The aim of this study was to evaluate the diagnostic accuracies of cone beam computed tomography (CBCT) and panoramic techniques in predicting inferior alveolar nerve (IAN) exposure. The sample size was determined based on a pilot study. This prospective clinical series study included 59 third molar extraction sites with any of seven previously suggested panoramic signs of IAN exposure. The diagnosis of nerve exposure was done on panoramic and CBCT images. Molars were extracted and nerve exposure was evaluated clinically.
http://ift.tt/2f6IeIA
Δευτέρα 31 Οκτωβρίου 2016
Diagnostic value of cone beam computed tomography and panoramic radiography in predicting mandibular nerve exposure during third molar surgery
Expression and clinical significance of TrkB in sinonasal squamous cell carcinoma: a pilot study
Previous studies have confirmed that tropomyosin-related kinase B (TrkB) plays a critical role in the occurrence, development, and metastasis of many kinds of malignant tumour. More recently, TrkB was found to be overexpressed in head and neck squamous cell carcinoma (SCC) and to be involved in multistep tumour progression. In this study, the expression of TrkB was investigated in 27 cases of sinonasal SCC using an immunohistochemical method. The clinical significance and possible role of TrkB as a prognostic marker in these tumours was also explored.
http://ift.tt/2dWwsTE
Oral mucosal epithelial cells express the membrane anchored mucin MUC1
Source:Archives of Oral Biology, Volume 73
Author(s): Helena Ukkonen, Paula Pirhonen, Maria Herrala, Jopi J.W. Mikkonen, Surya P. Singh, Raija Sormunen, Arja M. Kullaa
ObjectiveThe presence of a stable salivary pellicle (SP) is essential to provide a wet surface for the oral mucosal epithelia. The oral mucosa is covered by the SP which is suggested to be a mixed film of both salivary and epithelial components. Our aim was to analyse the presence of membrane-anchored mucin MUC1 in the oral mucosal epithelia.DesingThe presence of MUC1 was studied by immunohistochemical and immunoelectron microscopical methods in 19 buccal mucosal specimens. The localization and intensity of the epithelial expression were analyzed.ResultsStrong staining of MUC1 was found in the epithelial cells of intermediate and superficial layers. Some basal cells were shown faint expression. In the intermediate and superficial layers, the MUC1 expression was seen mainly on the upper cell surface. Furthermore, the expression of MUC1 was noted in the cytoplasm near the nucleus and in the rough granules. By electron microscopy, extracellular domain of membrane-anchored molecules extruded about 15–30nm above the cell surface in the apical cells of the oral epithelium. Immunoelectron microscopic examination shows that MUC1 is mainly localized in the plasma membrane of epithelial cells and also in small vesicles (75–100nm) just below the plasma membrane.ConclusionThe membrane-anchored MUC1 is expressed in the superficial layer of the oral mucosal epithelium, especially on the upper surface of epithelial cells. MUCI may be the anchoring protein of the salivary pellicle stabilization.
http://ift.tt/2eVoEyr
Oral mucosal epithelial cells express the membrane anchored mucin MUC1
Source:Archives of Oral Biology, Volume 73
Author(s): Helena Ukkonen, Paula Pirhonen, Maria Herrala, Jopi J.W. Mikkonen, Surya P. Singh, Raija Sormunen, Arja M. Kullaa
ObjectiveThe presence of a stable salivary pellicle (SP) is essential to provide a wet surface for the oral mucosal epithelia. The oral mucosa is covered by the SP which is suggested to be a mixed film of both salivary and epithelial components. Our aim was to analyse the presence of membrane-anchored mucin MUC1 in the oral mucosal epithelia.DesingThe presence of MUC1 was studied by immunohistochemical and immunoelectron microscopical methods in 19 buccal mucosal specimens. The localization and intensity of the epithelial expression were analyzed.ResultsStrong staining of MUC1 was found in the epithelial cells of intermediate and superficial layers. Some basal cells were shown faint expression. In the intermediate and superficial layers, the MUC1 expression was seen mainly on the upper cell surface. Furthermore, the expression of MUC1 was noted in the cytoplasm near the nucleus and in the rough granules. By electron microscopy, extracellular domain of membrane-anchored molecules extruded about 15–30nm above the cell surface in the apical cells of the oral epithelium. Immunoelectron microscopic examination shows that MUC1 is mainly localized in the plasma membrane of epithelial cells and also in small vesicles (75–100nm) just below the plasma membrane.ConclusionThe membrane-anchored MUC1 is expressed in the superficial layer of the oral mucosal epithelium, especially on the upper surface of epithelial cells. MUCI may be the anchoring protein of the salivary pellicle stabilization.
http://ift.tt/2eVoEyr
Immunoglobulin Glycosylation Effects in Allergy and Immunity
Abstract
Purpose of Review
The aim of this review will be to familiarize the reader with the general area of antibody (Ab) glycosylation and to summarize the known functional roles of glycosylation and how glycan structure can contribute to various disease states with emphasis on allergic disease.
Recent Findings
Both immunoglobulin (Ig) isotype and conserved Fc glycosylation sites often dictate the downstream activity of an Ab where complexity and degree of glycosylation contribute to its ability to bind Fc receptors (FcRs) and activate complement. Most information on the effects of glycosylation center on IgG in cancer therapy and autoimmunity. In cancer therapy, glycosylation modifications that enhance affinity for activating FcRs are utilized to facilitate immune-mediated tumor cell killing. In autoimmunity, disease severity has been linked to alterations in the presence, location, and composition of Fc glycans. Significantly less is understood about the role of glycosylation in the setting of allergy and asthma. However, recent data demonstrate that glycosylation of IgE at the asparagine-394 site of Cε3 is necessary for IgE interaction with the high affinity IgE receptor but, surprisingly, glycosylation has no effect on IgE interaction with its low-affinity lectin receptor, CD23.
