Idiopathic sudden sensorineural hearing loss is a frequent emergency, with unknown aetiology and usually treated with empiric therapy. Steroids represent the only validated treatment but prognosis is unpredictable and the possibility to select the patients who will not respond to steroids could avoid unnecessary treatments. Metabolomic profiling of the biofluids target the analysis of the final product of genic expression and enzymatic activity, defining the biochemical phenotype of a whole biologic system.
http://ift.tt/2ejRdnM
Πέμπτη 3 Νοεμβρίου 2016
Metabolomic analysis of urine with Nuclear Magnetic Resonance spectroscopy in patients with idiopathic sudden sensorineural hearing loss: A preliminary study
Contents
Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
http://ift.tt/2fJiEfQ
Forthcoming Issues
Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
http://ift.tt/2ejxDrL
Surgical Critical Care for the Trauma Patient with Cardiac Disease
Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
Author(s): Michael M. Woll, Linda L. Maerz
Teaser
The elderly population is rapidly increasing in number. Therefore, geriatric trauma is becoming more prevalent. All practitioners caring for geriatric trauma patients should be familiar with the structural and functional changes naturally occurring in the aging heart, as well as common preexisting cardiac diseases in the geriatric population. Identification of the shock state related to cardiac dysfunction and targeted assessment of perfusion and resuscitation are important when managing elderly patients. Finally, management of cardiac dysfunction in the trauma patient includes an appreciation of the inherent effects of trauma on cardiac function.http://ift.tt/2fJnA4v
Anesthesia for Patients with Peripheral Vascular Disease and Cardiac Dysfunction
Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
Author(s): Sara E. Neves
Teaser
Patients with vascular disease and cardiac dysfunction present particular challenges to the anesthesiologist. They are hemodynamically brittle, at high risk of morbidity and mortality during surgery, and often carry additional comorbidities that increase their complexity and risk. Those with peripheral vascular disease should be assumed to have coronary artery disease and tend to have other systemic vascular problems. Poor cardiac function further worsens perfusion in an already compromised peripheral vascular system. Care of these patients requires judicious monitoring, an anesthetic that optimizes hemodynamic function, and avoidance of particularly likely complications such as perioperative myocardial ischemia, stroke, and bleeding.http://ift.tt/2ejwCQD
Copyright
Publication date: December 2016
Source:Anesthesiology Clinics, Volume 34, Issue 4
http://ift.tt/2fJnI41
Efficacy and mechanism of mandibular advancement devices for persistent sleep apnea after surgery: a prospective study
To explore the feasibility, the efficacy, and the mechanism of mandibular advancement devices (MAD) in the treatment of persistent sleep apnea after surgery.
http://ift.tt/2f01JEw
Ein Jahr Epistaxisbehandlung in den Notfallambulanzen der Ostthüringer HNO-Kliniken
Laryngo-Rhino-Otol
DOI: 10.1055/s-0042-111013
Hintergrund: Ziel war die Analyse der Versorgungsrealität der Behandlung der Epistaxis in der Notfallbehandlung in einer HNO-Klinik. Material und Methoden: In den Ostthüringer HNO-Kliniken in Jena und Gera stellten sich im Jahr 2009 690 Patienten mit 862 Ereignissen einer Epistaxis vor (60% Männer, mittleres Alter: 60 Jahre). Die Charakteristika der Patienten wurden retrospektiv mit Blick auf die Komorbidität, Dauermedikation und Behandlungsmaßnahmen ausgewertet. Ergebnisse: Die Inzidenz für die Epistaxisbehandlung in den Notfallambulanzen der Ostthüringer Kliniken lag bei 121,28 pro 100 000 Einwohner Ostthüringens. Die häufigste Komorbidität war die Hypertonie (68% der Patienten). 27% der Patienten nahmen Thrombozytenaggregationshemmer und 19% Antikoagulantien ein. Als unabhängige Risikofaktoren für rezidivierende Epistaxis mit der Notwendigkeit einer erneuten Notfallbehandlung wurden die 3-fach Kombination antikoagulativer und Thrombozytenaggregations-hemmender Medikation (p=0,015), Morbus Osler (p=0,011) und Thrombozytopenie (p=0,009) identifiziert. Die angewendeten Therapiemaßnahmen in über 90% erfolgreich. Schlussfolgerung: Die derzeitige HNO-Notfallbehandlung der Epistaxis in Notfallambulanzen von Kliniken erscheint effizient. Die Eskalation der antikoagulativen Dauermedikationen erhöht die stationäre Behandlungsnotwendigkeit. Weiterführende Analysen der Versorgungsrealität und Risikofaktoren sind notwendig, um eine Patientenstratifizierung im klinischen Alltag und Leitlinie zum Epistaxismanagement zu entwickeln.
[...]
© Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2eF7QeD
Management of surgical difficulties during cochlear implant with inner ear anomalies
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Ahmad M. Aldhafeeri, Abdulrahman A. Alsanosi
ObjectiveTo review the difficulties that can occur during cochlear implant surgery in patients with inner ear abnormalities and the management thereof.MethodsA retrospective chart review of 316 patients who received cochlear implants was conducted. The data collected included the types of inner ear anomalies, intraoperative findings, and the clinical management strategies. A review of the literature was also performed.ResultsA total of 24 patients with inner ear malformations who underwent 28 total cochlear implant procedures were identified. The anomalies included isolated large vestibular aqueducts in 8 (33.3%) patients, isolated semicircular canal dysplasia in 8 (33.3%) patients, classical Mondini malformation in 7 (29.1%) patients, and cochlear hypoplasia in 1 (4.1%) patient. Four (14.2%) patients exhibited intraoperative cerebrospinal fluid (CSF) gushers. One patient experienced delayed facial nerve paralysis, and an electrode was partially inserted into one patient. In 2 (7.14%) cases, the surgeries were aborted because of difficulties.ConclusionCochlear implantation for inner ear anomalies can be performed safely. Special attention should be given to preoperative imaging to anticipate the potential intraoperative risks that can occur in inner ear anomaly cases. Every surgery should be planned with a safe approach and specific requirements, e.g., regarding electrode type, and the surgeries must be performed by experienced surgeons who are capable of modifying their technique according to the surgical findings.
