Preoperative continuation of aspirin administration in patients undergoing major abdominal malignancy surgery

Abstract

Purpose

In contrast to that in a nonoperative setting, it has been shown that perioperative administration of aspirin did not decrease the rate of death or myocardial infarction but increased major bleeding risk. Since these conflicting results might be due to concurrent use of anticoagulants and a lower thrombotic risk of patients, this cohort study was carried out for patients at a high thrombotic risk without concurrent use of anticoagulants.

Methods

Medical records for patients who underwent major abdominal malignancy surgery and who were on a preoperative antiplatelet regimen were reviewed. The patients were divided into two groups according to perioperative antiplatelet management: administration of all preoperative antiplatelet agent-suspended (no aspirin) group and only aspirin administration-continued (aspirin) group. The incidence of symptomatic thromboembolic events, frequency of exogenous blood transfusion within 30 days after surgery and the amount of intraoperative bleeding were compared between the two groups.

Results

After propensity score matching, 105 patients of each group were matched. The incidence of perioperative thromboembolic events in the no-aspirin group was significantly higher than that in the aspirin group [7/105 (6.7%) vs 0/105 (0%), 95% CI 1.44–∞, P = 0.016]. In contrast, neither the frequency of exogenous transfusion [21.0% vs 11.4%, 95% CI 0.88–4.38 P = 0.110] nor the amount of intraoperative bleeding [median (interquartile range), ml: 230 (70–500) vs 208 (50–500), P = 0.325] was different between the two groups.

Conclusion

Although the sample size is relatively small, our findings suggest that continuation of aspirin administration is likely to reduce the thrombotic risk but unlikely to increase the bleeding risk of patients who undergo major abdominal surgery for malignancy.

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Amputation for osteomyelitis in a patient with spina bifida

Abstract

We describe a case of osteomyelitis in a patient with spina bifida presenting to the vascular surgeon and highlight the complex challenges encountered. We review the literature and demonstrate how good multidisciplinary care and early consideration for surgical amputation may benefit this unique group of patients.

https://ift.tt/2FGcN8U

Syphilis as an atypical cause of perianal fissure

Abstract

We present the case of a 29-year-old woman who attended a surgical outpatient clinic with symptoms of perianal fissure due to syphilitic infection. This uncommon aetiology of a common condition is often alluded to in textbooks, but little information exists in the scientific literature regarding the pathogenesis, presentation and treatment of fissure-in-ano secondary to syphilis. We present the case and an overview of the topic aimed at surgeons and clinicians who manage patients with perianal pathology. Syphilis is far from a disease of antiquity; in patients presenting with fissure-in-ano a thorough sexual history and sexually transmissible infection screening in at-risk groups may avoid mis-diagnosis, community transmission and unnecessary procedures.

https://ift.tt/2r8SrLv

Risky Social Media Behaviors and the Potential for Victimization: A Descriptive Look at College Students Victimized by Someone Met Online

Violence and Gender, Ahead of Print.


https://ift.tt/2zsy5RP

Molecular Classification of Thyroid Nodules with Indeterminate Cytology: Development and Validation of a Highly Sensitive and Specific New miRNA-Based Classifier Test Using Fine-Needle Aspiration Smear Slides

Thyroid, Ahead of Print.


https://ift.tt/2KC6lOU

Innominate artery bifurcation pseudoaneurysm repair by “kissing stent-grafts technique”: a case report

We introduce the "kissing stent-grafts technique" for a patient who suffered from a pseudoaneurysm in bifurcation of innominate artery. This technique repaired an innominate artery bifurcation pseudoaneurysm; ...

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Case reports: old-timers and evergreens

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Ergonomic hazards in otolaryngology

Objectives/Hypothesis

To evaluate the presence of postural‐related strain and musculoskeletal discomfort, along with the level of ergonomics training and the availability of ergonomic equipment among otolaryngology surgeons.

Study Design

Intraoperative observations and survey study.

Methods

Using the Rapid Entire Body Assessment score system to identify ergonomic hazards, we conducted intraoperative observations assessing operating room personnel during different otolaryngological subspecialty procedures. Based on these findings, otolaryngology surgeons at a single academic institution in the United States were sent a survey that evaluated ergonomic practice, environmental infrastructure, and prior ergonomic training or education.

Results

A response rate of 69% was obtained from 70 surgeons, with 72.9% of responding surgeons suffering from some level of back pain, with cervical spine pain being the most common. Interestingly, residents were equally affected when compared to more senior surgeons both in subjective survey reports and from observational risk analysis. Furthermore, 43.8% of surgeons reported suffering from the highest level of pain when standing, whereas only 12.5% experienced pain when sitting. Importantly, 10% stated that pain impacted their work. Only 24% of surgeons had any prior ergonomic training or education.

Conclusions

Our data suggest that pain and disability induced by poor ergonomics are widespread among the otolaryngology community and confirm that surgeons rarely receive ergonomic training in the surgical context. Additionally, intraoperative observational findings identified that the majority of observed surgeons display poor posture, particularly a poor cervical angle and use of ergonomic setups, both of which increase ergonomic risk hazard. These data provide guidance for future interventional studies.

Level of Evidence

NA Laryngoscope, 2018

https://ift.tt/2KDt8dy

Isolated Paresis of Laryngeal Adduction: What Are the Laryngoscopic and Stroboscopic Findings?

Objectives/Hypothesis

This study aimed to describe the videolaryngostroboscopic (VLS) findings in a cohort of patients with isolated paresis of laryngeal adduction and identify predictive variables that may be related to voice recovery.

Study Design

Chart review and VLS analysis of dysphonic patients diagnosed with isolated paresis of laryngeal adduction by laryngeal electromyography (LEMG).

Methods

Demographic, clinical, VLS, and LEMG findings were analyzed according to the outcome of dysphonia.

Results

There were 17 patients, 12 males (70.6%), mean age of 46.6 years, with median dysphonia duration of 4 months (range, 1–60 months) included in the study. In all patients, gross movement of both vocal folds were normal. Laryngoscopy showed limited adduction of the ipsilateral ventricular fold, contralateral interarytenoid region deviation, and vocal fold atrophy in 100%, 94.1%, and 76.5% of patients, respectively. VLS findings included: impairment of glottic closure (94.1%), phase asymmetry (94.1%), and reduced mucosal wave on the affected side (76.5%). Predictors of good voice outcome were sudden onset (P = .012), duration of dysphonia on presentation shorter than 5 months (P = .005), and absence of polyphasic potentials on LEMG (P = .041).

Conclusions

Findings on VLS as described suggest isolated paresis of laryngeal adduction and should warrant indication of LEMG for definite diagnosis. Voice improvement may be related to clinical and LEMG findings.

Level of Evidence

4 Laryngoscope, 2018

https://ift.tt/2BA2LC8

Presentation and eustachian tube function test results in children evaluated at a specialty clinic

Objectives/Hypothesis

Interest in eustachian tube (ET) dysfunction (ETD) has increased with the recent Food and Drug Administration approval of a new device for balloon dilation of the ET (BDET) in adults. However, children have been receiving BDET treatment with ET‐specific or sinus balloons around the world and off‐label in the United States for years. It is important, therefore, to understand the manifestations of and methods to verify ETD in children.

Study Design

Retrospective cross‐sectional study.

Methods

This is a retrospective study of clinical presentations and results of ET function (ETF) tests in children referred to the ETD clinic. An otorhinolaryngology exam, nasopharyngeal videoendoscopy of the ET orifices during swallow and maneuvers, and ETF tests, including inflation deflation, forced response test, and pressure chamber tests, were performed as applicable.

Results

Data for 30 children aged 6.2 to 17.3 years (mean = 12.9 ± 2.8 years) were analyzed. Of 60 ears, 19 (31.7%) had an intact tympanic membrane (TM), 16 (26.7%) had a patent and two had a blocked ventilation tube, and 23 (38.3%) had a TM perforation. Endoscopy of the nasopharynx revealed a large amount of secretions in 19/45 (42.2%); ET orifices and mucosal inflammation in 22/45 (48.8%); a large amount of adenoid tissue in the fossa of Rosenmuller was noted in 21/45 (46.7%). ETF tests revealed abnormal active function in 43/54 ears (79.6%) and abnormal passive function in 40/54 ears (74.1%).

Conclusions

ETD in children is often associated with residual or regrowth of adenoids and inflammation. Caution should be taken assigning a uniform phenotype and treatment prior to thorough evaluation and testing.

Level of Evidence

4 Laryngoscope, 2018

https://ift.tt/2KAzpGL

The shifting relationship between weight and pediatric obstructive sleep apnea: A historical review

Objectives

For more than a century, pediatric obstructive sleep apnea (OSA) was associated with failure to thrive. However, that association has faded over the last few decades. A 21st century child with OSA is much more likely to be overweight than underweight. This raises the question: Has pediatric OSA changed over time, or has the rise of childhood obesity in the United States created a new, separate disease? This literature review explores the historical shift in the relationship between weight and OSA, and the associated changes in treatment.