Summary
Variations in the specific glycoform may modulate the interaction of an Ig with its receptors. Significantly more is known about the functional effects of glycosylation of IgG than for other Ig isotypes. Thus, the role of glycosylation is much better understood in the areas of autoimmunity and cancer therapy, where IgG is the dominant isotype, than in the field of allergy, where IgE predominates. Further work is needed to fully understand the role of glycan variation in IgE and other Ig isotypes with regard to the inhibition or mediation of allergic disease.
http://ift.tt/2eTePRL
Interleukin-5 Antagonists Usher in a New Generation of Asthma Therapy
Abstract
Asthma is the most common chronic respiratory disease in the USA. A subset of patients with asthma have refractory symptoms, persistent eosinophilic inflammation, and recurrent exacerbations despite maximal medical therapy. The monoclonal antibodies targeting the IL-5 pathway are a new class of medications designed to target severe eosinophilic asthma. There are two medications clinically available: mepolizumab and reslizumab, both of which target IL-5. A third medication, benralizumab, is currently under development and targets the IL-5 receptor. Clinical data suggest these medications can reduce asthma exacerbations and improve lung function in patients with peripheral eosinophilia and poorly controlled asthma despite maximal medical therapy. The anti-IL-5 medications are among the first targeted molecular therapies for asthma and will usher in an exciting new era in the treatment of severe asthma.
http://ift.tt/2eZPMPR
The Reemergence of the Asthma-COPD Overlap Syndrome: Characterizing a Syndrome in the Precision Medicine Era
Abstract
Purpose of Review
The asthma-COPD overlap syndrome (ACOS) has reemerged in the medical literature. This review addresses our current understanding of ACOS as a clinical and biological entity and how new and existing therapies may be targeted to this group.
Recent Findings
Many studies suggest that ACOS is common and associated with more morbidity than asthma and COPD in general. However, there is no consensus on an ACOS definition, likely due to the heterogeneity of the disease. Variable definitions have led to variable results in ACOS studies. Given this clinical variability, biomarkers (e.g., eosinophils and type 2 inflammatory markers) are increasingly being used to identify an ACOS molecular phenotype which appears to be more responsive to inhaled corticosteroids.
Summary
Although ACOS has become a popular diagnosis, it is unclear whether identifying ACOS as a separate disease entity is clinically useful. Future studies should focus on identifying key clinical features and biomarkers that characterize vulnerable and treatment-responsive patients.
http://ift.tt/2eTc42V
Erratum to “The effect of human papillomavirus on DNA repair in head and neck squamous cell carcinoma” [Oral Oncol. 61 (2016) 27–30]
The publisher regrets that Vicky Yamamoto's forename appeared incorrectly in the original article. It appears correctly above.
http://ift.tt/2faUN4r
Erratum to “Neoadjuvant radiotherapy plus radical surgery for locally advanced stage III/IV oral cancer: Analysis of prognostic factors affecting overall survival” [Oral Oncol. 60 (2016) 1–7]
The publisher regrets that the author's forename and surnames were displayed in an incorrect order in the original article. They appear correctly above.
http://ift.tt/2egjAX8
Modern Management of Familial Hypercholesterolemia
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
http://ift.tt/2f2pqN3
Evaluation of the reliability of preoperative descriptive airway assessment tests in prediction of the Cormack-Lehane score: A prospective randomized clinical study
In this study we investigated and compared the predictive values of different airway assessments tests including thyromental height measurement test, which has been recently suggested, in difficult laryngoscopy (Cormack and Lehane [C-L] scores 3 and 4). In addition, we compared the effectiveness of methods and C-L scores, by IDS, in terms of predicting difficult intubation.
http://ift.tt/2eV88yE
Typology of Perceived Causes of Intimate Partner Violence Perpetration in Young Adults
Violence and Gender , Vol. 0, No. 0.
http://ift.tt/2esHcW0
A Novel Thyroid Hormone Receptor Beta Gene Mutation (G251V) in a Thai Patient with Resistance to Thyroid Hormone Coexisting with Pituitary Incidentaloma
http://ift.tt/2e6nj6j
Assessment of Nutritional Status of Iodine Through Urinary Iodine Screening Among Local Children and Adolescents After the Fukushima Daiichi Nuclear Power Plant Accident
http://ift.tt/2e6u7Rf
Systemische Therapie des metastasierten Prostatakarzinoms
Zusammenfassung
Zur Behandlung von Patienten mit metastasiertem kastrationssensitivem (mCSPC) und kastrationsresistentem Prostatakarzinom (mCRPC) stehen aktuell verschiedene therapeutische Optionen mit unterschiedlichen Wirkprinzipien zur Wahl. Beim mCSPC konnte in verschiedenen Studien gezeigt werden, dass neben der Standardtherapie mittels Androgendeprivation (ADT-Therapie) der frühzeitige Einsatz einer Chemotherapie mit Docetaxel eine signifikante Verlängerung des Gesamtüberlebens erzielen kann. Besonders Patienten mit hoher Tumorlast profitieren dabei. Basierend auf den Ergebnissen wird daher der Einsatz der Chemotherapie bereits beim mCSPC, insbesondere bei Patienten mit hoher Tumorlast empfohlen. Durch die Entwicklung neuerer Substanzen wie Abirateron und Enzalutamid, den α-Strahler Radium-223, einsetzbar bei Patienten mit ausschließlich ossärer Metastasierung und den klassischen Chemotherapeutika Docetaxel in der Erst- und Cabazitaxel in der Zweitlinie ist es gelungen, die Prognose des mCRPC deutlich zu verbessern und die Überlebenszeit signifikant zu verlängern. Die optimale Therapiesequenz bleibt dabei weiter unklar; es liegen bislang nur wenige, meist retrospektive Daten an kleinen Fallzahlen vor. Weitere prospektive Studien sind erforderlich, um neue Erkenntnisse über sinnvolle Sequenzen zu gewinnen. Eine Kreuzresistenz zwischen Enzalutamid und Abirateron, vermittelt z. B. durch die Androgen-Rezeptor Splicevariante 7, ist eine mögliche Ursache einer reduzierten Effektivität in nachfolgenden Therapielinien. Neben den bereits zugelassenen Medikamenten befinden sich weitere Substanzen in der klinischen und vorklinischen Entwicklung.
