Publication date: Available online 27 December 2016
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Chien-Ho Wang, Chang-Yo Yang, Reyin Lien, Shih-Ming Chu, Jen-Fu Hsu, Ren-Huei Fu, Ming-Chou Chiang
BackgroundAlthough we've made big strides in perinatal and neonatal care, auditory handicap remains a serious complication in those who were born very premature.ObjectivesThe aim was to determine the prevalence and analyze possible risk factors of hearing impairment in very-low-birth-weight (VLBW) infants.Materials and MethodsThis was a retrospective study by reviewing medical records of all VLBW infants (BW ≤ 1500 g) admitted to NICU of Chang Gung Children's Hospital over 2 years period from Jan. 2010 to 2011. Brainstem auditory evoked potentials (BAEP) hearing screening was performed at 3 months postnatal corrective age and repeated if failed the 1st time, then refer to ENT doctor if BAEP confirmed abnormal. All VLBW infants examined for hearing impairment were included and data were retrieved retrospectively and analyzed for neonatal risk factors using logistic regression.ResultsOver the period, 309 VLBW infants were screened. Prevalence of uni- or bilateral hearing impairment was 3.9% (12/309; 95% CI 2.6-4.1). The mean corrective age on diagnosed of hearing impairment was 2.9±1.1 (range 1-5) months. Mean gestational age was 27.9 weeks (SD 1.4) and mean birth weight was 1028 g (SD 180). By univariant analysis for hearing impairment, severe birth asphyxia, craniofacial anomalies, ventilator dependence, patent ductus arteriosus ligation, and use of postnatal ototoxins yielded good prediction of hearing impairment in this population. However, using multivariate analysis revealed that the only independent risk factors for hearing impairment were ototoxins (OR: 3.62; CI: 1.67-7.82), PDA ligation (OR: 4.96; CI: 2.34-10.52) , craniofacial anomalies (OR: 3.42; CI: 1.70-6.88)and assisted prolonged use of oxygen at gestational age of >36 weeks (OR: 5.94; CI: 2.61-13.54).ConclusionThe incidence of hearing impairment among VLBW infants was 3.9%. Prolonged supplemental oxygen use is a marker for predicting hearing impairment; this requires detailed analysis of the pathophysiologic features, to reduce the prevalence of hearing impairment.
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Τρίτη 27 Δεκεμβρίου 2016
Prevalence and Independent Risk Factors for Hearing Impairment Among Very Low Birth Weight Infants
qSOFA should replace SIRS as the screening tool for sepsis
No description available
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qSOFA should replace SIRS as the screening tool for sepsis
No description available
http://ift.tt/2i5UNre
qSOFA should replace SIRS as the screening tool for sepsis
No description available
http://ift.tt/2i5UNre
qSOFA should replace SIRS as the screening tool for sepsis
No description available
http://ift.tt/2i5UNre
Early Pregnancy Thyroid Function Test Abnormalities in Biobank Sera from Women Clinically Diagnosed with Thyroid Dysfunction Before or After Pregnancy
http://ift.tt/2hrSU7p
Fusion Oncogenes Are the Main Genetic Events Found in Sporadic Papillary Thyroid Carcinomas from Children
http://ift.tt/2icBY3B
qSOFA should replace SIRS as the screening tool for sepsis
No description available
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The Association of Sleep Duration and Morbid Obesity in a Working Population: The Baptist Health South Florida Employee Study
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
http://ift.tt/2iCPi0j
qSOFA should replace SIRS as the screening tool for sepsis
No description available
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qSOFA should replace SIRS as the screening tool for sepsis
No description available
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Mid-face toddler excoriation syndrome (MiTES): a new paediatric diagnosis
Summary
Chronic ulcerating lesions on the face are rarely seen in toddlers. Blistering disease, vasculitis, infections and self-mutilation due to neurometabolic disease can usually be excluded on clinical and histological grounds. In the absence of identifiable disease, such lesions are sometimes attributed to child abuse or fabricated illness. We describe three toddlers with chronic mid-face erosions, two from India and one from the UK. One had moderate developmental delay and one had had seizures. The lesions appeared to be self-inflicted, no underlying disease was identified and there was no suspicion of child abuse. Recognition of the same disease pattern in different continents implies a distinct pathological entity. The pattern closely resembles that seen in some patients with mutations in the pain-insensitivity genes PRDM12 and SCN11A. We suggest the term 'mid-face toddler excoriation syndrome' (MiTES) to acknowledge the existence of this condition, encourage further reports and help clarify the pathogenesis.
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Possible association between germline methylenetetrahydrofolate reductase gene polymorphisms and psoriasis risk in a Turkish population
Summary
Background
Psoriasis is a common chronic inflammatory skin disease caused by genetic and epigenetic factors. There are conflicting results in the literature about the association between psoriasis and the methylenetetrahydrofolate reductase gene (MTHFR), ranging from strong linkage to no association.
Aim
To investigate the association between the germline MTHFR polymorphisms C677T and A1298C with psoriasis risk in a Turkish population.
Methods
The study enrolled 84 patients with psoriasis and 212 healthy controls (HCs) without any history of psoriasis. DNA was extracted from peripheral blood samples of patients and HCs, and real-time PCR was used for genotyping. Results were compared by Pearson χ² test and multiple logistic regression models.
Results
The frequency of both the MTHFR 677TT and A1298C (homozygous) genotypes was statistically significantly different from HCs. Point mutations were detected in all patients with early-onset psoriasis (before the age of 20 years). The T allele of MTHFR 677 and the C allele of MTHFR 1298 increased psoriasis risk by 12.4- and 17.0-fold, respectively, in patients compared with HCs.
Conclusion
A possible association was detected betweengermline MTHFR 677 C>T and 1298 A>C genotypes and psoriasis risk in a Turkish population. These results need to be confirmed in further studies with larger sample sizes.
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Cutaneous protothecosis on the bilateral wrists of a food handler
Summary
Cutaneous protothecosis is caused by the achlorophyllic algae Prototheca, typically presenting as a localized plaque in immunocompetent individuals. We report a patient with bilateral erythematous plaques and pustules on her forearms, which had initially been treated with steroids for presumed eczema. Histology showed spherical spore-like bodies with internal morula-like septation, which were positive for periodic-acid–Schiff (PAS) staining, consistent with cutaneous protothecosis. Definitive treatment with oral itraconazole resulted in resolution of the lesions.
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British Association of Dermatologists’ national audit on nonmelanoma skin cancer excision, 2014
Summary
Background
Diagnosis and management of nonmelanoma skin cancer (NMSC) represents a large part of the dermatology workload, and complete excision is a required surgical standard for treatment.
Aim
To conduct an audit of the surgical practice for the treatment of NMSC by dermatologists in the UK.
Methods
Data on 10 consecutive nonmicrographic excisions of nonmelanoma skin cancer by UK dermatologists. Data collected included site, preoperative diagnosis, histological diagnosis, proximity to previous scars, and histological deep and peripheral margins.
Results
A total of 227 responses from 135 centres reported 2739 excisions. Excisions on the head and neck accounted for 58.3% of cases. Tumour diameter (mean ± SD) was 10.61 ± 6.9 mm (maximum 130 mm), and 96.7% of cases were primary excisions, with 3.3% being re-excisions. Basal cell carcinomas (BCCs) accounted for 79.1% (n = 2167) of the total cases and squamous cell carcinomas (SCCs) for 17.9% n = 491). Of the suspected BCCs and SCCS, 94.4% (n = 2045) and 66.8% (328), respectively, were confirmed histologically to be the respective carcinomas. Similar proportions of BCC and SCC cases were within 10 mm of a previous excision. Lateral and deep margins were clear in 98.3% and 99.2% of BCC cases, respectively, and in 98.4% and 97.1% of SCC cases, respectively. Reported surgical complication rate in the audit was 3.4%.
Conclusions
The majority of excisions for NMSC are for BCC and SCC. Our figures for diagnostic accuracy are at the upper range of previously published figures. Most patients were not followed up in secondary care, hence complication rates may be under-reported.
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Three-dimensional evaluation of subclinical extension of extramammary Paget's disease: Visualization of histological border and its comparison to clinical border
Summary
Background
In extramammary Paget's disease (EMPD), Paget cells are sometimes detected outside the clinical border (subclinical extension). The spreading pattern of Paget cells in subclinical extension, however, remains unclear. In addition, the macroscopic appearances of lesions accompanied by subclinical extension are totally unknown.
Objectives
To characterize the spreading pattern of Paget cells as well as the macroscopic appearance of lesions of EMPD with subclinical extension.
Methods
Nineteen patients with primary anogenital EMPD underwent mapping biopsies and excisional surgeries, then biopsy samples were taken at the periphery of well-demarcated lesions. Samples were transparentized and subjected to whole-mount immunostaining with anti-cytokeratin 7 antibody to label Paget cells. The histological border was evaluated in three dimensions by two-photon microscopy. The shape and location of the histological border were compared with those of the clinical border.
