Serum Soluble CD Molecules Associated With Vitiligo

This cross-sectional study evaluates soluble CD molecules associated with disease activity and progression of vitiligo.

http://archderm.jamanetwork.com/article.aspx?articleid=2546027

Longitudinal Erythronychia of the Fingernail

A man in his 70s presented with a split in the right fifth fingernail with paroxysmal, intermittent pain that was exacerbated by cold weather for the past 10 years. What is your diagnosis?

http://archderm.jamanetwork.com/article.aspx?articleid=2538521

Detection of Occult Invasion in Melanoma In Situ

This study compares the use of immunohistochemistry and Breslow depth of in situ melanoma tissue blocks for the detection of occult invasion of melanoma.

http://archderm.jamanetwork.com/article.aspx?articleid=2541903

Treatment of Refractory Pityriasis Rubra Pilaris With Secukinumab

This case report describes successful treatment of refractory pityriasis rubra pilaris with secukinumab.

http://archderm.jamanetwork.com/article.aspx?articleid=2565592

Perianal Melanocytic Nevi

This study examines the prevalence and morphologic features of perianal melanocytic nevi according to race/ethnicity, sex, and age in a convenience sample of patients in an outpatient dermatology clinic.

http://archderm.jamanetwork.com/article.aspx?articleid=2527382

Preserving Physical Diagnosis

Physicians of old were masters of eliciting relevant diagnostic information through their physical examination skills. Rich descriptions of disease presentations formed the basis of study, and the most proficient practitioners would render accurate diagnoses by gleaning subtle signs by using all 5 senses. In the past century, burgeoning advances in imaging, genetic, and serologic technology have allowed us to enhance our diagnostic accuracy and even to uncover nascent and as-yet undeclared disease. The art form of physical diagnosis is at risk in our modern age: teaching physical examination skills may suffer as medical school curricula expand to include a myriad of technological advances, and the value of possessing such skills may be questioned as we become more reliant on adjunctive tests for diagnosis. The scope of curriculum in dermatology residency training has similarly increased and many subspecialty areas compete for residents' attention.

http://archderm.jamanetwork.com/article.aspx?articleid=2579114

Geographic Clusters of Basal Cell Carcinoma

This study uses basal cell carcinoma registry data to determine rates of basal cell carcinoma by census block group, and spatial scan statistics to identify statistically significant geographic clusters.

http://archderm.jamanetwork.com/article.aspx?articleid=2536064

Dermatology’s Balanced Diet

We were interested to read the Notable Note by Higgins et al, and we agree that dermatology is indeed "the sweetest specialty." However, practicing moderation with sweets would be wise. Fortunately, classical dermatologic descriptions span the spectrum of tastes and foods.

http://archderm.jamanetwork.com/article.aspx?articleid=2579117

Evidence of ochratoxin A conjugates in urine samples from infants and adults

Abstract

Ochratoxin A (OTA), a mycotoxin with nephrotoxic and carcinogenic properties, is an important contaminant of food and feed. Analysis of OTA in human biological fluids (blood, urine, or breast milk) has documented frequent exposure to this mycotoxin, yet at quite variable levels in different population groups across the world. Urine is the preferred matrix in biomonitoring since sample collection is non-invasive and better accepted by study participants. As only a small fraction of the ingested OTA is excreted in urine, determination of urinary OTA requires sensitive analytical techniques, and phase-II-metabolites should be also considered as biomarkers of exposure. Yet, data published so far on the presence of OTA-glucuronide/sulfate in human urine have been contradictory. In this study, urines (n = 38) from two groups of breastfed infants (German and Turkish) and from German adults were now analysed for the presence of OTA glucuronides or sulfates by an indirect method, i.e. by comparing the levels of OTA (aglycone) in urines without and after enzymatic hydrolysis with ß-glucuronidase/arylsulfatase. Additionally, ochratoxin A-8-β-glucuronide and open lactone ochratoxin A-8-β-glucuronide were synthesized to serve as reference materials for metabolite analysis. Attempts for definitive confirmation of glucuronides of OTA via direct identification in LC–MS/MS analysis were hampered by the lower ionizability of the conjugates compared to the parent compound. Considerable increases in OTA levels were found after enzymatic hydrolysis in several (not all) urine samples and provide clear evidence for the excretion of OTA-conjugates. The latter observation is of importance, since OTA phase-II-metabolites may escape detection when direct methods are applied for urinary biomarker analysis. In conclusion, enzymatic hydrolysis of urine samples is highly advisable in order to avoid an underestimation of the OTA-exposure.

http://link.springer.com/10.1007/s12550-016-0261-y

High-Grade Dysplasia in Anogenital Warts of HIV-Positive Men

This report describes a case series of men who have sex with men who are HIV-positive and have typical anogenital warts harboring different grades of dysplasia.

http://archderm.jamanetwork.com/article.aspx?articleid=2537025

Haematological, clinical–chemical and immunological consequences of feeding Fusarium toxin contaminated diets to early lactating dairy cows

