely, melanoma cells are more resilient to these two commonly used local anaesthetics. Further in vivo studies or clinical trials are needed.

https://ift.tt/2QJ2br6

Mutated Thyroid Hormone Transporter OATP1C1 Associates with Severe Brain Hypometabolism and Juvenile Neurodegeneration

Thyroid, Volume 28, Issue 11, Page 1406-1415, November 2018.


https://ift.tt/2T8ZekT

Future Meetings

Thyroid, Volume 28, Issue 11, Page 1559-1560, November 2018.


https://ift.tt/2zLSLDV

Physician Choice of Hypothyroidism Therapy: Influence of Patient Characteristics

Thyroid, Volume 28, Issue 11, Page 1416-1424, November 2018.


https://ift.tt/2TaLNkq

Metal Coordinated Poly-Zinc-Liothyronine Provides Stable Circulating Triiodothyronine Levels in Hypothyroid Rats

Thyroid, Volume 28, Issue 11, Page 1425-1433, November 2018.


https://ift.tt/2zQggLM

Regional Influences on Nutritional Iodine Status of Pregnant Women in Pakistan

Thyroid, Volume 28, Issue 11, Page 1538-1546, November 2018.


https://ift.tt/2T6BUEw

Diagnostic Performance of Ultrasound-Based Risk-Stratification Systems for Thyroid Nodules: Comparison of the 2015 American Thyroid Association Guidelines with the 2016 Korean Thyroid Association/Korean Society of Thyroid Radiology and 2017 American Congress of Radiology Guidelines

Thyroid, Volume 28, Issue 11, Page 1532-1537, November 2018.


https://ift.tt/2zNRc8n

Patients with Oncocytic Variant Papillary Thyroid Carcinoma Have a Similar Prognosis to Matched Classical Papillary Thyroid Carcinoma Controls

Thyroid, Volume 28, Issue 11, Page 1462-1467, November 2018.


https://ift.tt/2TaLCFM

Feasibility of Intraoperative Neuromonitoring During Thyroid Surgery Using Transcartilage Surface Recording Electrodes

Thyroid, Volume 28, Issue 11, Page 1508-1516, November 2018.


https://ift.tt/2zNR2xN

Monitoring of fluconazole and caspofungin activity against in vivo Candida glabrata biofilms by bioluminescence imaging. [Experimental Therapeutics]

Candida glabrata can attach to various medical implants and forms thick biofilms despite its inability to switch from-yeast-to hyphae. Current in vivo C. glabrata biofilm models only provide limited information about colonization and infection and usually require animal sacrifice. To gain real-time information from individual BALB/c mice we developed a non-invasive imaging technique to visualize C. glabrata biofilms in catheter fragments that were subcutaneously implanted on the back of mice. Bioluminescent C. glabrata reporter strains (luc_OPT 7/2/4 and luc_OPT 8/1/4), free of auxotrophic markers, expressing a codon-optimized firefly luciferase were generated. A murine subcutaneous model was used to follow real-time in vivo biofilm formation in the presence and absence of fluconazole and caspofungin. Fungal load in biofilms was quantified by colony forming unit counts and by bioluminescence imaging (BLI). C. glabrata biofilms formed within the first 24 h, as documented by the increased number of device-associated cells and elevated bioluminescent signal compared to adhesion at the time of implant. The in vivo model allowed monitoring of the anti-biofilm activity of caspofungin against C. glabrata biofilms through bioluminescent imaging from day four after initiation of treatment. Contrarily, signals emitted from biofilms implanted in fluconazole-treated mice was similar to the light emitted from control-treated mice.

This study gives insights into real-time development of C. glabrata biofilms under in vivo conditions. BLI proved to be a dynamic, non-invasive and sensitive tool to monitor continuous biofilm formation and activity of antifungal agents against C. glabrata biofilms formed on abiotic surfaces in vivo.

https://ift.tt/2T8ooQX

Development of a broad-spectrum antimicrobial combination for the treatment of Staphylococcus aureus and Pseudomonas aeruginosa corneal infections [Experimental Therapeutics]

Staphylococcus aureus and Pseudomonas aeruginosa are two of the most common causes of bacterial keratitis and corresponding corneal blindness. Accordingly, such infections are predominantly treated with broad spectrum fourth generation fluoroquinolones, such as moxifloxacin. Yet rising fluoroquinolone resistance has necessitated the development of alternative therapeutic options. Herein we describe development of a polymyxin B/trimethoprim (PT) ophthalmic formulation containing the antibiotic rifampicin, which exhibits synergistic antimicrobial activity toward a panel of contemporary ocular clinical S. aureus and P. aeruginosa isolates, low spontaneous resistance frequency, and displays in vitro bactericidal kinetics and antibiofilm activities equaling or exceeding the antimicrobial properties of moxifloxacin. The PT + rifampicin combination also demonstrated increased efficacy in comparison to either commercial PT or moxifloxacin in a murine keratitis model of infection, resulting in bacterial clearance of 70% in animals treated. These results suggest that the combination PT and rifampicin may represent a novel antimicrobial agent in the treatment of bacterial keratitis.

https://ift.tt/2zPrf8v

Antibiotic Resistance of Campylobacter spp. in a Pediatric Cohort Study [Epidemiology and Surveillance]

Objectives

To determine phenotypic patterns of antibiotic resistance and epidemiology of drug-resistant Campylobacter spp. from a low-resource setting.

Methods

A birth cohort of 303 was followed until 5 years of age. Stool from asymptomatic (n= 10,008) and diarrhea samples (n=3175) were cultured for Campylobacter. Disk diffusion to CIP, NAL, ERY, AZM, TET, GM, AMP, AMC, CRO, C and TMS were determined. Antibiotic resistance between C. jejuni and non-C. jejuni isolates, and surveillance and diarrhea samples were compared and the association between personal macrolide exposure and subsequent occurrence of a macrolide resistant Campylobacter spp. was assessed.

Results

Of 917 Campylobacter isolates, 77.4% of C. jejuni isolates and 79.8% non-C. jejuni isolates were resistant to ciprofloxacin while 4.9% of C. jejuni isolates and 24.8% of non-C. jejuni isolates were not susceptible to azithromycin. Of the 303 children, 33.1% were ever diagnosed with a Campylobacter strain non-susceptible to both azithromycin and ciprofloxacin. Personal macrolide exposure did not affect the risk of macrolide resistant Campylobacter. Amoxicillin and clavulanic acid (94.0%) was one of the antibiotics with the highest rates of susceptibility.

Conclusion

There is a high incidence of quinolone and macrolide resistant Campylobacter infections in infants under 24 months of age. Given the lack of association between personal exposure to macrolides and a subsequent Campylobacter infection resistant to macrolides, there is a need to evaluate the source of MDR Campylobacter. This study provides compelling evidence to propose amoxicillin/clavulanic acid as a treatment for Campylobacteriosis.

https://ift.tt/2T8oiZB

The inhibition of protein secretion in Escherichia coli and sub-MIC effects of arylomycin antibiotics [Mechanisms of Action]

At sufficient concentrations, antibiotics effectively eradicate many bacterial infections. However, during therapy bacteria are unavoidably exposed to lower antibiotic concentrations, and sub-minimum inhibitory concentration (MIC) exposure can result in a wide variety of other effects, including the induction of virulence, which can complicate therapy, or horizontal gene transfer (HGT), which can accelerate the spread of resistance genes. Bacterial type I signal peptidase (SPase) is an essential protein that acts at the final step of the general secretory pathway. This pathway is required for the secretion of many proteins, including many required for virulence, and the arylomycins are a class of natural product antibiotics that target SPase. Here, we investigated the consequences of exposing Escherichia coli to sub-MIC levels of an arylomycin. Using multidimensional protein identification technology mass spectrometry, we find that arylomycin treatment inhibits the proper extracytoplasmic localization of many proteins, both those that appear to be SPase substrates as well as several that do not. The identified proteins are involved in a broad range of extracytoplasmic processes and include a number of virulence factors. The effects of arylomycin on several processes required for virulence were then individually examined, and we found that even at sub-MIC levels, the arylomycins potently inhibit flagellation, motility, biofilm formation, and the dissemination of antibiotic resistance via HGT. Thus, we conclude that the arylomycins represent promising novel therapeutics with the potential to eradicate infections while simultaneously reducing virulence and the dissemination of resistance.

https://ift.tt/2zPr5hp

A protein complex from human milk enhances the activity of antibiotics and drugs against Mycobacterium tuberculosis [Experimental Therapeutics]

