Κυριακή 4 Δεκεμβρίου 2016
Burden of herpes zoster and postherpetic neuralgia in Japanese adults 60 years of age or older: Results from an observational, prospective, physician practice-based cohort study
Abstract
Approximately one in three persons will develop herpes zoster during their lifetime, and it can lead to serious complications such as postherpetic neuralgia. However, evidence on burden of herpes zoster and postherpetic neuralgia in Japan is limited. This prospective, observational, multicenter, physician practice-based cohort study was conducted in Kushiro, Hokkaido, Japan (Clinicaltrials.gov identifier NCT01873365) to assess the incidence and hospitalization rates of herpes zoster, and the proportion, clinical burden and risk factors for postherpetic neuralgia in adults aged 60 years or more. Within the study area, 800 subjects developed herpes zoster and 412 were eligible for the study. Herpes zoster incidence was 10.2/1000 person-years and higher among women and older subjects. Subjects with herpes zoster required on average 5.7 outpatient consultations. Herpes zoster-associated hospitalization rate was 3.4% (27/800). The proportion of postherpetic neuralgia and other complications was 9.2% (38/412) and 26.5% (109/412), respectively. Statistically significant association with the development of postherpetic neuralgia was male sex (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.17–5.38), age of 70–74 years (OR, 3.51; 95% CI, 1.09–11.3), immunosuppressive therapy (OR, 6.44; 95% CI, 1.26–32.9), severe herpes zoster pain at first consultation (OR, 3.08; 95% CI, 1.10–8.62) and rash on upper arms (vs no rash on upper arms; OR, 3.46; 95% CI, 1.10–10.9). Considerable herpes zoster and postherpetic neuralgia burden exists among elderly in Japan, and there may be predictive factors at the first visit which could be indicative of the risk of developing postherpetic neuralgia.
http://ift.tt/2h4N34Q
Effects of rinsing with arginine bicarbonate and urea solutions on initial enamel lesions in situ
Abstract
Objective
The aim of this study was to investigate the effects of rinsing with arginine or urea solution on initial enamel lesions in situ.
Methods
Fourteen subjects wore mandibular removable partial dentures embedded with bovine enamel blocks with artificial enamel lesions were included. The experiment included four 4-week rinsing periods with a 10-day washout period between each rinsing period. In each rinsing period, the subjects rinsed after meal or snack using water, or 2% arginine bicarbonate, or 1% urea, or 0.05% NaF solution, 5 times daily. The mineralization changes of the enamel lesions were assessed using quantitative light-induced fluorescence.
Results
All groups except the water group showed a statistically significant decrease in the fluorescence loss after treatment, compared with their respective baseline. Although both the arginine group and urea group showed more decrease of fluorescence loss than that of the water group, the decrease was not statistically significantly different from that of the water group. The decrease of fluorescence loss of the NaF group was statistically significant than that of the water group, arginine group and urea group.
Conclusion
Rinsing with arginine or urea solution offers limited remineralizing benefit to enamel lesions over a period of 4-week time.
This article is protected by copyright. All rights reserved.
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Neonatal airway obstruction in bilateral congenital dacryocystocoele: Case report and review of the literature
Publication date: January 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 92
Author(s): Tary Yin, Graeme van der Meer
Bilateral nasal obstruction due to simultaneous bilateral dacrocystocoeles is a rare and potentially life threatening condition. We present a five day old girl with this condition who presented with respiratory distress without any eye signs or symptoms associated with dacryocystocoeles. She was successfully managed with surgery and the clinical and radiological features of this condition are presented here with a review of the literature.