Results

We demonstrate a clear transition in the prevalence of failure to thrive and obesity in the OSA literature in the mid‐2000s. What is less clear is whether these two clinical phenotypes should be considered two distinct diseases, or whether subtle differences in one set of pathophysiologic pathways—adenotonsillar hypertrophy, altered inflammation, and increased energy expenditure—can lead to divergent metabolic outcomes. More research is needed to fully elucidate the pathophysiology of OSA in children with obesity.

Conclusions

We may need new and different treatments for obesity‐associated OSA as adenotonsillectomy—which is effective at reversing failure to thrive in OSA—is not as effective at treating OSA in children with obesity. One option is drug‐induced sleep endoscopy, which could personalize and improve surgical treatment of OSA. There is some evidence that therapies used for OSA in adults (e.g., weight loss and positive airway pressure) are also helpful for overweight/obese children with OSA. Laryngoscope, 2018

https://ift.tt/2BAyRhd

CCR10+ ILC2s with ILC1‐like properties exhibit a protective function in severe allergic asthma

Abstract

Background

We previously showed that patients with severe allergic asthma have high numbers of circulating ILC2s expressing CCR10.

Method

Herein, CCR10⁺ ILC2s were further analyzed in the blood of healthy individuals or patients with allergic and non−allergic asthma. Characteristics of human CCR10⁺ and CCR10⁻ ILC2s were assessed by flow cytometry as well as single‐cell multiplex RT‐qPCR. The role of CCR10⁺ ILC2s in asthma pathophysiology was studied in allergen‐treated mice.

Results

When compared to healthy controls, CCR10⁺ ILC2s are enriched in the blood of both allergic and non‐allergic severe asthmatic patients, and these cells are recruited to the lungs. Plasma concentrations of the CCR10 ligand CCL27 are significantly increased in severe asthmatics when compared to non‐asthmatic patients. CCR10⁺ ILC2s secrete little T_H2 cytokines, but exhibit ILC1‐like properties, including a capacity to produce IFN‐γ. Also, single cell analysis reveals that the CCR10⁺ ILC2 subset is enriched in cells expressing Amphiregulin. CCR10⁺ ILC2s depletion, as well as blocking of IFN‐γ activity, exacerbates airway hyperreactivity in allergen‐challenged mice, providing evidence for a protective role of these cells in allergic inflammation.

Conclusions

Frequencies of circulating CCR10⁺ ILC2s and CCL27 plasma concentrations represent candidate markers of asthma severity. The characterization of CCR10⁺ ILC2s in human samples and in mouse asthma models suggests that these cells downregulate allergic inflammation through IFN‐γ production.

This article is protected by copyright. All rights reserved.

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RNA is taking its Toll – Impact of RNA‐specific Toll‐like receptors on health and disease

Abstract

RNA‐sensing Toll‐like receptors (TLRs) are often described as anti‐viral receptors of the innate immune system. However, the past decade has shown that the function and importance of these receptors is far more complex. These receptors were found to be relevant for the detection of various bacterial, archaeal, and eukaryotic microorganisms and facilitate the discrimination between dead and living microbes. The cytokine and interferon response profile that is triggered has the potential to improve the efficacy of next‐generation vaccines and may prevent the development of asthma and allergy. Nevertheless, the ability to recognize foreign RNA comes with a cost as also damaged host cells can release nucleic acids that might induce an inappropriate immune response. Thus, it is not surprising that RNA‐sensing TLRs play a key role in various autoimmune diseases. However, promising new inhibitors and antagonists are on the horizon to improve their treatment.

This article is protected by copyright. All rights reserved.

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All items of the Food Allergy Quality of Life Questionnaires are relevant for peanut‐allergic patients

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Case 36-2018: A 29-Year-Old Man with an Incidentally Discovered Renal Mass

Presentation of Case. Dr. Keyan Salari (Urology): A 29-year-old man was seen at this hospital because of an incidentally discovered renal mass. The patient had been well until 6 weeks before this evaluation, when he identified a painless lump above his left testicle during a monthly…

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Pigmented villonodular synovitis occurring in the temporomandibular joint

Pigmented villonodular synovitis occurring in the region of the temporomandibular joint is a rare disease, requiring a review of the treatment method, follow-up period.

https://ift.tt/2PYqO6I

Multicenter population pharmacokinetic study of colistimethate sodium and colistin dosed as in normal renal function in patients on continuous renal replacement therapy [Pharmacology]

Background: Intravenous colistimethate sodium (CMS) is used to treat infections with multi-resistant Gram-negative bacteria. Optimal dosing in patients undergoing continuous renal replacement therapy (CRRT) is unclear.

Materials/methods: In a prospective study, we determined CMS and colistin pharmacokinetics in 10 critically ill patients requiring CRRT (8 underwent continuous venovenous hemofiltration (CVVHD), median blood flow 100 ml/min). Intensive sampling was performed on treatment day 1, 3 and 5 after a 9 MU intravenous CMS loading dose (6 MU if body weight < 60 kg) with a consecutive 8-hourly 3 MU (respectively 2 MU) maintenance dose. CMS and colistin were determined by liquid chromatography with mass spectroscopy. A model-based population pharmacokinetic analysis incorporating CRRT settings was applied to the observations.

Results: Sequential model building indicated a monocompartmental distribution for both CMS and colistin, with interindividual variability in both volume and clearance. Hematocrit was shown to affect the efficacy of drug transfer across the filter. CRRT clearance accounted for on average 41% of total CMS and 28% of total colistin clearance, confirming enhanced elimination of colistin compared to normal renal function. Target colistin steady state trough concentrations of at least 2.5 mg/L were achieved in all patients receiving 3 MU 8-hourly.

Conclusion: A loading dose of 9 MU followed after 8 h by a maintenance dosage of 3 MU 8 hourly independent of body weight is expected to achieve therapeutic colistin concentrations in patients undergoing CVVHD using low blood flows. Colistin therapeutic drug monitoring might help to further ensure optimal dosing in individual patients.

https://ift.tt/2Aod0I8

Patients at Risk for Aortic Rupture Often Exposed to Fluoroquinolones During Hospitalization [Epidemiology and Surveillance]

Several studies have indicated that fluoroquinolone use may be associated with an increased risk of aortic aneurysm or dissection (AAD). Because patients with AAD or Marfan syndrome are at increased risk for aortic rupture, we performed a retrospective cohort study to determine the prevalence of systemic fluoroquinolone exposure and predictors of fluoroquinolone use in these patients. Data were obtained from the Advisory Board billing and administrative database, which contained information on 22 million adult hospitalizations in the United States for the study period (2009-2015). International Classification of Diseases (9/10) and Current Procedural Terminology codes were used to identify patients who had AAD or Marfan syndrome or underwent aortic repair. We identified 136,789 admissions for AAD, which involved 99,818 unique patients, 20% of whom received fluoroquinolone during a hospital admission. Of the 7,045 patients with dissection, 18% were exposed to fluoroquinolone. Of the 27,876 AAD patients who underwent aortic repair, 19% received fluoroquinolone during a hospitalization before the repair. In the AAD patients, having a diagnosis of pneumonia or urinary tract infection increased the likelihood of receiving fluoroquinolone during admission by 46% and 40%, respectively (P<0.001). Additionally, we identified 2,871 admissions for Marfan syndrome, which involved 1,872 patients, 14% of whom received fluoroquinolone during an admission. In these patients, pneumonia and urinary tract infections also increased the risk of fluoroquinolone exposure. If the deleterious effects of fluoroquinolone on aortic integrity are substantiated, reducing fluoroquinolone use in hospitalized patients with aortic disorders will become an urgent safety issue for antibiotic stewardship programs.

https://ift.tt/2THnFpY

The global implications of the gentamicin histamine contamination- sorting fact from fiction [Letters]

On the 6^th of October 2017 the Therapeutics Goods Administration (TGA) in conjunction with Pfizer Australia released a statement to recall 10 batches of gentamicin Infection BP 80mg in 2ml Steriluer ampoules, due to the finding that these batches may have contained higher than expected amounts of histamine, a residual from the manufacturing process(1)....