Mycobacterium tuberculosis (Mtb), the causative agent of human tuberculosis (TB), has surpassed HIV/AIDS as the leading cause of death from a single infectious agent. The increasing occurrence of drug resistant strains has become a major challenge for health care systems and, in some cases, rendered TB untreatable. However, developing new TB drugs has been plagued with high failure rates and costs. Alternative strategies to increase the efficacy of current TB treatment regimens include host-directed therapies or agents that make Mtb more susceptible to existing TB drugs. In this study, we show that HAMLET, an alpha-lactalbumin - oleic acid complex derived from human milk, has bactericidal activity against Mtb. HAMLET consists of a micellar oleic acid core surrounded by a shell of partially denatured alpha-lactalbumin molecules and unloads oleic acid into cells upon contact with lipid membranes. At sub-lethal concentrations, HAMLET potentiated a remarkably broad array of TB drugs and antibiotics against Mtb. For example, the minimal inhibitory concentrations of rifampicin, bedaquiline, delamanid and clarithromycin were decreased by 8- to 16-fold. HAMLET also killed Mtb and enhanced the efficacy of TB drugs inside macrophages, a natural habitat of Mtb. Previous studies showed that HAMLET is stable after oral delivery in mice and non-toxic in humans and that it is possible to package hydrophobic compounds in the oleic acid core of HAMLET to increase their solubility and metabolic stability. The potential of HAMLET and other liprotides as drug delivery and sensitization agents in TB chemotherapy is discussed.

https://ift.tt/2T35UB8

Target (MexB) and efflux based mechanisms decreasing the effectiveness of the efflux pump inhibitor D13-9001 in P. aeruginosa PAO1: uncovering a new role for MexMN-OprM in efflux of {beta}-lactams and a novel regulatory circuit (MmnRS) controlling MexMN expression [Mechanisms of Resistance]

Efflux pumps contribute to antibiotic resistance in Gram-negative pathogens. Correspondingly, efflux pump inhibitors (EPIs) may reverse this resistance. D13-9001 specifically inhibits MexAB-OprM in P. aeruginosa. Mutants with decreased susceptibility to MexAB-OprM inhibition by D13-9001 were identified and these fell into two categories; those having alterations in the target MexB (F628L and V177) and those with mutations in PA1438 (L172P substitution) which encoded a putative sensor kinase of unknown function. The alterations in MexB were consistent with reported structural studies of D13-9001 interaction with MexB. The PA1438_L172P alteration mediated a >150-fold upregulation of MexMN pump gene expression and >50-fold upregulation of PA1438 and the neighboring response regulator gene PA1437. We propose that these be renamed as mmnR/mmnS for MexMN Regulator and Sensor. MexMN was shown to partner with the outer membrane channel protein OprM and to pump several β-lactams, monobactams and tazobactam. Upregulated MexMN functionally replaced MexAB-OprM to efflux these compounds but was insusceptible to inhibition by D13-9001. MmnS_L172P also mediated a decrease in susceptibility to imipenem / biapenem that was independent of MexMN-OprM. Expression of oprD, encoding the uptake channel for these compounds was downregulated, suggesting that this channel is also part of the MmnSR regulon. RNA-seq of cells encoding MmnS_L172P revealed among other things an interrelationships between regulation of mexMN and genes involved in heavy metal resistance.

https://ift.tt/2zNaLh3

High-dosage cefazolin achieves sufficient cerebrospinal diffusion to treat an external ventricular drainage-related Staphylococcus aureus ventriculitis. [Pharmacology]

A patient received continuous infusion of cefazolin 10 g then 8 g daily for an external ventricular drainage-related methicillin susceptible Staphylococcus aureus (MSSA) ventriculitis.

Median free concentrations in the cerebrospinal fluid were 11.9 mg/L and 6.1 mg/L after a 10-g and an 8-g dosage respectively. Free concentrations in the cerebrospinal fluid were always above MIC usually displayed by MSSA.

These results support the use of high dose cefazolin to achieve sufficient meningeal concentrations.

https://ift.tt/2T35MSa

DRUG INTERACTIONS BETWEEN DOLUTEGRAVIR AND ARTEMETHER-LUMEFANTRINE OR ARTESUNATE-AMODIAQUINE [Antiviral Agents]

Across sub-Saharan Africa, patients with HIV on antiretrovirals often get malaria and need co-treatment with artemisinin-containing therapies. We undertook two pharmacokinetic studies in healthy volunteers, using standard adult doses of artmether-lumefantrine or artesunate-amodiaquine given with 50mg once daily dolutegravir (DTG) to investigate the drug-drug interaction between artmether-lumefantrine or artesunate-amodiaquine and dolutegravir. The dolutegravir/artmether-lumefantrine interaction was evaluated in a two-way cross-over study and measured artemether, dihydroartemisinin, lumefantrine, desbutyl-lumefantrine over 264 hours. The dolutegravir/artesunate-amodiaquine interaction was investigated using a parallel study design due to long half-life of the amodiaquine metabolite, desethylamodiaquine and measured artesunate, amodiaquine, desethylamodiaquine over 624 hours. Non-compartmental analysis was performed, and geometric mean ratios and 90% confidence intervals generated for evaluation of both interactions. Dolutegravir did not significantly change the maximum concentration in plasma, time to maximum concentration and area under the concentration-time curve (AUC) for artemether, dihydroartemisinin, lumefantrine and desbutyl-lumefantrine nor significantly alter AUC for artesunate, dihydroartemisinin, amodiaquine and desethylamodiaquine. Co-administration of dolutegravir with artmether-lumefantrine resulted in a 37% decrease in DTG trough concentrations. Co-administration of dolutegravir with artesunate-amodiaquine resulted in a decrease of approximately 42% and 24% in DTG trough concentrations and AUC respectively. The significant decreases in DTG trough concentrations with artemether-lumefantrine and artesunate-amodiaquine and dolutegravir exposure with artesunate-amodiaquine are unlikely to be of clinical significance as DTG trough concentrations were above dolutegravir target concentrations of 300ng/mL. Study drugs were well-tolerated with no serious adverse events. Standard doses of artemether-lumefantrine and artesunate-amodiaquine should be used in patients receiving dolutegravir.

https://ift.tt/2zPAFRv

Population Pharmacodynamics of Amphotericin B Deoxycholate for Disseminated Infection Caused by Talaromyces marneffei [Pharmacology]

Amphotericin B deoxycholate (DAmB) is a first-line agent for the initial treatment of talaromycosis. However, little is known about the population pharmacokinetics and pharmacodynamics of DAmB for talaromycosis. Pharmacokinetic data were obtained from 78 patients; among them 55 patients had serial fungal colony forming units counts in blood also available for analysis. A population pharmacokinetics-pharmacodynamics model was fitted to the data. The relationships between area under the concentration time curve (AUC):MIC, and the time to blood culture sterilization and the time to death were investigated. There was only modest pharmacokinetic variability in the average AUC with a mean (standard deviation) of 11.51 (3.39) mg*h/L. The maximal rate of drug induced kill was 0.133 log₁₀CFU/mL/h, and the plasma concentration of the DAmB that induced half-maximal rate of kill was 0.02 mg/L. Fifty percent of patients sterilized their bloodstream by 83.16 hours (range 13-264 hours). A higher initial fungal burden was associated with longer time to sterilization (hazard ratio (HR): 0.51, 95% confidence interval (CI): 0.36-0.70, p<0.001). There was no relationship between AUC:MIC and the time to sterilization (HR: 1.03, 95% CI: 1.00-1.06, p=0.091). Furthermore, there was no relationship between the AUC:MIC and time to death (HR: 0.97, 95% CI: 0.88-1.08, p=0.607); or early fungicidal activity (slope= log(0.501-0.003*AUC:MIC), p=0.319) adjusted for the initial fungal burden. The population pharmacokinetics of DAmB are surprisingly consistent. The time to sterilization of the bloodstream is a useful pharmacodynamic endpoint for future studies.

https://ift.tt/2TbJ2jd

Efficacy of Humanized Cefiderocol Exposures Over 72 hours Against a Diverse Group of Gram-Negative Isolates in the Neutropenic Murine Thigh Infection Model [Pharmacology]

Herein, we evaluated sustainability of humanized exposures of cefiderocol in vivo over 72h against pathogens with cefiderocol MICs of 0.5–16 μg/mL in the neutropenic murine thigh model. In Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacteriaceae displaying MICs 0.5–8 (n=11), sustained kill was observed at 72h among 9 isolates. Post-exposure MICs revealed a single 2 dilution increase compared with control in one animal (1/54 samples, 1.8%) at 72h. Adaptive resistance during therapy was not observed.