http://ift.tt/2h8ZRvl
Surgical scheduling categorization system (SSCS): A novel classification system to improve coordination and scheduling of operative cases in a tertiary pediatric medical system
Publication date: January 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 92
Author(s): Eric A. Gantwerker, Cassandra Bannos, Michael J. Cunningham, Reza Rahbar
ObjectiveTo describe a surgical categorization system to create a universal nomenclature, delineating patient complexity as a first step toward developing a true risk stratification system.MethodsRetrospective database review of all otolaryngology surgical procedures performed in a tertiary pediatric hospital system over one academic year (July 2012–June 2013). All otolaryngology surgical procedures were reviewed, encompassing 8478 procedures on 5711 patients. The attending otolaryngologist assigned surgical scheduling category (SSCS) at the time of case booking based on an institution specific guidelines. The guidelines are as follow: Category I was assigned to American Society of Anesthesiologists physical status classification (ASA) I/II patients, designating them appropriate for institution's suburban ambulatory surgery centers; Category II was ASA I/II patients with social or transportation issues; Category III was ASA I/II patients who required case coordination with other medical or surgical departments; Category IV was reserved for patients of any ASA class whom the surgeon designated to be of a higher complexity.Results8478 total procedures analyzed with 7198 having complete records. 48% were Category I, 13.6% were Category II, 1.9% were Category III and 36.5% were Category IV. The ASA were 34.7% ASA I, 50% ASA II, 13.39% ASA III, and 1.9% ASA IV. Although the largest proportion of patients were ASA II (50%), 39.6% of all ASA II were Category IV. Category IV was split into 54.2% ASA II and 34% ASA III and shows that peri-operative surgical concerns were not encompassed by the ASA system.ConclusionThis surgical categorization system streamlines surgical scheduling in a tertiary pediatric hospital system, particularly with respect to the designation of cases as ambulatory surgery center or main operating room appropriate. The case mix complexity is also readily apparent, enhancing recognition of the coordination and attention required for the perioperative management of high complexity patients. The SSCS helps convey concerns not addressed by ASA physical status alone.
http://ift.tt/2g1q2yJ
Subspecialist training program in pediatric otorhinolaryngology of UEMS ORL-HNS section
Publication date: Available online 5 December 2016
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Tomislav Baudoin
The ORL Section and Board of Otorhinolaryngology-Head and Neck Surgery of the European Union of Medical Specialists (UEMS) developed pediatric ORL subspecialty program. The program was created with support and consultation of the European Society of Pediatric Otorhinolaryngology. It is divided into four sections: Pediatric Otology, Pediatric Rhinology and Facial Plastic Surgery, Pediatric Laryngology and Phoniatrics and Pediatric Head and Neck Surgery. After completion of the program, the trainee is supposed to achieve an advanced level of competency. The aim of the program is to serve as a guideline for training centers, enabling them to meet the European Standard as set out by the European Board of UEMS through competency based assessments.
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Dry skin conditions are related to the recovery rate of skin temperature after cold stress rather than to blood flow
Abstract
Background
Cutaneous blood flow plays an important role in the thermoregulation, oxygen supply, and nutritional support necessary to maintain the skin. However, there is little evidence for a link between blood flow and skin physiology. Therefore, we conducted surveys of healthy volunteers to determine the relationship(s) between dry skin properties and cutaneous vascular function.
Methods
Water content of the stratum corneum, transepidermal water loss, and visual dryness score were investigated as dry skin parameters. Cutaneous blood flow in the resting state, the recovery rate (RR) of skin temperature on the hand after a cold-stress test, and the responsiveness of facial skin blood flow to local cooling were examined as indices of cutaneous vascular functions. The relationships between dry skin parameters and cutaneous vascular functions were assessed.
Results
The RR correlated negatively with the visual dryness score of skin on the leg but correlated positively with water content of the stratum corneum on the arm. No significant correlation between the resting state of blood flow and dry skin parameters was observed. In both the face and the body, deterioration in skin dryness from summer to winter was significant in subjects with low RR. The RR correlated well with the responsiveness of facial skin blood flow to local cooling, indicating that the RR affects systemic dry skin conditions.