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Molecular Analysis of Linezolid Resistant Clinical Isolates of Mycobacterium abscessus [Mechanisms of Resistance]

A total of 194 Mycobacterium abscessus isolates were collected from patients and the whole genomes were sequenced. Eighty-five (43.8%) showed linezolid (LZD) resistant. Only 8.2% of resistant isolates harbored 23S rRNA mutations. qRT-PCR revealed higher transcriptional levels of efflux pumps lmrS and mmpL9 in LZD-resistant isolates. Genome comparative analysis identified several new LZD resistance-associated genes. This study highlights the role of efflux pumps in LZD-resistant M. abscessus and proposes potential target genes for further studies.

https://ift.tt/2TMHTik

In vivo applicability of Neosartorya fischeri antifungal protein 2 (NFAP2) in treatment of vulvovaginal candidiasis [Experimental Therapeutics]

In the consequence of emerging number of vulvovaginitis caused by azole-resistant and biofilm-forming Candida species, the fast and efficient treatment of this infection has become challenging. The problem is further exacerbated by the severe side-effects of azoles as long-term use medications in the recurrent form. There is therefore an increasing demand for novel and safely applicable effective antifungal therapeutic strategies. The small, cysteine-rich and cationic antifungal proteins from filamentous ascomycetes are potential candidates as they inhibit the growth of several Candida spp. in vitro; however no information is available about their in vivo antifungal potency against yeasts. In the present study we investigated the possible therapeutic application of one of their representatives in the treatment of vulvovaginal candidiasis, the Neosartorya fischeri antifungal protein 2 (NFAP2). NFAP2 inhibited the growth of a fluconazole (FLC)-resistant Candida albicans strain isolated from vulvovaginal infection, and it was effective against both planktonic cells and biofilm in vitro. We observed that the fungal cell killing activity of NFAP2 is connected to its pore-forming ability in the cell membrane. NFAP2 did not exert cytotoxic effects on primary human keratinocytes and dermal fibroblasts at the minimal inhibitory concentration in vitro. In vivo murine vulvovaginitis model experiments showed that NFAP2 significantly decreases the cell number of the FLC-resistant C. albicans, and the combined application with FLC enhances the efficacy. These results suggest that NFAP2 provides a feasible base for the development of a fundamental new, safely applicable mono- or polytherapeutic topical agent in the treatment of superficial candidiasis.

https://ift.tt/2AtpvSO

Comparative genomics of serial Candida glabrata isolates and the rapid acquisition of echinocandin resistance during therapy [Mechanisms of Resistance]

The opportunistic pathogen Candida glabrata shows a concerning increase in drug resistance. Here we present the analysis of two serial bloodstream isolates, taken 12 days apart. Both isolates show pan-azole resistance and echinocandin resistance was acquired during the sampling interval. Genome sequencing identified 9 nonsynonymous SNVs between the strains, including a S663P substitution in FKS2 and previously undescribed SNVs in MDE1 and FPR1, offering insight into how C. glabrata acquires drug resistance and adapts to a human host.

https://ift.tt/2TO6Cm5

Emergence of resistance to quinolones and {beta}-lactam antibiotics in enteroaggregative and enterotoxigenic Escherichia coli causing travelers diarrhea. [Epidemiology and Surveillance]

The objective of this study was to assess the antimicrobial resistance of enteroaggregative Escherichia coli (EAEC) and enterotoxigenic E. coli (ETEC) causing traveler's diarrhea (TD) and investigate the molecular characterization of antimicrobial resistance genes to third generation cephalosporins, chepamycins and quinolones. Overall, 39 EAEC and 43 ETEC clinical isolates were studied. The susceptibility of EAEC and ETEC against ampicillin, amoxicillin-clavulanic acid, cefotaxime, imipenem, chloramphenicol, tetracycline, cotrimoxazole, nalidixic acid, ciprofloxacin, azithromycin and rifaximin was determined. All genes encoding resistant determinants were detected by PCR or PCR and DNA sequencing. The epidemiology of selected EAEC and ETEC strains was studied using MLST. The resistance to quinolones of EAEC and ETEC strains causing TD has significantly increased over the last decades, and high percentages has been found especially in patients traveling to India and sub-Saharan Africa. The ST38 and ST131 carrying the bla_CTX-M-15 and bla_CTX-M-27 genes, respectively, are highly prevalent among ESBL-producing EAEC and ETEC. The cephamycinase ACT-20 is described in the present study for the first time in EAEC and ETEC strains causing TD in patients who had traveled to Central America. The percentages of resistance to azithromycin in EAEC and ETEC isolates from patients to South-East Asia/India and Africa are above 25%. Meanwhile, rifaximin is still active against EAEC and ETEC with the prevalence of resistant strains not being high. In conclusion, fluoroquinolones should no longer be considered the drugs of choice for the prevention or treatment in TD for travelers traveling to India and Africa. Azithromycin and rifaximin are still a good alternative to treat TD caused by EAEC or ETEC.

https://ift.tt/2AobPIw

LEISHMANICIDAL ACTIVITY OF ISOSELENOCYANATE DERIVATIVES. [Chemistry; Biosynthesis]

Conventional chemotherapy against leishmaniasis includes agents exhibiting considerable toxicity. In addition, reports of drug-resistance are not uncommon. Thus, safe and effective therapies are urgently needed. Isoselenocyanate compounds have recently been identified with potential antitumor activity. It is well known that some antitumor agents demonstrate effects against Leishmania. In this study, the in vitro leishmanicidal activities of several organo- selenium and sulfur compounds were tested against Leishmania major and Leishmania amazonensis parasites, using promastigotes and intracellular amastigote forms. The cytotoxicity of these agents was measured in murine peritoneal macrophages and their selectivity indexes were calculated. One of the tested compounds, an isoselenocyanate derivative NISC-6, showed selectivity indexes two- and ten-fold higher than those of the reference drug Amphotericin B when evaluated in L. amazonensis and L. major, respectively. The American strain (L. amazonensis) was less sensitive to NISC-6 than L. major, showing a similar trend as described previously for Amphotericin B. In addition, we also observed that NISC-6 significantly reduced the number of amastigotes per infected macrophage. On the other hand, we showed that NISC-6 decreases expression levels of Leishmania genes involved in the cell cycle, such as topoisomerase-2 (TOP-2), PCNA and MCM4, therefore contributing to its leishmanicidal activity. The effect of this compound on cell cycle progression was confirmed by flow cytometry. We observed a significant increase of cells in the G1 phase and a dramatic reduction of cells in the S phase compared to untreated cells. Altogether, our data suggest that the isoselenocyanate NISC-6 may be a promising candidate for new drug development against leishmaniasis.

https://ift.tt/2TSMMq6

SCY-078, A Novel Fungicidal Agent, Demonstrates Distribution to Tissues Associated with Fungal Infections During Mass Balance Studies with IV and PO 14C-SCY-078 in Albino and Pigmented Rats [Pharmacology]

SCY-078, a fungicidal ß-1,3-glucan synthesis inhibitor, administered as intravenous or oral [¹⁴C]-SCY-078 to rat, distributed primarily into tissues associated with invasive fungal disease (kidney, lung, liver, spleen, bone marrow, muscle, vaginal tissue, and skin) to levels exceeding plasma. Oral fraction absorbed was ~40%. Elimination was primarily via bile and feces (~90%) and urine (~1.5%). Mean t_1/2 was ~8 h. Quantitative whole-body autoradiography showed a rapid distribution 8 h post-dose, and elimination by 168 h.

https://ift.tt/2Atp7Um

A Case Report of Scrotal Rejuvenation: Laser Treatment of Angiokeratomas of the Scrotum

Abstract

Scrotal rejuvenation encompasses not only the functional quality but also the aesthetic appearance of the scrotum. It includes medical therapy and procedural interventions to improve scrotal conditions that require morphologic restoration and/or aesthetic alteration. Rejuvenation of the scrotum may be appropriate for aging-related and non-aging-related changes concerning the hair (alopecia and hypertrichosis), the morphology (laxity and wrinkles), and/or the vascularity (angiokeratoma) of the scrotum. Angiokeratomas—typically small, asymptomatic, purple papules—may occur on the scrotum. However, these benign vascular lesions may be of cosmetic concern to the affected individuals; in addition, the angiokeratomas can become an issue of medical importance if they begin to bleed. Multiple locally destructive modalities are available for the treatment of scrotal angiokeratomas; indeed, several lasers have effectively been used to treat angiokeratomas of the scrotum. A 70-year-old man with numerous scrotal angiokeratomas experienced scrotal bleeding in the absence of prior trauma to the area or sexual activity. He presented for treatment to prevent future episodes of spontaneous bleeding from his scrotal angiokeratomas, but he also had not liked the aesthetic appearance of the previously asymptomatic angiokeratomas on his scrotum. His angiokeratomas were successfully treated with three sequential 532-nm potassium titanyl phosphate (KTP) laser sessions, which led to not only functional but also cosmetic improvement of his scrotum. In conclusion, men can develop scrotal changes due to either intrinsic (aging) or extrinsic (trauma) causes, but nonsurgical interventions and surgical procedures are available for the management of these conditions in individuals who desire to rejuvenate their scrotum.

https://ift.tt/2P3GX5g

Postoperative radiotherapy for T1/2N0M0 mucoepidermoid carcinoma positive for CRTC1/3‐MAML2 fusions

Abstract

Background

The National Comprehensive Cancer Network (NCCN) guidelines recommend considering postoperative radiotherapy (PORT) for completely resected T1/2N0M0 salivary mucoepidermoid carcinomas when they show tumor spillage, perineural invasion, or intermediate/high‐grade histology. CRTC1/3‐MAML2 fusions have been associated with a favorable clinical outcome.

Methods

Forty‐seven T1/2N0M0 mucoepidermoid carcinoma cases positive for CRTC1/3‐MAML2 fusions were completely resected and were not treated with PORT.