https://ift.tt/2zKdJTw

Food OIT is Superior to Food Avoidance

Over the last decade much attention has focused on the possibility of using oral immunotherapy (OIT) as a therapeutic approach for treatment of IgE-mediated food allergies, a disease without a Food and Drug Administration (FDA)-approved disease-modifying therapy. Peanut allergy has been a particular concern because of its persistent nature and association with potentially life-threatening reactions. The OIT literature has been criticized for heterogeneity in trial design with disparities in identification of allergic individuals by double blind placebo controlled food challenges (DBPCFC), differences in desensitization approaches and maintenance doses of allergen, absence of a standardized product, inconsistency in the primary endpoint (e.g.

https://ift.tt/2qI49fL

An Ounce of Caution: Superparamagnetic Iron Oxide Nanoparticle Based MRI Contrast Associated Anaphylaxis

Superparamagnetic iron oxide nanoparticles (SPIONs) are increasingly utilized alternatives to gadolinium-based Magnetic Resonance Imaging (MRI) contrast agents in the diagnosis of osteomyelitis in diabetic patients with renal failure [1]. Ferumoxytol is approved by the United States Food and Drug Administration (FDA), the European Medicines Agency, for intravenous (IV) use for iron replacement therapy [1-3]. Ferumoxytol is composed of an iron-carbohydrate complex that minimizes dissociation and appearance of free iron into the serum.

https://ift.tt/2QEECiY

The Effect of Delayed and Early Diagnosis in Siblings, and Importance of Newborn Screening for SCID

Severe combined immunodeficiency (SCID) is a form of primary immunodeficiency that affects both cellular and humoral immunity, caused by genetic defects in lymphocyte development and function. There are over 20 known genes mutations that lead to SCID including defects that cause radiosensitivity due to impairment in DNA repair (1). Mutations in DCLREC1 resulting in absent or dysfunctional Artemis protein are the most common cause of SCID associated with increased radiosensitivity and were identified as the etiology of the unusually high incidence of T-B-NK+ SCID in Athabascan-speaking tribes, Apache and Navajo (2,3).

https://ift.tt/2qJc1xO

CORRECTION

https://ift.tt/2DAyGoh

Serum levels of oxidative stress indicators and antioxidant enzymes in Bell palsy

Nazim Bozan, MD; Ömer Faruk Kocak, MD; Canser Y&inodot;lmaz Demir, MD; Mehmet Emre Dinc, MD; Koray Avc&inodot;, MD; Halit Demir, PhD; Ahmet Faruk K&inodot;roglu, MD

Abstract

We conducted a prospective study to comparatively evaluate serum levels of malondialdehyde, an oxidative stress indicator, and the antioxidant enzymes glutathione, catalase, and superoxide dismutase in patients with Bell palsy. Our study population was made up of 30 patients with Bell palsy-15 men and 15 women, aged 25 to 68 years (mean: 50.4)-who were seen in the Department of Otorhinolaryngology at a tertiary care medical center. For comparison purposes, we recruited 26 healthy age- and sex-matched controls-16 men and 10 women, aged 40 to 67 years (mean: 54.3). Serum samples were obtained from all participants before the initiation of steroid treatment to the Bell palsy patients. A correlation was sought between demographic data and serum levels of malondialdehyde, glutathione, catalase, and superoxide dismutase. We found that the serum level of malondialdehyde was significantly higher in the Bell palsy group and that the levels of glutathione, catalase, and superoxide dismutase were all significantly lower (p < 0.001 for all comparisons). Correlation analysis revealed that only superoxide dismutase levels were positively correlated with age (r = 0.347, p = 0.009). We suggest that oxidative stress and antioxidant mechanisms may be involved in the pathogenesis of Bell palsy. In this context, serum levels of malondialdehyde, glutathione, catalase, and superoxide dismutase may serve as biomarkers in the diagnosis and follow-up of Bell palsy. Confirmation of the validity, reliability, and reproducibility of these findings necessitates further prospective, randomized clinical trials in larger populations.

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Desmoid tumors of the head and neck: Two decades in a single tertiary care unit and review of the literature

Aleksi Schrey, MD, PhD; Maria Gardberg, MD, PhD; Riitta Parkkola, MD, PhD; Ilpo Kinnunen, MD, PhD

Abstract

Desmoid tumors (DTs) of the head and neck have typically been classified as extra-abdominal, although the anatomic challenges of the head and neck warrant consideration of these DTs as a special entity. We present a review of DTs and describe our series of five patients with DTs of the head and neck treated within 2 decades. Altogether, 53 patients with DTs treated surgically at a tertiary care center over a 20-year period were retrospectively reviewed. Outcomes of the treatment of DTs of the head and neck (n = 5) were analyzed as a case series. DTs are rare, histologically benign, but locally aggressive tumors. In our series of 5 patients with head and neck DTs, no patient experienced a recurrence during a median follow-up of 47.5 months (range 13 to 150), although all had positive histologic margins. The functional integrity of vital structures over meticulous radicality of the tumor resection must be considered, especially in the head and neck.

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Long-term use of Le Fort I osteotomy for the management of nasopharyngeal rhinosporidiosis: A case series

Vikram Shetty, DNB; Akshaya Kulkarni, MDS; Suman Banerjee, MDS

Abstract

Rhinosporidiosis is a rare, chronic, granulomatous infection of the mucous membranes that mainly involves the nose and nasopharynx; it occasionally involves the pharynx, conjunctiva, larynx, trachea and, rarely, the skin. The characteristic clinical features of this disease include the formation of painless polyps in the nasal mucosa or the nasopharynx that bleed easily on touch. At our center, excision of the lesion with a Le Fort I osteotomy is carried out in patients (1) in whom two or more previous attempts at excision of biopsy-proven rhinosporidiosis arising from the nasal mucosa was carried out or (2) in whom the rhinosporidiosis arises from the nasophayrngeal mucosa and/or extranasal sites. In this article we retrospectively present 7 cases in which, according to our inclusion criteria, complete excision of the lesion was carried out with a Le Fort I osteotomy. Excellent visualization of the entire maxillary and ethmoidal air cells after the down-fracture of the maxilla helped in the total removal of the lesions. Most of these lesions had multiple points of origin through the nasal, maxillary, and ethmoidal mucosa; the excellent visualization enabled direct cauterization of all these points of origin. The mean follow-up period was 7.96 years, and all patients were disease-free by the time the study was prepared. This article presents details of the treatment protocol and technique followed at our center for the treatment of nasopharyngeal rhinosporidiosis and the details of long-term follow-up. Through this study we hope to prove the efficacy of Le Fort I osteotomy in the definitive management of nasopharyngeal rhinosporidiosis.

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A rare case of coexisting lacrimal sac adenocarcinoma and transitional cell carcinoma

Tsutomu Nomura, MD, DDS, PhD; Daisuke Maki, MD; Fumihiko Matsumoto, MD, PhD; Taisuke Mori, DDS, PhD; Seichi Yoshimoto, MD, PhD

Abstract

Lacrimal sac tumors are rare and difficult to diagnose. We present a case of coexisting lacrimal sac adenocarcinoma and transitional cell carcinoma in a 73-year-old woman who presented with swelling of the inner canthus. Biopsy identified the growth as an adenocarcinoma. After dissection of the lacrimal carcinoma via a lateral rhinotomy, histopathologic examination confirmed the adenocarcinoma and identified a coexisting transitional cell carcinoma. A recurrence developed, but only of the adenocarcinoma component. For the recurrence, the patient was treated with wide resection, including the orbital contents, and subsequent irradiation. At 49 months postoperatively, the patient remained alive but with a lung metastasis. Wide resection was the key to treatment.

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Oropharyngeal histoplasmosis in an HIV-negative patient

Mohamedkazim Alwani, MD; Todd J. Wannemuehler, MD; Don-John Summerlin, DMD, MS; Marion E. Couch, MD, PhD, FACS

The occurrence of histoplasmosis in immunocompetent patients presents a unique diagnostic challenge due to its rarity and mimicry of other disease processes.

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Endoscopic view of a posterior nasal and nasopharyngeal vascular plexus

Dewey A. Christmas, MD; Joseph P. Mirante, MD, MBA, FACS; Eiji Yanagisawa, MD, FACS

Woodruff described a predominantly venous plexus in the posterior nasal mucosa located in the posteroinferior meatus beneath and posterior to the inferior turbinate.

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Eagle syndrome: Transient ischemic attack and subsequent carotid dissection

Thomas Sullivan, MD; Jordan Rosenblum, MD

Prophylactic contralateral styloidectomy was considered for this patient, but he was deemed a poor surgical candidate given his underlying cardiomyopathy and anticoagulation.