Conclusions
These results suggest that the RR but not blood flow at the resting state is associated with dry skin conditions and is involved in skin homeostasis during seasonal environmental changes.
http://ift.tt/2gShnQY
Co-distribution of cysteine cathepsins and matrix metalloproteases in human dentin
Source:Archives of Oral Biology, Volume 74
Author(s): Polliana Mendes Candia Scaffa, Lorenzo Breschi, Annalisa Mazzoni, Cristina de Mattos Pimenta Vidal, Rosa Curci, Fabianni Apolonio, Pietro Gobbi, David Pashley, Leo Tjäderhane, Ivarne Luis dos Santos Tersariol, Fábio Dupart Nascimento, Marcela Rocha Carrilho
It has been hypothesized that cysteine cathepsins (CTs) along with matrix metalloproteases (MMPs) may work in conjunction in the proteolysis of mature dentin matrix. The aim of this study was to verify simultaneously the distribution and presence of cathepsins B (CT-B) and K (CT-K) in partially demineralized dentin; and further to evaluate the activity of CTs and MMPs in the same tissue. The distribution of CT-B and CT-K in sound human dentin was assessed by immunohistochemistry. A double-immunolabeling technique was used to identify, at once, the occurrence of those enzymes in dentin. Activities of CTs and MMPs in dentin extracts were evaluated spectrofluorometrically. In addition, in situ gelatinolytic activity of dentin was assayed by zymography. The results revealed the distribution of CT-B and CT-K along the dentin organic matrix and also indicated co-occurrence of MMPs and CTs in that tissue. The enzyme kinetics studies showed proteolytic activity in dentin extracts for both classes of proteases. Furthermore, it was observed that, at least for sound human dentin matrices, the activity of MMPs seems to be predominant over the CTs one.
http://ift.tt/2h3RJbe
Co-distribution of cysteine cathepsins and matrix metalloproteases in human dentin
Source:Archives of Oral Biology, Volume 74
Author(s): Polliana Mendes Candia Scaffa, Lorenzo Breschi, Annalisa Mazzoni, Cristina de Mattos Pimenta Vidal, Rosa Curci, Fabianni Apolonio, Pietro Gobbi, David Pashley, Leo Tjäderhane, Ivarne Luis dos Santos Tersariol, Fábio Dupart Nascimento, Marcela Rocha Carrilho
It has been hypothesized that cysteine cathepsins (CTs) along with matrix metalloproteases (MMPs) may work in conjunction in the proteolysis of mature dentin matrix. The aim of this study was to verify simultaneously the distribution and presence of cathepsins B (CT-B) and K (CT-K) in partially demineralized dentin; and further to evaluate the activity of CTs and MMPs in the same tissue. The distribution of CT-B and CT-K in sound human dentin was assessed by immunohistochemistry. A double-immunolabeling technique was used to identify, at once, the occurrence of those enzymes in dentin. Activities of CTs and MMPs in dentin extracts were evaluated spectrofluorometrically. In addition, in situ gelatinolytic activity of dentin was assayed by zymography. The results revealed the distribution of CT-B and CT-K along the dentin organic matrix and also indicated co-occurrence of MMPs and CTs in that tissue. The enzyme kinetics studies showed proteolytic activity in dentin extracts for both classes of proteases. Furthermore, it was observed that, at least for sound human dentin matrices, the activity of MMPs seems to be predominant over the CTs one.
http://ift.tt/2h3RJbe
Relative costs of anesthesiologist prepared, hospital pharmacy prepared and outsourced anesthesia drugs
Anesthesia drugs can be prepared by anesthesia providers, hospital pharmacies or outsourcing facilities. The decision whether to outsource all or some anesthesia drugs is challenging since the costs associated with different anesthesia drug preparation methods remain poorly described.