Results

Pathologically, none of the cases showed tumor spillage or perineural invasion. Cases with intermediate/high‐grade histology numbered 9 (19%) to 26 (55%) with the currently used 3 different grading systems. During the follow‐up (median 60 months), locoregional tumor recurrence occurred in 4 cases, which were treated with surgery alone. At the last follow‐up (median 60 months; 7‐160), all patients were alive with no evidence of disease.

Conclusion

An excellent prognosis may be achieved without PORT in T1/2N0M0 mucoepidermoid carcinoma patients positive for CRTC1/3‐MAML2 fusions when the tumors are completely resected without tumor spillage.

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Operative technique: Lateral neck dissection

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Neonatal gut colonisation by Staphylococcus aureus strains with certain adhesins and superantigens is negatively associated with subsequent development of atopic eczema

Abstract

Background

Insufficient early immune stimulation may predispose to atopic disease. Staphylococcus aureus, a skin and gut colonizer, produces the B‐cell mitogen protein A and T‐cell activating superantigens. Early gut colonization by S. aureus strains that possess the superantigens encoded by enterotoxin gene (egc) cluster and the elastin‐binding protein, is negatively associated with development of atopic eczema.

Objectives

To investigate whether these findings could be replicated in a second birth‐cohort, FARMFLORA and, secondly, whether nasal colonization by S. aureus also relates to subsequent atopic eczema development.

Methods

Faecal samples and nasal swabs from infants in the FARMFLORA birth‐cohort (N=65) were cultured for S. aureus. Individual strains were distinguished by RAPD (random amplified polymorphic DNA) and assessed for adhesin and superantigen gene carriage by PCR. Atopic eczema at 18 months of age was related to nasal and gut S. aureus colonisation patterns during the first 2 months of life (well before onset of eczema).

Results

S. aureus colonisation per se was unrelated to subsequent eczema development. However, gut S. aureus strains from the infants who subsequently developed atopic eczema less frequently carried the ebp gene, encoding elastin‐binding protein, and superantigen genes encoded by the egc, as compared to strains from children who remained healthy. Nasal colonization by S. aureus was less clearly related to subsequent eczema development.

Conclusion

The results precisely replicate our previous observations and may suggest that mucosal colonisation by certain S. aureus strains provides immune stimulation that strengthens the epithelial barrier and counteracts the development of atopic eczema.

This article is protected by copyright. All rights reserved.

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Social media and psoriasis treatment: What are people saying on Twitter?

Abstract

Almost half of households use the internet for seeking health related information. Because there is no regulation over the accuracy of this information, disease myths and unconventional remedies may be perpetuated. There are few studies that have used social media as a tool to assess people's perception of psoriasis or its treatment. Our aim was to evaluate commonly discussed psoriasis treatments on the social media site Twitter.

This article is protected by copyright. All rights reserved.

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Gene expression profiling in aggressive digital papillary adenocarcinoma sheds light on the architecture of a rare sweat gland carcinoma

Abstract

Background

Sweat gland carcinomas are rare cutaneous adnexal malignancies. Aggressive digital papillary adenocarcinoma (ADPA) represents a very rare sub‐entity, thought to arise almost exclusively from sweat glands of the fingers and toes. The aetiology of sweat gland carcinomas and ADPA is largely unknown. ADPAs are most likely driven by somatic mutations. However, somatic mutation patterns are largely unexplored, creating barriers to the development of effective therapeutic approaches to the treatment of ADPA.

Objective

To investigate the transcriptome profile of ADPA using a sample of eight formalin‐fixed, paraffin embedded (FFPE) tissue samples of ADPA and healthy control tissue.

Methods

Transcriptome profiling was performed using the Affymetrix PrimeView Human Gene Expression Microarray and findings were validated via reverse‐transcription of RNA and real‐time qPCR.

Results

Transcriptome analyses showed increased tumour expression of 2,266 genes, with significant involvement of cell cycle, ribosomal and crucial cancer pathways. Our results furthermore point to tumour‐overexpression of FGFR2 (p = 0.001).

Conclusions

Our results indicate the involvement of crucial oncogenic driver pathways, highlighting cell cycle and ribosomal pathways in the aetiology of ADPA. Suggested tumour‐overexpression of FGFR2 raises the hope that targeting the FGF/FGFR axis might be a promising treatment for ADPA and probably for the overall group of sweat gland carcinomas.

This article is protected by copyright. All rights reserved.

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Histologie bei Adenoiden

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Nachruf auf Herrn Prof. Dr. med. Henning Bier (1957–2018)

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Vitamin D receptor ApaI, TaqI, BsmI, and FokI polymorphisms and psoriasis susceptibility: an updated meta‐analysis

Summary

Background

Vitamin D is considered a regulator of the immune system, and its polymorphisms have been associated with psoriasis in some but not all reports.

Aim

To explore whether vitamin D receptor (VDR) polymorphisms are associated with susceptibility to psoriasis.

Methods

Meta‐analyses were conducted to determine the associations between psoriasis and the VDR ApaI, TaqI, BsmI and FokI polymorphisms in all participants, and stratified by ethnic group.

Results

In total, 16 studies on VDR polymorphisms and psoriasis were included in this meta‐analysis, which involved 2086 patients and 2182 controls. The meta‐analysis indicated an association between psoriasis and the VDR TaqI TT genotype in Caucasian (OR = 1.29, 95% CI = 1.00–1.66, P < 0.05), but not in Asian (OR = 1.32, 95% CI = 0.89–1.96, P = 0.16) populations. However, no association was found between psoriasis and the VDR TaqI polymorphism using dominant, allele contrast or homozygous contrast models. No association was found between psoriasis and either the VDR ApaI, BsmI or FokI polymorphisms by meta‐analyses of the allele contrast, recessive, or dominant models or homozygous contrast models in the overall, Caucasian or Asian populations.

Conclusion

This meta‐analysis showed that polymorphisms in VDR ApaI, BsmI and FokI are not associated with psoriasis susceptibility in overall, Caucasian or Asian populations. However, the VDR TaqI polymorphism is associated with psoriasis susceptibility in Caucasian populations.

https://ift.tt/2RjUKXH

Advances in POEMS treatment and the need to define standardised outcome measures

Keddie, S; D'Sa, S; Lunn, MP; (2018) Advances in POEMS treatment and the need to define standardised outcome measures. British Journal of Haematology 10.1111/bjh.15529 . (In press).

https://ift.tt/2PSw4J3

Selecting patterns and features for between- and within-crop-row weed mapping using UAV-imagery

Perez-Ortiz, M; Manuel Pena, J; Antonio Gutierrez, P; Torres-Sanchez, J; Hervas-Martinez, C; Lopez-Granados, F; (2016) Selecting patterns and features for between- and within-crop-row weed mapping using UAV-imagery. Expert Systems with Applications , 47 pp. 85-94. 10.1016/j.eswa.2015.10.043 . Green open access

https://ift.tt/2Rdlysh

Effectiveness and acceptability of myo-inositol nutritional supplement in the prevention of gestational diabetes (EMmY): a protocol for a randomised, placebo-controlled, double-blind pilot trial

Amaefule, CE; Drymoussi, Z; Dodds, J; Sweeney, L; Pizzo, E; Daru, J; Robson, J; ... Thangaratinam, S; + view all Amaefule, CE; Drymoussi, Z; Dodds, J; Sweeney, L; Pizzo, E; Daru, J; Robson, J; Poston, L; Khalil, A; Myers, J; Harden, A; Hitman, GA; Khan, K; Zamora, J; Huda, MSB; Thangaratinam, S; - view fewer (2018) Effectiveness and acceptability of myo-inositol nutritional supplement in the prevention of gestational diabetes (EMmY): a protocol for a randomised, placebo-controlled, double-blind pilot trial. BMJ Open , 8 (9) , Article e022831. 10.1136/bmjopen-2018-022831 . Green open access

https://ift.tt/2PZ0h9d

On the use of evolutionary time series analysis for segmenting paleoclimate data

Pérez-Ortiz, M; Durán-Rosal, AM; Gutiérrez, PA; Sánchez-Monedero, J; Nikolaou, A; Fernández-Navarro, F; Hervás-Martínez, C; (2017) On the use of evolutionary time series analysis for segmenting paleoclimate data. Neurocomputing 10.1016/j.neucom.2016.11.101 . Green open access

https://ift.tt/2RfegEm

The acquisition of the weaker language: Evidence from the acquisition of Russian cases by a Turkish-Russian child

Unlu, EA; Wei, L; (2018) The acquisition of the weaker language: Evidence from the acquisition of Russian cases by a Turkish-Russian child. Linguistic Approaches to Bilingualism , 8 (5) pp. 637-663. 10.1075/lab.16029.ant . Green open access

https://ift.tt/2PWOV5M

Bourgeois Modernity Versus the Historical Aristocracy in Christoph Meiners’s Political Thought

Golf-French, MA; (2019) Bourgeois Modernity Versus the Historical Aristocracy in Christoph Meiners's Political Thought. The Historical Journal (In press).