http://ift.tt/2e6Sovq
Soft-wall reconstruction of the canal wall with retrograde bone work for pediatric cholesteatoma: Long-term results
Source:International Journal of Pediatric Otorhinolaryngology, Volume 91
Author(s): Miyako Hatano, Makoto Ito, Hisashi Sugimoto, Masao Noda, Hiroki Hasegawa, Tomokazu Yoshizaki
ObjectiveTo retrospectively evaluate the long-term results of surgery for retrograde bone work, using soft-wall reconstruction of the canal wall, for pediatric cholesteatoma.MethodsWe retrospectively evaluated a series of 25 consecutive ears of 24 patients who were ≤16 years of age. All children underwent cholesteatoma surgery between October 2002 and August 2008. The type of cholesteatoma, the length of follow-up, the incidence of residual and recurrent cholesteatoma, postoperative hearing results, and the form of the reconstructed external canal wall and tympanic membrane were assessed.ResultsThere were 21 males and 3 females. The procedure was performed on both ears of one patient who had bilateral congenital cholesteatoma (CC). At the initial surgery, 16 cases (64%) had CC and nine (36%) had acquired cholesteatoma (AC). The mean age at surgery was 8.2 years and 10.4 years for CC and AC cases, respectively. The mean postoperative follow-up period after the initial surgery was 90 months for CC cases and 108 months for AC cases. Cholesteatoma recurrence occurred for 6% and 56% of cases with CC and AC, respectively. Successful serviceable hearing was achieved for 93.8% with CC and 100% with AC. Cases with inadequate hearing after surgery were characterized by disease extension to the mastoid and the protympanum. The long-term forms of the reconstructed external canal wall changed depending on their middle ear aeration. Some cases of tympanic membrane perforation and otitis media with effusion were occurred during the follow-up period.ConclusionOverall, the retrograde approach with soft-wall reconstruction of the canal wall achieved a low recurrence rate for cholesteatoma and good hearing outcomes during long-term follow-up for the pediatric case. However, in cases with eustachian tube dysfunction and/or cholesteatoma involving the protympanum, the hearing outcomes were less favorable.
http://ift.tt/2eF4Lv1
Diagnostic hearing testing of infants aged 0–36 months in 3 South African provinces – Comparison of audiology records to HPCSA guidelines
Source:International Journal of Pediatric Otorhinolaryngology, Volume 91
Author(s): Selvarani Moodley, Claudine Störbeck
IntroductionWithin the Early Hearing Detection and Intervention (EHDI) pathway, which includes the processes of screening, diagnosis and intervention for paediatric hearing loss, paediatric diagnostic audiology involves a battery of specific tests and procedures. International studies have highlighted a golden standard for diagnosis of paediatric hearing loss as based on the Joint Committee of Infant Hearing (2007) diagnostic guidelines, closely resembling the HPCSA diagnostic guidelines. There are limited South African studies on the processes and protocols followed in diagnostic paediatric audiology.ObjectivesThis study aims to provide a comparison for how the tests used for diagnosis of paediatric hearing loss in South Africa (within both the public and private healthcare sectors) compare to the HPCSA recommended diagnostic guidelines.MethodsA retrospective record review of paediatric clients with hearing loss (recruited through nonprobability convenience sampling) was conducted. This study is part of a longitudinal study of 711 deaf or hard of hearing children referred to the HI HOPES early intervention programme from September 2006 to December 2011. Diagnostic data from audiology reports of 117 children between 0 and 36 months were coded and analysed.ResultsLarge variation was found in the tests included in the diagnostic audiology reports. For 22 children (19%) a comprehensive test battery was used. Health Professions Council of South Africa (HPCSA) recommended guidelines for diagnostic testing were not followed in any of the records analysed. Components of the HPCSA recommended test battery most frequently omitted was bone conduction testing. For both electrophysiology and behavioural testing, there was limited frequency specificity information. This exclusion of information is evidence of deficiencies in data recording and management, as well as having an effect on accuracy of classification of degree and type of hearing loss.ConclusionThere are gaps in age-appropriate assessment protocols, which will have an effect on accurate differential diagnosis of paediatric hearing loss. Reasons for not including all testing components of the HPCSA recommended guidelines, as well as the possibility of developing guidelines more relevant to a developing world context, should be explored. There might be a need for. The impact of South African specific factors that have an effect on provision of accurate paediatric diagnostic audiology services should be determined.
http://ift.tt/2e6PpTO
Polymorphisms of Cytokine Genes and Polycystic Ovary Syndrome: A Review
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
http://ift.tt/2f6jy2t
The functional role of the pharyngeal plexus in vocal cord innervation in humans
Abstract
Classical understanding of the function of the pharyngeal plexus in humans is that it relies on both motor branches for innervation of the majority of pharyngeal muscles and sensory branches for the pharyngeal wall sensation. To date there has been no reported data on the role of the pharyngeal plexus in vocal cord innervation. The aim of this study is to evaluate whether or not the plexus pharyngeus contributes to the innervation of the vocal cords. One hundred twenty-five sides from 79 patients (59 female, 20 male) undergoing thyroid surgery with intraoperative neuromonitoring were prospectively evaluated. While vocal cord function was evaluated with endotracheal tube surface electrodes, cricothyroid and cricopharyngeal muscle electromyographic recordings were obtained with a pair of needle electrodes. The ipsilateral pharyngeal plexus, external branch of the superior laryngeal nerve, and recurrent laryngeal nerve were stimulated with a monopolar probe at 1 mA. With stimulation of the plexus pharyngeus on 125 operated sides, positive electromyographic waveforms were detected from five ipsilateral vocal cords (accounting for 3.2% of all vocal cords monitored and 6.3% of patients). The mean EMG amplitude of the vocal cords with stimulation of the plexus pharyngeus was 147 ± 35.5 μV (range 110–203). In one case, the long latency time of 19.8 ms correlated with innervation by the glottic closure reflex pathway. The short latencies seen in the other four cases [3.9 ± 1.1 ms (range 3.2–5.5)] correlated with direct innervation. In some cases, the plexus pharyngeus may contribute to vocal cord innervation by reflex or direct innervation patterns in humans.