http://ift.tt/2gRbFyX
Complement in basic processes of the cell
Source:Molecular Immunology
Author(s): Anaïs Jiménez-Reinoso, Ana V. Marin, José R. Regueiro
The complement system is reemerging in the last few years not only as key element of innate immunity against pathogens, but also as a main regulator of local adaptive responses, affecting dendritic cells as well as T and B lymphocytes. We review data showing that leucocytes are capable of significant autocrine synthesis of complement proteins, and express a large range of complement receptors, which in turn regulate their differentiation and effector functions while cross talking with other innate receptors such as Toll-like receptors. Other unconventional roles of complement proteins are reviewed, including their impact in non-leukocytes and their intracellular cleavage by vesicular proteases, which generate critical cues required for T cell function. Thus, leucocytes are very much aware of complement-derived information, both extracellular and intracellular, to elaborate their responses, offering rich avenues for therapeutic intervention and new hypothesis for conserved major histocompatibility complex complotypes.
http://ift.tt/2gDgga7
Maxillofacial features related to mandibular asymmetries in skeletal Class III patients
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Guilherme Thiesen, Bruno Frazão Gribel, Ki Beom Kim, Maria Perpétua Mota Freitas
PurposeTo analyze the components related to the different degrees of mandibular asymmetry in adults with skeletal Class III using cone-beam computed tomography (CBCT) images.Patients and MethodsCBCT images from 138 patients were analyzed. Asymmetry was determined by the deviation of the gnathion point in relation to the midsagittal plane and classified as relative symmetry, moderate mandibular asymmetry, or severe mandibular asymmetry. Several maxillary and mandibular measurements were made that compared the different degrees of mandibular asymmetry and also the difference between the measurements of contralateral side and the deviated side.ResultsFor patients with moderate and severe mandibular asymmetry, there were statistically significant differences between bilateral measurements of the sagittal position of the heads of the condyle, transversal and sagittal positioning of the gonion, ramus height and mandibular body length, as well as in the transversal and vertical positioning of the jugale point, besides a vertical positioning of the gonion only for severe asymmetry. In patients with severe mandibular asymmetry, there was a highly significant correlation of the gnathion lateral displacement with the lower dental midline displacement, as well as with the difference in the height of the mandibular rami between the deviated and contralateral sides.ConclusionIn subjects with skeletal Class III, not only the lateral displacement of the menton but also a series of morphological changes differed significantly for each degree of mandibular asymmetry.
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Rapamycin Preferentially Inhibits Human IL-5+ Th2 Cell Proliferation via an mTORC1/S6 Kinase-1 Dependent Pathway
Source:Journal of Allergy and Clinical Immunology
Author(s): Yuzhi Yin, Alyssa Mitson-Salazar, Daniel L. Wansley, Satya P. Singh, Calman Prussin
http://ift.tt/2fVIqOq
Association between the CDHR3 rs6967330 risk allele and chronic rhinosinusitis
Source:Journal of Allergy and Clinical Immunology
Author(s): Eugene H. Chang, Amanda L. Willis, Hilary C. McCrary, George T. Noutsious, Christopher H. Le, Alexander G. Chiu, Corrine J. Mansfield, Danielle R. Reed, Steven G. Brooks, Nithin D. Adappa, James N. Palmer, Noam G. Cohen, Debra A. Stern, Stefano Guerra, Fernando D. Martinez
Teaser
A retrospective, multi-center study of adults with and without chronic rhinosinusitis (CRS) identifies a significant association between rs6967330 in the viral receptor CDHR3 – known to be associated with wheezing and asthma in children – and the development of CRS.http://ift.tt/2h1AS92
Orbital fracture repair outcomes with preformed titanium mesh implants and comparison to porous polyethylene coated titanium sheets
Publication date: Available online 3 December 2016
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Michelle Y. Peng, Shannath L. Merbs, Michael P. Grant, Nicholas R. Mahoney
BackgroundRestoration of orbital volume after internal orbital fractures can prevent enophthalmos. A variety of allografts are commonly used including titanium mesh with and without porous polyethylene coating. Some controversy exists over the use of uncoated titanium mesh in the orbit. Newer products contoured to the three dimensional orbital anatomy aim to improve reestablishment of the complex orbital shape though studies of outcomes with their use are limited.MethodsA retrospective chart review was performed to evaluate surgical outcomes in all patients who underwent orbital fracture repair with DePuy/Synthes titanium MatrixMIDFACE prefabricated implants (PFTi) as compared with porous polyethylene/titanium hybrid implants (PPETi) including Stryker Medpor Titan, MTB, and BTB implants. Incidence of reoperation, diplopia, and movement restriction between PFTi and PPETi groups and the risk ratio of the above outcomes between implant types were compared.ResultsA total of 464 orbital implants were reviewed. Patients were divided by implant type with 195 patients receiving a PFTi impant and 269 patients receiving PPETi impant. (PFTi) and 269 had placement of a porous polyethyelene/titanium hybrid implant. Despite statistically significant increased probability of utilization in more complex and delayed fractures, the PFTi implant showed no significant difference in complication profile or reoperation rate compared to the more commonly used PPETi.ConclusionsPFTi implants, designed to replicate the native orbital shape, have similar surgical outcomes and no difference in complication profile compared to standard porous polyethylene/titanium implants hybrid plates.