https://ift.tt/2R9sHdc

New ways of thinking about research on class size: an international perspective. Introduction to the special section

Blatchford, P; Russell, A; (2018) New ways of thinking about research on class size: an international perspective. Introduction to the special section. International Journal of Educational Research 10.1016/j.ijer.2018.09.011 .

https://ift.tt/2Q0iS52

Trajectories of functional impairment and depressive symptoms in relation to subsequent dementia risk: Evidence from the English Longitudinal Study of Ageing

Cadar, D; Davies, H; Llewellyn, D; Batty, D; Steptoe, A; (2018) Trajectories of functional impairment and depressive symptoms in relation to subsequent dementia risk: Evidence from the English Longitudinal Study of Ageing. Presented at: Annual Scientific Meeting of the Gerontological Society of America, Boston, Massachusetts. Green open access

https://ift.tt/2Ra9OXr

Changes in cognition during retirement transition: the Whitehall II Cohort study

Xue, B; Cadar, D; Fleischmann, M; Stansfeld, SA; Carr, E; Kivimaki, M; McMunn, A; Xue, B; Cadar, D; Fleischmann, M; Stansfeld, SA; Carr, E; Kivimaki, M; McMunn, A; Head, J; - view fewer (2018) Changes in cognition during retirement transition: the Whitehall II Cohort study. Presented at: GSA 2018: Annual Scientific Meeting, Boston, Massachusetts. Green open access

https://ift.tt/2PWNBQc

Non-Invasive Detection of Mechanical Alternans Utilizing Photoplethysmography

Besleaga, T; Badiani, S; Lloyd, G; Toschi, N; Canichella, A; Demosthenous, A; Lambiase, PD; Besleaga, T; Badiani, S; Lloyd, G; Toschi, N; Canichella, A; Demosthenous, A; Lambiase, PD; Orini, M; - view fewer (2018) Non-Invasive Detection of Mechanical Alternans Utilizing Photoplethysmography. IEEE Journal of Biomedical and Health Informatics 10.1109/JBHI.2018.2882550 . (In press). Green open access

https://ift.tt/2R9sbvM

Is cognitive decline before death in the oldest old a universal phenomenon

Robitaille, A; Cadar, D; Koval, A; Stephan, BC; Jagger, C; Johansson, B; Hofer, S; ... Muniz-Terrera, GM; + view all Robitaille, A; Cadar, D; Koval, A; Stephan, BC; Jagger, C; Johansson, B; Hofer, S; Piccinin, A; Muniz-Terrera, GM; - view fewer (2018) Is cognitive decline before death in the oldest old a universal phenomenon. Presented at: GSA 2018: Annual Scientific Meeting, Boston, Massachusetts. Green open access

https://ift.tt/2Q0iQtW

Vision of 3D printing with concrete — Technical, economic and environmental potentials

De Schutter, G; Lesage, K; Mechtcherine, V; Nerella, VN; Habert, G; Agusti-Juan, I; (2018) Vision of 3D printing with concrete — Technical, economic and environmental potentials. Cement and Concrete Research , 112 pp. 25-36. 10.1016/j.cemconres.2018.06.001 .

https://ift.tt/2Ra4XWw

The Erber: Tracing Global Trade through a London Building

Milne, SA; (2019) The Erber: Tracing Global Trade through a London Building. Urban History (In press).

https://ift.tt/2PRLSf3

Productivity of digital fabrication in construction: Cost and time analysis of a robotically built wall

de Soto, BG; Agustí-Juan, I; Hunhevicz, J; Joss, S; Graser, K; Habert, G; Adey, BT; (2018) Productivity of digital fabrication in construction: Cost and time analysis of a robotically built wall. Automation in Construction , 92 pp. 297-311. 10.1016/j.autcon.2018.04.004 .

https://ift.tt/2RaLyEN

Characterizing functional brain networks and emotional centers based on Rasa theory of Indian aesthetics

Tripathi, R; Mukhopadhyay, D; Singh, CK; Miyapuram, KP; Jolad, S; (2018) Characterizing functional brain networks and emotional centers based on Rasa theory of Indian aesthetics. q-bio.NC Green open access

https://ift.tt/2PUW4nc

Identification and preliminary review of doctoral theses in engineering education that have used phenomenological methods

Chance, S; Direito, I; (2018) Identification and preliminary review of doctoral theses in engineering education that have used phenomenological methods. In: Clark, R and Munkebo Hussmann, P and Jarvinen, HM and Murphy, M and Etchells Vigild, M, (eds.) Proceedings of the 46th SEFI Annual Conference 2018. Creativity, innovation and entrepreneurship for engineering education excellence. Societe Europeenne pour la Formation des Ingenieurs (SEFI): Brussels, Belgium. Green open access

https://ift.tt/2Repj0R

Integration of environmental criteria in early stages of digital fabrication

Agustí-Juan, I; Hollberg, A; Habert, G; (2017) Integration of environmental criteria in early stages of digital fabrication. In: Fioravanti, A and Cursi, S and Elahmar, S and Gargaro, S and Loffreda, G and Novembri, G and Trento, A, (eds.) eCAADe 2017. ShoCK - Sharing of Computable Knowledge - Proceedings of the 35th International Conference on Education and Research in Computer Aided Architectural Design in Europe. (pp. pp. 185-192). eCAADe: Education and research in Computer Aided Architectural Design in Europe: Rome, Italy.

https://ift.tt/2PVdd00

European multicentre study validates enhanced liver fibrosis test as biomarker of fibrosis in systemic sclerosis

Abignano, G; Blagojevic, J; Bissell, L-A; Dumitru, RB; Eng, S; Allanore, Y; Avouac, J; ... Del Galdo, F; + view all Abignano, G; Blagojevic, J; Bissell, L-A; Dumitru, RB; Eng, S; Allanore, Y; Avouac, J; Bosello, S; Denton, CP; Distler, O; Ferraccioli, G; Jordan, S; Matucci-Cerinic, M; Ong, V; Messenger, M; Hutchinson, M; Buch, MH; Emery, P; Del Galdo, F; - view fewer (2018) European multicentre study validates enhanced liver fibrosis test as biomarker of fibrosis in systemic sclerosis. Rheumatology 10.1093/rheumatology/key271 . (In press).

https://ift.tt/2Rf7UFh

Cost effectiveness of a community based prevention and treatment of acute malnutrition programme in Mumbai slums, India

Goudet, S; Jayaraman, A; Chanani, S; Osrin, D; Devleesschauwer, B; Bogin, B; Madise, N; Goudet, S; Jayaraman, A; Chanani, S; Osrin, D; Devleesschauwer, B; Bogin, B; Madise, N; Griffiths, P; - view fewer (2018) Cost effectiveness of a community based prevention and treatment of acute malnutrition programme in Mumbai slums, India. PLoS One , 13 (11) , Article e0205688. 10.1371/journal.pone.0205688 . Green open access

https://ift.tt/2PWWJnO

Markers of neuroinflammation and neuronal injury in bipolar disorder: Relation to prospective clinical outcomes

Isgren, A; Sellgren, C; Ekman, C-J; Holmen-Larsson, J; Blennow, K; Zetterberg, H; Jakobsson, J; Isgren, A; Sellgren, C; Ekman, C-J; Holmen-Larsson, J; Blennow, K; Zetterberg, H; Jakobsson, J; Landen, M; - view fewer (2017) Markers of neuroinflammation and neuronal injury in bipolar disorder: Relation to prospective clinical outcomes. Brain Behavior and Immunity , 65 pp. 195-201. 10.1016/j.bbi.2017.05.002 . Green open access

https://ift.tt/2Rdlb0R

Assessing staining resistance of a CAD/CAM interpenetrating network composite material

Abstract

Background

Color change of dental materials over time because of staining agents has important effects on the long-term prognosis of dental esthetic treatments. In the present study, staining resistance of an interpenetrating network composite material with different translucency levels (translucent and high translucent) and various surface procedures for finishing were investigated.

Methods

Same shade CAD/CAM interpenetrating network composite specimens having two different translucency levels were prepared using by a water cooling cutting saw. Specimens were grouped and different finishing procedures were performed. Then, specimens were kept in distilled water, red wine and coffee for different periods. Color was evaluated before and after exposure to staining liquids using a clinical spectrophotometer.

Results

In the 7 days Glaze group (ΔE₀₀ > 2.2), color difference was only perceivable in the specimens kept in red wine. In the 28 days red wine high translucent groups, only the high translucent Clinical group showed a clinically acceptable (ΔE₀₀ < 2.2) color change. In the translucent groups kept in red wine, only the translucent Glaze group showed a clinically perceivable color change (ΔE₀₀ > 2.2). In the 28 day measurements, all the translucent groups showed a clinically perceivable color change (ΔE₀₀ > 2.2). Of the translucent groups kept in coffee for 28 days, it was observed that only the translucent Clinical group demonstrated a clinically non-perceivable color change (ΔE₀₀ < 2.2).