Abstract

Dairy cows experience a negative energy balance at the onset of lactation which results in an enhanced vulnerability for infectious diseases. Any dietary imbalances, including Fusarium toxin contamination, might therefore exacerbate this situation. The aim of the present investigations was to study the effects of increasing dietary concentrations of deoxynivalenol (DON) and zearalenone (ZEN) on clinical-chemical, haematological and immunological traits up to week 14 of lactation. For this purpose, ten cows each were assigned to a control group (CON; 0.02 mg ZEN and 0.06 mg DON per kg diet at 88 % DM), toxin level 1 (TOX-1; 0.29 mg ZEN and 2.31 mg DON per kg diet at 88 % DM) and toxin level 2 (TOX-2; 0.58 mg ZEN and 4.61 mg DON per kg diet at 88 % DM). The measured values of most parameters were affected by parturition but only a few of them were further modified by dietary treatment. For example, the time-dependent decrease in haemoglobin concentration, haematocrit and erythrocyte counts occurred at a significantly higher level for group TOX-2 while a serum glucose increase was missing in this group. Proportions of CD4+ and CD8+ cells decreased significantly over time solely in group TOX-2 while the CD4+/CD8+ ratio remained uninfluenced. Ability of granulocytes to mount an oxidative burst tended to increase at the end of the study in groups TOX-1 and TOX-2 while the opposite was observed in group CON. The results of this time-limited study indicate that feeding of Fusarium-toxin contaminated diets in early lactation affects health related parameters without compromising milking performance. However, long-term consequences of the observed effects on health need to be addressed in further studies.

http://link.springer.com/10.1007/s12550-016-0258-6

A Large Verrucous Plaque on the Calf

A man in his 20s presented with a large, verrucous plaque on his right calf; the lesion initially appeared as a small, bluish plaque at a young age and had gradually increased in size with subsequent development of wart-like features. What is your diagnosis?

http://archderm.jamanetwork.com/article.aspx?articleid=2544683

Epidemiology of Inherited Epidermolysis Bullosa

This cross-sectional and longitudinal study determines the incidence and prevalence of epidermolysis bullosa stratified by subtype in the United States during a 16-year period.

http://archderm.jamanetwork.com/article.aspx?articleid=2537024

Progressive Proliferation of Dark Papules in an African American Woman

An African American woman in her 30s with no medical history presented with a 4-year history of diffuse progressive proliferation of dark papules with first onset several weeks after a sunburn. What is your diagnosis?

http://archderm.jamanetwork.com/article.aspx?articleid=2541900

Sequelae After Involution of Hemangiomas of Infancy

This cohort study describes cosmetic sequelae after natural involution of infantile hemangioma and associations between clinical characteristics and risk of permanent sequelae.

http://archderm.jamanetwork.com/article.aspx?articleid=2544685

Firmicutes in Lesions of Hidradenitis Suppurativa in Obese Patients

This study examines the prevalence of Firmicutes in bacterial cultures of purulent drainage from hidradenitis suppurativa lesions and explores its potential association with body mass index.

http://archderm.jamanetwork.com/article.aspx?articleid=2536062

The fatum of preterm lungs: Every week counts

Publication date: November–December 2016
Source:Allergologia et Immunopathologia, Volume 44, Issue 6
Author(s): L. Garcia-Marcos, M. Sánchez-Solís




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Duration of exclusive breastfeeding and wheezing in the first year of life: A longitudinal study

Publication date: Available online 8 November 2016
Source:Allergologia et Immunopathologia
Author(s): Elvira Verduci, Giuseppe Banderali, Diego Peroni, Carlotta Lassandro, Giovanni Radaelli
IntroductionWheezing is the most common symptom associated with asthma in young children. There is a lack of well-designed prospective studies on the relationship of exclusive breastfeeding with wheezing in infants. This prospective cohort study investigated whether a relationship exists of exclusive breastfeeding with wheezing at 12 months of age.Materials and methodsA series of 1632 mother–infant pairs were sequentially recruited. Mothers were trained at hospital on breastfeeding practices and how to recognise wheezing. At hospital discharge they received a calendar-diary to record the date at stopping breastfeeding and at onset of wheezing. Data were collected by telephone interviews through 12 months post-delivery. Breastfeeding was in accordance with the World Health Organisation and wheezing with the International Classification of Diseases (ICD-10-CM code R06.2).ResultsAt 12 months 1522 mother–infant pairs were participating. Breastfeeding started in 95.9% of them and was exclusive in 86.1%. The incidence of wheezing ever and recurrent wheezing at 12 months of age was 33.7% and 10.0%, respectively. Duration of exclusive breastfeeding was shorter in wheezing than non-wheezing infants (median 2.6 months vs. 4.1 months, P<0.001). After adjustment for confounders each month of exclusive breastfeeding reduced the risk of wheezing ever by 11% and of recurrent wheezing by 15%, at 12 months of age.ConclusionLonger duration of exclusive breastfeeding reduces the risk of wheezing throughout the first 12 months of life. These findings would be relevant to all healthcare operators and mothers, also to improve their awareness about the best feeding practices for the infant's health.



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Erratum to: “Quantitative defects in invariant NKT cells and TLR responses in patients with hyper-IgE syndrome” [Allergol Immunopathol [Madr] 43 (6) (2015) 553–561]

Publication date: November–December 2016
Source:Allergologia et Immunopathologia, Volume 44, Issue 6
Author(s): S. Gutierrez-Hincapié, C.E. Muskus-López, C.J. Montoya, J.L. Franco-Restrepo, C.M. Trujillo-Vargas




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A Large Verrucous Plaque on the Calf

A man in his 20s presented with a large, verrucous plaque on his right calf; the lesion initially appeared as a small, bluish plaque at a young age and had gradually increased in size with subsequent development of wart-like features. What is your diagnosis?

http://archderm.jamanetwork.com/article.aspx?articleid=2544683

Epidemiology of Inherited Epidermolysis Bullosa

This cross-sectional and longitudinal study determines the incidence and prevalence of epidermolysis bullosa stratified by subtype in the United States during a 16-year period.