Results
In 21 samples taken at the lesion where subclinical extension was not shown by mapping biopsy, the shape and location of the histological border were almost identical to those of the clinical border. Two samples, however, exhibited small foci of Paget cells outside the clinical border, showing subclinically extended satellite lesions. In the two samples taken at the lesions where subclinical extension was shown by mapping biopsy, a continuous arrangement of Paget cells extending beyond the clinical border was identified. Subclinically extended Paget cells were detected solely outside hypopigmented patches with erythema.
Conclusions
In EMPD, at least two patterns of subclinical extension exist: continuous and satellite lesions. Subclinical extension might exist preferentially outside hypopigmented patches with erythema.
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Topical Photodynamic Therapy for Primary Bowen's Disease and Basal Cell Carcinoma – Optimising Patient Selection
Abstract
Topical photodynamic therapy (PDT) is widely used in the treatment of Bowen's Disease (BD) and Basal Cell Carcinoma (BCC) and is known to be effective.1,2 However there is little evidence available on the impact of patient, lesion and treatment characteristics on the effectiveness of therapy.
This article is protected by copyright. All rights reserved.
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Allelic loss in amalgam-associated oral lichenoid lesions compared to oral lichen planus and mucosa
Abstract
Background
The amalgam-associated oral lichenoid lesion (AAOLL) shows clinical and histopathological features similar to oral lichen planus (OLP). Molecular researches to improve knowledge of pathogenesis and clinical behavior of AAOLL are still scarce.
Objective
We investigated for the first time the use of LOH as a molecular approach for genetic characterization of AAOLL in comparison with OLP and evaluated the cell proliferation index.
Materials and methods
The sample comprised nine AAOLLs, 10 OLPs and eight NOMs matched by patients' gender and age. LOH was assessed using polymorphic microsatellite markers at chromosomes 9p (D9S157, D9S162, D9S171), 11q (D11S1369) and 17p (TP53, AFM238WF2). Cell proliferation was assessed by immunohistochemical expression of Ki-67 (MIB-1). The association between LOH and Ki-67 was investigated.
Results
LOH occurred in 5/9 AAOLLs and in 2/10 OLPs in at least one marker each, while NOM showed no LOH. Cell proliferation index in AAOLL ranged from 2 to 23%. There was no association between cell proliferation and LOH, independent of the marker.
Conclusion
Our study shows that the profile of molecular changes in AAOLL and OLP, evaluated by LOH and Ki-67 expression, is similar. Additional studies including larger samples should be performed to confirm or to refute our findings.
This article is protected by copyright. All rights reserved.
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Pentoxifylline – a review of its use in osteoradionecrosis
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A.J. Lyons, P.A. Brennan
Pentoxifylline has been used to treat complications related to fibrosis for over 20 years. Formerly used to treat those after radiotherapy such as osteoradionecrosis (ORN), it is now being tried for medication-related osteonecrosis of the jaw (MRONJ), which can occur after prolonged use of bisphosphonates. We review theories on the formation of fibrosis in patients with ORN, discuss the pharmacology of pentoxifylline and vitamin E, and report published outcomes. To our knowledge no prospective randomised controlled trial has investigated the benefits of these agents in cases of ORN, but reported outcomes in many published case series are encouraging.
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A patient with postpolio syndrome developed cauda equina syndrome after neuraxial anesthesia: a case report
Combined spinal anesthesia and postoperative epidural analgesia is widely used in orthopedic surgery. Uncommon but serious neurologic complications of neuraxial anesthesia (NA) include direct trauma during needle or catheter insertion, central nervous system infections, and neurotoxicity of local anesthetics. Cauda equina syndrome (CES) is a rare complication after NA but can result in severe neurologic deterioration that may require surgical intervention. We present a case of a 69-year-old woman with postpolio syndrome who developed CES after combined spinal anesthesia and postoperative epidural analgesia.
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Ovarian borderline tumors in the 2014 WHO classification: evolving concepts and diagnostic criteria
Abstract
Borderline ovarian tumors (BOT) are uncommon but not rare epithelial ovarian neoplasms, intermediate between benign and malignant categories. Since BOT were first identified >40 years ago, they have inspired controversies disproportionate to their incidence. This review discusses diagnostic criteria for the histologic subtypes of BOT, highlighting areas of diagnostic challenges, ongoing controversies, and changes in terminology implemented by the recent 2014 WHO Classification of Tumours of the Female Genital Organs. Emerging knowledge supports the notion that subtypes of borderline ovarian tumors comprise distinct biologic, pathogenetic, and molecular entities, precluding a single unifying concept for BOT. Serous borderline tumors (SBT) share molecular and genetic alterations with low-grade serous carcinomas and can present at higher stages with peritoneal implants and/or lymph node involvement, which validates their borderline malignant potential. All other (non-serous) subtypes of BOT commonly present at stage I confined to the ovary(ies) and are associated with overall survival approaching that of the general population. An important change in the WHO 2014 classification is the new terminology of non-invasive implants associated with SBT, as any invasive foci (previously called "invasive implants") are now in line with their biological behavior considered peritoneal low-grade serous carcinoma (LGSC). The controversy regarding the terminology of non-serous borderline tumors, called by some pathologists "atypical proliferative tumor" in view of their largely benign behavior, has not been resolved. The concepts of intraepithelial carcinoma and microinvasion may evolve in further studies, as their presence appears to have no prognostic impact and is subject to considerable inter-observer variability.
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Cathepsin S inhibition changes regulatory T-cell activity in regulating bladder cancer and immune cell proliferation and apoptosis
Source:Molecular Immunology, Volume 82
Author(s): Xiang Yan, Chun Wu, Tao Chen, Marcela M. Santos, Cong-Lin Liu, Chongzhe Yang, Lijun Zhang, Jingyuan Ren, Sha Liao, Hongqiang Guo, Galina K. Sukhova, Guo-Ping Shi
Regulatory T cells (Tregs) are immune suppressive cells, but their roles in tumor growth have been elusive, depending on tumor type or site. Our prior study demonstrated a role of cathepsin S (CatS) in reducing Treg immunosuppressive activity. Therefore, CatS inhibition in Tregs may exacerbate tumor growth. Using mouse bladder carcinoma MB49 cell subcutaneous implant tumor model, we detected no difference in tumor growth, whether mice were given saline- or CatS inhibitor-treated Tregs. However, mice that received inhibitor-treated Tregs had fewer splenic and tumor Tregs, and lower levels of tumor and splenic cell proliferation than mice that received saline-treated Tregs. In vitro, inhibitor-treated Tregs showed lower proliferation and higher apoptosis than saline-treated Tregs when cells were exposed to MB49. In contrast, both types of Tregs showed no difference in proliferation when they were co-cultured with normal splenocytes. Inhibitor-treated Tregs had less apoptosis in splenocytes, but more apoptosis in splenocytes with MB49 conditioned media than saline-treated Tregs. In turn, we detected less proliferation and more apoptosis of MB94 cells after co-culture with inhibitor-treated Tregs, compared with saline-treated Tregs. B220+ B-cell, CD4+ T-cell, and CD8+ T-cell proliferation and apoptosis were also lower in splenocytes co-cultured with inhibitor-treated Tregs than with saline-treated Tregs. Under the same conditions, the addition of cancer cell-conditioned media greatly increased CD8+ T-cell proliferation and reduced CD8+ T-cell apoptosis. These observations suggest that CatS inhibition of Tregs may reduce overall T-cell immunity under normal conditions, but enhance CD8+ T-cell immunity in the presence of cancer cells.
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Streptococcus gordonii induces nitric oxide production through its lipoproteins stimulating Toll-like receptor 2 in murine macrophages
Source:Molecular Immunology, Volume 82
Author(s): Hyun Young Kim, Jung Eun Baik, Ki Bum Ahn, Ho Seong Seo, Cheol-Heui Yun, Seung Hyun Han
Streptococcus gordonii, a Gram-positive commensal in the oral cavity, is an opportunistic pathogen that can cause endodontic and systemic infections resulting in infective endocarditis. Lipoteichoic acid (LTA) and lipoprotein are major virulence factors of Gram-positive bacteria that are preferentially recognized by Toll-like receptor 2 (TLR2) on immune cells. In the present study, we investigated the effect of S. gordonii LTA and lipoprotein on the production of the representative inflammatory mediator nitric oxide (NO) by the mouse macrophages. Heat-killed S. gordonii wild-type and an LTA-deficient mutant (ΔltaS) but not a lipoprotein-deficient mutant (Δlgt) induced NO production in mouse primary macrophages and the cell line, RAW 264.7. S. gordonii wild-type and ΔltaS also induced the expression of inducible NO synthase (iNOS) at the mRNA and protein levels. In contrast, the Δlgt mutant showed little effect under the same condition. Furthermore, S. gordonii wild-type and ΔltaS induced NF-κB activation, STAT1 phosphorylation, and IFN-β expression, which are important for the induction of iNOS gene expression, with little activation by Δlgt. S. gordonii wild-type and ΔltaS showed an increased adherence and internalization to RAW 264.7 cells compared to Δlgt. In addition, S. gordonii wild-type and ΔltaS, but not Δlgt, substantially increased TLR2 activation while none of these induced NO production in TLR2-deficient macrophages. Triton X-114-extracted lipoproteins from S. gordonii were sufficient to induce NO production. Collectively, we suggest that lipoprotein is an essential cell wall component of S. gordonii to induce NO production in macrophages through TLR2 triggering NF-κB and STAT1 activation.