Conclusions

All the translucent groups kept in red wine showed a clinically perceivable color change after 28 days. Only the high translucent Clinical Kit group showed a clinically acceptable color change. Among high translucent and translucent specimens kept in coffee only the translucent Clinical group showed a clinically acceptable color change after 28 days.

https://ift.tt/2BzgEkh

Frontal fibrosing alopecia: a case series of 65 patients seen in a single Italian center

Abstract

Background

Frontal fibrosing alopecia (FFA) is increasing in prevalence worldwide and several series from different countries have been published, in order to detect possible causes of the disease outbreak.

Objective

To analyze the epidemiological, clinical and trichoscopic features of FFA seen in an Italian Dermatology Unit.

Methods

Clinical, trichoscopy, histopathology and medical details of all patients were compared with literature and general population data.

Results

From 2005 to 2017 we diagnosed FFA in 65 Caucasian females, with the number of diagnoses per year progressively rising. Premenopausal onset was detected in 21%. Frontal hair line recession was associated with parietal involvement in 80% of cases, occipital in 12.3% and eyebrows alopecia in 86.1%. In 6 cases eyebrow alopecia preceded hair loss. Non‐inflammatory facial papules were detected in 1/3 of the patients. Itching was reported by 2/3 of the patients and was indicative of disease progression. Trichoscopy showed empty follicles/yellow dots, absence of follicular ostia, mild follicular hyperkeratosis, perifollicular erythema and "lonely hair". Scalp lichen plano pilaris was seen in 15 patients, female pattern hair loss in 22. Therapy included short‐term treatment with systemic or intralesional corticosteroids followed by therapy with 5α‐reductase inhibitors of hydroxychloroquine and topical drugs. Arrest of FFA progression was seen in 75% of the patients, while 16 experienced worsening of the hairline despite therapy.

Conclusions

FFA not rarely starts before menopause, loss of the eyebrows can be the first sign of the disease, about 50% of the patients have other autoimmune conditions, FFA severity is not related to its duration, itching, follicular hyperkeratosis and erythema at trichoscopy are signs of disease progression, 25% of the patients show progression of hairline recession despite therapy.

This article is protected by copyright. All rights reserved.

https://ift.tt/2PYPewL

Managing adverse effects by dose reduction during routine treatment of locally advanced basal cell carcinoma with the hedgehog inhibitor vismodegib: a single center experience

Abstract

Locally advanced basal cell carcinoma (laBCC) represents an uncommon, difficult to treat form of skin cancer (1,2). The approval of hedgehog inhibitor (HHI) vismodegib in 2012 opened a novel therapeutic option (2–10). "Drug holidays" have been proposed to increase patients' compliance and adherence which is poor due to the high frequency of adverse effects (AE's) of HHI (3–5), however, up to date, the effect of dose reduction during HHI treatment has not been reported. Herein we report the data of a single center's experience in dose adjustment in 13 patients with laBCC treated with vismodegib.

This article is protected by copyright. All rights reserved.

https://ift.tt/2Rf4Use

Calcipotriol plus betamethasone dipropionate aerosol foam versus apremilast, methotrexate, acitretin, or fumaric acid esters for the treatment of plaque psoriasis: A matching‐adjusted indirect comparison

Abstract

Background

Plaque psoriasis has significant impact on patients' quality of life. Topical therapy is considered the treatment mainstay for mild‐to‐moderate disease according to guidelines. Calcipotriol/betamethasone dipropionate (Cal/BD) [0.005%/0.05%] aerosol foam is indicated for psoriasis vulgaris treatment in adults. Cal/BD foam trials demonstrated improved efficacy and similar safety in this population. Psoriasis treatment is complicated by the broad range of disease presentation, variability, and therapeutic options; particularly decisions on transition from topical to non‐biologic systemic treatment are difficult. Assessing comparative effectiveness of treatment options provides meaningful value to treatment decisions.

Objective

To compare efficacy of Cal/BD foam individual patient data from pooled trials with efficacy of non‐biologic systemic treatments based on aggregated patient characteristics and treatment outcomes.

Methods

Individual data from 4 Cal/BD foam trials in 749 psoriasis patients were pooled to conduct matching‐adjusted indirect comparisons. Literature review identified non‐biologic systemic treatment trials where methods, populations, and outcomes align with Cal/BD foam trials. Of 3,090 screened publications, 4 studies of apremilast, methotrexate, acitretin, or Fumaric Acid Esters (FAE) were included.

Results

After baseline matching, patients treated with 4 weeks of Cal/BD foam had greater Physician's Global Assessment 0/1 response compared to those treated with 16 weeks of apremilast (52.7% vs. 30.4%; P<0.001). Patients treated with Cal/BD foam had significantly greater Psoriasis Area and Severity Index (PASI) 75 response at Week 4 compared to 16 weeks of apremilast treatment (51.1% vs. 21.6%; P<0.001). Cal/BD foam patients demonstrated significantly greater PASI 75 response improvements at Week 4 versus 12 weeks of methotrexate (50.8% vs. 33.5%; P<0.001) or acitretin (50.9% vs. 31.7%; P=0.009), and comparable response to FAE (42.4% vs. 47.0%; P=0.451).

Conclusions

Despite recent treatment advances, unmet needs for psoriasis patients remain. Cal/BD foam offers improved efficacy in baseline matched psoriasis patients compared to apremilast, methotrexate, or acitretin, and comparable efficacy to FAE.

This article is protected by copyright. All rights reserved.

https://ift.tt/2PSzcoa

Impact of Resident Autonomy Clinics in a Dermatology Residency: Improving Residents’ Perception of Autonomy

Abstract

Over recent years, concerns have been raised by residents within the Harvard Combined Dermatology Residency Program regarding lack of autonomy, including not being viewed by patients as the primary provider and lack of independence when formulating plans under the "apprenticeship" model. Literature from both surgical and medical specialties suggests a gradual decline in resident autonomy over time with ramifications on resident satisfaction and preparedness for future practice. Here we describe the actualization of resident‐run autonomy clinics within our program and compare two years of survey data to assess resident perception of autonomy before and after implementation.

This article is protected by copyright. All rights reserved.

https://ift.tt/2RdwZ3m

Abnormal lipid storage related to adipocyte shrinkage in acquired partial lipodystrophy (Barraquer‐Simons syndrome)

Abstract

Background

Acquired partial lipodystrophy (APL) is characterized by the gradual symmetrical loss of subcutaneous fat starting from the face, spreading towards the upper part of the body and sparing the lower extremities.

Objective

We report a 33‐ year‐old woman with facial lipodystrophy, loss of buccal fat pads, and breast fat tissue. The subcutaneous fat was preserved in other anatomic regions, and we noted some excess of fat accumulation in the lower abdomen and thighs. She had a low serum level of C3 was positive for a polyclonal immunoglobulin C3NeF in the serum. She was diagnosed with APL.

Methods

We examined fat from lipoatrophic and healthy areas and compared it to subcutaneous fat samples from a healthy control.

Results

Using scanning electron microscopy, we saw shrunken adipocytes with numerous small lipid droplets detaching from the surface of the adipocytes as compared to the classic aspect of adipose tissue in the control subject where the cytoplasm is occupied by one big lipid droplet. A loss of contact between adipocytes was observed in the APL patient when compared to the normal network of adipocytes in the control subject. The healthy fat seemed not affected by lipoatrophy; we observed normal sized adipocytes, though their surface was not as regular as in the control samples.

Conclusion

The significance and mechanism of the electron microscopic findings are unknown, but they suggest adipocyte shrinkage related to a defect in the retaining triglycerides, which could contribute to the pathogenesis of this disorder.

This article is protected by copyright. All rights reserved.

https://ift.tt/2PSlYYF

Correlation between disease severity and quality of life in patients with epidermolysis bullosa

Abstract

There is an increased interest of medical staff to have a more objective evidence of the severity of clinical picture of the patient with epidermolysis bullosa (EB), but also about the patient's quality of life. The goal of these studies is to develop a personalized treatment, based on the patients' needs.

The aims of our study were to develop a validated and reliable quality of life questionnaire (QOLEB) in Romania, to assess the health‐related quality of life (HRQoL) in Romanian EB patients, and to perform an objective evaluation of the clinical features of patients with EB. This study was observational, analytical, prospective, transversal, cohort type.

This article is protected by copyright. All rights reserved.

https://ift.tt/2Rdb0JH

Spiky follicular Mycosis Fungoides : A trichoscopic feature

Abstract

We have read with great interest a case report published by Slawinka et al describing trichoscopic spectrum of folliculotropic mycosis fungoides (FMF) [1]. Different trichoscopic aspects were reported by authors as the presence of milky white globules, yellow dots, short hair with split or triangle‐shaped end, broken hair and pigtail appearance hair.

This article is protected by copyright. All rights reserved.

https://ift.tt/2PYXU6B

Preliminary experience of the Q‐switched 1064‐nm neodymium:yttrium aluminum garnet laser in the treatment of Café‐au‐lait macules

Abstract

Solitary CALMs are a common finding and they occur in 10‐20% of the normal polulation. Although benign, CALMs in exposed parts of the body(face, forearms, neck et al) are cosmetically distressing to patients. Various types of laser devices have been utilized to remove CALMs over the years with high rates of recurrence and adverse events. Based on the theory of selective photothermolysis, the Q‐switched lasers were most accepted modality to remove CALMs with higher efficacy and minimal adverse effects.