http://ift.tt/2fAe2tf
Prophylactic exercises among head and neck cancer patients during and after swallowing sparing intensity modulated radiation: adherence and exercise performance levels of a 12-week guided home-based program
Abstract
The background and purpose of this paper is to investigate adherence, exercise performance levels and associated factors in head and neck cancer (HNC) patients participating in a guided home-based prophylactic exercise program during and after treatment [swallowing sparing intensity modulated radiation therapy (SW-IMRT)]. Fifty patients were included in the study. Adherence was defined as the percentage of patients who kept up exercising; exercise performance level was categorized as low: ≤1, moderate: 1–2, and high: ≥2 time(s) per day, on average. Associations between 6- and 12-week exercise performance levels and age, gender, tumour site and stage, treatment, intervention format (online or booklet), number of coaching sessions, and baseline HNC symptoms (EORTC-QLQ-H&N35) were investigated. Adherence rate at 6 weeks was 70% and decreased to 38% at 12 weeks. In addition, exercise performance levels decreased over time (during 6 weeks: 34% moderate and 26% high; during 12 weeks: 28% moderate and 18% high). The addition of chemotherapy to SW-IMRT [(C)SW-IMRT] significantly deteriorated exercise performance level. Adherence to a guided home-based prophylactic exercise program was high during (C)SW-IMRT, but dropped afterwards. Exercise performance level was negatively affected by chemotherapy in combination with SW-IMRT.
http://ift.tt/2fhkcdW
Terapia omalizumabem u pacjentki z ciężką eozynofilową astmą alergiczną i bólem stawów występującym podczas terapii – opis przypadku
Publication date: Available online 3 November 2016
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Marek Przybyszowski, Agnieszka Gawlewicz-Mroczka, Weronika Zastrzeżyńska, Krzysztof Sładek
Implementation of omalizumab in the treatment of patients with severe allergic asthma opened the possibility of obtaining optimal control of the disease and improving the quality of life. We present a case of a patient with severe allergic asthma qualified to biological treatment with omalizumab. Before qualification, the patient suffered from numerous severe exacerbations and uncontrolled asthma symptoms, despite treatment with high doses of inhaled medications and systemic corticosteroids. After 2 years of biological therapy, we achieved a significant, but incomplete improvement in asthma control, a marked improvement in the quality of life, and a decrease in the number of exacerbations. We observed persistent elevation of eosinophilia in peripheral blood and bronchoalveolar lavage, despite treatment with anti-IgE and systemic corticosteroids, indicating eosinophil phenotype of severe asthma. Moreover, in the course of therapy, the patient reported joint symptoms of unknown origin, which after further testing were eventually attributed to post-steroid complications and osteoarthritis. In appropriately qualified patients, treatment with omalizumab gives hope for significant improvement in asthma control. The development of new biological agents will allow individualizing asthma treatment depending on asthma phenotype and endotype.
http://ift.tt/2fjQeqa
Astma prurigo
Publication date: Available online 3 November 2016
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Jacek Gocki, Krystyna Romańska-Gocka, Zbigniew Bartuzi
The term asthma prurigo defines the cases of coexistence of asthma and atopic dermatitis (AD). Patients with the combination of these two disease entities are still difficult to treat despite the significant advances in medicine. The described case of a patient showed that treatment with anti-IgE has the ability not only to fully control the symptoms of asthma, but also to gain control of troublesome symptoms for patients of atopic dermatitis, leading to a complete resolution changes on the skin.
http://ift.tt/2eZtbCq
Radykalna poprawa kontroli astmy oskrzelowej po włączeniu do leczenia omalizumabu – opis przypadku
Publication date: Available online 3 November 2016
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Aleksandra Chudzicka, Renata Rożyńska, Adam Wesołowski
Asthma is an important medical, social and economical problem. 5–10% of all patients with asthma constitute cases of severe asthma. One treatment method for severe asthma includes omalizumab. Its efficacy was acknowledged in many studies. We present a case of radical improvement of asthma control after omalizumab addition. It constitutes affirmation of drug efficacy.
http://ift.tt/2fk29nL
Skuteczne leczenia omalizumabem chorej na ciężką astmę alergiczną z utrzymującą się łagodną eozynofilią krwi obwodowej
Publication date: Available online 3 November 2016
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Joanna Hermanowicz-Salamon, Renata Rubinsztajn
A 46-year-old, non-smoking woman, treated for 18 years for allergic asthma associated with chronic sinusitis after bilateral ethmoidectomy in 02.2013, treated for hypertension and after cataract surgery in 2010 permanently treated with glucocorticosteroid treatment, was qualified for omalizumab treatment. She started therapy in March 2014. Despite oral glucocorticosteroids therapy (methylprednisolone 32– 4mg per day), blood eosinophil count remained high. In 16th and 52nd weeks of treatment, the effectiveness of omalizumab was assessed. Symptoms of asthma decreased which were expressed in ACQ and AQLQ along with an improvement in pulmonary function tests, associated with the reduction of daily oral glucocorticosteroids. Regardless of the improvement of asthma symptoms, mild blood eosinophilia was observed. In concomitance of severe asthma. inadequately controlled sinusitis and skin lesion EGPA were taken into account as reasons of all symptoms. EGPA was not confirmed in this patient, and mild eosinophilia was regarded as a phenotypic feature of asthma in this patient.