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Editorial Board/ Publication Information
Source:Molecular Immunology, Volume 81
http://ift.tt/2hqKsW9
Revised grading system of tympanosclerosis
Publication date: Available online 27 December 2016
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Rauf Ahmad, Zafarullah Beigh, Tabish Maqbool
IntroductionTympanosclerosis (TS) is a common sequelae of chronic otitis media found in all age groups, this study was conducted to analyze the extent of tympanosclerosis in patients operated for chronic suppurative otitis media in our hospital and have intraoperative findings of tympanosclerosis.Material and method165 patients of tympanoplasty who had TS involving ossicular chain, were enrolled in our study. Pre operative air bone gap and operative findings of extent of TS involving ossicles was recorded, time required to mobilize ossicles was also recorded. Post operative air bone gap was documented after 3months of surgery.ResultThis study showed that majority of patients were females from rural area. Most of the patients had grade II tympanosclerosis followed by grade III. There was no statistically significant difference in post operative air bone gap in patients with grade I and grade II TS. Our new grading system for TS removes the overlap between various grading systems for TS developed in past.ConclusionNew grading system for TS helps us to determine time taken for mobilizing ossicular chain, type of ossiculoplasty required and outcome of tympanoplasty surgery.
http://ift.tt/2ibqNs3
Unilateral vocal cord palsy: Finding the culprit
Publication date: Available online 27 December 2016
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Shiun Chuen Chew, Hazama Mohamad, Nik Fariza Husna Nik Hassan
Unilateral vocal cord palsy after recent chicken pox or varicella zoster virus infection is indeed rare. Viral neuronitis is a self-limiting disease; with complete or partial recovery. However, any lesions, which could compress the laryngeal nerve along its course causing unilateral vocal cord palsy, should be excluded. Imaging studies; i.e. computed tomography (CT) scan should be done to address this problem. CT scans enable us to image the entire course of the laryngeal nerve as well as any lesion in the mediastinum which could compress on it.
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Photoprotection in specific populations: Children and people of color
Improved education on appropriate photoprotection in children is vital. Photoprotection for these individuals should include seeking shade, the use of physical agents (clothing, hat, sunglasses), and application of sunscreens on exposed areas. Avoidance of the use of tanning beds is an important component of education for teenagers. Ultraviolet radiation exposure induces DNA damage and photoaging in all skin types, including people of color. The extent of such damage is inversely related to constitutive skin pigmentation.
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Ultraviolet radiation and the skin: Photobiology and sunscreen photoprotection
The efficacy of sunscreens can be measured by different methods, involving in vitro, ex vivo, or in vivo techniques. There is a need for a worldwide standardization of these methods to avoid misunderstanding and confusion among sunscreen users. The clinical benefits of sunscreens have been demonstrated in randomized controlled trials that established the role of sunscreens in the prevention of actinic keratoses, squamous cell carcinomas, nevi, and melanomas. Sunscreens also prevent photoimmunosuppression and signs of photoaging.
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Current challenges in photoprotection
Electromagnetic radiation in the ultraviolet, visible, and infrared ranges all produce biologic effects. Ultraviolet filters are the most well-studied photoprotective measure for the adverse effects of ultraviolet radiation. Because of the reported endocrinologic effects of oxybenzone in animal studies, its effects on coral reefs, and its photocontact allergy potential, its use has been minimized in many countries worldwide. New developments in topical antioxidants and oral and subcutaneous agents (eg, Polypodium leucotomos extract, afamelanotide, nicotinamide) with photoprotective and antiphotocarcinogenic properties could potentially provide addition modalities for protection against the effects of visible light and infrared radiation.
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Clinical Thyroidology High-Impact Articles
FREE ACCESS through January 9, 2017.
Read Now:
Lateral Lymph-Node Dissection for Papillary Thyroid Cancer Should Be Limited to Clinically Positive Compartments
Masha J. Livhits, Michael W. Yeh
RAI Dosimetry Does Not Improve Survival As Compared with Empiric Doses of 131I for RAI-avid Metastatic Thyroid Cancer
Jerome M. Hershman
Radiofrequency Ablation Is a Treatment Option for Low-Risk Papillary Thyroid Microcarcinoma
Wendy Sacks
The post Clinical Thyroidology High-Impact Articles appeared first on American Thyroid Association.
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Omega 3: a novel treatment agent in oral submucous fibrosis: A pilot study
Abstract
Background
Oral submucous fibrosis (OSF) is a chronic debilitating disease and a premalignant condition of the oral cavity. It is well known for its impervious nature to medical therapy. Omega 3 polyunsaturated fatty acids have been reported to have anti inflammatory properties. However, its role in OSF is still not known. This preliminary study assessed the efficacy of systemic omega 3 in this disease.
Methods
A randomized single blinded controlled trial was designed and a total of 10 clinically confirmed adult patients of OSF were included in the study. Group A was given biweekly intralesional injections of dexamethasone 1.5ml & Hyaluronidase 1500 IU mixed with lignocaine for 6 weeks & a placebo for 3 months. Group B was also given similar intralesional injections but with 1 gm of omega 3 three times daily continuously for 3 months. Patients were followed every month for 3 months and then after 6 months.
Results
Significant improvement was noted among all clinical parameters (interincisal distance, tongue protrusion, cheek flexibility and visual analogue scale) in both the groups. Intergroup comparison showed significant reduction of burning sensation in group B i.e. i.e. p value was 0.005 while improvement in rest three clinical features was not statistically significant.
Conclusion
Omega 3 can be used as an adjunctive treatment option in patients of OSF to reduce subjective symptoms. More studies should be conducted with a larger sample size to study the effect of omega 3 in OSF patients.
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Challenges in photoprotection: Introduction
The biologic effects of ultraviolet radiation (UVR), which range from erythema, tanning, and photoaging to photocarcinogenesis, are well known to dermatologists and photobiologists. In the past few years, visible light has been shown to induce prolonged tanning response in dark-skinned individuals, which may contribute to melasma and postinflammatory hyperpigmentation frequently seen in these individuals.1 Furthermore, generation of cyclobutane-pyrimidine dimers has been shown to occur even after exposure to UVR has ended2; this has been termed "dark cyclobutane-pyrimidine dimer formation," and is associated with the presence of melanin, especially pheomelanin.
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Staphylococcus aureus enterotoxin sensitization involvement and its association with the CysLTR1 variant in different asthma phenotypes
Source:Annals of Allergy, Asthma & Immunology
Author(s): Hisako Matsumoto, Yoshihiro Kanemitsu, Tadao Nagasaki, Yuji Tohda, Takahiko Horiguchi, Hideo Kita, Kazunobu Kuwabara, Keisuke Tomii, Kojiro Otsuka, Masaki Fujimura, Noriyuki Ohkura, Katsuyuki Tomita, Akihito Yokoyama, Hiroshi Ohnishi, Yasutaka Nakano, Tetsuya Oguma, Soichiro Hozawa, Yumi Izuhara, Isao Ito, Tsuyoshi Oguma, Hideki Inoue, Tomoko Tajiri, Toshiyuki Iwata, Junya Ono, Shoichiro Ohta, Tomomitsu Hirota, Takahisa Kawaguchi, Mayumi Tamari, Tetsuji Yokoyama, Yasuharu Tabara, Fumihiko Matsuda, Kenji Izuhara, Akio Niimi, Michiaki Mishima
BackgroundSensitization to Staphylococcus aureus enterotoxin (SE) is a known risk factor for asthma susceptibility and severity. However, how SE sensitization is involved in asthma, particularly nonatopic asthma and/or late-onset asthma, remains uncertain.ObjectiveTo clarify the involvement of SE sensitization in nonatopic and/or late-onset asthma and its association with a polymorphism of the cysteinyl leukotriene receptor 1 gene (CysLTR1), which was examined because CysLT signaling is closely associated with late-onset eosinophilic asthma.MethodsWe assessed associations between sensitization to SE (A and/or B) and clinical indexes in 224 patients with asthma (mean age, 62.3 years; 171 women) from a cohort of the Kinki Hokuriku Airway Disease Conference, particularly those with nonatopic asthma (not sensitized to common aeroallergens) and/or late-onset asthma. Associations between SE sensitization and CysLTR1 polymorphism (rs2806489), a potential regulatory variant for atopic predisposition in women, were also assessed in a sex-stratified manner.ResultsA total of 105 patients (47%) with asthma were sensitized to SE. Among patients with nonatopic asthma (n = 67) or with late-onset asthma (n = 124), those sensitized to SE had significantly higher serum total IgE and periostin levels than those not sensitized. In nonatopic patients, a rapid decrease in forced expiratory volume in 1 second was associated with SE sensitization. In women with asthma, rs2806489 was associated with sensitization to SEB and age at asthma onset.ConclusionSE sensitization contributes to TH2 inflammation in nonatopic and/or late-onset asthma. In women with asthma, the CysLTR1 variant might be associated with sensitization to SEB and age at asthma onset.