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Risk of developing sudden sensorineural hearing loss in patients with hepatitis B virus infection: A population-based study

Yao-Te Tsai, MD; Ku-Hao Fang, MD; Yao-Hsu Yang, MD, MSc; Meng-Hung Lin, PhD; Pau-Chung Chen, MD, PhD; Ming-Shao Tsai, MD; Cheng-Ming Hsu, MD

Abstract

Sudden sensorineural hearing loss (SSNHL) has significant impact on quality of life. It may result from viral infection, but the relationship between hepatitis B virus (HBV) infection and SSNHL remains uncertain. To investigate the risk of developing SSNHL in patients with HBV, we conducted a nationwide, population-based, retrospective cohort study from the Taiwan National Health Insurance Research Database. A total of 33,234 patients diagnosed with HBV infection and 132,936 control subjects without viral hepatitis were selected from claims made from 2000 to 2008. Each patient was followed for at least 5 years to identify new-onset SSNHL. Among the 166,170 patients, 279 patients (303,793 person-years) from the HBV cohort and 845 patients (1,225,622 person-years) from the control cohort were diagnosed with SSNHL. The incidence of SSNHL was 1.33-fold higher in the HBV group than in the control group (0.92 vs. 0.69 per 10,000 person-years), with an adjusted hazard ratio (HR) of 1.315 (95% confidence interval [CI] = 1.148 to 1.506) calculated using a Cox proportional hazard regression model. We also observed that HBV patients in the 50 to 64 years of age subgroup showed the highest incidence of SSNHL and the highest adjusted hazard ratio (HR = 2.367; 95% CI = 1.958 to 2.861). Patients with HBV infection had a higher risk of acquiring SSNHL than patients without viral hepatitis. For the early detection and timely treatment of SSNHL, clinicians should be aware of the increased risk of SSNHL in HBV patients and arrange auditory examinations for those complaining about acute hearing change.

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Iatrogenic external auditory canal cholesteatoma with mastoid erosion

Yen-Hui Lee, MD; Chih-Yu Hu, MD; Wen-Yu Chuang, MD; Kai-Chieh Chan, MD

Large, complicated iatrogenic EAC cholesteatomas usually require surgical management, with the selected technique generally based on the extent of disease and the surgeon's preference.

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Primary cutaneous histoplasmosis

Blake Raggio, MD

Diagnosis of cutaneous histoplasmosis hinges on evidence of fungus in the wound and absence of systemic disease.

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Effects of l-carnitine administration on health-related quality of life during cisplatin-based chemoradiotherapy in patients with head and neck squamous cell carcinoma

Cancer-related fatigue impairs daily functioning and negatively impacts health-related quality of life (HRQoL). Our previous study revealed that cisplatin-based chemoradiotherapy (CRT) impairs the carnitine system and carnitine deficiency leads to poor physical functioning. This open label, randomized, controlled prospective study investigated the effects of l-carnitine administration on plasma carnitine concentration, CRT-induced fatigue, and decline in HRQoL in patients with head and neck squamous cell carcinoma (HNSCC).

https://ift.tt/2DBFvGe

Efficacy of anti-PD-1 therapy in a patient with brain metastasis of parotid carcinoma: A case report

CheckMate 141, an open-label, randomized phase III trial of nivolumab, indicated that treatment with nivolumab prolonged overall survival of patients with platinum-refractory, recurrent head and neck squamous cell carcinoma. Herein, we describe a case of brain metastasis of parotid carcinoma in which a good response was achieved after nivolumab treatment. The patient was a 67-year-old woman with parotid carcinoma (cT4bN0M0) who received induction chemotherapy followed by chemoradiation. Computed tomography and magnetic resonance imaging performed 10 weeks after the primary treatment revealed a residual tumor and brain and lung metastases.

https://ift.tt/2RS2U9A

Cochlear implantation after canal wall down mastoidectomy — Outcomes after partial mastoid obliteration

To describe and evaluate the partial mastoid obliteration of the so-called radical mastoid cavity after canal-wall down mastoidectomy (CWD) for cochlear implantation (CI) compared to overclosure of the external ear canal as two stage procedures.

https://ift.tt/2DBdSx2

On Malfunction, Mechanisms and Malware Classification

Abstract

Malware has been around since the 1980s and is a large and expensive security concern today, constantly growing over the past years. As our social, professional and financial lives become more digitalised, they present larger and more profitable targets for malware. The problem of classifying and preventing malware is therefore urgent, and it is complicated by the existence of several specific approaches. In this paper, we use an existing malware taxonomy to formulate a general, language independent functional description of malware as transformers between states of the host system and described by a trust relation with its components. This description is then further generalised in terms of mechanisms, thereby contributing to a general understanding of malware. The aim is to use the latter in order to present an improved classification method for malware.

https://ift.tt/2ROI6je

Atopic dermatitis: the relationship to temperature and seasonality in the United States

Abstract

Background

Climatologic factors may affect atopic dermatitis (AD), and there have been few explorations into this topic. Because of its size, the United States (US) has a broad range of climates. The objective of this study is to assess the relationship between ambulatory office visits physicians for AD with temperature and season.

Methods

US region‐specific satellite‐derived data air temperature from the North America Land Data Assimilation System from 1993 to 2011 were studied in relation with ambulatory AD visits to all physicians from the National Ambulatory Medical Care Survey.

Results

Over the 19‐year study period, in no regional location in the US is there clear evidence of a winter flare of AD. The greatest numbers of visits occur in May and June, and smaller peaks also occur in January and October. As the ambient air temperature increases, the likelihood of an AD visit rises (P < .0001). In the South, the hottest US climate, summer is responsible for substantially more AD visits. In every other region and the US overall, the largest number of AD visits occur in spring. AD visits appear to display regional variation in comparing the Northeast, South, Midwest, and West.

Conclusions

Increased temperatures predict increased likelihood of AD office visits.

https://ift.tt/2z5qWqq

Health care costs and resource utilization for different asthma severity stages in Colombia: a claims data analysis

Asthma is one of the most common chronic respiratory conditions worldwide. Asthma-related economic burden has been reported in Latin America, but knowledge about its economic impact to the Colombian health car...

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Summary of the Third World Congress on Thyroid Cancer

Thyroid, Volume 28, Issue 11, Page 1401-1405, November 2018.


https://ift.tt/2DhCfPf

Vestibular Evoked Myographic Correlation

Abstract

This work started from the hypothesis that the physiological processes giving rise to the vestibular evoked myogenic potential (VEMP) can be induced not only by transient sounds but also by a continuous stimulation with a stochastic signal. The hypothesis is based on the idea that the number of motor unit action potentials (MUAPs) decreases after a momentary amplitude increase of the effective stimulus, whereas a momentary amplitude decrease has the opposite effect. This concept was theoretically analyzed by assuming that the effective stimulus is closely related to the envelope of the stimulus actually presented. The analysis led to the prediction that the cross-correlation function of the effective stimulus and the measured electromyogram (EMG) has VEMP-like properties. Experiments confirmed this prediction, thus providing evidence of a novel electrophysiological response: the vestibular evoked myographic correlation (VEMCorr). The methodological approach corresponded to a conventional VEMP study, except that the stimulus (delivered with a hand-held minishaker) comprised not only a series of 500-Hz tone pulses (classical VEMP measurement, for comparison) but also sequences of narrow-band noise with a center frequency of 500 Hz (VEMCorr measurement). Each of the 12 test persons showed a clear VEMCorr. Moreover, VEMP and VEMCorr largely resembled each other, as predicted. Apparently they are two different expressions of a more general mechanism that leads to a roughly linear relationship between stimulus envelope and expectation of the EMG. Future applications of the VEMCorr could exploit that a continuous-stimulation paradigm allows for varying the center frequency of the stimulus without changing the relative bandwidth.

https://ift.tt/2PoiWed

Peak airway pressure is lower during pressure-controlled than during manual facemask ventilation for induction of anesthesia in pediatric patients—a randomized, clinical crossover trial

Abstract

Purpose

Facemask ventilation during the induction of general anesthesia in paediatric patients remains a challenge as it may result in hypoxic conditions and gastric insufflation with subsequent regurgitation and aspiration. So far, it is unclear if pressure-controlled or manual facemask ventilation is preferable in children. We hypothesized that pressure-controlled ventilation in apnoeic children results in lower peak airway pressure and flow rates compared to manual ventilation at comparable respiratory rates and tidal volumes.

Methods

Sixty-two lung-healthy children undergoing scheduled ear-nose-throat surgery were included in the study. After the induction of anesthesia, the patient's lungs were consecutively ventilated via a facemask in either manual or pressure-controlled mode, in randomized order. The primary outcome measure was peak airway pressure. Secondary outcome measures included positive end-expiratory pressure, airway compliance, tidal volume and airway flow.