http://ift.tt/2eZzNRa
Pokrzywka przewlekła u chorej na ciężką astmę atopową – podwójna korzyść z leczenia omalizumabem
Publication date: Available online 3 November 2016
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Joanna Goździk-Spychalska, Małgorzata Rzymkowska, Halina Batura-Gabryel
Urticaria is one of the most common skin disorders. A characteristic feature of this disease is the sudden appearance and rapid regression (up to 24hours) of blisters, angioedema, or both of these simultaneously. Often, the above changes are accompanied by symptoms of itching and pain. Chronic urticaria, i.e. one that lasts for at least 6 weeks, is divided into spontaneous (CSU) and induced. CSU, because of its unpredictable nature, strongly reduces the quality of life, especially the patient's active professionally and socially. Below is a description of a 38-year-old female patient, with the profession of teacher diagnosed with atopic chronic severe asthma coexisting with CSU, which has been qualified for the program with omalizumab in 2013, i.e., one year before the registration of the drug in the latter diagnosis. Since the inclusion of the patient into the program in addition to the vast improvement in asthma control in spite of the withdrawal of systemic corticosteroids (sGCS) and the reduction of inhaled glucocorticosteroids (ICS), any episode of CSU is not repeated which is undoubtedly the added benefit of applied therapy.
http://ift.tt/2fjZj22
Korzyści z leczenia omalizumabem wykraczające poza spodziewane efekty u 38-letniej chorej na ciężką postać astmy alergicznej
Publication date: Available online 3 November 2016
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Andrzej Obojski, Paulina Wełna, Robert Pawłowicz
We report the case of a 38-year-old woman suffering from allergic asthma since the age of 4. In the last 10 years, the patient presented with severe uncontrolled asthma with frequent exacerbations, despite stage-5 treatment according to GINA guidelines, including constant high doses of methylprednisolone. Long-time treatment with high doses of systemic corticosteroids induced many side effects including arterial hypertension, diabetes, GERD, hypercholesterolemia and obesity (weight 121kg, height 176cm, BMI 39kg/m2). Despite the treatment, asthma control remained poor, and quality of life and lung function test results were low (ACQ: 4,71 p, miniAQLQ: 3,2 p, FEV1 2,04 L 60,3% pred., FEV1/FVC 60,85%). The patient was enrolled into the omalizumab treatment program in March 2014. After 24 months of omalizumab treatment, the dose of methylprednisolone was reduced by 30mg/day. At the same time, asthma control and quality of life improved significantly (ACQ 1,85, miniAQLQ 4,73). Body weight was reduced by 30kg (BMI 29kg/m2) as well. Asthma exacerbation rate was also significantly reduced, and there was no asthma exacerbation in the last 12 months of the treatment. Unexpectedly, we observed improvement and further normalization of spirometry with finally normal FEV1/FVC ratio and FEV1 (FEV1 2,87 L 86,4% pred.). The patient has resumed her all daily-life activities.
http://ift.tt/2eZyfqF
Pacjentka z ciężką astmą wyłączona z leczenia omalizumabem po 12 tygodniach
Publication date: Available online 3 November 2016
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Agnieszka Gawlewicz-Mroczka, Marek Przybyszowski, Weronika Zastrzeżyńska, Krzysztof Sładek
We present the case of 20-year-old woman with the short history of severe course of asthma since its beginning. The patient met the inclusion criteria to omalizumab therapy in the program reimbursed by Polish Health Fund, so we expected that this therapy will enable to improve asthma control in the patient and decrease the dose of oral steroids or completely withdraw them. However within twelve weeks of therapy, the day of omalizumab application had to be rescheduled many times because of infectious asthma exacerbations. Moreover, in between exacerbations, asthma remained uncontrolled in spite of the very high doses of inhaled steroids and bronchodilators. Only on the day of last omalizumab injection, the patient reported better condition, and we observed improvement in spirometry and questionnaires score. We hoped that patient started to respond to the therapy. In the twelfth week of therapy, the patient reported that she became pregnant and had to be excluded from the therapeutical program. From the patients' findings, high eosinophil count in peripheral blood as well as in broncho-alveolar lavage fluid were remarkable and chronic sinusitis preceded asthma diagnose.
http://ift.tt/2fjTt0Z
Metabolomic analysis of urine with Nuclear Magnetic Resonance spectroscopy in patients with idiopathic sudden sensorineural hearing loss: A preliminary study
Publication date: Available online 3 November 2016
Source:Auris Nasus Larynx
Author(s): Filippo Carta, Milena Lussu, Fabrizio Bandino, Noto Antonio, Marcello Peppi, Natalia Chuchueva, Atzori Luigi, Vassilios Fanos, Roberto Puxeddu
ObjectiveIdiopathic sudden sensorineural hearing loss is a frequent emergency, with unknown aetiology and usually treated with empiric therapy. Steroids represent the only validated treatment but prognosis is unpredictable and the possibility to select the patients who will not respond to steroids could avoid unnecessary treatments. Metabolomic profiling of the biofluids target the analysis of the final product of genic expression and enzymatic activity, defining the biochemical phenotype of a whole biologic system.MethodsWe studied the metabolomics of the urine of a cohort of patients with idiopathic sudden sensorineural hearing loss, correlating the metabolic profiles with the clinical outcomes. Metabolomic profiling of urine samples was performed by 1H Nuclear Magnetic Resonance spectroscopy in combination with multivariate statistical approaches.Results26 patients were included in the study: 5 healthy controls, 13 patients who did not recover after treatment at 6 months while the remaining 8 patients recovered from the hearing loss. The orthogonal partial least square-discriminant analysis score plot showed a significant separation between the two groups, responders and non-responders after steroid therapy, R2Y of 0.83, Q2 of 0.38 and p value <0.05. The resulting metabolic profiles were characterized by higher levels of urinary B-Alanine, 3-hydroxybutyrate and Trimethylamine N-oxide, and lower levels of Citrate and Creatinine in patients with worst outcome.ConclusionIdiopathic sudden sensorineural hearing loss is a specific disease with unclear systemic changes, but our data suggest that there are different types of this disorder or patients predisposed to effective action of steroids allowing the recover after treatment.