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A randomized clinical trial of a culturally responsive intervention for African American women with asthma
Source:Annals of Allergy, Asthma & Immunology
Author(s): Minal R. Patel, Peter X.K. Song, Georgiana Sanders, Belinda Nelson, Elena Kaltsas, Lara J. Thomas, Mary R. Janevic, Kausar Hafeez, Wen Wang, Margaret Wilkin, Timothy R. Johnson, Randall W. Brown
BackgroundFew interventions have focused on the difficulties that African American women face when managing asthma.ObjectiveTo evaluate a telephone-based self-regulation intervention that emphasized African American women's management of asthma in a series of 6 sessions.MethodsA total of 422 African American women with persistent asthma were randomly assigned to either an intervention or control group receiving usual care. Behavioral factors, symptoms and asthma control, asthma-related quality of life, and health care use at baseline and 2 years after baseline were assessed. Generalized estimating equations were used to assess the long-term effect of the intervention on outcomes.ResultsCompared with the control group, those who completed the full intervention (6 sessions) had significant gains in self-regulation of their asthma (B estimate, 0.73; 95% CI, 0.17–1.30; P < .01), noticing changes to their asthma during their menstrual cycle (B estimate, 1.42; 95% CI, 0.69–2.15; P < .001), and when having premenstrual syndrome (B estimate, 1.70; 95% CI, 0.67–2.72; P < .001). They also had significant reductions in daytime symptoms (B estimate, −0.15; 95% CI, −0.27 to −0.03; P < .01), asthma-related hospitalization (B estimate, 0.51; 95% CI, 0.00–1.02; P < .05), and improved asthma control (B estimate, 1.34; 95% CI, 0.57–2.12; P < .001). However, neither grouped changed over time in outcomes.ConclusionDespite high comorbidity, African American women who completed a culturally responsive self-management program had improvements in asthma outcomes compared with the control group. Future work should address significant comorbidities and psychosocial issues alongside asthma management to improve asthma outcomes in the long term.Trial Registrationclinicaltrials.gov Identifier NCT01117805.
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Breast milk poly unsaturated fatty acids: associations with adolescent allergic disease and lung function
Abstract
Background
It has been hypothesised that n-3 PUFA in breast-milk may assist immune and lung development. There are very limited data on possible long-term effects on allergic disease and lung function. The aim was to investigate associations of n-3 and n-6 PUFA levels in colostrum and breast milk with allergic disease and lung function at ages 12 and 18 years.
Method
PUFAs were measured in 194 colostrum samples and in 118 three month expressed breast milk samples from mothers of children enrolled in the Melbourne Atopy Cohort (MACS) Study, a high risk birth cohort study. Associations with allergic diseases, skin prick tests and lung function assessed at 12 and 18 years were estimated using multivariable regression.
Results
Higher levels of n-3 but not n-6 PUFAs in colostrum were associated with a trend towards increased odds of allergic diseases, with strong associations observed for allergic rhinitis at 12 (OR=5.69[ 95%CI: 1.83,17.60] per weight%) and 18 years (4.43[1.46,13.39]) and eczema at 18 years (9.89[ 1.44, 68.49]). Higher levels of colostrum n-3 PUFAs were associated with reduced sensitisation (3.37[1.18, 9.6]), mean FEV1 (-166ml [-332, -1]) and FEV1/FVC ratio (-4.6%, [-8.1,-1.1]) at 12 years.
Conclusion
Higher levels of colostrum n-3 PUFAs were associated with increased risks of allergic rhinitis and eczema up to 18 years, and sensitisation and reduced lung function at 12 years. As residual confounding may have caused these associations, they should be replicated, but these results could indicate that strategies that increase maternal n-3 PUFA intake may not aid in allergic disease prevention.
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Shellfish allergens: tropomyosin and beyond
Abstract
IgE-mediated shellfish allergy constitutes an important cause of food-related adverse reactions. Shellfish are classified into molluscs and crustaceans, the latter belonging to the class of arthropoda. Among crustaceans, shrimps are the most predominant cause of allergic reactions and thus more extensively studied. Several major and minor allergens have been identified and cloned. Amongst them invertebrate tropomyosin, arginine kinase, myosin light chain, sarcoplasmic calcium-binding protein and hemocyanin are the most relevant. This review summarizes our current knowledge about these allergens.
This article is protected by copyright. All rights reserved.
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Transoral laser microsurgery for T1b glottic cancer: review of 51 cases
Abstract
For the treatment of T1b glottic carcinoma, different treatment options, such as transoral laser microsurgery, open surgical techniques, and primary radiotherapy, are under discussion. In this context, the aim of the present study was to describe oncologic results and complication rates of transoral laser microsurgery in treatment of T1b glottic carcinoma. This is a retrospective unicenter chart review of patients treated at an academic tertiary referral center between 1986 and 2006. Fifty-one previously untreated T1b cases were exclusively treated by transoral laser microsurgery and included into this study, 47 were male, and 4 were female. The main outcome measures included local control rate and complications, overall, disease specific, and recurrence-free survival. The median follow-up period was 98 months. The 5-year local control rate was 90.2%; larynx preservation rate was 92.2%. No intra- or postoperative complications, such as wound infections, postoperative bleeding, hematoma, edema, and fistula development, were observed. A single patient required revision surgery due to synechia. Five-year survival rates were: overall 84.7%, disease specific 97.7%, and recurrence free 72.4%. Our data support the conclusion that transoral laser microsurgery is a considerable treatment option in T1b glottic carcinoma. The oncologic outcome was at least comparable to other treatment options, while the perioperative morbidity and complication rate were lower.
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Editorial Board Page
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 1
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Table of Contents
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 1
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AAOMS Author Disclosure forms
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 1
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The Use of Sequential VEGF- and BMP2-Releasing Biodegradable Scaffolds in Rabbit Mandibular Defects
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 1
Author(s): Nilüfer Çakır-Özkan, Sinan Eğri, Esengül Bekar, B. Zuhal Altunkaynak, Yonca Betil Kabak, Elfide Gizem Kıvrak
PurposePromising developments have materialized in reconstructive surgical procedures with the applications of tissue engineering. In our study, we used tissue scaffolds fabricated from polylactic acid-polyethylene glycol (PLLA-PEG) copolymers to ensure different release rates of selective growth factors recombinant human bone morphogenetic protein 2 [rhBMP-2] and vascular endothelial growth factor (rhVEGF165) in the repair of mandibular bone defects.Materials and MethodsIn our experimental study, 54 New Zealand rabbits were used. The rabbits were separated into 4 groups: group I (control group), PLLA-PEG scaffold only; group II, PLLA-PEG scaffold plus rhBMP-2 application; group III, PLLA-PEG scaffold plus VEGF165 application; and group IV, PLLA-PEG scaffold plus rhBMP-2 and VEGF165 applications. The rabbits were killed at 4 and 8 weeks postoperatively, and histopathologic and immunohistochemical assessments were performed.ResultsThe greatest bone volume was observed in rhBMP-2–containing groups, the greatest vessel volume was observed in VEGF165-containing groups; however, the scaffold containing rhBMP-2 and VEGF165 provided the best outcomes in conjunction with increased remodeling of the new bone.ConclusionsThe use of polymer tissue scaffolds that release rhVEGF165 and rhBMP-2 in coordination and mimic the natural healing process in the regeneration of especially complex tissues, such as bone, is a promising treatment alternative in the field of reconstructive surgery.