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Synchronous perforations of the oesophagus and stomach by air insufflation: an uncommon complication of endoscopic dilation
A 72-year-old woman had a history of carcinoma of the hypopharynx treated by total laryngectomy, circumferential pharyngectomy and free jejunal graft. Endoscopic dilation of the pharyngojejunal anastomotic stricture resulted in synchronous perforations of the oesophagus and stomach. We postulate that the perforations were caused by high intraoesophageal and intragastric pressure resulted from air insufflation during the procedure; in a situation simulating closed-loop obstruction, because of proximal obstruction by the endoscope at the stricture site and distal obstruction by pylorospasm. The sites of perforations were inherent points of weakness at the left side of the distal oesophagus and at the high lesser curve of stomach. Satisfactory outcome of our patient was attributed to prompt diagnosis and surgical repair. Endoscopists should be aware of this possibility during oesophagogastroduodenoscopy and dilation. Rapid and over insufflation of air should be avoided.
http://ift.tt/2e5GWeM
Prolonged unassisted survival in an infant with anencephaly
Anencephaly is one of the most lethal congenital defects. This case report is of an anencephalic infant who lived to 28 months of life and defies current literature. She is the longest surviving anencephalic infant who did not require life-sustaining interventions. This case presents the obstacles that arose from this infant's prolonged life and recommendations based on these findings.
http://ift.tt/2fx8NJW
Metastatic prostate adenocarcinoma presenting as a large right supraclavicular and anterior chest wall mass
Left-sided cervical lymphadenopathy as first presentation of metastatic prostate carcinoma is not a novel observation. Here, we discuss a case of metastatic prostate primary carcinoma with an initial presentation of a right supraclavicular mass with extension into the anterior chest wall, which on radiological investigation was suggestive of a sarcomatous tumour; however, was confirmed to be pervasive metastatic prostatic adenocarcinoma. This is the second case in literature, which reports a prostatic primary cancer presenting as a right-sided supraclavicular and anterior chest wall mass.
http://ift.tt/2e5FyIW
Disseminated Mycobacterium haemophilum infection in a renal transplant recipient
Opportunistic infections are a major concern in renal and transplant medicine. We present the case of a renal transplant recipient with a generalised Mycobacterium haemophilum infection after an increase in immunosuppressive therapy and treatment with a tumour necrosis factor-α (TNF-α) inhibitor. Infection involved skin and soft tissue, joints and bones, as well as the renal transplant with an interstitial nephritis. Rapid diagnosis using PCR and DNA sequencing allowed early appropriate treatment. Triple antibiotic therapy and reduction in immunosuppression resulted in a slow but sustained recovery. Immunosuppression causes severe opportunistic infections. TNF-α inhibitors are very effective and well tolerated but have an increased susceptibility to infections with mycobacteria. Mycobacterial infections represent a significant clinical risk to transplant recipients because of their aggressive clinical course and the need for complex toxic antibiotic treatments. In these patients, M. haemophilum is a cause of skin infections.
http://ift.tt/2fx8Mpm
Severe metallosis following oxidised zirconium wear in total hip arthroplasty
Description
We present a case of a man aged 81 years who underwent a primary cementless total hip arthroplasty. Eight years after the index surgery, failure of the arthroplasty was revealed by the presence of the radiographic 'cloud sign' (figure 1). The original components used were the R3 acetabular cup with a Synergy femoral stem, highly crossed linked polyethylene liner and an oxidised zirconium (Oxinium) femoral head (Smith & Nephew Synergy, Memphis, Tennessee, USA). The initial investigation included a CT scan, full blood tests and a tissue biopsy which revealed no malignancy. Subsequently, during revision surgery, there was extensive osteolysis with metallosis. There was black staining of the periprosthetic soft tissues and the hip pseudocapsule was filled with thick black fluid (figure 2). There was severe wear of the femoral head and the polyethylene liner. Following debridement and removal of the components, a revision...
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Putting T cells to work – outsourcing neoantigen detection in head and neck cancer?
The recent genomic characterization of head and neck squamous cell carcinomas by The Cancer Genome Atlas demonstrated the high frequency of mutations affecting these cancers (Cancer Genome Atlas Network, 2015). This high rate of genomic alterations allows head and neck cancers to be highly immunogenic, thus promoting responses to immune therapies (Allen et al, 2015; Ferris, 2015). For instance, inhibitors of immune checkpoints like the anti-PD-1 monoclonal antibodies nivolumab and pembrolizumab have demonstrated promising results in head and neck cancer (Ferris et al, 2016; Chow et al, 2016), both recently receiving FDA approval in the setting of recurrent or metastatic disease.
This article is protected by copyright. All rights reserved.
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Stage-specific Embryonic Antigen-4 (SSEA-4) as a novel marker of ductal cells of human eccrine sweat glands
Summary
Background
Different populations of unipotent or multipotent stem cells were identified in human epidermis and its appendages. It is well documented that these cells maintain tissue homeostasis and actively participate in epidermal regeneration after injury. However, there is no evidence of the presence of pluripotent stem cells in human epidermis.
Objective
In this study, we investigated whether cells positive for embryonic stem cell marker SSEA-4 are present in adult human epidermis and if so, whether they are pluripotent and may correspond to the population of primitive stem cells.
Methods
The expression of SSEA-4 antigen and pluripotency transcription factors were analysed using flow cytometry. By means of immunohistochemical staining, we studied the exact localization of these cells in human skin sections.
Results
We show that a population of SSEA-4+ cells is present in human epidermis. In contrast to a commonly accepted belief, the expression of SSEA-4 antigen is not connected with the pluripotent character of the isolated cells. We found that these SSEA-4+ cells are localized in the ducts of eccrine sweat glands.