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Patterns of constitutively phosphorylated kinases in B cells are associated with disease severity in common variable immunodeficiency
Source:Clinical Immunology
Author(s): Eli Taraldsrud, Pål Aukrust, Silje Jørgensen, Ole Christian Lingjærde, Johanna Olweus, June H. Myklebust, Børre Fevang
Patients with common variable immunodeficiency (CVID) constitute a clinically and immunologically heterogeneous group characterized by B-cell dysfunction with hypogammaglobulinemia and defective immunoglobulin class switch of unknown etiology. Current classification systems are insufficient to achieve precise disease management. Characterization of signaling pathways essential for B-cell differentiation and class switch could provide new means to stratify patients. We evaluated constitutive and induced signaling by phospho-specific flow cytometry in 26 CVID patients and 18 healthy blood donors. Strong responses were induced both in CVID and healthy donor B cells upon activation. In contrast, constitutive phosphorylation levels of STAT3,-5,-6, Erk, PLC-γ and Syk were significantly increased in CVID B cells only. Hierarchical clustering revealed a subgroup of CVID patients with elevated constitutive phosphorylation of Syk and PLC-γ. All these patients had non-infectious complications, indicating that a distinct phosphorylation pattern of kinases in B cells identifies a clinically important subgroup of CVID patients.
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NFKB1 regulates human NK cell maturation and effector functions
Source:Clinical Immunology
Author(s): Vassilios Lougaris, Ornella Patrizi, Manuela Baronio, Giovanna Tabellini, Giacomo Tampella, Eufemia Damiati, Natalie Frede, Jos W.M. van der Meer, Manfred Fliegauf, Bodo Grimbacher, Silvia Parolini, Alessandro Plebani
NFKB1, a component of the canonical NF-κB pathway, was recently reported to be mutated in a limited number of CVID patients. CVID-associated mutations in NFKB2 (non-canonical pathway) have previously been shown to impair NK cell cytotoxic activity. Although a biological function of NFKB1 in non-human NK cells has been reported, the role of NFKB1 mutations for human NK cell biology and disease has not been investigated yet. We decided therefore to evaluate the role of monoallelic NFKB1 mutations in human NK cell maturation and functions. We show that NFKB1 mutated NK cells present impaired maturation, defective cytotoxicity and reduced IFN-γ production upon in vitro stimulation. Furthermore, human IL-2 activated NFKB1 mutated NK cells fail to up-regulate the expression of the activating marker NKp44 and show reduced proliferative capacity. These data suggest that NFKB1 plays an essential novel role for human NK cell maturation and effector functions.