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Notice to Contributors
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 1
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Implant Dentistry: Growing Our Opportunities
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 1
Author(s): James R. Hupp
http://ift.tt/2iAa4Sh
Masthead
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 1
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Periodontally Accelerated Osteogenic Orthodontics
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 1
Author(s): John H. Campbell
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Virtual Reconstructive Surgical Planning
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 1
Author(s): Eric R. Carlson
http://ift.tt/2hkAjXG
Improved Temporomandibular Joint Position After 3-Dimensional Planned Mandibular Reconstruction
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 1
Author(s): Rajendra Sawh-Martinez, Yassmin Parsaei, Robin Wu, Alexander Lin, Philipp Metzler, Christopher DeSesa, Derek M. Steinbacher
PurposeVirtual surgical planning (VSP) using computer-aided design and manufacturing (CAD-CAM) has been reported to aid in craniofacial reconstruction. The reported improvements have been related mainly to operative performance, with limited evaluations of the position and function of the temporomandibular joint (TMJ). This study analyzed the radiographic detail of postoperative outcomes related to the TMJ.Materials and MethodsPatients who underwent mandibular reconstruction with and without VSP were analyzed. All patients underwent preoperative computed tomography (CT) of their mandible. In the VSP group, CAD-CAM planning was performed preoperatively using CT Digital Imaging and Communications in Medicine (DICOM) data. Postoperative CT images from the 2 groups were quantitatively compared to evaluate the TMJ. CT images were digitized for 2- and 3-dimensional analysis using surgical planning software (Materialise, Leuven, Belgium). Anatomic landmarks and cephalometric relations were analyzed.ResultsSixteen patients who underwent traditional planning or VSP for mandibular reconstruction were compared. Two groups (n = 8 each) were compared for positioning of the mandibular condyle in the glenoid fossa. Measurements of superior, anterior, and lateral movements were comparable in the pre- and postoperative groups for the traditional and VSP groups (P < .001 by analysis of variance). Subgroup analysis evaluating ipsilateral changes in the mandibular condyle position for traditional planning versus VSP noted decreased percentages of change in superior (22 vs 10%; P < .05), anterior (32 vs 15%; P < .05), and lateral (7 vs 1%, P < .01) shifts of the condyle for left mandibular reconstructions (n = 8). Ipsilateral right mandibular reconstructions (n = 6) showed changes in superior (62 vs 15%; P < .05) and anterior (5 vs 9%; not significant) shifts.ConclusionThese data showed comparable pre- and postoperative positions of the TMJ for traditional and VSP mandibular reconstructions. Evaluation of condyle movements showed differences in the ipsilateral position in the pre- and postoperative groups. VSP resulted in decreased superior and lateral shifts of the ipsilateral condyle and decreased changes in the condylar and condylar neck angles. This work shows that VSP can lead to increased precision in reconstruction leading to preserved normative anatomic relations.
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Use of Vancomycin-Impregnated Calcium Sulfate in the Treatment of Osteomyelitis of the Jaw
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 1
Author(s): Hai-Jiang Sun, Lei Xue, Chuan-Bin Wu, Qing Zhou
PurposeThe aim of this study was to describe the effect of vancomycin-impregnated calcium sulfate in the treatment of osteomyelitis of the jaw.Materials and MethodsTwelve patients who were diagnosed with osteomyelitis of the jaw underwent treatment with vancomycin-impregnated calcium sulfate since July 2014 at the Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University (Shenyang, China). All patients underwent debridement of nonviable bone and implantation of vancomycin-impregnated calcium sulfate. The wounds were covered with an acellular dermal matrix and sutured.ResultsTen patients had satisfactory wound healing. However, 2 cases of maxillary central osteomyelitis had delayed wound healing. The wounds healed after the surgical site was resutured under local anesthesia. At 3 months, the panoramic radiograph showed that most implants had been reabsorbed and replaced by new bone formation. All patients in this study had no recurrence of infection at 6 to 18 months (mean, 10.8 months) of follow-up.ConclusionsThe use of vancomycin-impregnated calcium sulfate in the surgical debridement site for chronic osteomyelitis of the jaw has shown encouraging results. In addition, calcium sulfate can promote the formation of new bone to a certain extent.
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Cone-Beam Computed Tomography Findings in the Early Diagnosis of Calcified Atheromas
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 1
Author(s): Artur Dos Santos Soares, Ana Márcia Viana Wanzeler, Maria Daniela Oliveria Renda, Cláudia Gemaque Marinho, Fabrício Mesquita Tuji
PurposeComputed tomograms of the mandibles of 285 patients with indications for dental implants were evaluated at a private clinic.Materials and MethodsThis study involved the evaluation of 285 cone-beam computed tomograms of patients 50 to 75 years of age who were referred to the clinic for the evaluation for implant placement images with visible C3 and C5 vertebrae that were obtained using the same I-Cat tomographic device (Imaging Sciences-Kavo, Hatfield, PA). Atheromas in the carotid space were visualized using paraxial images.ResultsData were analyzed using Student t and χ2 tests, with a significance level of a P value less than or equal to .05. Atheromas in the carotid space were observed in 17.89% of patients; a significant difference in the incidence of atheromas was observed between men (24.27%) and women (14.29%; P = .034). However, no significant correlation was found between the frequency of occurrence of atheromas and the affected side of the carotid bifurcation (right or left) in women (P = .431) or men (P = .558).ConclusionBased on these results, cone-beam computed tomography could be a useful tool for the diagnosis of atheroma.
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The Influence of the Mandibular Gonial Angle on the Incidence of Mandibular Angle Fracture—A Radiomorphometric Study
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 1
Author(s): Elavenil Panneerselvam, Pooja J. Prasad, Sasikala Balasubramaniam, Shanmugasundaram Somasundaram, Krishnakumar V.B. Raja, Dilip Srinivasan
PurposeThe aim of this radiomorphometric study was to analyze the association between the mandibular gonial angle and the risk of mandibular angle fracture.Materials and MethodsA retrospective analysis of medical records and radiographs of patients treated for mandibular fractures was performed. The exposure studied was the presence of a high gonial angle and the outcome was fracture of the mandibular angle. The mandibular gonial angle and mandibular height at the angle were measured using Facad software (Ilexis AB, Linköping, Sweden). Data obtained were analyzed using SPSS 16 (IBM Corp, Armonk, NY).ResultsThe study sample was comprised of 210 mandibular fractures (70 mandibular angle fractures and 140 non-angle fractures). The mean gonial angle in patients with mandibular angle fractures was 126.8 ± 7.9°, which was 4.5° larger than in patients with other mandibular fractures (P = .0001). Patients with a high gonial angle were 11.77 times more likely to sustain an angle fracture than those with normal or low gonial angles (adjusted odds ratio = 11.77; 95% confidence interval, 3.65-37.94; P < .001). There also was a statistically significant decrease in mandibular height at the angle in patients with a high gonial angle (P = .0001).ConclusionThis study shows that people with a high gonial angle are at an increased risk for angle fracture and presents the related clinical implications.
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Syndrome hémorragique sous cobimétinib : vigilance avec les nouveaux anticoagulants
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A. Le Guern, D. Lebas, E.-M. Thillard, C. Martincic, T. Wiart, P. Modiano
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Stroke-like onset of brain stem degeneration presents with unique MRI sign and heterozygous NMNAT2 variant: a case report
Background: Acute-onset neurodegenerative diseases in older patients are rare clinical cases, especially when the degeneration only affects specific regions of the nervous system. Several neurological disorders have been described in which the degeneration of brain parenchyma originates from and/or primarily affects the brain stem. Clinical diagnosis in these patients, however, is often complicated due to a poor understanding of these diseases and their underlying mechanisms.Case presentationIn this manuscript we report on a 73-year-old female who had experienced a sudden onset of complex neurological symptoms that progressively worsened over a period of 2 years. Original evaluation had suggested a MRI-negative stroke as underlying pathogenesis. The combination of patient's medical history, clinical examination and exceptional pattern of brain stem degeneration presenting as "kissing swan sign" in MR imaging was strongly suggestive of acute onset of Alexander's disease. This leukoencephalopathy is caused by GFAP (glial fibrilary acidic protein) gene mutations and may present with brain stem atrophy and stroke-like onset of symptoms in elderly individuals. However, a pathognomonic GFAP gene mutation could not be identified by Sanger sequencing. Conclusions: After an extended differential diagnosis and exclusion of other diseases, a definite diagnosis of the patient's condition presently remains elusive. However, whole-exome sequencing performed from patient's blood revealed 12 potentially disease-causative heterozygous variants, amongst which several have been associated with neurological disorders in vitro and in vivo – in particular the axon degeneration-related NMNAT2 gene.
http://ift.tt/2hJRqD8
Stroke-like onset of brain stem degeneration presents with unique MRI sign and heterozygous NMNAT2 variant: a case report
Background: Acute-onset neurodegenerative diseases in older patients are rare clinical cases, especially when the degeneration only affects specific regions of the nervous system. Several neurological disorders have been described in which the degeneration of brain parenchyma originates from and/or primarily affects the brain stem. Clinical diagnosis in these patients, however, is often complicated due to a poor understanding of these diseases and their underlying mechanisms.Case presentationIn this manuscript we report on a 73-year-old female who had experienced a sudden onset of complex neurological symptoms that progressively worsened over a period of 2 years. Original evaluation had suggested a MRI-negative stroke as underlying pathogenesis. The combination of patient's medical history, clinical examination and exceptional pattern of brain stem degeneration presenting as "kissing swan sign" in MR imaging was strongly suggestive of acute onset of Alexander's disease. This leukoencephalopathy is caused by GFAP (glial fibrilary acidic protein) gene mutations and may present with brain stem atrophy and stroke-like onset of symptoms in elderly individuals. However, a pathognomonic GFAP gene mutation could not be identified by Sanger sequencing. Conclusions: After an extended differential diagnosis and exclusion of other diseases, a definite diagnosis of the patient's condition presently remains elusive. However, whole-exome sequencing performed from patient's blood revealed 12 potentially disease-causative heterozygous variants, amongst which several have been associated with neurological disorders in vitro and in vivo – in particular the axon degeneration-related NMNAT2 gene.