http://ift.tt/2esNDeh
Clinical benefit of component-resolved diagnosis in Japanese birch-allergic patients with a convincing history of apple or peach allergy
Publication date: Available online 3 November 2016
Source:Auris Nasus Larynx
Author(s): Hideaki Shirasaki, Tetsuo Yamamoto, Shu Abe, Etsuko Kanaizumi, Megumi Kikuchi, Tetsuo Himi
ObjectiveIn northern Japan, birch pollen is the major allergen in pollinosis, while oral allergy syndrome (OAS) is caused primarily by apple and peach, and is almost exclusively related to birch pollinosis. To clarify the clinical benefit of allergen-based component-resolved diagnosis (CRD) in Japanese birch-allergic patients with OAS, we present an analysis of IgE profiles in response to crude extracts and recombinant component-resolved allergen to birch pollen and Rosaceae fruits allergens.MethodsThe sera of 30 patients with birch pollen-related OAS to apple or peach were analyzed for specific IgE reactivity to pathogenesis-related class 10 (PR-10) family (birch: rBet v 1, apple: rMal d 1, and peach: rPru p 1), profilin (birch: rBet v 2 and peach: rPru p 4), and lipid transfer protein (LTP) (apple: rMal d 3 and peach: rPru p 3) allergens, as well as to conventional crude, unfractionated extracts (birch: T3, apple: f49, and peach: f95) using the ImmunoCAP System™. Allergen-specific IgE values <0.35kUA/L were considered negative.ResultsOf the 30 sera CAP-positive for natural birch pollen extract, 28 (93.3%) exhibited specific IgE against Bet v1, and two (6.7%) contained specific IgE against Bet v2. Of the 26 sera of OAS to apple patients, only 17 were positive for specific IgE against f49 extract (65.4%); however, 24 were positive for specific IgE against rMal d 1 (92.3%). Similarly, only 17 of the 23 sera of OAS to peach patients contained specific IgE against the f95 extract (73.9%); however, 22 were positive for specific IgE against rPru p 1 (95.7%).ConclusionOur data suggest that CRD constitutes a reliable tool for the diagnosis of birch pollen-related OAS.
http://ift.tt/2fmo9wX
Efficacy and mechanism of mandibular advancement devices for persistent sleep apnea after surgery: a prospective study
Abstract
Background
To explore the feasibility, the efficacy, and the mechanism of mandibular advancement devices (MAD) in the treatment of persistent sleep apnea after surgery.
Methods
Nineteen patients who failed uvulopalatopharyngoplasty (UPPP) or UPPP plus genioglossus advancement and hyoid myotomy (GAHM) were given a non-adjustable MAD for treatment. All patients had polysomnography (PSG) at least 6 months post-UPPP with and without the MAD. Seventeen patients had computed tomography (CT) examinations.
Results
After the application of MAD, the apnea hypopnea index (AHI) decreased significantly from 41.2 ± 13.1/h to 10.1 ± 5.6/h in the responder group. The response rate was 57.9 % (11/19). During sleep apnea/hypopnea acquired from sedated sleep, the cross-sectional area and anterior-posterior and lateral diameters of the velopharynx enlarged significantly from 4.2 ± 6.0 mm2 to 17.5 ± 15.3 mm2, 1.9 ± 2.3 mm to 6.5 ± 4.1 mm, and 1.1 ± 1.3 mm to 2.6 ± 2.1 mm, respectively (P < 0.01) in the responder group with MAD. The velopharyngeal collapsibility also decreased significantly from 83.3 ± 21.8 % to 46.5 ± 27.1 %. The glossopharyngeal collapsibility decreased from 39.8 ± 39.1 % to −22.9 ± 73.2 % (P < 0.05).
Conclusion
MAD can be an effective alternative treatment for patients with moderate and severe OSAHS after surgery. The principal mechanisms underlying the effect of MAD are expansion of the lateral diameter of the velopharynx, the enlargement of the velopharyngeal area, the reduction of velopharyngeal and glossopharyngeal collapsibility, and the stabilization of the upper airway.
http://ift.tt/2fh0eT7
Springtime Birth as a Melanoma Risk: Is It Real?
Being born in March, April, and May has been repeatedly reported to be a possible risk factor for melanoma later in life. A new study concludes otherwise. Who's more convincing?
Medscape Medical News
http://ift.tt/2eirNaa
Two Ipilimumab Trials Show Survival Benefit, and More Toxicity
Dr Weber discusses two studies that show a clear survival advantage with ipilimumab, but at a significant price in toxicity.
Medscape Oncology
http://ift.tt/2fgMaZU
Phase II Trial of Pembrolizumab With Trastuzumab and Chemotherapy in Advanced HER2 Positive Esophagogastric (EG) Cancer
Conditions: Esophageal Cancer; Gastric Cancer
Interventions: Drug: pembrolizumab; Drug: trastuzumab; Drug: capecitabine; Drug: cisplatin
Sponsor: Memorial Sloan Kettering Cancer Center
Not yet recruiting - verified November 2016
http://ift.tt/2f5NlZh
Interventions: Drug: pembrolizumab; Drug: trastuzumab; Drug: capecitabine; Drug: cisplatin
Sponsor: Memorial Sloan Kettering Cancer Center
Not yet recruiting - verified November 2016
http://ift.tt/2f5NlZh
Trial of Hu5F9-G4 in Combination With Cetuximab in Patients With Solid Tumors and Advanced Colorectal Cancer
Conditions: Colorectal Neoplasms; Solid Tumors
Interventions: Drug: Hu5F9-G4; Drug: Cetuximab
Sponsor: Forty Seven, Inc.
Not yet recruiting - verified November 2016
http://ift.tt/2fgN8oO
Interventions: Drug: Hu5F9-G4; Drug: Cetuximab
Sponsor: Forty Seven, Inc.