http://ift.tt/2fYUNVl
Prognostic significance of repeat biopsy in lupus nephritis: Histopathologic worsening and a short time between biopsies is associated with significantly increased risk for end stage renal disease and death
Source:Clinical Immunology
Author(s): Cristina Arriens, Sixia Chen, David R. Karp, Ramesh Saxena, Kamalanathan Sambandam, Eliza Chakravarty, Judith A. James, Joan T. Merrill
Background/purposeApproximately half of patients with systemic lupus erythematosus (SLE) develop lupus nephritis (LN), a major cause of morbidity and early mortality in that disease. Prolonged renal inflammation is associated with irreversible kidney damage which confers a 30% risk of end stage renal disease (ESRD), making early, aggressive treatment mandatory. Failure to achieve therapeutic response or recurrence of renal flare often prompts repeat biopsy. However, the role of repeat biopsy in determining long-term renal prognosis remains controversial. For this reason repeat biopsies are usually not utilized unless clinical evidence of refractory or recurrent disease is already present, despite known mismatches between clinical and biopsy findings. The current study quantifies the degree to which histopathologic worsening between first and second biopsies and duration between them predicts ESRD and death.MethodsMedical records of 141 LN patients with more than one biopsy were obtained from a single large urban medical center. Cases were attained using billing codes for diagnosis and procedures from 1/1999–1/2015. Biopsy worsening was defined as unfavorable histopathologic classification transitions and/or increased chronicity; if neither were present, the patient was defined as non-worsening. We used Cox proportional hazard models to study the relationship between ESRD and survival adjusting for covariates which included age at first biopsy, gender, race, initial biopsy class, and initial induction therapy.ResultsOf 630 patients screened, 141 had more than one biopsy. Advancing chronicity was detected in 48 (34.0%) and a renal class switch to worse grade of pathology was found in 54 (38.3%). At least one of these adverse second biopsy features was reported in 79 (56.0%) patients. Five years following initial biopsy, 28 (35.4%) of those with worsening histopathology on second biopsy developed ESRD, compared to 6 (9.7%) of non-worsening patients and 10 (12.7%) of patients with worsening histopathology had died compared to 2 (3.2%) of non-worsening patients. Biopsy worsening was associated with a significantly greater 15-year risk of ESRD (Hazard Ratio 4.2, p=0.0001) and death (Hazard Ratio 4.3, p=0.022), adjusting for age, gender, race, biopsy class, and treatment. Time between first and second biopsies was <1year in 32 patients, 1–5years in 81, and >5years in 28. Over a 15-year period, those with <1year between first and second biopsies (presumably enriched for patients with early clinical signs of progression) had a significantly greater risk of ESRD (Hazard Ratio 13.7, p<0.0001) and death (Hazard Ratio 16.9, p=0.0022) after adjusting for age, gender, race, biopsy class, and treatment.ConclusionA repeat renal biopsy demonstrating worsening pathology increases the risk of ESRD and death more than four-fold compared to non-worsening patients. Given known potential mismatch between biopsy and clinical data, repeat biopsies may add important information and justify changes in treatment not considered on clinical grounds. Earlier detection of poor prognostic signs in those without early clinical deterioration might improve outcomes in enough patients to reconsider cost effectiveness of routine repeat biopsy.
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Enthesitis in a 16-Year-Old Boy with M694V Mutation
Introduction. FMF (Familial Mediterranean Fever) is characterized by recurrent attacks of fever and articular pain. Enthesitis is the hallmark of pain in spondyloarthropathy. Literature suggests association of M694V mutation and enthesitis. We report a case of a 16-year-old boy with enthesitis and FMF. Case Presentation. A 16-year-old boy of Turkish origin with a history of FMF presented with localized tenderness of the heel and severe disability. MRI showed an enthesitis of the plantar fascia. Standard treatment of FMF and enthesitis was not successful. After referral to a university hospital and expert opinion of a professor in rheumatology, this enthesitis should be treated as an enthesitis related arthritis. With this treatment, our patient fully recovered 8 months after the onset of the disease symptoms. Conclusion. M694V mutation related enthesitis should be considered in FMF patients with enthesitis. We would suggest treatment for enthesitis related arthritis in similar cases. This is of clinical importance because the treatment is different from treatment of enthesitis or articular pain caused by FMF.
http://ift.tt/2gnN3wO
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