http://archderm.jamanetwork.com/article.aspx?articleid=2537024

Progressive Proliferation of Dark Papules in an African American Woman

An African American woman in her 30s with no medical history presented with a 4-year history of diffuse progressive proliferation of dark papules with first onset several weeks after a sunburn. What is your diagnosis?

http://archderm.jamanetwork.com/article.aspx?articleid=2541900

Sequelae After Involution of Hemangiomas of Infancy

This cohort study describes cosmetic sequelae after natural involution of infantile hemangioma and associations between clinical characteristics and risk of permanent sequelae.

http://archderm.jamanetwork.com/article.aspx?articleid=2544685

Firmicutes in Lesions of Hidradenitis Suppurativa in Obese Patients

This study examines the prevalence of Firmicutes in bacterial cultures of purulent drainage from hidradenitis suppurativa lesions and explores its potential association with body mass index.

http://archderm.jamanetwork.com/article.aspx?articleid=2536062

Appareil manducateur et prothèse maxillo-faciale : de la pathologie à la fonction retrouvée

Publication date: Available online 9 November 2016
Source:Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
Author(s): S. Vo Quang, J. Dichamp
La prothèse maxillo-faciale (PMF) peut être définie comme l'art et la science de la reconstruction esthétique et fonctionnelle du massif facial, art car elle applique des règles artisanales et empiriques, science de par son rigorisme technique et son intégration dans des disciplines médicales. Pluridisciplinaire, la PMF vise à réhabiliter des patients ayant des pertes de substances du revêtement cutané et des structures sous-jacentes. Elle permet aussi la rééducation fonctionnelle des atteintes des articulations temporo-mandibulaires (ATM) affectant la phonation et la déglutition. Quelle qu'en soit l'origine (traumatique, infectieuse ou tumorale), le traitement de ces atteintes articulaires n'est le plus souvent pas chirurgical en première intention. Le traitement fonctionnel est suffisant dans la grande majorité des cas si sa mise en oeuvre est précoce et si le patient est observant. L'objectif de cet article était de présenter les différents types d'appareil permettant la rééducation fonctionnelle de l'appareil manducateur en fonction de la pathologie. La première partie traitera de la conservation des amplitudes articulaires dans un traitement préventif. La seconde partie traitera de la récupération des amplitudes articulaires en curatif. La troisième partie traitera du repositionnement de la mandibule. Enfin, nous présenterons les différents appareils de correction des troubles de la cinétique mandibulaire chez l'adulte puis dans un cas particulier chez l'enfant.Maxillofacial prosthesis (MFP) can be defined as the art and science of esthetic and functional reconstruction of the facial bones, art because it uses hand-crafted and empirical rules, science because of its technical rigorism and its integration in medicine. MFP aims to multidisciplinary rehabilitate patients presenting with cutaneous and underlying structures defects, It also allows for functional speech and swallowing rehabilitation related to temporo-mandibular joint disorders. Whatever the origin, (traumatic, infectious ortumoral), surgical treatment of these TMJ disorders is usually not indicated in first-line. Functional treatment is often sufficient if started early in an observant patient. The aim of our article was to present the different types devices available for the rehabilitation of the masticatory system according to pathology. The first part will treat about the preservation of the TMJ range of motion in a preventive way. A second part will treat about the possibilities to recover the range of motion in a curative way. A third part will treat about mandibular reposition. At last, we will focus on the devices allowing for mandibular kinetic rehabilitation in adults and in a special pediatric case.



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Facteurs associés au recours aux soins dentaires dans une population d’adolescents marocains

Publication date: Available online 9 November 2016
Source:Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
Author(s): S. Chala, K. Silorh, R. Abouqal, F. Abdallaoui
IntroductionLes lésions carieuses non traitées sont un véritable problème de santé publique en raison de l'impact sur la qualité de vie de l'individu mais également du coût élevé des soins dentaires. Notre objectif était l'identification des facteurs associés au recours aux soins dentaires dans une population d'adolescents résidants en milieu urbain.Matériel et méthodesUne étude transversale incluant des adolescents résidant en milieu urbain a été réalisée. Les adolescents ont été recrutés dans des lycées choisis selon la méthode d'échantillonnage en grappe. Les données recueillis ont été les paramètres sociodémographiques, l'existence ou non d'une assurance médicale et l'état dentaire par l'évaluation des indices CAO (nombre de dents adultes cariées, absentes et obturées d'un individu) et Significant Caries Index (SiC). La régression logistique a été utilisée pour évaluer les facteurs associés au recours aux soins dentaires.RésultatsQuatre cent cinquante adolescents ont été inclus en 2012 et 2013. Trois cent quatre-vingt-sept (86 %) d'entre eux avaient au moins une dent cariée non traitée. Cent soixante et onze (38 %) d'entre eux avaient au moins une dent restaurée. L'analyse multivariée a montré que l'existence d'une assurance médicale, le revenu familial, le sexe et l'indice CAO étaient des variables statistiquement associées au recours aux soins dentaires chez la population étudiée.DiscussionLe renoncement aux soins dentaires n'est pas uniquement dû à l'absence d'assurance médicale. D'autres facteurs semblent influencer cette attitude comme le sexe féminin et le niveau de revenus.IntroductionUntreated dental caries are a major public health concern because of the impact on quality of life and of the high cost of dental care. Our aim was to identify factors related to dental care use among a population of urban Moroccan adolescents.Material and methodsA cross-sectional study involving adolescents in an urban area was conducted. Adolescents were recruited in high schools selected by a cluster sampling method. The studied variables were recorded through a questionnaire and oral examinations. Collected data were socio-demographic parameters, medical insurance status and oral health status using DMFT (Decayed, Missing, Filled Teeth) and SiC (Significant Caries Index) indexes. Logistic regression analysis was applied to evaluate factors associated to dental care use.ResultsFour hundred and fifty adolescents were included in 2012 and 2013. Three hundred and eighty seven (86%) had one untreated dental caries at least. One hundred and seventy-one (38%) had at least one filled teeth. Logistic regression analysis showed that health insurance status, parental income, gender and DMFT index were statistically significant variables associated to dental care use.DiscussionRenouncement to dental care is not only related to the lack of medical insurance. Other factors such as gender and income level seems to be as important.