Results

Data of 52 patients could be analyzed. Pressure-controlled ventilation resulted in a lower mean and peak inspiratory pressure (both p < 0.001), airway pressure amplitude (p = 0.01) and inspiratory peak flow rate (p = 0.005) compared to manual ventilation. The ratio of inspiration to expiration time was lower in pressure-controlled ventilation compared to manual ventilation (p < 0.001).

Conclusion

Pressure-controlled facemask ventilation during induction of anesthesia in pediatric patients results in lower airway pressure, and lower flow rates compared to manual ventilation, at comparable tidal and minute volumes.

https://ift.tt/2qJFeIW

Vestibular Evoked Myographic Correlation

Abstract

This work started from the hypothesis that the physiological processes giving rise to the vestibular evoked myogenic potential (VEMP) can be induced not only by transient sounds but also by a continuous stimulation with a stochastic signal. The hypothesis is based on the idea that the number of motor unit action potentials (MUAPs) decreases after a momentary amplitude increase of the effective stimulus, whereas a momentary amplitude decrease has the opposite effect. This concept was theoretically analyzed by assuming that the effective stimulus is closely related to the envelope of the stimulus actually presented. The analysis led to the prediction that the cross-correlation function of the effective stimulus and the measured electromyogram (EMG) has VEMP-like properties. Experiments confirmed this prediction, thus providing evidence of a novel electrophysiological response: the vestibular evoked myographic correlation (VEMCorr). The methodological approach corresponded to a conventional VEMP study, except that the stimulus (delivered with a hand-held minishaker) comprised not only a series of 500-Hz tone pulses (classical VEMP measurement, for comparison) but also sequences of narrow-band noise with a center frequency of 500 Hz (VEMCorr measurement). Each of the 12 test persons showed a clear VEMCorr. Moreover, VEMP and VEMCorr largely resembled each other, as predicted. Apparently they are two different expressions of a more general mechanism that leads to a roughly linear relationship between stimulus envelope and expectation of the EMG. Future applications of the VEMCorr could exploit that a continuous-stimulation paradigm allows for varying the center frequency of the stimulus without changing the relative bandwidth.

https://ift.tt/2PoiWed

Extracorporeal shockwave treatment impedes tooth movement in rats

Abstract

Background

Accelerated tooth movement has been a topic of interest for orthodontic research recently. Surgically facilitated orthodontic treatment has been shown to be an effective approach to accelerate tooth movement; however, it remains invasive, requires additional surgery, and may increase post-operative complications. In this study, we evaluate the effects of extracorporeal shockwave treatment (ESWT), a non-invasive approach to regenerate alveolar bone, on orthodontic tooth movement in rats.

Materials and methods

Seventy-two male rats, aged 10 weeks old, were subjected to 10-cN closed-coil nickel-titanium springs for unilateral maxillary first molar tooth movement. One group of rats received a single treatment of extracorporeal shockwave treatment at 500 impulses at energy flux density 0.1 mJ/mm², with a pulse rate of 5 pulses per second immediately after spring installation while the non-ESWT-treated group served as a control group. The rats were sacrificed at day 3, 7, 14, 21 and 28 for tooth movement evaluation and sample analyses. Faxitron radiography, histological, double bone labeling and gene expression analyses were performed. Serum biochemistry was evaluated at day 3, 7 and 28 of the study. Kruskal-Wallis analysis of variance was used to determine the mean difference among groups, and multiple comparisons were analyzed by Mann-Whitney-U tests with a significance level = 0.05.

Results

The results demonstrated that tooth movement in the ESWT-treated rats (0.11 ± 0.07 mm) was impeded compared to the tooth movement in the non-ESWT-treated rats (0.44 ± 0.09 mm). ESWT up-regulated several osteoblastic and osteoclastic gene markers and cytokines; however, the effects on osteoclasts were only transient. Double-fluorescence bone labeling demonstrated that osteoblastic activity increased after ESWT treatment. There was no difference in systemic RANKL/OPG ratio between groups.

Conclusions

ESWT at 500 impulse at energy flux density 0.1 mJ/mm² increased osteoblast and osteoclast activities and imbalanced bone remodeling resulting in impeded tooth movement in rats.

https://ift.tt/2qHnFsM

Germination of pollen grains in the esophagus of individuals with eosinophilic esophagitis

Abstract

Background

Eosinophilic esophagitis (EoE) is characterized by esophageal dysfunction and, histologically, by eosinophilic inflammation. There is no a clear etiologic treatment. EoE exacerbations are often seasonal. We hypothesized that the inflammatory response of the esophageal mucosa in patients with high levels of antibodies to pollen allergens and worsened seasonal EoE might be due to swallowing airborne pollen and the intrusion into the esophageal mucosa of pollen allergens and pollen tubes, which encounter a pH and humidity resembling the stigma at pollination.

Objective

The aim of our study was to demonstrate the possible pathogenic role of environmental allergens in EoE through molecular and anatomopathological studies.

Methods

129 patients with EoE were tested for environmental and food allergens. Component resolved diagnosis (CRD), histological and botanical analysis was performed. Microscopic examination of esophageal biopsies of 129 adults patients with EoE, 82 of them with seasonal exacerbation, and 100 controls, with gastroesophageal reflux without eosinophilic infiltrate, were made to verify the presence of callose (polysaccharide abundant in pollen tubes but absent in animal tissues) in the esophagus.

Results

CRD detected pollen allergens in 87.6% of patients with EoE. The predominant allergens were group 1 grass (55%), Art v 3 (11.3%) and lipid transfer proteins (LTPs) (19.4%) of common Mediterranean foods such as peach, hazelnuts, walnuts and wheat. Callose from pollen tubes was found in 65.6% of biopsies.

Conclusion

Alteration of the mucosal barrier in EoE might cause the penetration of pollen grains into the esophageal tissues. In EoE patients, anatomopathological studies searching for intrusion to plant foods and pollen, and specific‐guided diet and immunotherapy after plant structures detection in biopsies, might be effective.

This article is protected by copyright. All rights reserved.

https://ift.tt/2zICK1e

Dermatological manifestations in Noonan syndrome: A prospective multicentric study of 129 mutation‐positive patients

Summary

Background

Data on dermatological manifestations of Noonan syndrome (NS) remain heterogeneous and based on little dermatological expertise.

Objectives

To describe the dermatological manifestations of NS, compare them with the literature findings, and test for dermatological phenotype‐genotype correlations with or without the presence of PTPN11 mutations.

Methods

We performed a large, 4‐year, prospective, multicentric, collaborative dermatological and genetic study.

Results

One hundred and twenty‐nine patients were enrolled, including 65 with PTPN11‐NS, 34 with PTPN11‐NS with multiple lentigines (NSML), and 30 without PTPN11‐NS. Easy bruising was the most frequent dermatological finding in PTPN11‐NS, present in 53.8%. Multiple lentigines and café‐au‐lait macules (≥3) were present in, respectively, 94% and 80% of NSML linked to specific mutations of PTPN11. Atypical forms of NSML could be associated with NS with RAF1 or NRAS mutations. In univariate analysis, patients without a PTPN11 mutation showed (i) a significantly higher frequency of keratinization disorders (P=0.001), including keratosis pilaris (P=0.005), ulerythema ophryogenes (P=0.0001) and palmar and/or plantar hyperkeratosis (P=0.06, trend association), and (ii) a significantly higher frequency of scarce scalp hair (P=0.035) and scarce or absent eyelashes (P=0.06, trend association) than those with PTPN11 mutations.

Conclusions

Cutaneous phenotype of NS with a PTPN11 mutation is generally mild and non‐specific, whereas the absence of a PTPN11 mutation is associated with a high frequency of keratinization disorders and hair abnormalities.