Not yet recruiting - verified November 2016
http://ift.tt/2fgN8oO
Seventy-six-year-old woman with an unusual anatomy of the left ureter
We present a case of a 76-year-old woman, who attended with features suggestive of renal colic; however on imaging, she was found to have a right pelvic kidney and a left-sided uretero-sciatic hernia (USH), identified on CT urography (CT urogram). She was managed conservatively as she had a normal renal function and reported no symptoms in follow-up appointments. USH are rare hernias, where the ureter herniates through the sciatic foramen. Patients might present with sepsis in which case they require emergency stenting either anterograde or retrograde or with pain in which a less urgent approach can be followed and plan for surgery. Our literature review only identified a small number of similar cases, and the most successful treatment method for those symptomatic patients who required a procedure was the surgical repair.
http://ift.tt/2f59IOx
Surgical Removal of an Extrauterine Device Migrating to Appendix
Intrauterine devices (IUDs) remain highly effective reversible family planning methods in developing countries. We aimed to report one of the complications of extrauterine and intrauterine devices. A 44-year-old woman was admitted to our hospital with mislocated intrauterine device and abnormal uterine bleeding. Extrauterine IUD device was proven by ultrasound and X-ray. She had normal blood test count with a negative pregnancy test. There are several cases of complications with intrauterine devices, but this is the first case report about an extrauterine IUD embedded by inflame enlarged appendix presenting with abnormal uterine bleeding. Although intrauterine devices are a common safe method for contraception, there is no risk-free insertion even with advanced ultrasounds. A regular self-examination should be taught to the patients and ultrasonography should be performed in the follow-up of the patients especially for inserted devices during lactation period. Extrauterine IUDs can be successfully removed by laparotomy.
http://ift.tt/2fHz7Bc
The BANK1 SLE-risk variants are associated with alterations in peripheral B cell signaling and development in humans
Publication date: Available online 2 November 2016
Source:Clinical Immunology
Author(s): Elizabeth M. Dam, Tania Habib, Janice Chen, Andrew Funk, Veronika Glukhova, Mel Davis-Pickett, Shan Wei, Richard James, Jane H Buckner, Karen Cerosaletti
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by the development of autoantibodies that drive disease pathogenesis. Genetic studies have associated nonsynonymous variants in the BANK1 B cell scaffolding gene with susceptibility to SLE and autoantibodies in lupus. To determine how the BANK1 SLE-risk variants contribute to the dysregulated B cell program in lupus, we performed genotype/phenotype studies in human B cells. Targeted phospho-proteomics were used to evaluate BCR/CD40 signaling in human B cell lines engineered to express the BANK1 risk or non-risk variant proteins. We found that phosphorylation of proximal BCR signaling molecules was reduced in B cells expressing the BANK1 risk protein compared to the non-risk protein. Similar to these findings, we observed decreased B cell signaling in primary B cells from genotyped healthy control subjects carrying the BANK1 risk haplotype, including blunted BCR- and CD40-dependent AKT activation. Consistent with decreased AKT activation, we found that BANK1 risk B cells expressed increased basal levels of FOXO1 protein and increased expression of FOXO1 target genes upon stimulation compared to non-risk B cells. Healthy subjects carrying the BANK1 risk haplotype were also characterized by an expansion of memory B cells. Taken together, our results suggest that the SLE susceptibility variants in the BANK1 gene may contribute to lupus by altering B cell signaling, increasing FOXO1 levels, and enhancing memory B cell development.
Graphical abstract
http://ift.tt/2f53AFH
Long-term low-dose macrolides for Chronic Rhinosinusitis in adults – a systematic review of the literature
Abstract
Background
Chronic Rhinosinusitis is a very common inflammatory disease that impairs quality of life and is associated with high healthcare spending. Chronic rhinosinusitis treatment commonly involves the use of intranasal corticosteroids, oral antibiotics and surgery. Macrolides have been identified as a potential treatment option for chronic rhinosinusitis due to their immunomodulatory effects; however the evidence supporting their use is still conflicting.
Objective
The purpose of this systematic review was to evaluate new evidence along with previously reported studies of the use of macrolides in the treatment of chronic rhinosinusitis.
Search strategy
Medline, EMBASE, Cochrane CENTRAL, LILACS, clinicaltrials. gov and the International Clinical Trials Registry Platform were all searched (until June 2015 Medline and EMBASE searches were updated January 2016). Randomized controlled trials comparing low dose macrolide antibiotics versus placebo, as an adjunct to other therapies or, low dose macrolide therapy alone versus other therapies were included in this review.
Evaluation method
Quality of the evidence was evaluated using the Cochrane Risk of Bias Tool. Continuous outcomes were expressed as mean differences or standardized mean differences with 95% confidence interval. Data were pooled using fixed effects models.
Results
Nine randomized controlled trials met the inclusion criteria. Studies were classified into three distinct comparisons: Low dose macrolide therapy vs. placebo, low dose macrolide +/- nasal steroids vs. nasal steroid and low dose macrolides vs other therapies. The overall quality of the evidence is low due to limitations in study design, imprecision, and indirectness.
Conclusions
Positive results were seen with the use of macrolide therapy in the post-operative period in patients with nasal polyps. A firm conclusion in respect to the effectiveness of the use of macrolides for the treatment of chronic rhinosinusitis cannot be reached based on the available evidence. Further study using a placebo controlled design evaluating the use of macrolides in clearly defined chronic rhinosinusitis populations is needed.
This article is protected by copyright. All rights reserved.
http://ift.tt/2f51wxN
Fibro-odontome améloblastique mandibulaire chez une patiente de 3 ans
Publication date: Available online 2 November 2016
Source:Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
Author(s): G. Royer, R. Lan, J. Garçonnet, F. Cheynet
IntroductionLe fibro-odontome améloblastique (FOA) est une tumeur bénigne rare représentant 1 à 3 % des tumeurs odontogènes. Le FOA touche le patient jeune, avant 20 ans. L'exérèse chirurgicale permet habituellement la guérison. Les récidives et les transformations malignes sont possibles.ObservationUne patiente de 3 ans, sans antécédent médico-chirurgical, a été adressée pour une tuméfaction jugale droite indolore déformante évoluant depuis plusieurs mois. Les examens radiographiques montraient une volumineuse lésion mixte. Les corticales vestibulaires et linguales étaient soufflées. L'exérèse chirurgicale a été réalisée sous anesthésie générale. Microscopiquement, la lésion était constituée d'un tissu dentaire comportant de la dentine et de l'émail matures et une composante épithéliale. Ces éléments ont permis de poser le diagnostic de fibro-odontome améloblastique. Les suites opératoires ont été simples.DiscussionLa prise en charge chez cette patiente de 3 ans a été tardive du fait d'un retard de consultation. La taille de la lésion, englobant toutes les structures dentaires du secteur 4, était importante compte tenu du très jeune âge de la patiente. Le traitement chirurgical conservateur en première intention a permis de conserver les dents et le nerf alvéolaire inférieur, la seule séquelle étant le sacrifice du germe de la dent no 4 directement en rapport avec la tumeur.IntroductionThe ameloblastic fibro-odontoma (FOA) is a rare benign tumor representing 1–3% of odontogenic tumors. The FOA affects young patients before the age of 20. Surgical treatment allows usually for recovery. Recurrence and malignant transformation are possible.ObservationA 3-year-old patient, with no medical and surgical history, was referred for a painless swelling of the right cheek progressing for several months. Radiographic examination showed a large mixed lesion. Buccal and lingual cortices were blown out. Surgical resection was performed under general anesthesia. Microscopically, the lesion consisted of dental tissue composed of mature dentin and enamel and of an epithelial component. These elements allowed for the diagnosis of ameloblastic fibro-odontoma. The postoperative course was uneventful.DiscussionThe management of this 3-year-old patient was delayed due to late consultation. The size of the lesion, that included all dental structures of sector 4, was big considering the very young age of the patient. The primary conservative surgical treatment allowed for preservation of teeth and of the inferior alveolar nerve, the only sequelae being the removal of the germ of the tooth no 44 directly involved in the tumor.