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Acouphènes et articulation temporo-mandibulaire : état des connaissances

Publication date: Available online 9 November 2016
Source:Revue de Stomatologie, de Chirurgie Maxillo-faciale et de Chirurgie Orale
Author(s): G. Lina-Granade, E. Truy, E. Ionescu, P. Garnier, H. Thai Van
Les signes otologiques, en particulier les acouphènes, sont nettement plus fréquents chez les patients souffrant des articulations temporo-mandibulaires (ATM) que dans la population générale. Toutefois, près de 90 % des acouphènes sont associés à un déficit auditif, souvent méconnu par le patient, et les facteurs somesthésiques et auditifs, mais aussi neurologiques et cognitivo-émotionnels, sont intriqués dans la genèse des acouphènes. Le clinicien doit donc évaluer le rôle de ces divers facteurs chez un patient donné. La présence de signes de dysfonction des ATM, et les modifications acoustiques de l'acouphène lors des mouvements des ATM ou du cou, orientent vers des mesures de soulagement des tensions musculaires. Mais comme aucun traitement n'apporte à lui seul de rémission complète et immédiate chez tous les patients, une prise en charge complémentaire, pluridisciplinaire, comportant thérapie sonore et thérapie cognitivo-comportementale, est impérative et constitue la base actuelle du traitement des acouphènes.Tinnitus has been described in temporomandibular joint dysfunction for a long time. Yet, other disorders, such as hearing loss, stress, anxiety and depression, play a major role in the pathophysiology of tinnitus. Temporomandibular joint dysfunctions seem to increase the risk of tinnitus in patients with other predisposing factors. Especially somatosensory tinnitus, which is characterized by sound modulations with neck or mandible movements, is frequently associated with temporomandibular joint dysfunction, but it is not pathognomonic of such a disorder. In such cases, functional therapy of the temporomandibular joint should be part of the multidisciplinary rehabilitation of patients with tinnitus.



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Experimental research on laser interference micro/nano fabrication of hydrophobic modification of stent surface

Abstract

Coronary artery disease (CAD) has become one of the important causes of human death, and coronary stent implantation is one of the most effective methods for the treatment of CAD. But the current clinical treatment has a high long-term restenosis rate and is easy to form late stent thrombosis. In order to solve these problems, coronary artery stent surface was directly modified by laser interference lithography and the highly ordered concave structures were fabricated. The morphology and contact angle (CA) of the microstructure were measured with scanning electron microscopy (SEM) and CA system. The water repellent property of the stent was also evaluated by the method of contacting the water drop with the stent and then separating. The result showed that the close-packed concave structure with the period of about 12.194 μm can be fabricated on the stent surface under special parameters (laser energy density of 3.5 J/cm⁻², incident angles of 3°, exposure time of 80 s) by the three-beam laser interference of 1064 nm and the form structure has good water repellency with contact angle of 120°.

http://link.springer.com/10.1007/s10103-016-2105-6

Case Report of a Child after Hematopoietic Cell Transplantation with Acute Aspergillus Tracheobronchitis as a Cause for Respiratory Failure

Rapid respiratory failure due to invasive mycosis of the airways is an uncommon presentation of Aspergillus infection, even in immunocompromised patients, and very few pediatric cases have been reported. Patients with Aspergillus tracheobronchitis present with nonspecific symptoms, and radiologic studies are often noninformative, leading to a delay in diagnosis. Prompt initiation of adequate antifungal therapies is of utmost importance to improve outcome. We report the case of a 9-year-old girl with chronic myelogenous leukemia who developed respiratory distress 41 days after hematopoietic cell transplantation and rapidly deteriorated despite multiple interventions and treatment modalities.

http://www.hindawi.com/journals/cripe/2016/9676234/

Life-threatening Wunderlich's syndrome with concurrent clopidogrel use

Spontaneous non-traumatic renal haemorrhage, or Wunderlich's syndrome, is a rare but potentially life-threatening event. We present the case of a 63-year-old man on clopidogrel who became haemodynamically unstable as a result of this condition. Angioembolisation revealed the unusual finding of active bleeding from multiple distinct subsegmental renal vessels, for which haemostasis was successfully achieved by coil placement. The patient remains well and with near-normal renal function on follow-up.

http://casereports.bmj.com/cgi/content/short/2016/nov08_2/bcr2016216171?rss=1

Q fever hepatitis and endocarditis in the context of haemochromatosis

Hereditary haemochromatosis is associated with increased susceptibility to some infections. We report here a case of Q fever in a patient with coexistent haemochromatosis. The literature is reviewed in regard to the effect of haemochromatosis on susceptibility to infectious disease in general and Q fever in particular. Although there is documented increased risk in these patients for some infectious conditions, a specific association with Q fever has not been previously reported. The present report raises the possibility of such a clinically relevant connection.

http://casereports.bmj.com/cgi/content/short/2016/nov08_2/bcr2016215214?rss=1

Acute aortic dissection in postpartum

Description

A Caucasian woman aged 35 years, with no relevant personal history or history of drug abuse and an uneventful pregnancy, presented in the emergency room (ER) at 34 weeks of gestation, with preterm premature rupture of membranes. On physical examination, she had elevated blood pressure and bilateral peripheral oedema. An extensive blood panel was performed, providing the diagnosis of pre-eclampsia. Four hours after admission, she had a vaginal delivery and, 36 hours later, discharged herself against medical advice. A few hours later, she returned to the ER, reporting of severe thoracic pain of sudden onset, sweating and nausea. Her vitals were within normal range, and peripheral pulses were present and symmetrical.