This article is protected by copyright. All rights reserved.

https://ift.tt/2RdwXIM

Gastrointestinal bleeding with severe mucosal involvement in a patient with generalized pustular psoriasis without IL36RN mutation

Abstract

Generalized pustular psoriasis (GPP) is a systemic inflammatory disease that presents with erythema and sterile pustules, pathologically characterized by Kogoj's spongiform pustules. GPP is sometimes accompanied by mucosal involvement, and the most common lesion is on the tongue. IL36RN mutation was found to contribute to the pathogenesis of GPP especially in patients who develop GPP without a past medical history of psoriasis vulgaris. The association of IL36RN mutation with mucosal involvement in GPP is controversial. We herein report a 60‐year‐old male GPP patient with no past history of plaque psoriasis presenting with not only severe skin lesions and arthritis but also severe mucosal involvements of pharyngeal and gastrointestinal lesions, which led to gastrointestinal bleeding. Our case did not have any mutation in the IL36RN gene. We should be aware that severe GPP can cause gastrointestinal bleeding. The relevancy of IL36RN mutation with mucosal involvement in GPP remains to be elucidated.

https://ift.tt/2TGhKSd

Can benign lymphoid tissue changes in 18 F-FDG PET/CT predict response to immunotherapy in metastatic melanoma?

Abstract

Background

An association between immune-related adverse events (irAEs) caused by immunotherapeutic agents and the clinical benefit of immunotherapy has been suggested. We retrospectively evaluated by means of ¹⁸F-FDG PET/CT lymphoid tissue changes in the mediastinal/hilar lymph nodes and the spleen in response to ipilimumab administration in metastatic melanoma.

Methods

A total of 41 patients with unresectable metastatic melanoma underwent ¹⁸F-FDG PET/CT before the start of ipilimumab (baseline PET/CT), after two cycles (interim PET/CT) and at the end of treatment (late PET/CT). Data analysis was focused on the mediastinal/hilar lymph nodes and the spleen. The patients' best clinical response (BCR) was used as reference.

Results

According to the BCR reference, 31 patients showed disease control (DC) and 10 patients showed progressive disease (PD). Mediastinal/hilar lymph node evaluation revealed that in total 4 patients in the interim or late PET/CT (10%) demonstrated a 'sarcoid-like lymphadenopathy' as response to treatment (LN-positive). All LN-positive patients responded to ipilimumab with DC. On the other hand, no significant differences between the DC and PD groups regarding both semi-quantitative and quantitative ¹⁸F-FDG PET spleen-related parameters at baseline and as response to treatment were detected.

Conclusion

Based on our findings, 10% patients in the interim or late PET/CT showed 'sarcoid-like lymphadenopathy' as response to treatment. All these patients showed disease control, implying a relation between the appearance of sarcoid-like lymphadenopathy and the clinical benefit of anti-CTLA-4 therapy. On the other hand, quantitative ¹⁸F-FDG PET analysis of the spleen showed a poor performance in predicting clinical benefit to ipilimumab.

https://ift.tt/2TRqGUW

The changing epidemiological profile of HIV-1 subtype B epidemic in Ukraine

Vasylyeva, TI; Liulchuk, M; du Plessis, L; Fearnhill, E; Zadorozhna, V; Babii, N; Scherbinska, A; ... Faria, NR; + view all Vasylyeva, TI; Liulchuk, M; du Plessis, L; Fearnhill, E; Zadorozhna, V; Babii, N; Scherbinska, A; Novitsky, V; Pybus, O; Faria, NR; - view fewer (2018) The changing epidemiological profile of HIV-1 subtype B epidemic in Ukraine. AIDS Research and Human Retroviruses 10.1089/AID.2018.0167 . (In press).

https://ift.tt/2TL52BB

O canto como comunicação interpessoal e intrapessoal* [Singing as Inter- and Intra-personal Communication]

Welch, GF; Preti, C; (2018) O canto como comunicação interpessoal e intrapessoal* [Singing as Inter- and Intra-personal Communication]. Orfeu (Revista do Programa de Pós-Graduação em Música - CEART - UDESC) , 3 (1) pp. 197-229. 10.5965/2525530403012018197 . Green open access

https://ift.tt/2AnJ92q

Cost-Effectiveness Analysis of Adalimumab for the Treatment of Uveitis Associated with Juvenile Idiopathic Arthritis

Hughes, DA; Culeddu, G; Plumpton, C; Wood, E; Dick, AD; Jones, AP; McKay, A; ... Ramanan, AV; + view all Hughes, DA; Culeddu, G; Plumpton, C; Wood, E; Dick, AD; Jones, AP; McKay, A; Williamson, PR; Compeyrot Lacassagne, S; Hardwick, B; Hickey, H; Woo, P; Beresford, MW; Ramanan, AV; - view fewer (2018) Cost-Effectiveness Analysis of Adalimumab for the Treatment of Uveitis Associated with Juvenile Idiopathic Arthritis. Ophthalmology 10.1016/j.ophtha.2018.09.043 . (In press).

https://ift.tt/2TIi4jg

Evolution of major non-HIV-related comorbidities in HIV-infected patients in the Italian Cohort of Individuals, Naïve for Antiretrovirals (ICONA) Foundation Study cohort in the period 2004-2014

d'Arminio Monforte, A; Diaz-Cuervo, H; De Luca, A; Maggiolo, F; Cingolani, A; Bonora, S; Castagna, A; ... ICONA Foundation Study Group, ; + view all d'Arminio Monforte, A; Diaz-Cuervo, H; De Luca, A; Maggiolo, F; Cingolani, A; Bonora, S; Castagna, A; Girardi, E; Antinori, A; Lo Caputo, S; Guaraldi, G; Cozzi-Lepri, A; ICONA Foundation Study Group, ; - view fewer (2018) Evolution of major non-HIV-related comorbidities in HIV-infected patients in the Italian Cohort of Individuals, Naïve for Antiretrovirals (ICONA) Foundation Study cohort in the period 2004-2014. HIV Medicine 10.1111/hiv.12683 . (In press).

https://ift.tt/2AlQ0JG

Environmental design guidelines for digital fabrication

Agustí-Juan, I; Hubert, G; (2017) Environmental design guidelines for digital fabrication. Journal of Cleaner Production , 142 (4) pp. 2780-2791. 10.1016/j.jclepro.2016.10.190 . Green open access

https://ift.tt/2TPk1L1

Experimental insight into the particle morphology changes associated with landslide movement

Zuo, L; Lourenco, SDN; Baudet, BA; (2018) Experimental insight into the particle morphology changes associated with landslide movement. Landslides (In press).

https://ift.tt/2AnXKe5

Environmental Implications and Opportunities of Digital Fabrication

Agusti-Juan, I; Habert, G; (2016) Environmental Implications and Opportunities of Digital Fabrication. In: Habert, G and Schlueter, A, (eds.) Expanding Boundaries: Systems Thinking in the Built Environment Sustainable Built Environment (SBE) Regional Conference Zurich 2016. (pp. pp. 304-308). vdf Hochschulverlag AG an der ETH Zürich: Zürich, Switzerland.

https://ift.tt/2TFYwMx

A role in response: the place of voluntarism in emergency organisation

Alexander, DE; (2018) A role in response: the place of voluntarism in emergency organisation. Alert , Summer pp. 23-26.

https://ift.tt/2AqvyHo

Introduction; Shakespeare and the Jews

Kahn, L; (2018) Introduction; Shakespeare and the Jews. European Judaism , 51 (2) pp. 1-5. 10.3167/ej.2018.510202 .

https://ift.tt/2TL4YBN

An Environmental Perspective on Digital Fabrication in Architecture and Construction

Agusti-Juan, I; Habert, G; (2016) An Environmental Perspective on Digital Fabrication in Architecture and Construction. In: Chien, SF and Choo, S and Schnabel, MA and Nakapan, W and Kim, MJ and Roudavski, S, (eds.) Living Systems and Micro-Utopias: Towards Continuous Designing. (pp. pp. 797-806). CAADRIA: Hong Kong, China. Green open access

https://ift.tt/2Atn56m

Early contractor involvement in government construction projects in Ghana

Opoku, A; Ibrahim-Adam, R; (2018) Early contractor involvement in government construction projects in Ghana. In: (Proceedings) ARCOM Thirty-Fourth Annual Conference 2018. (pp. pp. 199-208). Association of Researchers in Construction Management (ARCOM): Belfast, Northern Ireland. Green open access

https://ift.tt/2TIhUsa

Gendered adoption of bird photography

Song, EY; (2018) Gendered adoption of bird photography. In: (Proceedings) The 113th Annual Meeting of American Sociological Association. American Sociological Association: Philadelphia, USA. (In press). Green open access

https://ift.tt/2ArvpDB

The Entrepreneurial Organization: The Effects of Organizational Culture on Innovation Output