http://ift.tt/2eYmrVg
Glimpses of the near future: A new generation of mTOR inhibitors
Abstract
The PI3K/AKT/mTOR intracellular signaling pathway is frequently activated in a wide variety of malignant neoplasms, controlling many cancer-related biological processes, such as cell growth and survival, protein translation, cytoskeletal organization and metabolism (Polivka and Janku, 2014; Moschetta et al, 2014). In Head and Neck Squamous Cell Carcinoma (HNSCC), aberrant activation of the mTOR pathway is regarded as one of the prevailing cell signaling abnormalities in both HPV− and HPV+ cancers, representing a point of convergence of various genetic and epigenetic alterations (Iglesias-Bartolome et al, 2013). A recent meta-analysis has indicated that abnormal expression of mTOR pathway-related proteins is identified in 74,42% of HNSCC and is significantly associated with poor survival (Marques et al, 2016).
This article is protected by copyright. All rights reserved.
http://ift.tt/2eDrRlC
HMGA2 is associated with the aggressiveness of tongue squamous cell carcinoma cells
Abstract
Objective
To analyze the effects of HMGA2 on proliferation, invasion and metastasis in tongue squamous cell carcinoma (TSCC).
Methods
HMGA2-knockdown was performed in SCC15 cell lines and functional assay was applied to observe the effects on cell migration and invasion. Real time-PCR, western blotting and immunohistochemistry (IHC) were also used to measure the expression of HMGA2 and EMT markers.
Results
HMGA2 expression was decreased after lentivirus infection. Functional assay showed that silence of HMGA2 can inhibit the proliferation of SCC15 cells and arrest the cells in G1/S phase. Moreover, knockdown of HMGA2 enhanced apoptosis of SCC15 cells. Wound healing and transwell assay indicated that knockdown of HMGA2 significantly inhibited migration and invasion ability of SCC15 cells. Expression detection suggested that HMGA2 may be involved in the metastasis of SCC15 cells by activating Twist family expression and inducing epithelial-mesenchymal transition (EMT) process. IHC analysis showed that HMGA2 and Vimentin were up-regulated in TSCC tissues, while E-cadherin was down-regulated. Clinicopathological analysis indicated that expression of HMGA2, E-cadherin and Viemntin were associated with recurrence of patients with TSCC.
Conclusion
Our findings demonstrated that HMGA2 may promote malignant transformation of TSCC through EMT process and may be an independent prognosis biomarker for TSCC.
This article is protected by copyright. All rights reserved.
http://ift.tt/2e5qpMM
Characterizing mortality in pediatric tracheostomy patients
Objectives/Hypothesis
To assess the longitudinal risk of death following tracheostomy in the pediatric age group.
Study Design
Retrospective cohort study.
Methods
Hospital records of 513 children (≤18 years) at a tertiary care children's hospital who underwent tracheostomy between 1984 and 2015 were reviewed. The primary outcome measure was time from tracheostomy to death. Secondary patient demographic and clinical characteristics were assessed, with likelihood of death using χ2 tests and the Cox proportional hazards model.
Results
Median age at time of tracheostomy was 0.8 years (interquartile range, 0.3–5.2 years).The highest mortality rate (27.8%) was observed in patients in the 13- to 18-year-old age category; their mortality rate was significantly higher when compared to the lowest mortality risk group patients (age 1–4 years, P = .031). Timing of death was evenly distributed: <90 days (37.6%), 90 days to 1 year (27.1%), and >1 year after tracheostomy (35.3%). Patients who underwent tracheostomy for cardiopulmonary disease had an increased risk of mortality compared with airway obstruction (adjusted hazard ratio: 3.53, 95% confidence interval: 1.72-7.24, P < .001) and other indications. Adjusted hazard ratios for bronchopulmonary dysplasia (BPD) and congenital heart disease (CHD) were 2.63 and a 2.61, respectively (P < .001).
Conclusions
Pediatric patients with tracheostomy have a high mortality rate, with an increased risk of death associated with a cardiopulmonary indication for undergoing tracheostomy. The majority of deaths occur after the index hospitalization during which the tracheostomy was performed. BPD and CHD are independent predictors of mortality in pediatric tracheostomy patients.
Level of Evidence
4 Laryngoscope, 2016
http://ift.tt/2ffJ7yB
A new solution for neonatal bilateral vocal cord paralysis: Endoscopic arytenoid abduction lateropexy
Objectives/Hypothesis
Bilateral vocal cord paralysis in early childhood is a life-threatening condition, which often requires immediate intervention. One of the treatment options is a quick, reversible simple suture vocal cord lateralizing technique, whereby the arytenoid cartilage is directly lateralized to the normal abducted position. Considering pediatric laryngeal anatomy, a small endolaryngeal thread guide instrument was designed for precise suture insertion.
Study Design
New instrument validation.