Suspecting a pulmonary embolism, a thoracic CT was performed (figures 1–3), showing 'extensive dissection of the ascending aorta, extending from the aortic root to the origin of the celiac artery. No aneurism is...

http://casereports.bmj.com/cgi/content/short/2016/nov08_2/bcr2016218236?rss=1

Aneurysmal wall imaging in a case of cortical superficial siderosis and multiple unruptured aneurysms

We report a case of interhemispheric and bifrontal cortical superficial siderosis in association with two intracranial aneurysms. The patient had no clinical history suggestive of aneurysm rupture, no feature of amyloid angiopathy or other apparent etiology for cortical siderosis. We performed high resolution brain MRI with dark blood T1 sequences before and after IV contrast injection. An anterior communicating aneurysm showed partial wall enhancement on the posterior wall whereas a left posterior communicating aneurysm did not. In the light of recent reports of the association of wall enhancement with unstable aneurysms, we considered wall enhancement to be a marker of inflammation and remodeling of the aneurysm wall, resulting in chronic hemorrhagic suffusion in the subarachnoid spaces. To our knowledge, this is the first report offering proof for a possible link between apparently unruptured aneurysms and cortical siderosis.

http://casereports.bmj.com/cgi/content/short/2016/nov08_2/bcr2016012680?rss=1

Whole-Neck Computed Tomography Perfusion Scan in Imaging Patients With Head and Neck Tumors

Conditions:   Head and Neck Neoplasm;   Malignant Head and Neck Neoplasm
Intervention:   Radiation: Computed Tomography Perfusion Imaging
Sponsors:   University of Southern California;   National Cancer Institute (NCI)
Recruiting - verified November 2016

https://clinicaltrials.gov/ct2/show/NCT02960308?term=HEAD+AND+NECK&recr=Open&lup_s=10%2F26%2F2016&lup_d=14&show_rss=Y&sel_rss=mod14

hTERT Immunotherapy Alone or in Combination With IL-12 DNA Followed by Electroporation in Adults With Solid Tumors at High Risk of Relapse

Conditions:   Breast Cancer;   Lung Cancer;   Pancreatic Cancer;   Head and Neck Cancer;   Ovarian Cancer;   ColoRectal Cancer;   Gastric Cancer;   Esophageal Cancer;   HepatoCellular Carcinoma
Interventions:   Biological: INO-1400;   Biological: INO-9012
Sponsors:   Inovio Pharmaceuticals;   University of Pennsylvania;   University of North Carolina;   Thomas Jefferson University;   University of Pittsburgh;   Wayne State University;   Mayo Clinic
Recruiting - verified November 2016

https://clinicaltrials.gov/ct2/show/NCT02960594?term=HEAD+AND+NECK&recr=Open&lup_s=10%2F26%2F2016&lup_d=14&show_rss=Y&sel_rss=mod14

A Phase II Trial to Compare Efficacy and Safety of CRT VS Neo-CRT in Patients Who Achieved CCR for Esophageal Cancer

Conditions:   Stage II Esophageal Cancer;   Stage III Esophageal Cancer
Interventions:   Radiation: Definitive Radiochemotherapy;   Procedure: Neoadjuvant Radiochemotherapy
Sponsor:   Tianjin Medical University Cancer Institute and Hospital
Recruiting - verified October 2016

https://clinicaltrials.gov/ct2/show/NCT02959385?term=HEAD+AND+NECK&recr=Open&lup_s=10%2F26%2F2016&lup_d=14&show_rss=Y&sel_rss=mod14

Refractory Obstructive Sleep Apnea in a Patient with Diffuse Idiopathic Skeletal Hyperostosis

Diffuse Idiopathic Skeletal Hyperostosis (DISH) can cause ossification of ligaments and may affect the spine. We report a case of obstructive sleep apnea in a patient with significant upper airway narrowing secondary to cervical DISH. This patient had an initial apnea-hypopnea index (AHI) of 145 events/hour and was treated with uvulopalatopharyngoplasty, genial tubercle advancement, hyoid suspension, septoplasty, inferior turbinoplasties, and radiofrequency ablations to the tongue base which reduced his AHI to 40 events/hour. He redeveloped symptoms, was started on positive airway pressure (PAP) therapy, and later underwent a maxillomandibular advancement which improved his AHI to 16.3 events/hour. A few years later his AHI was 100.4 events/hour. His disease has gradually progressed over time and he was restarted on PAP therapy. Despite PAP titration, years of using PAP therapy, and being 100 percent compliant for the past three months (average daily use of 7.6 hours/night), he has an AHI of 5.1 events/hour and has persistent hypersomnia with an Epworth Sleep Scale questionnaire score of 18/24. At this time he is pending further hypersomnia work-up. DISH patients require prolonged follow-up to monitor the progression of disease, and they may require unconventional measures for adequate treatment of obstructive sleep apnea.