Conclusion
Our results indicate that the SSEA-4 antigen is a novel marker identifying the ductal cells of human sweat glands. The surface character of the antigen provides for simple method of isolation of this cell population and suggests the application of SSEA-4 for future cell therapy research.
This article is protected by copyright. All rights reserved.
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DOMINO, doxycycline 40mg vs minocycline 100mg in the treatment of rosacea: a randomised, single blinded, non-inferiority trial, comparing efficacy and safety
Summary
Background
There is lack of evidence for minocycline in the treatment of rosacea.
Objectives
To compare the efficacy and safety of doxycycline 40mg versus minocycline 100mg in papulopustular rosacea.
Methods
In this randomised single centre, 1:1 allocation, assessor blinded, non-inferiority trial, patients with a mild to severe papulopustular rosacea, were randomly allocated to either oral doxycycline 40mg or minocycline 100mg for a 16-week period with 12 weeks of follow up.
Our primary outcomes were the change in lesion count and change in patient's Health Related Quality of Life (HRQoL): RosaQoL scores.
Our secondary outcomes were: Patient's Global Assessment (PaGA) success ("excellent" or "good" improvement), Investigator Global Assessment (IGA) success ("clear" or "near clear"), Clinicians Erythema Assessment (CEA) success (at least one point decrease), the relapse rate at follow up and safety profile of the treatment drugs.
Intention to treat (ITT) and per protocol analyses (PPA) were performed.
Results
Of the 80 patients randomised, (40 for minocycline and 40 for doxycycline) 71 patients were treated for 16 weeks. 68 patients completed the study.
At week 16, the median change in lesion count was comparable in both groups: doxycycline versus minocycline respectively 13 versus 14 lesions less. (Non-inferiority difference 3, 90% Confidence interval (CI) -2 to 8). The RosaQoL scores were decreased for both doxycycline and minocycline, respectively 0.62 and 0.86. (Non-inferiority difference 0.15, 90% CI -0.09 to 0.42).
Secondary outcomes were comparable except for IGA success, which was assessed significantly more often in the minocycline group than in the doxycycline group (respectively 60% and 17.5%; p<0.001).
At week 28, outcomes were comparable, except for RosaQoL scores and PaGA, which were significantly different in favour of minocycline (P=0.005 and P=0.043 respectively), and less relapses were recorded in the minocycline group than in the doxycycline group (respectively 6.7% and 48%; p<0.001). In this study no serious adverse reactions (SAEs) were reported.
Conclusions
Minocycline 100mg is non-inferior to doxycycline 40mg in efficacy over a 16- week treatment period. Furthermore, at follow up, RosaQoL scores and PaGA were statistically significantly more improved in the minocycline group than in the doxycycline group, and minocycline 100mg gives longer remission than doxycycline 40mg. In this study there was no significant difference in safety between these treatments, however, based on previous literature minocycline has a lower risk/benefit ratio than doxycycline. Minocycline 100mg may be a good alternative treatment for those patients who, for any reason, are unable or unwilling to take doxycycline 40mg.
This article is protected by copyright. All rights reserved.
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The expression of serine protease inhibitors in epidermal keratinocytes is increased by calcium, but not 1,25(OH)2 vitamin D3 or retinoic acid
Summary
Background
In the human skin, the serine proteases kallikrein-related peptidases (KLK) 5 and KLK7 degrade corneodesmosome proteins, which leads to desquamation. The serine protease activity of the skin is tightly regulated by the interplay between such proteases and serine protease inhibitors, which include lympho-epithelial Kazal-type related inhibitor (LEKTI) encoded by SPINK5, secretory leukocyte peptidase inhibitor (SLPI), and elafin. The expression of KLK5 and KLK7 is controlled and up-regulated by stimulants such as calcium, 1,25(OH)2 vitamin D3 (1,25(OH)2VD3), and retinoic acid (RA).
Objectives
To understand the effect of calcium, 1,25(OH)2VD3, and RA on the expression of serine protease inhibitors in epidermal keratinocytes.
Methods
We stimulated normal human epidermal keratinocytes (NHEKs) with high calcium, 1,25(OH)2VD3, or RA and then analysed the expression of serine protease inhibitors using quantitative real-time-PCR, ELISA, and immunocytofluorescence. We also analysed trypsin- and chymotrypsin-like serine protease activities in stimulated NHEKs.
Results
High calcium, but not 1,25(OH)2VD3 or RA, significantly induced the expression of LEKTI, SLPI, and elafin at both transcript and protein levels in NHEKs. These inductions were time- and dose-dependent. The activities of trypsin- and chymotrypsin-like serine proteases were significantly up- and down-regulated by high calcium, respectively, in NHEKs.
Conclusions
High calcium, but not 1,25(OH)2VD3 or RA, increases the expression of serine protease inhibitors in epidermal keratinocytes. Our findings contribute to the understanding of the mechanisms by which serine protease activities are regulated by serine proteases and related inhibitors in epidermal keratinocytes.
This article is protected by copyright. All rights reserved.
http://ift.tt/2f0YPA4
Re: The effects of Air Pollution on asthma Hospital admissions in Adelaide, South Australia, 2003-2013: time series and case-crossover analysis
Abstract
We read with great interest the recent study by Chen K and colleagues [1] which showed an increase risk of asthma hospital admissions in all age groups with total pollen. However, there are numerous issues that have been overlooked in the analysis of the pollen variable. If these issues were considered, the authors may have observed stronger species-specific effects thereby contributing to the evidence base on which pollen species is the major trigger of asthma exacerbations requiring hospitalization.
This article is protected by copyright. All rights reserved.
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Can routine office-based audiometry predict cochlear implant evaluation results?
Objectives/Hypothesis
Determining cochlear implant candidacy requires a specific sentence-level testing paradigm in best-aided conditions. Our objective was to determine if findings on routine audiometry could predict the results of a formal cochlear implant candidacy evaluation. We hypothesize that findings on routine audiometry will accurately predict cochlear implant evaluation results in the majority of candidates.