Methods
Four newborns had inspiratory stridor immediately after birth; two had to be intubated. Laryngotracheoscopy revealed bilateral vocal cord paralysis. Unilateral, left-sided endoscopic arytenoid abduction lateropexy was performed with supraglottic jet ventilation on the 4th, 5th, 5th, and 27th day of life for the four patients, respectively.
Results
All babies remained intubated for 3 to 7 days with an uncuffed tracheal tube. After extubation, no dyspnea or swallowing disorder occurred. A subjective quality of life questionnaire, laryngotracheoscopy, clinical growth charts, and voice analysis showed satisfactory functional results.
Conclusions
Minimally invasive, quick, reversible endoscopic arytenoid abduction lateropexy might be a more favorable solution for neonatal bilateral vocal cord paralysis than earlier treatment strategies. In one step, the airway can be maintained without the risk of any permanent damage to voice production. Good swallowing function is also preserved. The specially modified endolaryngeal thread guide instrument gives a fast and effective option for creating the lateralized arytenoid position even in the technically challenging surgical context of a neonate larynx.
Level of Evidence
4. Laryngoscope, 2016
http://ift.tt/2fyr3DL
Subsite variation in survival of oropharyngeal squamous cell carcinomas 2004 to 2011
Objectives/Hypothesis
To evaluate subsite-specific differences in survival between squamous cell carcinomas of the base of tongue and tonsillar fossa in a modern cohort likely to have been treated with intensity-modulated radiation therapy, chemotherapy for stage III and IV, and have had a high incidence of human papillomavirus–associated tumors.
Study Design
Retrospective cohort analysis utilizing data from the Surveillance, Epidemiology, and End Results program of patients with base of tongue and tonsillar fossa squamous cell carcinoma from 2004 to 2011.
Methods
The cohort included 15,299 primary base of tongue and tonsillar fossa squamous cell carcinoma patients without distant metastases treated between 2004 and 2011. Subsite differences in overall survival and disease-specific survival were examined with Kaplan-Meier curves. Multivariate cox proportional hazard ratios were estimated for overall and disease-specific survival.
Results
The cohort included 7,220 (47.2%) base of tongue and 8,079 (52.8%) tonsillar fossa squamous cell carcinoma patients. Overall survival with all stages combined favored tonsillar fossa (P < .001) and remained superior when stratified by stage. In multivariate analyses adjusted for age, gender, race, and treatment, the hazard ratio for overall survival was superior for tonsillar fossa tumors compared to base of tongue tumors for all stages (stage 1, P = .041; stage 2, P = .006; stages 3 and 4, P < .001). Disease-specific survival also favored improved outcomes for tonsillar fossa.
Conclusions
In this large modern cohort, overall and disease-specific survival favored outcomes in tonsillar fossa compared with base of tongue. Further study is required to evaluate factors that influence survival differences between tonsillar fossa and base of tongue despite modern therapy.
Level of Evidence
4 Laryngoscope, 2016
http://ift.tt/2ffF9WK
An open-label study of sodium oxybate in Spasmodic dysphonia
Objectives/Hypothesis
Spasmodic dysphonia (SD) is a task-specific laryngeal dystonia that affects speech production. Co-occurring voice tremor (VT) often complicates the diagnosis and clinical management of SD. Treatment of SD and VT is largely limited to botulinum toxin injections into laryngeal musculature; other pharmacological options are not sufficiently developed.
Study Design
Open-label study.
Methods
We conducted an open-label study in 23 SD and 22 SD/VT patients to examine the effects of sodium oxybate (Xyrem), an oral agent with therapeutic effects similar to those of alcohol in these patients. Blinded randomized analysis of voice and speech samples assessed symptom improvement before and after drug administration.
Results
Sodium oxybate significantly improved voice symptoms (P = .001) primarily by reducing the number of SD-characteristic voice breaks and severity of VT. Sodium oxybate further showed a trend for improving VT symptoms (P = .03) in a subset of patients who received successful botulinum toxin injections for the management of their SD symptoms. The drug's effects were observed approximately 30 to 40 minutes after its intake and lasted about 3.5 to 4 hours.
Conclusions
Our study demonstrated that sodium oxybate reduced voice symptoms in 82.2% of alcohol-responsive SD patients both with and without co-occurring VT. Our findings suggest that the therapeutic mechanism of sodium oxybate in SD and SD/VT may be linked to that of alcohol, and as such, sodium oxybate might be beneficial for alcohol-responsive SD and SD/VT patients.
Level of Evidence
4 Laryngoscope, 2016
http://ift.tt/2fyvyOm
Transepidermal water loss in infancy associated with atopic eczema at 2 years: a population-based cohort study
Skin barrier function can be evaluated by measuring transepidermal water loss (TEWL).1,2 High TEWL is found in children with atopic eczema (AE)3 and in infants with a mutation in the gene encoding for profilaggrin,4 a precursor for filaggrin, an important protein for skin barrier function. In a recent study by Kelleher et al5, high TEWL at 2 days and 2 months preceded and predicted AE at 1 year, independent of parental atopy and filaggrin mutation status.
This article is protected by copyright. All rights reserved.
http://ift.tt/2fkDzSj
Increased airway hyperresponsiveness to adenosine in patients with aspirin intolerant asthma
Publication date: Available online 2 November 2016
Source:Allergology International
Author(s): Sumito Isogai, Yoshikazu Niwa, Hiroshi Yatsuya, Masamichi Hayashi, Naoki Yamamoto, Takuya Okamura, Tomoyuki Minezawa, Yasuhiro Goto, Tappei Yamaguchi, Tomoko Takeyama, Yosuke Sakakibara, Sayako Morikawa, Tomoya Horiguchi, Yusuke Gotoh, Yuki Mieno, Sakurako Uozu, Toru Nakanishi, Mitsushi Okazawa, Hiroki Sakakibara, Kazuyoshi Imaizumi
http://ift.tt/2fy1mDj
Just a Cut
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 51-year-old surgeon lacerated…
http://ift.tt/2fe67Aq
Εγγραφή σε:
Αναρτήσεις (Atom)