This article is protected by copyright. All rights reserved.

https://ift.tt/2z0QBAH

Bilateral central retinal artery occlusion from catastrophic antiphospholipid syndrome

A 23-year-old woman with history of systemic lupus erythematous presented with dizziness and headache and was admitted for the stroke workup. During her stay, she had sudden painless loss of vision in her right eye consistent with central retinal artery occlusion (CRAO). Ocular massage and paracentesis were attempted without success to resume the flow. She was started on oral high-dose steroids (1 mg/kg) for lupus flare and therapeutic anticoagulation for antiphospholipid syndrome (positive for anticardiolipin and beta-2 microglobulin antibodies). On day 4, she started having painful bluish discoloration of her left index finger and right fifth toe, and on day 5 she had acute onset of left blurry vision with findings consistent with CRAO. She fulfilled the criteria of catastrophic antiphospholipid syndrome and was started on intravenous pulse steroids, plasmapheresis and higher international normalised ratio goal of 3–3.5 with improvement in her left eye vision from 20/200 to 20/20 on near card test by the end of treatment.

https://ift.tt/2PUq5CH

Renal pseudomass: be aware of splenorenal fusion

Splenosis is the heterotopic implantation of splenic tissue that usually occurs in a previous major abdominal trauma or splenectomy setting. However, splenorenal fusion is an uncommon entity, categorised as a developmental anomaly. There have been several confirmed cases in the literature. Despite some helpful imaging features, it can be easily misdiagnosed as a neoplastic renal mass, resulting in unnecessary nephrectomy. Here we presented a case of splenorenal fusion in an elderly female patient, which was initially misdiagnosed as renal cell carcinoma in sonography. More specific imaging modalities and biopsy are helpful in suggesting the correct diagnosis.

https://ift.tt/2DeOE6q

Anti-HMGCR antibody-associated necrotising myopathy and its association with statin use

A 66-year-old man presented with chest pain and a 1-year history of generalised weakness, accompanied with generalised aches and pains. Symptoms worsened when he was initiated on statins. Investigations yielded high creatine kinase, high HMG-coenzymeA reductase (HMGCR) antibody titre, myopathic features on electromyography and muscle biopsy, and muscle atrophy on MRI. These results were in keeping with anti-HMGCR antibody myopathy. The patient responded well to immunosuppressive therapy.

https://ift.tt/2Q19OvX

Cerebral tuberculomas in a 6-year-old girl causing central diabetes insipidus

A 6-year-old girl presented acutely with worsening frontal headaches. She had a 3-month history of lethargy, reduced appetite, weight loss, cough and intermittent fevers. A chest X-ray showed a left upper lobe consolidation, and a CT head showed multiple enhancing lesions with significant surrounding oedema in both cerebral hemispheres. Due to the strong suspicion of tuberculosis (TB), she was admitted and treated with anti-TB therapy and steroids. Following this, pulmonary infection with Mycobacterium tuberculosis was confirmed by a positive PCR from induced sputum. Cerebral spinal fluid (CSF) analysis was normal and tested negative for M. tuberculosis on PCR. During her first week of treatment, she developed polyuria, nocturia and polydipsia and was diagnosed with central diabetes insipidus. She was started on desmopressin which rapidly improved her symptoms, and she was continued on desmopressin for 3 months. Currently, she remains well and has shown a good response to TB treatment.

https://ift.tt/2DeOwns

Clinical and radiological findings in a severe case of cleidocranial dysplasia

Cleidocranial dysplasia (CCD) is a rare congenital autosomal dominant condition, causing hypoplasia of the clavicle, abnormal formation of teeth, skeletal and craniofacial bones. CCD is caused by the mutation of RUNX2/CBFA1 present in the short arm of chromosome 6 at position 21.1, a transcription factor essential for the formation of teeth, cartilage and bone. Patients with CCD show the classical features of excessive mobility of the shoulder bone, lack of resorption of the deciduous teeth, failure to erupt permanent teeth, multiple impacted and supernumerary teeth, and open fontanelle and sutures of the skull. In this article we report a case of CCD in a 16-year-old male patient, with an aim to highlight the clinical, radiological and recommended treatment guidelines.

https://ift.tt/2PUpXmH

Secretory cervical schwannoma: first of its kind

Schwannomas arising from cervical sympathetic chain are rare benign neoplasms which are slow growing, usually asymptomatic, biochemically non-secretory and functionally inactive tumours. We present a case of secretory schwannoma arising from the cervical sympathetic chain, causing hypertension and associated with raised urinary catecholamine degradation by-products. Transcervical excision of the tumour was followed by normalisation of blood pressure and urinary vanillylmandelic acid levels and pathologically the tumour was proved to be a schwannoma.

https://ift.tt/2Dj591D

Massive release of the histamine‐degrading enzyme diamine oxidase during severe anaphylaxis in mastocytosis patients

Abstract

Background

Histaminolytic activity mediated by diamine oxidase (DAO) is present in plasma after induction of severe anaphylaxis in rats, guinea pigs and rabbits. Heparin released during mast cell degranulation in the gastrointestinal tract might liberate DAO from heparin‐sensitive storage sites. DAO release during anaphylaxis has not been demonstrated in humans.

Methods

Plasma DAO, tryptase and histamine concentrations of four severe anaphylaxis events were determined at multiple serial time points in two patients with systemic mastocytosis. The histamine degradation rates were measured in anaphylaxis samples and in pregnancy sera and plasma with comparable DAO concentrations.

Results

Mean DAO (132 ng/ml) and tryptase (304 ng/ml) concentrations increased 187‐ and 4.0‐fold respectively over baseline values (DAO 0.7 ng/ml, tryptase 76 ng/ml) during severe anaphylaxis. Under non‐anaphylaxis conditions DAO concentrations were not elevated in 29 mastocytosis patients compared to healthy volunteers and there was no correlation between DAO and tryptase levels in mastocytosis patients. The histamine degradation rate of DAO in plasma from mastocytosis patients during anaphylaxis is severely compromised compared to DAO from pregnancy samples.

Conclusions

During severe anaphylaxis in mastocytosis patients DAO is likely released from heparin‐sensitive gastrointestinal storage sites. The measured concentrations can degrade histamine, but DAO activity is compromised compared to pregnancy samples. For accurate histamine measurements during anaphylaxis DAO inhibition is essential to inhibit further histamine degradation after blood withdrawal. Determination of DAO antigen levels might be of clinical value to improve the diagnosis of mast cell activation.

This article is protected by copyright. All rights reserved.

https://ift.tt/2T3rupc

Protofibrillar and Fibrillar Amyloid-β Binding Proteins in Cerebrospinal Fluid

Rahman, MM; Westermark, GT; Zetterberg, H; Härd, T; Sandgren, M; (2018) Protofibrillar and Fibrillar Amyloid-β Binding Proteins in Cerebrospinal Fluid. Journal of Alzheimer's Disease 10.3233/JAD-180596 . (In press). Green open access

https://ift.tt/2Ddh9Sd

Homogeneous antibody-drug conjugates via site-selective disulfide bridging

Forte, N; Chudasama, V; Baker, JR; (2018) Homogeneous antibody-drug conjugates via site-selective disulfide bridging. Drug Discovery Today: Technologies 10.1016/j.ddtec.2018.09.004 . (In press).

https://ift.tt/2PRpD8d

Feasibility and Biocompatibility of 3D-Printed Photopolymerized and Laser Sintered Polymers for Neuronal, Myogenic, and Hepatic Cell Types.

Rimington, RP; Capel, AJ; Player, DJ; Bibb, RJ; Christie, SDR; Lewis, MP; (2018) Feasibility and Biocompatibility of 3D-Printed Photopolymerized and Laser Sintered Polymers for Neuronal, Myogenic, and Hepatic Cell Types. Macromolecular Bioscience , 18 (7) , Article e1800113. 10.1002/mabi.201800113 .

https://ift.tt/2DeVs49

Learning Filterbanks from Raw Speech for Phone Recognition

Zeghidour, N; Usunier, N; Kokkinos, I; Schatz, T; Synnaeve, G; Dupoux, E; (2018) Learning Filterbanks from Raw Speech for Phone Recognition. In: 2018 IEEE International Conference on Acoustics, Speech and Signal Processing (ICASSP). (pp. pp. 5509-5513). IEEE Green open access

https://ift.tt/2PRHz2E

Mortality reduction by post-dilution online-haemodiafiltration: a cause-specific analysis

Nube, MJ; Peters, SAE; Blankestijn, PJ; Canaud, B; Davenport, A; Grooteman, MPC; Asci, G; ... Bots, ML; + view all Nube, MJ; Peters, SAE; Blankestijn, PJ; Canaud, B; Davenport, A; Grooteman, MPC; Asci, G; Locatelli, F; Maduell, F; Morena, M; Ok, E; Torres, F; Bots, ML; - view fewer (2017) Mortality reduction by post-dilution online-haemodiafiltration: a cause-specific analysis. Nephrology Dialysis Transplantation , 32 (3) pp. 548-555. 10.1093/ndt/gfw381 . Green open access

https://ift.tt/2Dgnhcg

Environmental Rights and Principles in the EU Context: Investigating Article 37 of the Charter of Fundamental Rights

Scotford, EAK; (2018) Environmental Rights and Principles in the EU Context: Investigating Article 37 of the Charter of Fundamental Rights. In: Rayfuse, R and Bogojevic, S, (eds.) Environmental Rights in Europe and Beyond. Hart Publishing: Oxford, UK.

https://ift.tt/2PPMLEd

Remote Ischemic Preconditioning: Would You Give Your Right Arm to Protect Your Kidneys?