Study Design
Retrospective, observational, diagnostic study.
Methods
The charts of all adult patients who were evaluated for implant candidacy at a tertiary care center from June 2008 through June 2013 were included. Routine, unaided audiologic measures (pure-tone hearing thresholds and recorded monosyllabic word recognition testing) were then correlated with best-aided sentence-level discrimination testing (using either the Hearing in Noise Test or AzBio sentences test).
Results
The degree of hearing loss at 250 to 4,000 Hz and monosyllabic word recognition scores significantly correlated with sentence-level word discrimination test results. Extrapolating from this association, we found that 86% of patients with monosyllabic word recognition scores at or below 32% (or 44% for patients with private insurance) would meet candidacy requirements for cochlear implantation.
Conclusions
Routine audiometric findings can be used to identify patients who are likely to meet cochlear implant candidacy upon formal testing. For example, patients with pure-tone thresholds (250, 500, 1,000 Hz) of ≥75 dB and/or a monosyllabic word recognition test score of ≤40% have a high likelihood of meeting candidacy criteria. Utilization of these predictive patterns during routine audiometric evaluation may assist hearing health professionals in deciding when to refer patients for a formal cochlear implant evaluation.
Level of Evidence
4 Laryngoscope, 2016
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Multimodality Cardiac Imaging in a Patient with Kawasaki Disease and Giant Aneurysms
Kawasaki disease is a well-known cause of acquired cardiac disease in the pediatric and adult population, most prevalent in Japan but also seen commonly in the United States. In the era of intravenous immunoglobulin (IVIG) treatment, the morbidity associated with this disease has decreased, but it remains a serious illness. Here we present the case of an adolescent, initially diagnosed with Kawasaki disease as an infant, that progressed to giant aneurysm formation and calcification of the coronary arteries. We review his case and the literature, focusing on the integral role of multimodality imaging in managing Kawasaki disease.
http://ift.tt/2eTLOW9
Mercury Vapour Long-Lasting Exposure: Lymphocyte Muscarinic Receptors as Neurochemical Markers of Accidental Intoxication
Introduction. Chronic poisoning may result in home setting after mercury (Hg) vapours inhalation from damaged devices. We report a chronic, nonoccupational Hg poisoning due to 10-year indoor exposure to mercury spillage. Case Report. A 72-year-old man with polyneuropathy of suspected toxic origin. At hospitalization, toxicological clinical evaluations confirmed the altered neurological picture documented across the last decade. Periodic blood and urine Hg levels (BHg, UHg) monitoring were performed from admission (), until 1 year later (), paralleled by blood neurochemical markers assessment, that is, lymphocytes muscarinic receptors (l-MRs). At : BHg and UHg were 27 and 1.4 microg/L, respectively (normal values: BHg 1–4.5; UHg 0.1–4.5), associated with l-MRs increase, 185.82 femtomoL/million lymphocytes (normal range: 8.0–16.0). At (two days after DMSA-mobilization test), BHg weak reduction, paralleled by UHg 3.7-fold increase, was measured together with further l-MRs enhancement (205.43 femtomoL/million lymphocytes). At (eight months after two cycles of DMSA chelating therapy ending), gradual improving of clinical manifestations was accompanied by progressive decrease of BHg and UHg (4.0 and 2.8 microg/L, resp.) and peripheral l-MRs neurochemical marker (24.89 femtomoL/million lymphocytes). Conclusion. l-MRs modulatory effect supports their use as peripheral neurochemical marker in Hg poisoning diagnosis and chelation therapy monitoring.
http://ift.tt/2f0Iqvo
Phase I/II Study OF Metformin in Combination With Cisplatin and Radiation in Head and Neck Squamous Cell Carcinoma
Condition: Head and Neck Squamous Cell Carcinoma
Intervention: Drug: Metformin
Sponsor: Baylor College of Medicine
Not yet recruiting - verified October 2016
http://ift.tt/2f5caoE
Intervention: Drug: Metformin
Sponsor: Baylor College of Medicine
Not yet recruiting - verified October 2016
http://ift.tt/2f5caoE
A Study of Laparoscopic Right Hemicolectomy Using the Caudal-to-cranial Approach
Conditions: Ascending Colon Cancer; Ileocaecal Valve Carcinoma; Cancer Flexure Hepatic; Adenocarcinoma of Hepatic Flexure (Diagnosis)
Interventions: Procedure: the caudal-to-cranial approach; Procedure: the medial-to-lateral approach
Sponsor: Guangdong Provincial Hospital of Traditional Chinese Medicine
Recruiting - verified October 2016
http://ift.tt/2f0PnwD
Interventions: Procedure: the caudal-to-cranial approach; Procedure: the medial-to-lateral approach
Sponsor: Guangdong Provincial Hospital of Traditional Chinese Medicine
Recruiting - verified October 2016
http://ift.tt/2f0PnwD
The Efficacy of Vocal Function Exercises for Laryngeal Cancers
Condition: Vocal Folds
Interventions: Procedure: Vocal Function Exercises; Procedure: Vocal Hygiene
Sponsor: Vrushali Angadi
Recruiting - verified October 2016
http://ift.tt/2eTSdjV
Interventions: Procedure: Vocal Function Exercises; Procedure: Vocal Hygiene
Sponsor: Vrushali Angadi
Recruiting - verified October 2016
http://ift.tt/2eTSdjV
Test
Test thyroid system post
The post Test appeared first on American Thyroid Association.