http://www.hindawi.com/journals/criot/2016/4906863/

Bone-Anchored Titanium Implants in Patients with Auricular Defects: Three Years and 27 Patients’ Experience

Different surgical solutions have been proposed for reconstruction of the auricle following loss of the pinna through traumatic injury or neoplastic disease or in patients with congenital defects. Surgical treatment may involve the insertion of an autogenous rib cartilage framework or the use of a porous polymer material inserted into an expanded postauricular flap. Reconstruction with rib cartilage has yielded good results but requires more than one surgical step, and adverse events can occur both at the donor and at the acceptor site; cases of prosthesis rejection have also been described following application of the polymeric prosthesis. The use of a titanium, dowel-retained silicone prosthetic pinna, fixed to the temporal bone, has recently been proposed. This useful surgical approach is indicated particularly after resection of the pinna caused by neoplastic disease or in traumatic auricular injury. Osseointegrated titanium implants used in 27 patients in this study provided them with a safe, reliable, adhesive-free method of anchoring the auricular prostheses. The prostheses allowed recovery of normal physical appearance and all the patients reported that they were completely satisfied with the outcome of the surgical reconstruction. No surgical complications, implant failures, or prosthetic failures were encountered over six months to three years.

http://www.hindawi.com/journals/ijoto/2016/9872048/

The P Value Problem in Otolaryngology: Shifting to Effect Sizes and Confidence Intervals

There is a lack of reporting effect sizes and confidence intervals in the current biomedical literature. The objective of this article is to present a discussion of the recent paradigm shift encouraging the use of reporting effect sizes and confidence intervals. Although P values help to inform us about whether an effect exists due to chance, effect sizes inform us about the magnitude of the effect (clinical significance), and confidence intervals inform us about the range of plausible estimates for the general population mean (precision). Reporting effect sizes and confidence intervals is a necessary addition to the biomedical literature, and these concepts are reviewed in this article.

http://oto.sagepub.com/cgi/content/abstract/0194599816677735v1?rss=1

A New Theory for Menieres Disease: Detached Saccular Otoconia

Ménière's disease is an inner ear disorder characterized by vertigo attacks, fluctuating and progressive hearing loss, tinnitus, and aural fullness in the affected ear. The pathophysiology of Ménière's disease remains elusive. Theories so far are anatomical variation in the size or position of the endolymphatic sac and duct, viral inflammation or autoimmune involvement of the sac, or a genetically determined abnormality of endolymph control. Animal studies on blocking the ductus reuniens and endolymphatic duct have produced hydrops in the cochlea, saccule, and utricle. Cone beam computed tomography images show a similar pattern with apparent obstruction of the ductus reuniens, saccular duct, and endolymphatic sinus. New studies documenting the age of onset of Ménière's disease show a pattern similar to benign paroxysmal positional vertigo, raising the possibility that the fundamental cause of Ménière's disease might be detached saccular otoconia.

http://oto.sagepub.com/cgi/content/abstract/0194599816675843v1?rss=1

The Effect of Vestibular Rehabilitation in Patients with Menieres Disease: A Systematic Review

Objective

To systematically review the evidence on the effect of vestibular rehabilitation in patients with Ménière's disease (MD) on balance and dizziness-related quality of life.

Data Sources

A literature search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, Web of Science, and CINAHL databases.

Review Methods

Articles were reviewed by 2 independent authors and data were compiled in tables for analysis regarding balance (ie, posturography) and dizziness-specific quality of life in patients with MD. A comprehensive search was performed up to November 2015. Studies on relevance and methodological quality were assessed by means of the Cochrane risk of bias tool. For outcome on balance and quality of life, we calculated mean differences and their 95% confidence intervals.

Results

A total of 986 unique studies were retrieved. Five studies, including a total of 498 patients, fulfilled the eligibility criteria, including 2 randomized controlled trials and 3 prospective cohort studies. There was no study with a low risk of bias. We found inconsistent evidence for the effect of vestibular rehabilitation on balance and dizziness-related quality of life.

Conclusion

Based on the low quality of the selected studies, it is inconclusive whether there is a positive effect of vestibular rehabilitation in patients with MD on balance and dizziness-related quality of life.

http://oto.sagepub.com/cgi/content/abstract/0194599816678386v1?rss=1

Evaluation of a Web-Based Module and an Otoscopy Simulator in Teaching Ear Disease

Objective

To determine which teaching method—otoscopy simulation (OS), web-based module (WM), or standard classroom instruction (SI)—produced the best improvement in the diagnosis of middle/external ear pathologies and the development of otoscopy clinical skills.

Study Design

Prospective randomized controlled nonclinical trial.

Setting

Preclerkship undergraduate medical education.

Subjects and Methods

Fifty-four medical students (first year, 26; second year, 28) were randomized to receive 1 of the 3 interventions: OS, WM, or SI. All students underwent baseline testing of diagnostic accuracy (25 ear pathologies) and otoscopy skills. Immediately following each intervention and 3 months later, testing was repeated.

Results

Baseline scores for diagnostic accuracy and otoscopy skills did not differ across intervention groups. Immediately postintervention, all groups showed an improvement in diagnostic accuracy (P < .001). OS scored significantly higher than SI (P < .001), as did WM (P = .003). At 3-month follow-up, all groups continued to demonstrate improved diagnostic accuracy as compared with baseline. Again, OS showed improvement over SI (P = .031). For otoscopy clinical skills, only OS improved immediately postintervention (P < .001). OS had significantly higher scores than WM and SI (P < .001). At 3-month follow-up, OS again showed improvement over WM (P < .001) and SI (P = .009).