Ahmetoglu, G; Akhtar, R; Tsivrikos, D; Chamorro-Premuzic, T; (2018) The Entrepreneurial Organization: The Effects of Organizational Culture on Innovation Output. Consulting Psychology Journal: Practice and Research 10.1037/cpb0000121 . (In press).

https://ift.tt/2TJt3sI

Identifying multiple deep aquifers in the Bengal Basin: Implications for resource management

Ravenscroft, P; McArthur, JM; Rahman, MS; (2018) Identifying multiple deep aquifers in the Bengal Basin: Implications for resource management. Hydrological Processes , 32 (24) pp. 3615-3632. 10.1002/hyp.13267 . (In press).

https://ift.tt/2AmYxMy

Black-sky thinking

Alexander, DE; (2018) Black-sky thinking. Alert: Journal of the Institute of Civil Protection and Emergency Management , Summer (2018) pp. 2-5.

https://ift.tt/2TLUKRx

Adopting Team-Based Learning for In-Service Teachers: A Case Study

Walker, ZM; Guo Zheng, T; (2017) Adopting Team-Based Learning for In-Service Teachers: A Case Study. International Journal for the Scholarship of Teaching and Learning , 11 (1) 10.20429/ijsotl.2017.110106 . Green open access

https://ift.tt/2Arv3wL

Pokemon go, augmented reality, and universal design for learning

Walker, ZM; McMahon, D; Rosenblatt, K; (2017) Pokemon go, augmented reality, and universal design for learning. Sage Open , 7 (4) 10.1177/2158244017737815 . Green open access

https://ift.tt/2TL4StV

Treatment of oral manifestations of toxic epidermal necrolysis with low‐level laser therapy in a pediatric patient

Abstract

Drug‐induced reactions are complications associated with high mortality and significant morbidity. Stevens–Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are examples of these conditions, which are characterized by skin and mucous lesions. Here, we report a case of a 9‐year‐old girl who presented with blisters associated with an extensive vesicular rash and multiple ulcerations on the lips and oral cavity. A drug‐induced hypersensitivity reaction to antibiotics was suspected, and a diagnosis of TEN was made. The patient was managed with withdrawal of the suspected causative agent, and the oral lesions were treated with low‐level laser therapy (LLLT) and oral hygiene. This case highlights that TEN requires interdisciplinary intervention with dental assistance and follow‐up to improve symptoms, nutrition, systemic condition, and quality of life.

https://ift.tt/2Qm7Q9w

Dramatic effect of nivolumab against melanoma and immune‐related liver toxicity: A detailed histopathological and immunohistochemical analysis of nivolumab‐induced liver toxicity

https://ift.tt/2r2DDOo

Metabolic syndrome and psoriatic arthritis among patients with psoriasis vulgaris: Quality of life and prevalence

Abstract

Interest has increased in comorbidities associated with psoriasis and their effects on health‐related quality of life (HRQoL). This study aimed to evaluate the prevalence of metabolic syndrome (MetS) and psoriatic arthritis (PsA) and to investigate HRQoL and the prevalence of hypertension, type 2 diabetes mellitus (T2DM), obesity and dyslipidemia. In a cross‐sectional design, patients diagnosed with plaque psoriasis answered an interview and standardized questionnaires (Dermatology Life Quality Index questionnaire [DLQI], 36‐Item Short Form Health Survey [SF‐36] and EuroQol Five‐Dimension Questionnaire Three‐Level version [EQ‐5D‐3L]). Physical examination and several tests to assess desired outcomes were performed by a dermatologist and a rheumatologist during three visits. The prevalence of MetS and PsA was 50.0% and 41.8%, respectively. Dyslipidemia was the most prevalent (74.5%) secondary comorbidity, followed by hypertension (61.8%), obesity (52.5%) and T2DM (30.9%). The mean (standard deviation) DLQI score was 6.5 (6.9), and mean physical and mental SF‐36 measures were 45.2 (10.4) and 45.5 (12.3), respectively, and for EQ‐5D‐3L, mean utility index and EQ‐VAS scores were 0.68 (0.27) and 72.7 (19.7), respectively. PsA and MetS are important comorbidities; a reduced HRQoL is noted among plaque psoriasis patients with these comorbidities, emphasizing the relevance of diagnosis and treatment beyond the care of skin lesions.

https://ift.tt/2FH7Ooy

Asthma, obesity and targeted interventions: an update

Purpose of review Obese asthma is now widely recognized as a phenotype of difficult asthma that is common and less responsive to traditional asthma treatments, so identifying specific treatments is increasingly important. Recent findings Obesity can lead to asthma through a complex relationship of causes including mechanical, inflammatory, metabolic and genetic factors. Exercise programmes including pulmonary rehabilitation, weight loss via dietary restriction, exercise and bariatric surgery, or combinations of all of these can improve quality of life, symptoms, and exercise capacity, with reductions in medication use and exacerbations, and represent tailored treatment for this phenotype of severe difficult to treat asthmatic patients. Summary Exercise programmes and pulmonary rehabilitation, weight loss programmes targeting 5–10% weight loss and bariatric surgery are effective treatments for the obese asthma phenotype. Correspondence to Douglas C. Cowan, Room 17, 4th Floor Walton Building, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK. Tel: +1 412115451; e-mails: Douglas.cowan@ggc.scot.nhs.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2DJe0tu

Keimbahnmutationen beim malignen Mesotheliom

https://ift.tt/2AoU2RB

Aktuelle Aspekte der Diagnostik von Ovarialtumoren

Zusammenfassung

Hintergrund

Der Artikel gibt eine Übersicht über die Diagnostik des Ovarialkarzinoms, eine seltene, aber häufig letale Erkrankung. Die jüngste Entwicklung auf dem Gebiet hat gezeigt, dass es sich beim Ovarialkarzinom tumorbiologisch nicht um eine Erkrankung, sondern vielmehr um verschiedene Subtypen mit jeweils spezifischer Pathogenese, Morphologie, Molekularpathologie und Prognose handelt.

Methode

Der Artikel basiert auf selektiver Literaturrecherche in PubMed und gängigen pathologischen Standardwerken sowie eigener Erfahrung in Diagnostik und konsiliarpathologischer Tätigkeit am Institut für Pathologie – Charité – Universitätsmedizin Berlin.

Ergebnisse

Der häufigste histologische Subtyp ist das seröse High-grade-Ovarialkarzinom; daneben gibt es die selteneren serösen Low-grade- sowie die endometrioiden, klarzelligen und muzinösen Ovarialkarzinome. Das seröse High-grade-Adenokarzinom entsteht nach aktueller Lehrmeinung auf dem Boden eines serösen tubaren intraepithelialen Karzinoms (STIC) und ist durch eine hohe Rate an p53-Mutationen und Defekte in der homologen Rekombination gekennzeichnet.

Das seröse Low-grade-Adenokarzinom entsteht hingegen über ein Borderline-Karzinom-Kontinuum und ist molekular durch pathologische Genmutationen von KRAS oder BRAF charakterisiert. Endometrioide und klarzellige Adenokarzinome entstehen am ehesten in Zusammenhang mit einer Endometriose und weisen daher entsprechende molekulare Aberrationen der Gene wie PI3KCA, CTNNB1 und ARID1A auf. Weiterhin ist das endometrioide Adenokarzinom mit einer Mikrosatelliteninstabilität assoziiert. Der Ursprung muzinöser Ovarialtumoren ist weitestgehend unbekannt. Auch wenn ein Primarius im Gastrointestinaltrakt ausgeschlossen wird, ähneln sie morphologisch und molekular den kolorektalen Karzinomen.

Schlussfolgerung

Die molekularen Eigenheiten beeinflussen entscheidend die Prognose, den klinischen Verlauf, die Chemosensititvität und die Rezidivneigung. Translationale und klinische Studien dieses spannenden Gebiets sind notwendig, um tumorbiologische Besonderheiten herauszukristallisieren und multimodale innovative Therapiestrategien zu entwickeln.

https://ift.tt/2TKfjOA

Interdisziplinäre Handlungsempfehlung bei Dupilumab-assoziierten entzündlichen Augenerkrankungen

https://ift.tt/2ApiZvY

Digitales papilläres Adenokarzinom

Zusammenfassung

Das digitale papilläre Adenokarzinom ist ein seltenes, aber charakteristisches Schweißdrüsenkarzinom, das bis auf sehr wenige ungewöhnliche Ausnahmefälle nur in akraler Lokalisation auftritt. Dieser Typ eines Schweißdrüsenkarzinoms neigt zur Ausbildung von Lokalrezidiven und führt in wenigen Fällen zu einer späten, zeitlich oft verzögerten Metastasierung. Das klinisch typische und histologisch breite Spektrum dieses Adnexkarzinoms stellen wir anhand von 4 Fällen dar und geben einen zusammenfassenden kurzen Literaturüberblick.

https://ift.tt/2TIuMym