http://ift.tt/1PAQjVG
New insights into Mesolithic human diet in the Mediterranean from stable isotope analysis: The sites of Campu Stefanu and Torre d'Aquila, Corsica
Abstract
Mesolithic human remains are rare in the archaeological record of the French Mediterranean. Only the island of Corsica has so far produced relatively well preserved burials, and recent archaeological excavations have brought to light new Mesolithic human remains. The site of Campu Stefanu, located in Sollacaro in the southeast of the island, contained a collective burial of 7-8 individuals in a previously unobserved funerary context. A re-evaluation of collections in regional museums yielded the remains from another Mesolithic individual from the site of Torre d'Aquila, excavated at Pietracorbara, in the northern part of the island, at the beginning of the 1990s. These two discoveries presented the rare opportunity to obtain new radiocarbon dates and paleodietary insights from this crucial time period using stable isotope analysis (δ13C, δ15N) on collagen. From Campu Stefanu one individual had sufficient collagen preserved for radiocarbon dating, revealing that it is the oldest Mesolithic human known on the island, dated to 10216-9920 cal. BP. At Torre d'Aquila, radiocarbon dates indicate that the individual belonged to a younger Mesolithic phase than Campu Stefanu, dated to 9903-9596 cal. BP. δ13C and δ15N isotope ratios are similar between the Campu Stefanu and Torre d'Aquila individuals and indicate a diet dominated by the consumption of terrestrial animal protein, and a lack of marine resources. These findings are in contrast with the previous results from two other Mesolithic individuals from Corsica from the sites of Araguina Sennola and Monte Leone, for which about 25-30% of the consumed proteins came from a marine diet. The dietary variability recorded in Corsica is consistent with results obtained from Mesolithic human remains of Sicily and the Iberian Peninsula. We can hypothesize, that despite the nomadic lifestyle, the distance to the sea played a major role in Mesolithic food choices in Corsica. This article is protected by copyright. All rights reserved.
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Morphometry of a Pre-Hispanic Dog From Northwestern Argentina (Ad 800-1200)
Abstract
A detailed morphometric description of a dog skull from the pre- Hispanic archaeological site La Isla de Tilcara (northwestern Argentina, ca. AD 800-1200) is presented. The resulting data were compared with those of dog skulls from other South American archaeological sites to establish dog morphotype. The examined skull belonged to a small, long-snouted dog, similar to the smallest morphotypes from the Central Andes.
http://ift.tt/2eqH7T0
BRAF V600D mutation in a paediatric high-grade glioma
The authors report a case of high-grade glioma with unusual pathology that has not previously been reported in glioma pathology. The 5-year-old patient presented to the emergency department with a 1-day history of a right temporal swelling on a background history of increasing nausea and vomiting for the preceding 5 months. A computed tomography brain was performed, which showed a large right-sided temporoparietal lesion. The patient underwent surgery to remove the mass and pathology confirmed anaplastic astrocytoma (WHO Grade 3). This report focuses on prognostic factors in high-grade glioma, particularly on pathological indicators, namely epidermal growth factor receptor, O6-methylguanine-DNA-methyltransferase expression and BRAF V600D mutation.
http://ift.tt/2ee67yY
Spontaneous resolution of symptomatic lumbar synovial cyst
Lumbar synovial cyst arises from the facet joint and can lead to back pain, radiculopathy, neurogenic claudication or even cauda equina syndrome. Although most surgeons would consider surgery to be the treatment of choice, the natural history of the disease process remains unknown and uncertainty still exists regarding optimal management of this controversial entity. We illustrate a case of large L5/S1 synovial cyst for which surgery was initially planned. However, it resolved spontaneously without any treatment. We also provide a brief literature review regarding conservative, surgical and minimally invasive management of symptomatic lumbar synovial cyst with special reference to patient outcome.
http://ift.tt/2eebaj3
Extensive upper extremity deep venous thrombosis following brief application of an operative arm tourniquet
Extensive upper extremity deep venous thrombosis and compartment syndrome secondary to operative tourniquet application are rare outcomes of established practice. We present the case of a 54-year-old female who underwent elective removal of a right olecranon plate under general anaesthetic with brief application of a tourniquet. In recovery, she developed a swollen and erythematous forearm, without significant pain and paraesthesia. An urgent dual-phase computed tomography angiogram identified no venous outflow proximal to the axillary vein. Concern for early compartment syndrome necessitated emergency fasciotomies of the right forearm and hand, precluding thrombolysis. Thrombosis was found in the superficial and deep veins throughout the forearm, but the muscles were healthy. The patient commenced anticoagulation therapy early and made good recovery. Further haematology review concluded that she had a 'provoked thrombosis' and no need for long-term anticoagulation.
http://ift.tt/2f8QKFB
Rosai-Dorfman Disease Involving Multiple Organs: An Unusual Case with Poor Prognosis
Rosai-Dorfman disease is a rare, benign histiocytic proliferative disorder that usually affects the lymph nodes. Although extranodal involvement has been reported in diverse sites, manifestation in the cardiovascular system is extremely rare. Specifically, cardiac involvement in Rosai-Dorfman disease is an extraordinarily infrequent event. We describe a case of a 36-year-old female who presented Rosai-Dorfman disease of multiple organs including the heart, with poor prognosis.
http://ift.tt/2dUxAY6
Immunoglobulin Glycosylation Effects in Allergy and Immunity
Abstract
Purpose of Review
The aim of this review will be to familiarize the reader with the general area of antibody (Ab) glycosylation and to summarize the known functional roles of glycosylation and how glycan structure can contribute to various disease states with emphasis on allergic disease.
Recent Findings
Both immunoglobulin (Ig) isotype and conserved Fc glycosylation sites often dictate the downstream activity of an Ab where complexity and degree of glycosylation contribute to its ability to bind Fc receptors (FcRs) and activate complement. Most information on the effects of glycosylation center on IgG in cancer therapy and autoimmunity. In cancer therapy, glycosylation modifications that enhance affinity for activating FcRs are utilized to facilitate immune-mediated tumor cell killing. In autoimmunity, disease severity has been linked to alterations in the presence, location, and composition of Fc glycans. Significantly less is understood about the role of glycosylation in the setting of allergy and asthma. However, recent data demonstrate that glycosylation of IgE at the asparagine-394 site of Cε3 is necessary for IgE interaction with the high affinity IgE receptor but, surprisingly, glycosylation has no effect on IgE interaction with its low-affinity lectin receptor, CD23.