http://ift.tt/2hJRqD8
CUDC-907 Treatment in People With Metastatic and Locally Advanced Thyroid Cancer
Intervention: Drug: CUDC-907
Sponsor: National Cancer Institute (NCI)
Not yet recruiting - verified December 2016
http://ift.tt/2iaGa3Y
A Study of Nasopharyngeal Carcinoma From Guangdong
Intervention:
Sponsor: Sun Yat-sen University
Not yet recruiting - verified December 2016
http://ift.tt/2hpVvi1
Audiological profile of patients treated for childhood cancer
Publication date: November–December 2016
Source:Brazilian Journal of Otorhinolaryngology, Volume 82, Issue 6
Author(s): Patricia Helena Pecora Liberman, Maria Valéria Schmidt Goffi-Gomez, Christiane Schultz, Paulo Eduardo Novaes, Luiz Fernando Lopes
ObjectiveTo characterize the hearing loss after cancer treatment, according to the type of treatment, with identification of predictive factors.MethodsTwo hundred patients who had cancer in childhood were prospectively evaluated. The mean age at diagnosis was 6 years, and at the audiometric assessment, 21 years. The treatment of the participants included chemotherapy without using platinum derivatives or head and neck radiotherapy in 51 patients; chemotherapy using cisplatin without radiotherapy in 64 patients; head and neck radiotherapy without cisplatin in 75 patients; and a combined treatment of head and neck radiotherapy and chemotherapy with cisplatin in ten patients. Patients underwent audiological assessment, including pure tone audiometry, speech audiometry, and immittancemetry.ResultsThe treatment involving chemotherapy with cisplatin caused 41.9% and 47.3% hearing loss in the right and left ear, respectively, with a 11.7-fold higher risk of hearing loss in the right ear and 17.6-fold higher in the left ear versus patients not treated with cisplatin (p<0.001 and p<0.001, respectively). Children whose cancer diagnosis occurred after the age of 6 have shown an increased risk of hearing loss vs. children whose diagnosis occurred under 6 years of age (p=0.02).ConclusionThe auditory feature found after the cancer treatment was a symmetrical bilateral sensorineural hearing loss. Chemotherapy with cisplatin proved to be a risk factor, while head and neck radiotherapy was not critical for the occurrence of hearing loss.
http://ift.tt/1qqmhZ2
Stroke-like onset of brain stem degeneration presents with unique MRI sign and heterozygous NMNAT2 variant: a case report
Background: Acute-onset neurodegenerative diseases in older patients are rare clinical cases, especially when the degeneration only affects specific regions of the nervous system. Several neurological disorders have been described in which the degeneration of brain parenchyma originates from and/or primarily affects the brain stem. Clinical diagnosis in these patients, however, is often complicated due to a poor understanding of these diseases and their underlying mechanisms.Case presentationIn this manuscript we report on a 73-year-old female who had experienced a sudden onset of complex neurological symptoms that progressively worsened over a period of 2 years. Original evaluation had suggested a MRI-negative stroke as underlying pathogenesis. The combination of patient's medical history, clinical examination and exceptional pattern of brain stem degeneration presenting as "kissing swan sign" in MR imaging was strongly suggestive of acute onset of Alexander's disease. This leukoencephalopathy is caused by GFAP (glial fibrilary acidic protein) gene mutations and may present with brain stem atrophy and stroke-like onset of symptoms in elderly individuals. However, a pathognomonic GFAP gene mutation could not be identified by Sanger sequencing. Conclusions: After an extended differential diagnosis and exclusion of other diseases, a definite diagnosis of the patient's condition presently remains elusive. However, whole-exome sequencing performed from patient's blood revealed 12 potentially disease-causative heterozygous variants, amongst which several have been associated with neurological disorders in vitro and in vivo – in particular the axon degeneration-related NMNAT2 gene.
http://ift.tt/2hJRqD8
Stroke-like onset of brain stem degeneration presents with unique MRI sign and heterozygous NMNAT2 variant: a case report
Background: Acute-onset neurodegenerative diseases in older patients are rare clinical cases, especially when the degeneration only affects specific regions of the nervous system. Several neurological disorders have been described in which the degeneration of brain parenchyma originates from and/or primarily affects the brain stem. Clinical diagnosis in these patients, however, is often complicated due to a poor understanding of these diseases and their underlying mechanisms.Case presentationIn this manuscript we report on a 73-year-old female who had experienced a sudden onset of complex neurological symptoms that progressively worsened over a period of 2 years. Original evaluation had suggested a MRI-negative stroke as underlying pathogenesis. The combination of patient's medical history, clinical examination and exceptional pattern of brain stem degeneration presenting as "kissing swan sign" in MR imaging was strongly suggestive of acute onset of Alexander's disease. This leukoencephalopathy is caused by GFAP (glial fibrilary acidic protein) gene mutations and may present with brain stem atrophy and stroke-like onset of symptoms in elderly individuals. However, a pathognomonic GFAP gene mutation could not be identified by Sanger sequencing. Conclusions: After an extended differential diagnosis and exclusion of other diseases, a definite diagnosis of the patient's condition presently remains elusive. However, whole-exome sequencing performed from patient's blood revealed 12 potentially disease-causative heterozygous variants, amongst which several have been associated with neurological disorders in vitro and in vivo – in particular the axon degeneration-related NMNAT2 gene.
http://ift.tt/2hJRqD8
Stroke-like onset of brain stem degeneration presents with unique MRI sign and heterozygous NMNAT2 variant: a case report
Background: Acute-onset neurodegenerative diseases in older patients are rare clinical cases, especially when the degeneration only affects specific regions of the nervous system. Several neurological disorders have been described in which the degeneration of brain parenchyma originates from and/or primarily affects the brain stem. Clinical diagnosis in these patients, however, is often complicated due to a poor understanding of these diseases and their underlying mechanisms.Case presentationIn this manuscript we report on a 73-year-old female who had experienced a sudden onset of complex neurological symptoms that progressively worsened over a period of 2 years. Original evaluation had suggested a MRI-negative stroke as underlying pathogenesis. The combination of patient's medical history, clinical examination and exceptional pattern of brain stem degeneration presenting as "kissing swan sign" in MR imaging was strongly suggestive of acute onset of Alexander's disease. This leukoencephalopathy is caused by GFAP (glial fibrilary acidic protein) gene mutations and may present with brain stem atrophy and stroke-like onset of symptoms in elderly individuals. However, a pathognomonic GFAP gene mutation could not be identified by Sanger sequencing. Conclusions: After an extended differential diagnosis and exclusion of other diseases, a definite diagnosis of the patient's condition presently remains elusive. However, whole-exome sequencing performed from patient's blood revealed 12 potentially disease-causative heterozygous variants, amongst which several have been associated with neurological disorders in vitro and in vivo – in particular the axon degeneration-related NMNAT2 gene.
http://ift.tt/2hJRqD8
Stroke-like onset of brain stem degeneration presents with unique MRI sign and heterozygous NMNAT2 variant: a case report
Background: Acute-onset neurodegenerative diseases in older patients are rare clinical cases, especially when the degeneration only affects specific regions of the nervous system. Several neurological disorders have been described in which the degeneration of brain parenchyma originates from and/or primarily affects the brain stem. Clinical diagnosis in these patients, however, is often complicated due to a poor understanding of these diseases and their underlying mechanisms.Case presentationIn this manuscript we report on a 73-year-old female who had experienced a sudden onset of complex neurological symptoms that progressively worsened over a period of 2 years. Original evaluation had suggested a MRI-negative stroke as underlying pathogenesis. The combination of patient's medical history, clinical examination and exceptional pattern of brain stem degeneration presenting as "kissing swan sign" in MR imaging was strongly suggestive of acute onset of Alexander's disease. This leukoencephalopathy is caused by GFAP (glial fibrilary acidic protein) gene mutations and may present with brain stem atrophy and stroke-like onset of symptoms in elderly individuals. However, a pathognomonic GFAP gene mutation could not be identified by Sanger sequencing. Conclusions: After an extended differential diagnosis and exclusion of other diseases, a definite diagnosis of the patient's condition presently remains elusive. However, whole-exome sequencing performed from patient's blood revealed 12 potentially disease-causative heterozygous variants, amongst which several have been associated with neurological disorders in vitro and in vivo – in particular the axon degeneration-related NMNAT2 gene.
http://ift.tt/2hJRqD8
Stroke-like onset of brain stem degeneration presents with unique MRI sign and heterozygous NMNAT2 variant: a case report
Background: Acute-onset neurodegenerative diseases in older patients are rare clinical cases, especially when the degeneration only affects specific regions of the nervous system. Several neurological disorders have been described in which the degeneration of brain parenchyma originates from and/or primarily affects the brain stem. Clinical diagnosis in these patients, however, is often complicated due to a poor understanding of these diseases and their underlying mechanisms.Case presentationIn this manuscript we report on a 73-year-old female who had experienced a sudden onset of complex neurological symptoms that progressively worsened over a period of 2 years. Original evaluation had suggested a MRI-negative stroke as underlying pathogenesis. The combination of patient's medical history, clinical examination and exceptional pattern of brain stem degeneration presenting as "kissing swan sign" in MR imaging was strongly suggestive of acute onset of Alexander's disease. This leukoencephalopathy is caused by GFAP (glial fibrilary acidic protein) gene mutations and may present with brain stem atrophy and stroke-like onset of symptoms in elderly individuals. However, a pathognomonic GFAP gene mutation could not be identified by Sanger sequencing. Conclusions: After an extended differential diagnosis and exclusion of other diseases, a definite diagnosis of the patient's condition presently remains elusive. However, whole-exome sequencing performed from patient's blood revealed 12 potentially disease-causative heterozygous variants, amongst which several have been associated with neurological disorders in vitro and in vivo – in particular the axon degeneration-related NMNAT2 gene.