Bulluck, H; Candilio, L; Hausenloy, DJ; (2016) Remote Ischemic Preconditioning: Would You Give Your Right Arm to Protect Your Kidneys? American Journal of Kidney Diseases , 67 (1) pp. 16-19. 10.1053/j.ajkd.2015.08.018 . Green open access

https://ift.tt/2Ddh4xT

Physical activity across adulthood and bone health in later life: the 1946 British birth cohort

Muthuri, SG; Ward, KA; Kuh, D; Elhakeem, A; Adams, JE; Cooper, R; (2018) Physical activity across adulthood and bone health in later life: the 1946 British birth cohort. Journal of Bone and Mineral Research 10.1002/jbmr.3607 .

https://ift.tt/2PRp7qN

Why won't children keep exercising? Barriers and facilitators to exercise and physical activity maintenance- a qualitative study

Douglas, HL; Rand, S; Denford, S; Bryon, M; Main, E; (2018) Why won't children keep exercising? Barriers and facilitators to exercise and physical activity maintenance- a qualitative study. Presented at: 41st European Cystic Fibrosis Conference, Serbia, Belgrade.

https://ift.tt/2DgGMBr

PWE-084 Relationship between indices of frailty/disability with disease severity and nutritional status in patients with cirrhosis

Dhar, P; Greenslade, L; Westbrooke, R; Jackson, CD; Marshall, A; Morgan, MY; (2018) PWE-084 Relationship between indices of frailty/disability with disease severity and nutritional status in patients with cirrhosis. [Lecture]. Presented at: British Society of Gastroenterology (BSG) Annual Meeting 2018, Liverpool, UK. Green open access

https://ift.tt/2PRoNs5

The Time Limit on Prosecutions for Underage Sexual Intercourse in the Sexual Offences Act 1956: A Continuing Problem

Rogers, JW; (2018) The Time Limit on Prosecutions for Underage Sexual Intercourse in the Sexual Offences Act 1956: A Continuing Problem. In: Child, J and Duff, A, (eds.) Criminal Law Reform Now: Proposals & Critique. Hart Publishing: Oxford, UK. (In press).

https://ift.tt/2DigQ8t

My quality of life or yours? The discrepancies between parent and child reported quality of life scores

Douglas, H; Bryon, M; Ledger, S; Main, E; (2017) My quality of life or yours? The discrepancies between parent and child reported quality of life scores. Presented at: 40th European Cystic Fibrosis Conference, Seville, Spain. Green open access

https://ift.tt/2PRoCwV

Collagen stable isotopes provide insights into the end of the mammoth steppe in the central East European plains during the Epigravettian

Drucker, DG; Stevens, RE; Germonpré, M; Sablin, MV; Péan, S; Bocherens, H; (2018) Collagen stable isotopes provide insights into the end of the mammoth steppe in the central East European plains during the Epigravettian. Quaternary Research , 2018 pp. 1-13. 10.1017/qua.2018.40 . Green open access

https://ift.tt/2DhHrmf

Inspire-CF: A randomised trial evaluating the longitudinal effects of a weekly supervised exercise programme on children with cystic fibrosis

Ledger, S; Douglas, H; Sarria-Jaramillo, L; Rayner, P; Goldman, A; Giardini, A; Prasad, A; ... Main, E; + view all Ledger, S; Douglas, H; Sarria-Jaramillo, L; Rayner, P; Goldman, A; Giardini, A; Prasad, A; Wade, A; Aurora, P; Main, E; - view fewer (2017) Inspire-CF: A randomised trial evaluating the longitudinal effects of a weekly supervised exercise programme on children with cystic fibrosis. Presented at: 18th International World Confederation for Physical Therapy Congress 2017, Cape Town, South Africa. Green open access

https://ift.tt/2PRGE24

The 'Least Repulsive' work on a 'Repulsive Subject': Jeremy Bentham on William Blackstone's 'Commentaries on the Laws of England'

Schofield, P; (2018) The 'Least Repulsive' work on a 'Repulsive Subject': Jeremy Bentham on William Blackstone's 'Commentaries on the Laws of England'. In: Page, A and Prest, W, (eds.) Blackstone and his critics. (pp. 23-40). Hart Publishing: Oxford, UK. Green open access

https://ift.tt/2DigoqN

Parkinson’s disease: evolution of cognitive impairment and CSF Aβ₁−₄₂ profiles in a prospective longitudinal study

Lerche, S; Wurster, I; Röben, B; Machetanz, G; Zimmermann, M; Bernhard, F; Stransky, E; ... Brockmann, K; + view all Lerche, S; Wurster, I; Röben, B; Machetanz, G; Zimmermann, M; Bernhard, F; Stransky, E; Deuschle, C; Schulte, C; Hansson, O; Zetterberg, H; Gasser, T; Berg, D; Maetzler, W; Brockmann, K; - view fewer (2018) Parkinson's disease: evolution of cognitive impairment and CSF Aβ₁−₄₂ profiles in a prospective longitudinal study. Journal of Neurology, Neurosurgery and Psychiatry 10.1136/jnnp-2018-318956 . (In press). Green open access

https://ift.tt/2PQPMEa

Connecting Public and Private International Law

Mills, A; (2018) Connecting Public and Private International Law. In: Ruiz Abou-Nigm, V and McCall-Smith, K and French, D, (eds.) Linkages and Boundaries in Private and Public International Law. Hart Publishing: Oxford, UK. Green open access

https://ift.tt/2Dhvc99

Seasonal records of palaeoenvironmental change and resource use from archaeological assemblages

Prendergast, AL; Pryor, AJE; Reade, H; Stevens, RE; (2018) Seasonal records of palaeoenvironmental change and resource use from archaeological assemblages. Journal of Archaeological Science: Reports , 21 pp. 1191-1197. 10.1016/j.jasrep.2018.08.006 .

https://ift.tt/2PRofm1

Mind the gap: A novel technique for space closure – a case report

Shah, R; Sharif, MO; Gill, D; (2019) Mind the gap: A novel technique for space closure – a case report. Journal of Orthodontics (In press).

https://ift.tt/2Dhv6hN

Ischaemic conditioning and reperfusion injury

Hausenloy, DJ; Yellon, DM; (2016) Ischaemic conditioning and reperfusion injury. Nature Reviews Cardiology , 13 (4) pp. 193-209. 10.1038/nrcardio.2016.5 . Green open access

https://ift.tt/2PVL7AN

Microcystic Calcifying Epithelial Odontogenic Tumor

Abstract

Microcystic variant of calcifying epithelial odontogenic tumor is rare. We herein describe an additional well-documented case of microcystic CEOT. The affected patient is a Guatemalan 42-year-old female with an expansile well-defined mixed radiolucent–radiopaque lesion located in the right posterior mandible. The lesion was associated to an unerupted third molar. Histopathologic examination revealed nests and cords of moderately pleomorphic, eosinophilic polyhedral epithelial cells surrounded by a fibromyxoid stroma. The neoplastic cells showed microcystic pattern made of pseudo-glandular spaces with variable diameter. Occasional amyloid deposits and calcified acellular material were observed. Tumor cells were positive for AE1/AE3, CK14, CK19, p63, CD138, and beta-catenin. Conservative surgical resection was performed with an uneventful immediate post-surgical follow-up. After 1 year follow-up there is no evidence of recurrence. Pathologists should be aware of this unusual microcystic presentation of CEOT, which may pose a diagnostic challenge and potential diagnostic dilemma.

https://ift.tt/2PXUKii

Dentoalveolar Abscesses Not Associated with Caries or Trauma: A Diagnostic Hallmark of Hypophosphatemic Rickets Initially Misdiagnosed as Hypochondroplasia

Abstract

Hypophosphatemic rickets is a rare genetic disorder involving the regulation of fibroblast growth factor 23 (FGF23), a phosphaturic agent, clinically showing bowing of the legs, short stature and dentoalveolar abscesses. A 7-year-old boy, with previous hypochondroplasia diagnosis, was referred to our pediatric dentistry clinic presenting short stature, bone deformities and sinus tracts at deciduous teeth apex levels not related with trauma, restorations or dental caries. After deciduous teeth extraction, due to root resorption and mobility, light microscopy exhibited typical hypophosphatemic dentin, and micro-computed tomography revealed tubular clefts and porosities throughout the teeth. Laboratory tests confirmed the HR diagnosis, after which the treatment was initiated.