Summary
Variations in the specific glycoform may modulate the interaction of an Ig with its receptors. Significantly more is known about the functional effects of glycosylation of IgG than for other Ig isotypes. Thus, the role of glycosylation is much better understood in the areas of autoimmunity and cancer therapy, where IgG is the dominant isotype, than in the field of allergy, where IgE predominates. Further work is needed to fully understand the role of glycan variation in IgE and other Ig isotypes with regard to the inhibition or mediation of allergic disease.
http://ift.tt/2eTePRL
Interleukin-5 Antagonists Usher in a New Generation of Asthma Therapy
Abstract
Asthma is the most common chronic respiratory disease in the USA. A subset of patients with asthma have refractory symptoms, persistent eosinophilic inflammation, and recurrent exacerbations despite maximal medical therapy. The monoclonal antibodies targeting the IL-5 pathway are a new class of medications designed to target severe eosinophilic asthma. There are two medications clinically available: mepolizumab and reslizumab, both of which target IL-5. A third medication, benralizumab, is currently under development and targets the IL-5 receptor. Clinical data suggest these medications can reduce asthma exacerbations and improve lung function in patients with peripheral eosinophilia and poorly controlled asthma despite maximal medical therapy. The anti-IL-5 medications are among the first targeted molecular therapies for asthma and will usher in an exciting new era in the treatment of severe asthma.
http://ift.tt/2eZPMPR
The Reemergence of the Asthma-COPD Overlap Syndrome: Characterizing a Syndrome in the Precision Medicine Era
Abstract
Purpose of Review
The asthma-COPD overlap syndrome (ACOS) has reemerged in the medical literature. This review addresses our current understanding of ACOS as a clinical and biological entity and how new and existing therapies may be targeted to this group.
Recent Findings
Many studies suggest that ACOS is common and associated with more morbidity than asthma and COPD in general. However, there is no consensus on an ACOS definition, likely due to the heterogeneity of the disease. Variable definitions have led to variable results in ACOS studies. Given this clinical variability, biomarkers (e.g., eosinophils and type 2 inflammatory markers) are increasingly being used to identify an ACOS molecular phenotype which appears to be more responsive to inhaled corticosteroids.
Summary
Although ACOS has become a popular diagnosis, it is unclear whether identifying ACOS as a separate disease entity is clinically useful. Future studies should focus on identifying key clinical features and biomarkers that characterize vulnerable and treatment-responsive patients.
http://ift.tt/2eTc42V
Biocompatibility of “On-command” dissolvable tympanostomy tube in the rat model
Objectives/Hypothesis
A prototype tympanostomy tube, composed of polybutyl/methyl methacrylate-co-dimethyl amino ethyl methacrylate (PBM), was tested to 1) evaluate the effect of PBM tubes on rat dermis as a corollary for biocompatibility and (2) to observe the efficacy of dissolution with isopropyl alcohol (iPrOH) and ethanol (EtOH).
Study Design
Original animal experiment and bench testing.
Methods
A two-part study was conducted to assess biocompatible substance with inducible dissolvability as a critical characteristic for a newly engineered tympanostomy tube. First, tympanostomy tubes were inserted subcutaneously in 10 rats, which served as an animal model for biosafety, and compared to traditional tubes with respect to histologic reaction. Tissue surrounding the PBM prototype tubes was submitted for histopathology and demonstrated no tissue reactivity or signs of major inflammation. In the second part, we evaluated the dissolvability of the tube with either isopropyl alcohol, ethanol, ofloxacin, ciprodex, water, and soapy water. PBM tubes were exposed to decreasing concentrations of iPrOH and EtOH with interval qualitative assessment of dissolution.
Results
Histologic examination did not reveal pathology with PBM tubes. Concentrations of at least 50% iPrOH and EtOH dissolve PBM tubes within 48 hours, whereas concentrations of at least 75% iPrOH and EtOH were required for dissolution when exposure was limited to four 20-minute intervals.
Conclusions
PBM is biocompatible in the rat model. Additionally, PBM demonstrates rapid dissolution upon alcohol-based stimuli, validating the proof-of-concept of dissolvable on-command or biocommandible ear tubes. Further testing of PBM is needed with a less ototoxic dissolver and in a better simulated middle ear environment before testing can be performed in humans.
Level of Evidence
NA Laryngoscope, 2016
http://ift.tt/2eLq4y2
Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta-analysis
Objectives/Hypothesis
To perform a systematic review with meta-analysis for sleep study outcomes in children who have undergone rapid maxillary expansion (RME) as treatment for obstructive sleep apnea (OSA).
Data Sources
PubMed/MEDLINE and eight additional databases.
Review Methods
Three authors independently and systematically reviewed the international literature through February 21, 2016.
Results
Seventeen studies reported outcomes for 314 children (7.6 ± 2.0 years old) with high-arched and/or narrow hard palates (transverse maxillary deficiency) and OSA. Data were analyzed based on follow-up duration: ≤3 years (314 patients) and >3 years (52 patients). For ≤3-year follow-up, the pre- and post-RME apnea–hypopnea index (AHI) decreased from a mean ± standard deviation (M ± SD) of 8.9 ± 7.0/hr to 2.7 ± 3.3/hr (70% reduction). The cure rate (AHI <1/hr) for 90 patients for whom it could be calculated was 25.6%. Random effects modeling for AHI standardized mean difference (SMD) is −1.54 (large effect). Lowest oxygen saturation (LSAT) improved from 87.0 ± 9.1% to 96.0 ± 2.7%. Random effects modeling for LSAT SMD is 1.74 (large effect). AHI improved more in children with previous adenotonsillectomy or small tonsils (73–95% reduction) than in children with large tonsils (61% reduction). For >3-year follow-up (range = 6.5–12 years), the AHI was reduced from an M ± SD of 7.1 ± 5.7/hr to 1.5 ± 1.8/hr (79% reduction).