http://ift.tt/2hJRqD8
Nasal Unit Transplantation
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Stability of delayed impulsive stochastic differential equations driven by a fractional Brown motion with time-varying delay
We study the stability problem of mild solutions of impulsive stochastic differential equations driven by a fractional Brown motion with finite time-varying delay. The Hurst parameter H of the fractional Brown motion belongs to ( 1 2 , 1 ) . In terms of fractional power of operators and semigroup theory, we obtain sufficient conditions that guarantee the stability of the mild solution of such a equation in two cases: the impulse depends on current states of the system and the impulse depends not only on current states but also on historical states of the system. We give two examples illustrating the theorems.
http://ift.tt/2imZV8b
What is frugal innovation? Three defining criteria
Recently, the innovation management literature has witnessed a rising interest in the so-called frugal innovation. The term was initially discussed in the context of emerging markets, giving non-affluent customers opportunities to consume affordable products and services suited to their needs. However, the meaning of frugal innovation is fuzzy. Further, the increasing appearance of frugal innovation in developed markets challenges earlier definitions that often characterised frugal innovation particularly in the context of emerging markets. So far, it has not been clear what differentiates frugal innovation from other innovation types. Thus, we need criteria that make it possible to determine what frugal innovation is and what is not. In order to determine a clear definition, we choose a multimethod approach, conduct a literature review, and interview 45 managers from companies and researchers from different research institutes. On the basis of the results, we define three criteria for frugal innovation: substantial cost reduction, concentration on core functionalities, and optimised performance level. We contribute to the literature by refining the meaning of frugal innovation. We also enable organisations to better deal with the challenge of developing frugal innovation in both emerging and developed markets.
http://ift.tt/2iyJSat
Stability of delayed impulsive stochastic differential equations driven by a fractional Brown motion with time-varying delay
We study the stability problem of mild solutions of impulsive stochastic differential equations driven by a fractional Brown motion with finite time-varying delay. The Hurst parameter H of the fractional Brown motion belongs to ( 1 2 , 1 ) . In terms of fractional power of operators and semigroup theory, we obtain sufficient conditions that guarantee the stability of the mild solution of such a equation in two cases: the impulse depends on current states of the system and the impulse depends not only on current states but also on historical states of the system. We give two examples illustrating the theorems.
http://ift.tt/2imZV8b
What is frugal innovation? Three defining criteria
Recently, the innovation management literature has witnessed a rising interest in the so-called frugal innovation. The term was initially discussed in the context of emerging markets, giving non-affluent customers opportunities to consume affordable products and services suited to their needs. However, the meaning of frugal innovation is fuzzy. Further, the increasing appearance of frugal innovation in developed markets challenges earlier definitions that often characterised frugal innovation particularly in the context of emerging markets. So far, it has not been clear what differentiates frugal innovation from other innovation types. Thus, we need criteria that make it possible to determine what frugal innovation is and what is not. In order to determine a clear definition, we choose a multimethod approach, conduct a literature review, and interview 45 managers from companies and researchers from different research institutes. On the basis of the results, we define three criteria for frugal innovation: substantial cost reduction, concentration on core functionalities, and optimised performance level. We contribute to the literature by refining the meaning of frugal innovation. We also enable organisations to better deal with the challenge of developing frugal innovation in both emerging and developed markets.
http://ift.tt/2iyJSat
When prescribing ceftriaxone, cotrimoxazole and clarithromycin in children, paediatricians should definitely be aware of their potential risk of liver injury, even if for short periods.
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Stability of delayed impulsive stochastic differential equations driven by a fractional Brown motion with time-varying delay
We study the stability problem of mild solutions of impulsive stochastic differential equations driven by a fractional Brown motion with finite time-varying delay. The Hurst parameter H of the fractional Brown motion belongs to ( 1 2 , 1 ) . In terms of fractional power of operators and semigroup theory, we obtain sufficient conditions that guarantee the stability of the mild solution of such a equation in two cases: the impulse depends on current states of the system and the impulse depends not only on current states but also on historical states of the system. We give two examples illustrating the theorems.
http://ift.tt/2imZV8b
What is frugal innovation? Three defining criteria
Recently, the innovation management literature has witnessed a rising interest in the so-called frugal innovation. The term was initially discussed in the context of emerging markets, giving non-affluent customers opportunities to consume affordable products and services suited to their needs. However, the meaning of frugal innovation is fuzzy. Further, the increasing appearance of frugal innovation in developed markets challenges earlier definitions that often characterised frugal innovation particularly in the context of emerging markets. So far, it has not been clear what differentiates frugal innovation from other innovation types. Thus, we need criteria that make it possible to determine what frugal innovation is and what is not. In order to determine a clear definition, we choose a multimethod approach, conduct a literature review, and interview 45 managers from companies and researchers from different research institutes. On the basis of the results, we define three criteria for frugal innovation: substantial cost reduction, concentration on core functionalities, and optimised performance level. We contribute to the literature by refining the meaning of frugal innovation. We also enable organisations to better deal with the challenge of developing frugal innovation in both emerging and developed markets.
http://ift.tt/2iyJSat
Case of late-onset erythropoietic protoporphyria with myelodysplastic syndrome who has homozygous IVS3-48C polymorphism in the ferrochelatase gene
Abstract
We report the case of a 42-year-old man with a 5-year history of myelodysplastic syndrome and photosensitivity who had developed painful erythema and blisters on sun-exposed sites. Histological examination of a mildly lichenified lesion on the dorsal finger revealed extensive deposits of a hyaline-like, periodic acid-Schiff-positive material around superficial dermal blood vessels. Laboratory tests showed elevated erythrocyte protoporphyrin and normal urinary porphyrins, suggesting a diagnosis of erythropoietic protoporphyria. Late-onset erythropoietic protoporphyria is rare and is usually associated with an acquired somatic mutation of the ferrochelatase gene secondary to a hematological malignancy such as myelodysplastic syndrome. DNA analysis revealed that our patient has the homozygous IVS3-48C polymorphism that is a low-expression variant of wild-type ferrochelatase allele.
http://ift.tt/2izYja5
Clinical features of Korean patients with rhinophyma
Abstract
Rhinophyma results from hyperplasia of the sebaceous glands and connective tissue. Clinical features in Asian rhinophyma patients are largely underreported. In this study, we aimed to evaluate the clinical features of rhinophyma in Korean patients. We reviewed clinical photos and medical records of 39 Korean patients diagnosed with rhinophyma and assessed the severity and clinical course by using the classical National Rosacea Society index. The male : female ratio was 6.8:1, and over 90% of the patients were older than 40 years. The mild-grade rhinophyma was the most dominant (46.1%), followed by the moderate (41.0%) and severe (12.8%) grades. Disease progression to severe grade occurred over an average of 8.2 years. Furthermore, 70% of all cases revealed lesion distribution limited to the nose. As disease severity progressed to higher grades, the extent of nasal involvement increased (Pearson correlation coefficient, 0.685). Rhinophyma is a slowly progressing disease showing male predominance unrelated to specific trigger factors. In many cases, this disease often exclusively affects the nose in Asian patients.
http://ift.tt/2i2UZHt
Positive correlation of vanilloid receptor subtype1 and prostaglandin E2 expression with pain in leiomyomas
Abstract
Cutaneous leiomyomas are benign smooth muscle tumors that are occasionally painful. The mechanism of pain related to leiomyoma is not fully understood. To investigate the possible involvement of algoneic factors in pain from cutaneous leiomyomas. We present a case of cutaneous leiomyoma with severe, diffused pain in a large area and collected 10 more specimens of cutaneous leiomyoma with or without pain in patient histories. We immunohistochemiacally examined the expression of algoneic factors: serotonin, histamin, Substance P, PGE2, BDKRB2, VR1 and CGRP. We compared the pain area and expression of algoneic factors to reveal possible correlations. We describe here a patient with a cutaneous leiomyoma 1-cm in diameter, which caused severe pain diffused throughout an area of 20-cm around the tumor. The pain completely resolved after surgical excision of the leiomyoma. We observed that the leiomyoma cells expressed CGRP, PGE2 and VR1 in this case. We found a positive correlation between VR1 and PGE2 expression in the leiomyoma cells and areas with pain around the tumors among 11 specimens in total. VR1 and PGE2 might be key algogenic substances in painful leiomyoma.
http://ift.tt/2izZUwN
Severe Rhabdomyolysis as Complication of Interaction between Atorvastatin and Fusidic Acid in a Patient in Lifelong Antibiotic Prophylaxis: A Dangerous Combination
Atorvastatin and HMG-CoA reductase inhibitors are the most frequently used medication in the world due to very few adverse toxic side effects. One potentially life threatening adverse effect is caused by clinically significant statin induced rhabdomyolysis, either independently or in combination with fusidic acid. The patient in our case who previously had cardiac insufficiency, atrial fibrillation, and thoracic aorta aneurysm and was treated with insertion of an endovascular metallic stent in the aorta is presented in the report. He had an inoperable aortitis with an infected stent and para-aortic abscesses with no identified microorganism. The patient responded well to empirical antibiotic treatment with combination therapy of fusidic acid and moxifloxacin. This treatment was planned as a lifelong prophylactic treatment. The patient had been treated with atorvastatin for several years. He developed severe rhabdomyolysis when he was started on fusidic acid and moxifloxacin. The patient made a fast recovery after termination of treatment with atorvastatin and fusidic acid. We here report a life threatening complication of rhabdomyolysis that physicians must be aware of. This can happen either in atorvastatin monotherapy or as a complication of pharmacokinetic interaction between atorvastatin and fusidic acid.