https://ift.tt/2Dj9GBc

Microcystic Calcifying Epithelial Odontogenic Tumor

Abstract

Microcystic variant of calcifying epithelial odontogenic tumor is rare. We herein describe an additional well-documented case of microcystic CEOT. The affected patient is a Guatemalan 42-year-old female with an expansile well-defined mixed radiolucent–radiopaque lesion located in the right posterior mandible. The lesion was associated to an unerupted third molar. Histopathologic examination revealed nests and cords of moderately pleomorphic, eosinophilic polyhedral epithelial cells surrounded by a fibromyxoid stroma. The neoplastic cells showed microcystic pattern made of pseudo-glandular spaces with variable diameter. Occasional amyloid deposits and calcified acellular material were observed. Tumor cells were positive for AE1/AE3, CK14, CK19, p63, CD138, and beta-catenin. Conservative surgical resection was performed with an uneventful immediate post-surgical follow-up. After 1 year follow-up there is no evidence of recurrence. Pathologists should be aware of this unusual microcystic presentation of CEOT, which may pose a diagnostic challenge and potential diagnostic dilemma.

https://ift.tt/2PXUKii

Dentoalveolar Abscesses Not Associated with Caries or Trauma: A Diagnostic Hallmark of Hypophosphatemic Rickets Initially Misdiagnosed as Hypochondroplasia

Abstract

Hypophosphatemic rickets is a rare genetic disorder involving the regulation of fibroblast growth factor 23 (FGF23), a phosphaturic agent, clinically showing bowing of the legs, short stature and dentoalveolar abscesses. A 7-year-old boy, with previous hypochondroplasia diagnosis, was referred to our pediatric dentistry clinic presenting short stature, bone deformities and sinus tracts at deciduous teeth apex levels not related with trauma, restorations or dental caries. After deciduous teeth extraction, due to root resorption and mobility, light microscopy exhibited typical hypophosphatemic dentin, and micro-computed tomography revealed tubular clefts and porosities throughout the teeth. Laboratory tests confirmed the HR diagnosis, after which the treatment was initiated.

https://ift.tt/2Dj9GBc

Microcystic Calcifying Epithelial Odontogenic Tumor

Abstract

Microcystic variant of calcifying epithelial odontogenic tumor is rare. We herein describe an additional well-documented case of microcystic CEOT. The affected patient is a Guatemalan 42-year-old female with an expansile well-defined mixed radiolucent–radiopaque lesion located in the right posterior mandible. The lesion was associated to an unerupted third molar. Histopathologic examination revealed nests and cords of moderately pleomorphic, eosinophilic polyhedral epithelial cells surrounded by a fibromyxoid stroma. The neoplastic cells showed microcystic pattern made of pseudo-glandular spaces with variable diameter. Occasional amyloid deposits and calcified acellular material were observed. Tumor cells were positive for AE1/AE3, CK14, CK19, p63, CD138, and beta-catenin. Conservative surgical resection was performed with an uneventful immediate post-surgical follow-up. After 1 year follow-up there is no evidence of recurrence. Pathologists should be aware of this unusual microcystic presentation of CEOT, which may pose a diagnostic challenge and potential diagnostic dilemma.

https://ift.tt/2PXUKii

Dentoalveolar Abscesses Not Associated with Caries or Trauma: A Diagnostic Hallmark of Hypophosphatemic Rickets Initially Misdiagnosed as Hypochondroplasia

Abstract

Hypophosphatemic rickets is a rare genetic disorder involving the regulation of fibroblast growth factor 23 (FGF23), a phosphaturic agent, clinically showing bowing of the legs, short stature and dentoalveolar abscesses. A 7-year-old boy, with previous hypochondroplasia diagnosis, was referred to our pediatric dentistry clinic presenting short stature, bone deformities and sinus tracts at deciduous teeth apex levels not related with trauma, restorations or dental caries. After deciduous teeth extraction, due to root resorption and mobility, light microscopy exhibited typical hypophosphatemic dentin, and micro-computed tomography revealed tubular clefts and porosities throughout the teeth. Laboratory tests confirmed the HR diagnosis, after which the treatment was initiated.

https://ift.tt/2Dj9GBc

Ingredients for 21 cm Intensity Mapping

Villaescusa-Navarro, F; Genel, S; Castorina, E; Obuljen, A; Spergel, DN; Hernquist, L; Nelson, D; ... Pakmor, R; + view all Villaescusa-Navarro, F; Genel, S; Castorina, E; Obuljen, A; Spergel, DN; Hernquist, L; Nelson, D; Carucci, IP; Pillepich, A; Marinacci, F; Diemer, B; Vogelsberger, M; Weinberger, R; Pakmor, R; - view fewer (2018) Ingredients for 21 cm Intensity Mapping. Astrophysical Journal , 866 (2) 10.3847/1538-4357/aadba0 . Green open access

https://ift.tt/2RPKBl4

Illegality in Equity

Davies, PS; (2018) Illegality in Equity. In: Davies, P and Douglas, S and Goudkamp, J, (eds.) Defences in Equity. Hart Publishing: Oxford, UK. Green open access

https://ift.tt/2Dywaih

How Idrimi came to London: Diplomacy and the division of archaeological finds in the 1930s

Maloigne, H; (2017) How Idrimi came to London: Diplomacy and the division of archaeological finds in the 1930s. Museum History Journal , 10 (2) pp. 200-216. 10.1080/19369816.2017.1328874 .

https://ift.tt/2RPr8kt

CATH: expanding the horizons of structure-based functional annotations for genome sequences

Sillitoe, I; Dawson, N; Lewis, TE; Das, S; Lees, JG; Ashford, P; Tolulope, A; ... Orengo, CA; + view all Sillitoe, I; Dawson, N; Lewis, TE; Das, S; Lees, JG; Ashford, P; Tolulope, A; Scholes, HM; Senatorov, I; Bujan, A; Ceballos Rodriguez-Conde, F; Dowling, B; Thornton, J; Orengo, CA; - view fewer (2018) CATH: expanding the horizons of structure-based functional annotations for genome sequences. Nucleic Acids Research 10.1093/nar/gky1097 . (In press). Green open access

https://ift.tt/2Dyw3TT

Ramifications of Patel v Mirza in the Law of Trusts

Davies, PS; (2018) Ramifications of Patel v Mirza in the Law of Trusts. In: Green, S and Bogg, A, (eds.) Illegality after Patel v Mirza. Hart Publishing: Oxford, UK. Green open access

https://ift.tt/2RPKkP4

Complementary Feeding Practices for South Asian Young Children Living in High-Income Countries: A Systematic Review

Manikam, L; Lingam, R; Lever, I; Alexander, EC; Amadi, C; Milner, Y; Shafi, T; ... Lakhanpaul, M; + view all Manikam, L; Lingam, R; Lever, I; Alexander, EC; Amadi, C; Milner, Y; Shafi, T; Stephenson, L; Ahmed, S; Lakhanpaul, M; - view fewer (2018) Complementary Feeding Practices for South Asian Young Children Living in High-Income Countries: A Systematic Review. Nutrients , 10 (11) , Article 1676. 10.3390/nu10111676 . Green open access

https://ift.tt/2DABqSG

Understanding participation dilemmas in community mobilisation: can collective action theory help

Gram, L; Daruwalla, N; Osrin, D; (2018) Understanding participation dilemmas in community mobilisation: can collective action theory help. Journal of Epidemiology and Community Health , 2018 10.1136/jech-2018-211045 . (In press). Green open access

https://ift.tt/2RPKLsG

Lifestyle modifications for non-alcohol related fatty liver disease: A network meta-analysis

Gurusamy, KS; Tsochatzis, E; Madden, AM; (2018) Lifestyle modifications for non-alcohol related fatty liver disease: A network meta-analysis. Cochrane Database of Systematic Reviews , 2018 (10) , Article CD013156. 10.1002/14651858.CD013156 . Green open access

https://ift.tt/2DzKVBl

Mirtazapine added to SSRIs or SNRIs for treatment resistant depression in primary care: phase III randomised placebo controlled trial (MIR)

Kessler, DS; MacNeill, SJ; Tallon, D; Lewis, G; Peters, TJ; Hollingworth, W; Round, J; ... Wiles, NJ; + view all Kessler, DS; MacNeill, SJ; Tallon, D; Lewis, G; Peters, TJ; Hollingworth, W; Round, J; Burns, A; Chew-Graham, CA; Anderson, IM; Shepherd, T; Campbell, J; Dickens, CM; Carter, M; Jenkinson, C; Macleod, U; Gibson, H; Davies, S; Wiles, NJ; - view fewer (2018) Mirtazapine added to SSRIs or SNRIs for treatment resistant depression in primary care: phase III randomised placebo controlled trial (MIR). BMJ , 363 , Article k4218. 10.1136/bmj.k4218 . Green open access

https://ift.tt/2RNPbAA