Conclusions
Improvement in AHI and lowest oxygen saturation has consistently been seen in children undergoing RME, especially in the short term (<3-year follow-up). Randomized trials and more studies reporting long-term data (≥3-year follow-up) would help determine the effect of growth and spontaneous resolution of OSA. Laryngoscope, 2016
http://ift.tt/2f3zVxs
Management of acute complicated mastoiditis at an urban, tertiary care pediatric hospital
Objectives/Hypothesis
To describe the presentation and management of acute complicated mastoiditis in children.
Study Design
Retrospective case series.
Methods
An analysis of pediatric patients with acute complicated mastoiditis treated at an urban, tertiary care children's hospital from 2007 to 2014 was performed.
Results
Forty-eight patients presented with a total of 67 complications of acute mastoiditis. Mean age at presentation was 4.8 years (range = 0.1–15.3 years). The most common complications were subperiosteal abscess (n = 22, 45.8%), epidural abscess (n = 16, 33.3%), and sigmoid sinus thrombosis (n = 14, 29.2%). The most common pathogens isolated included Streptococcus pneumoniae (n = 14, 29.2%) and group A streptococcus (n = 10, 20.8%). Multidrug resistance was not associated with complication type. Surgical management included myringotomy ± tympanostomy tube placement in 46 (95.8%) patients (the only surgery in 10), drainage of subperiosteal abscess without mastoidectomy in 18 (37.5%) patients, and mastoidectomy in 21 (43.8%) total patients. Patients presenting with intracranial complications were the most likely to undergo a mastoidectomy. Anticoagulation was used in the management of nine of 14 (64.3%) patients presenting with sigmoid sinus thrombosis. Neurosurgical interventions (n = 7, 14.6% patients) were primarily performed to manage increased intracranial pressure.
Conclusions
Subperiosteal abscess was the most common complication of acute mastoiditis, and when occurring as the sole complication was successfully managed with antibiotics and surgical intervention that did not include mastoidectomy. Epidural abscess and sigmoid sinus thrombosis were more prevalent than reported in prior series and were managed more aggressively. These patients were more likely to need neurosurgical interventions.
Level of Evidence
4. Laryngoscope, 2016
http://ift.tt/2eLp1Oj
Does drug-induced sleep endoscopy predict surgical success in transoral robotic multilevel surgery in obstructive sleep apnea?
Objectives/Hypothesis
The aim of this study was to determine if drug-induced sleep endoscopy (DISE) was predictive of success for patients undergoing transoral robotic surgery (TORS) and multilevel procedures for sleep apnea.
Study Design
Retrospective case series of patients who underwent TORS surgery for sleep apnea
Methods
Before and after polysomnograms were analyzed to assess improvement, success, and cure. Improvement was defined as any decrease in apnea-hypopnea index (AHI), success as an AHI <20 with a decrease >50%, and cure as an AHI <5. DISE videos were scored using the NOHL (nose, oropharynx, hypopharynx, larynx) and VOTE (velum, oropharynx, tongue, epiglottis) classification systems.
Results
One hundred one patients were available for analysis. Eighty-seven percent of patients had an improvement in their AHI. Fifty-one percent met criteria for success, whereas 17% were cured. The degree of collapse at individual NOHL and VOTE subsites as well as total additive scores did not predict improvement, success, or cure. Patients with no oropharyngeal lateral collapse in the VOTE classification system were more likely to improve following surgery (P = .001); however, this effect did not hold for success or cure. Multivariate analysis of DISE variables was not predictive of success.
Conclusions
In obstructive sleep apnea patients, there is a 51% success rate and a 17% cure rate. DISE, as scored by the NOHL and VOTE system, did not readily identify patients who would benefit most from surgery. Patients with lateral oropharyngeal collapse may be poorer candidates. Prospective, larger studies are required to further evaluate the use of DISE in predicting success following TORS.
Level of Evidence
4 Laryngoscope, 2016
http://ift.tt/2f3DML1
Optimal anesthetic regimen for ambulatory laser microlaryngeal surgery
Objectives/Hypothesis
Laser microlaryngeal surgery (LMS) is a short operation requiring brief and intense paralysis. Adequate muscle relaxation and rapid recovery of neuromuscular function are essential for improving surgical conditions and reducing the incidence of complications during LMS. However, the ideal muscle relaxant with a rapid onset and short duration of action is not yet available. Rocuronium has rapid onset at higher doses, but with a prolonged duration of action. Sugammadex is a selective relaxant-binding agent that allows for rapid reversal of rocuronium-induced neuromuscular blockade. This study aimed to compare the surgical conditions and anesthesia time between two combinations of neuromuscular blocker and reversal agent, rocuronium-sugammadex (R-S) and succinylcholine-cisatracurium-pyridostigmine (S-C-P), and propose an optimal anesthetic regimen for improving the surgical conditions in LMS patients.
Study Design
Prospective, randomized, double-blinded clinical study.
Methods
Patients in the R-S group received 1 mg/kg rocuronium bromide, whereas those in the S-C-P group received 1 mg/kg succinylcholine. After endotracheal intubation, 0.08 mg/kg cisatracurium was injected in S-C-P patients. After the procedure, R-S patients received 2 mg/kg sugammedex, whereas S-C-P patients received 0.2 mg/kg pyridostigmine plus 10 μg/kg atropine.
Results
In the R-S group, surgical condition scores were significantly higher and anesthesia time was significantly shorter. The use of additive neuromuscular blocking agents was significantly higher in the S-C-P group.
Conclusions
Muscle relaxation with rocuronium and reversal with sugammadex resulted in better surgical conditions and a shorter anesthesia time in patients undergoing LMS when compared to the S-C-P regimen.
Level of Evidence
1b Laryngoscope, 2016
http://ift.tt/2eLoYC9
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