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Orthodontic camouflage versus orthognathic surgery for class III deformity: comparative cephalometric analysis
Publication date: Available online 26 December 2016
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): P. Martinez, C. Bellot-Arcís, J.M. Llamas, R. Cibrian, J.L. Gandia, V. Paredes-Gallardo
The objective of this study was to compare different cephalometric variables in adult patients with class III malocclusions before and after treatment, in order to determine which variables are indicative of orthodontic camouflage or orthognathic surgery. The cases of 156 adult patients were assessed: 77 treated with orthodontic camouflage and 79 treated with orthodontics and orthognathic surgery. The following cephalometric variables were measured on pre-treatment (T1) and post-treatment (T2) lateral cephalograms: sella–nasion–A-point (SNA), sella–nasion–B-point (SNB), and A-point–nasion–B-point (ANB) angles, Wits appraisal, facial axis angle, mandibular plane angle, upper and lower incisor inclination, and inter-incisal angle. There were statistically significant differences in cephalometric variables before and after treatment between the two groups. The percentage of normal pre-treatment measurements in the camouflage orthodontics group was 30.7%, which worsened slightly to 28.4% post-treatment. However in the group receiving surgery, this was 24.5% pre-treatment, improving to 33.5% after surgery. SNA, SNB, Wits appraisal, lower incisor inclination, and inter-incisal angle showed differences between the two groups before and after treatment. Wits appraisal, lower incisor inclination, and inter-incisal angle were indicative of one or other treatment. Upper and lower incisor decompensation in both groups did not reach ideal values, which impeded complete skeletal correction in 52% of surgical cases.
http://ift.tt/2izmeKP
Day-case otological surgery
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A. Uziel
The author reviews day-case otological surgery, which has become increasingly popular in France and all over the world over recent years. Ear surgery is particularly suitable for short-stay admission because of the rapidity of these procedures and possibilities of pain control. This article discusses the advantages of this mode of management (for the patient, the surgeon and the healthcare institution), organizational and safety constraints, and ineligibility criteria. Day-case otological surgery should now become the rule rather than an opportunity.
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Vagal and recurrent laryngeal nerves neuromonitoring during thyroidectomy and parathyroidectomy: A prospective study
Publication date: Available online 27 December 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): N. Julien, E. Ferrary, A. Sokoloff, G. Lamas, O. Sterkers, D. Bernadeschi
ObjectivesThe aim of the study was to stimulate the vagal and the recurrent laryngeal nerves during and after thyroidectomy or parathyroidectomy, to record muscle responses, interpret the electrophysiological modifications and identify prognostic factors for postoperative vocal fold mobility.Patients and methodsA prospective study monitored 151 vagal nerves and 144 recurrent laryngeal nerves in 114 patients. Seven patients (14 vagal nerves) underwent continuous monitoring via an automatic periodic stimulation (APS®) electrode. In 15 patients (21 vagal nerves), the stimulation threshold was studied. Muscle response was recorded on direct vagal and/or recurrent laryngeal nerve stimulation by a monopolar electrode or direct repeated stimulation via an electrode on the vagal nerve. In case of signal attenuation on the first operated side, surgery was not extended to the contralateral side.ResultsThe vagal nerve stimulation checked inferior laryngeal nerve integrity and recurrent status, without risk of false negatives. The vagal nerve stimulation threshold, before and after dissection, that induced a muscle response of at least 100μV ranged from 0.1 to 0.8mA. Similarity between pre- and post-dissection responses to supramaximal stimulation, defined as 1mA, on the one hand, and between post-dissection vagal and laryngeal recurrent nerve responses on the other correlated with normal postoperative vocal cord mobility. Conversely, muscle response attenuation below 100μV and increased latency indicated a risk of vocal fold palsy.ConclusionVagal nerve stimulation allows suspicion or elimination of lesions on the inferior laryngeal nerve upstream of the stimulation point and detection of non-recurrent inferior laryngeal nerve. Intermittent monitoring assesses nerve function at the moment of stimulation, while continuous monitoring detects the first signs of nerve injury liable to induce postoperative recurrent nerve palsy. When total thyroidectomy is indicated, signal attenuation on the first operated side casts doubt on continuing surgery to the contralateral side in the same step.
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Real-life efficacy of volumetric modulated arc therapy in head and neck squamous cell carcinoma
Publication date: Available online 27 December 2016
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): C. Moncharmont, A. Vallard, J.-B. Guy, J.-M. Prades, C. Rancoule, N. Magné
ObjectivesThere is paucity of data on the efficacy of volumetric modulated arc therapy (VMAT) in head and neck squamous cell carcinoma (HNSCC). The objective of the present study was to investigate outcomes and patterns of recurrence in locally advanced HNSCC treated by VMAT.MethodsA retrospective study included all patients with stage III or IV HNSCC undergoing curative VMAT.ResultsFrom 2010 to 2013, 130 patients were treated for locally advanced oropharynx (n=55; 42%), hypopharynx (n=38; 29%), larynx (n=22; 17%) or oral cavity (n=15; 12%) SCC. Median age was 60 years (range, 39–85). Median follow-up was 18.1 months (range, 0–43.7). By end of follow-up, 60 patients (46%) had died. Two-year progression-free and overall survival were respectively 63.6% and 77.3% for laryngeal tumors, 60% and 60% for oral cavity tumors, 52.6% and 57.6% for oropharyngeal tumors, and 38.8% and 54.7% for hypopharyngeal tumors. Most recurrences were located within or marginal to radiation therapy fields.ConclusionThis retrospective analysis is, to our knowledge, the largest study of the efficacy of VMAT in HNSCC. Recurrence patterns and outcomes were consistent with those previously reported for intensity-modulated radiotherapy.
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Preclinical evaluation of Luffa operculata Cogn. and its main active principle in the treatment of bacterial rhinosinusitis
Publication date: Available online 26 December 2016
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Leonardo Silva, Henrique Olival Costa, Flávia Coelho de Souza, Elaine Monteiro Cardoso Lopes, Suely Mitoi Ykko Ueda
IntroductionThe prevalence of rhino sinusitis is quite high. Despite the widespread use of antibiotics for rhino sinusitis, there are other forms of treatment, including phytotherapy. One of the most widely used herbal medicines for treatment of rhino sinusitis is Luffa operculata.ObjectiveThis study aimed to evaluate the efficacy of topical nasal solution of the aqueous extract of L. operculata, determining the toxicity to its use and identifying the active principles presented in the aqueous extract. The secondary objective was to evaluate the action of active principles on bacteria commonly involved in acute rhino sinusitis.MethodsThe study was conducted in experimental model of sinusitis. Three different concentrations of L. operculata were used as local treatment of rhino sinusitis. The results were compared with those observed in control groups that received nasal saline solution. Histological examination of the liver, kidney, spleen, myocardium, brain and lungs of all animals evaluated the toxicity of L. operculata. The aqueous extract used was subjected to chromatographic analysis and an active principle was isolated and tested for in vitro inhibition of bacterial colonies usually found in rhino sinusitis.ResultsIntranasal treatment of sinusitis with L. operculata showed better clinical evolution than control group. Statistically significant difference (p>0.10) between the treated group and the control group was observed in the histologic evaluation for inflammatory pattern. The aqueous extract of L. operculata used presented a predominance of 2,3-dicafeoilglicaric acid, a substance not yet described in the literature. There was a significant difference in bacterial growth of Streptococcus pyogenes on blood-agar plates when under the influence of both the aqueous extract and the active substance.ConclusionTopical nasal solution of the aqueous extract of L. operculata is effective compared to the application of saline solution for the treatment of bacterial rhino sinusitis in an experimental model. L. operculata determined in vitro inhibition of growth of S. pyogenes.
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