Conclusion

All groups showed an improvement in diagnostic accuracy immediately postintervention, with the largest increases coming from OS and WM. Otoscopy clinical skills increased and were retained only in OS. Preclerkship medical student acquisition and retention of otolaryngology diagnostic skills can be greatly improved through web-based teaching modules and otoscopy simulation.

http://oto.sagepub.com/cgi/content/abstract/0194599816677697v1?rss=1

Association between Laryngeal Pepsin Levels and the Presence of Vocal Fold Polyps

Objective

To determine whether pepsin, the main component of refluxed gastric contents, is significantly associated with vocal fold polyps and to evaluate the diagnostic value of pepsin in vocal fold polyps' tissues.

Study Design

Cross-sectional study.

Setting

Nanfang Hospital of Southern Medical University.

Subjects and Methods

The study included 32 patients with vocal fold polyps and 16 healthy controls between 2011 and 2012. Reflux symptom index and reflux finding score assessments, 24-hour combined multichannel intraluminal impedance and pH monitoring, and biopsy of the vocal fold polyp tissues or posterior laryngeal mucosa (healthy controls) for immunohistochemical pepsin staining were performed.

Results

The expression of pepsin was significantly higher in patients with vocal fold polyps than in controls (28/32, 75% vs 5/16, 31.25%; P < .001). The pepsin levels were significantly positively correlated with upright position pharyngeal acid reflux and esophageal reflux parameters adjusted by age. Based on pepsin staining data, the sensitivity and negative predictive values of 24-hour pH monitoring, the reflux symptom index, and the reflux finding score were 70% to 84.62%, whereas their specificity and positive predictive values were relatively low (20%-31.58%).

Conclusion

Pepsin reflux may be a risk factor for vocal fold polyps formation. In addition, pepsin immunohistochemical analysis of polyp biopsy samples appears to be a more sensitive and effective test for diagnosing laryngopharyngeal reflux than the reflux symptom index, the reflux finding score, and 24-hour pH monitoring in a clinical setting.

http://oto.sagepub.com/cgi/content/abstract/0194599816676471v1?rss=1

Head and Neck Cancer: Underfunded and Understudied?

Despite a considerable expansion in our therapeutic repertoire for management of other malignancies, mortality from head and neck cancer (HNC) has not significantly improved in recent decades. Upon normalizing National Institutes of Health–awarded R01 and R01-equivalent grants by incidence, thyroid cancer ($214) and HNC ($1329) received the fewest funding dollars. Upon adjusting funding totals by mortality, HNC was 7th out of 9 cancers evaluated ($6138). These findings highlight HNC as an underfunded disease versus other cancers. As data detailing grant applications (including unsuccessful grants) are not publicly available, it is not clear if these disparities stem from fewer applications or fewer opportunities. Our hope is that this commentary will spur further investigation into strategies to increase HNC inquiry and funding for trainees as well as early-stage and established investigators.

http://oto.sagepub.com/cgi/content/abstract/0194599816674672v1?rss=1

Corrigendum

http://oto.sagepub.com/cgi/reprint/0194599816679126v1?rss=1

Geographic Variation in Use of Vestibular Testing among Medicare Beneficiaries

Objective

There is a lack of consensus regarding the indications for vestibular testing in the evaluation of dizziness and balance disorders. Geographic variation in health services utilization is associated with lack of consensus. To understand the variation in current practice, we investigated the patterns of use of vestibular testing and diagnosis codes for dizziness and balance disorders among individuals ≥65 years of age across different regions of the United States.

Study Design

Cross-sectional study.

Setting

Medicare administrative claims data.

Subjects and Methods

Using the Summarized Denominator file, a sample of the US population linked to the Surveillance, Epidemiology, and End Results (SEER)–Medicare files (years 2000-2010), we identified persons who were ≥65 years of age. We used multivariable analyses to determine the factors associated with vestibular testing and diagnoses.

Results

Of the 231,984 eligible Medicare beneficiaries, 27% were diagnosed with dizziness and balance disorders. Patterns of use of vestibular tests (eye movement recording for spontaneous nystagmus, caloric testing, and rotary chair testing) varied significantly by geographic region. Rotary chair test utilization varied most. We found significant geographic variation in vestibular testing and diagnoses after controlling for age, sex, race, Medicaid participation, and rurality.

Conclusions

There may be opportunities to improve the consistency and efficiency of care for dizziness and balance disorders. It will be important to define appropriate levels of vestibular diagnostic testing and which tests add sufficient value to justify the costs. Further work is needed to better characterize the causes and consequences of variation in vestibular test utilization.

http://oto.sagepub.com/cgi/content/abstract/0194599816676450v1?rss=1

Re: Le Fort I advancement osteotomies of 1cm or more. How safe or stable?

Publication date: Available online 8 November 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A.G. Smyth




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Optimising ballistic facial coverage from military fragmenting munitions: a consensus statement

Publication date: Available online 8 November 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): J. Breeze, D.C. Tong, D. Powers, N.A. Martin, A.M. Monaghan, D. Evriviades, J. Combes, G. Lawton, C. Taylor, A. Kay, J. Baden, B. Reed, N. MacKenzie, A.J. Gibbons, S. Heppell, R.F. Rickard
VIRTUS is the first United Kingdom (UK) military personal armour system to provide components that are capable of protecting the whole face from low velocity ballistic projectiles. Protection is modular, using a helmet worn with ballistic eyewear, a visor, and a mandibular guard. When all four components are worn together the face is completely covered, but the heat, discomfort, and weight may not be optimal in all types of combat. We organized a Delphi consensus group analysis with 29 military consultant surgeons from the UK, United States, Canada, Australia, and New Zealand to identify a potential hierarchy of functional facial units in order of importance that require protection. We identified the causes of those facial injuries that are hardest to reconstruct, and the most effective combinations of facial protection. Protection is required from both penetrating projectiles and burns. There was strong consensus that blunt injury to the facial skeleton was currently not a military priority. Functional units that should be prioritised are eyes and eyelids, followed consecutively by the nose, lips, and ears. Twenty-nine respondents felt that the visor was more important than the mandibular guard if only one piece was to be worn. Essential cover of the brain and eyes is achieved from all directions using a combination of helmet and visor. Nasal cover currently requires the mandibular guard unless the visor can be modified to cover it as well. Any such prototype would need extensive ergonomics and assessment of integration, as any changes would have to be acceptable to the people who wear them in the long term.



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Piezoelectric compared with conventional rotary osteotomy for the prevention of postoperative sequelae and complications after surgical extraction of mandibular third molars: a systematic review and meta-analysis

Publication date: Available online 8 November 2016
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): E.K. Badenoch-Jones, M. David, T. Lincoln
The purpose of this review was to determine if postoperative sequelae (facial swelling, trismus, pain) and neurological complications are reduced when mandibular third molars are surgically extracted using a piezoelectric device for osteotomy compared with conventional rotary burs, and to determine if there is a difference in operating time between the two techniques. Clinical trials were identified through a search (April 2015) on the PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases. Studies were assessed by study type, characteristics of participants, sample size, surgical technique, cointerventions, outcomes, risk of bias, and findings. We calculated a Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) rating of confidence in the effect estimates. We identified 2515 citations and found 15 eligible clinical trials. Patients who had osteotomies with the piezoelectric device had less facial swelling (standard mean difference -1.15; 95% CI -2.02 to -0.27; p<0.0001), trismus (greater maximum mouth opening, standard mean difference 0.78; 95% CI 0.56 to 1.00; p=0.33) and pain (standard mean difference -0.84; 95% CI -1.55 to -0.13; p<0.0001) at day 1, less facial swelling at day 7 (standard mean difference -0.98; 95% CI -1.52 to -0.44; p=0.05), and a reduced risk of neurological complications (odds ratio (OR) 0.28; 95% CI 0.09 to 0.89; p=0.79). Trismus at day 7 and pain at day 5 did not differ significantly between the two methods. Operating time was longer with the piezoelectric device (standard mean difference 0.83; 95% CI 0.57 to 1.09; p=0.001). The confidence in the effect estimates was low or very low across all outcomes. The findings raise the possibility of an improved clinical healing response to osteotomy with the piezoelectric device compared with one performed with conventional rotary burs for surgical extractions of mandibular third molars.



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A Rare Case Report of Thoracic Ectopia Cordis: An Obstetrician’s Point of View in Multidisciplinary Approach

Ectopia cordis is a rare congenital anomaly associated with the heart positioned outside of the thoracic cavity either partially or completely. It can be associated with other congenital abnormalities. Overall, the prognosis for infants with ectopia cordis is very poor but depends greatly on the type and severity of ectopia cordis and intracardiac and associated malformations. We present one case of a fetus with prenatally diagnosed thoracic ectopia cordis with intracardiac defects and omphalocele, all the abnormalities seen in pentalogy of Cantrell except a diaphragmatic defect. Considering poor prognosis for fetus, conservative management of prenatal care has been chosen. At the 42nd gestational week, during the active stage of labor, due to fetal distress, cesarean section was performed at a tertiary level hospital. The condition of the infant was impairing rapidly and the newborn succumbed within 24 hours. We discuss the perinatal care concerning this rare anomaly.

http://www.hindawi.com/journals/cripe/2016/5097059/

Lack of mutation of DICER1 and FOXL2 genes in microcystic stromal tumor of the ovary

Abstract

Microcystic stromal tumors (MCST), first described in 2009 by Irving et al., are rare ovarian neoplasms. The entity was introduced into the 2014 WHO classification of tumors of female reproductive organs in the group of sex cord-stromal tumors, which is rather heterogeneous. We studied three cases of ovarian tumor with the characteristic morphological features and immunohistochemical marker profiles of MCST. The three tumors showed micro, and macrocystic patterns with solid areas, and were composed of small round to spindle-shaped cells, without atypia. The tumors diffusely and strongly expressed CD10, FOXL2, and nuclear β-catenin, but without immmunoreactivity for hormone receptors, calretinin, or inhibin. Genome analyses showed no somatic mutation of exon 1 of the FOXL2 gene and of exons 24 and 25 of DICER1 gene, the latter not having been reported previously. The patients are well, without evidence of tumor progression 1 to 10 years after diagnosis.

The absence of FOXL2 and DICER1 gene mutation, along with strong FOXL2 immunoreactivity provides additional evidence to place MCST within pure gonadal stromal rather than sex cord ovarian tumors.

http://link.springer.com/10.1007/s00428-016-2038-2

Trump Wins Presidency and Chance to Dump ACA

The real-estate magnate and reality-TV star who told raucous crowds that he would 'Make America Great Again' now will try to fulfil his promise to dismantle President Barack Obama's signature legislation.
Medscape Medical News

http://www.medscape.com/viewarticle/871580?src=rss