Purpose of review: In this review, we discuss current thinking in relation to available guidelines for the care of preschool-aged children with recurrent wheezing, while highlighting the gaps in our knowledge and discussing changes that could occur over the next 5 years. Recent findings: The Asthma Predictive Index as well as allergen-specific IgE, peripheral eosinophil count and exhaled nitric oxide are perhaps underutilized sources of information that can assist in predicting progression to asthma and response to therapies. Inhaled corticosteroids and leukotriene receptor antagonists decrease impairment and exacerbation frequency in wheezing children but are not disease modifying. Macrolides may be useful during acute wheezing episodes for preventing progression to more severe symptoms. Monoclonal antibodies targeting IgE and TH2 cytokines have been successful in trials of adults and older children with asthma, but trials in younger children are needed. Summary: Establishing the phenotype and endotype of young wheezing children can be useful for prognostication of future asthma risk as well as for selection of the most appropriate treatment. Primary asthma prevention strategies are needed during the critical developmental window in early life prior to the onset of irrecoverable loss of lung function. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2jT6uyW
Δευτέρα 16 Ιανουαρίου 2017
Application of autologous hematopoietic stem cell transplantation for pemphigus
Abstract
Background
Pemphigus is a rare and fatal autoimmune disease for which the treatment options are limited. This study aimed to evaluate the efficacy of autologous peripheral hematopoietic stem cell transplantation (APHSCT) for pemphigus.
Methods
We conducted APHSCT for 12 pemphigus patients (seven males and five females, mean age 23.8 years) with life-threatening complications or who responded poorly to conventional therapy. Peripheral blood stem cells were mobilized with cyclophosphamide, granulocyte colony-stimulating factor, and rituximab, and purified autologous CD34+ stem cells were infused. Overall survival rate, progression-free survival, and adverse events were recorded.
Results
With a mean follow-up period of 80.3 months, overall survival and complete clinical remission rates were 92% (11/12) and 75% (9/12), respectively. Adverse effects included pyrexia, allergy, infection, and elevation of enzymes. Only one patient died of severe sepsis and multiple organ failure 2 months after APHSCT.
Conclusion
Overall APHSCT is a promising therapeutic option for pemphigus.
http://ift.tt/2jr3LAk
Tumor necrosis factor alpha gene promoter −238G/A polymorphism increases the risk of psoriasis vulgaris in Indian patients
Abstract
Background
Tumor necrosis factor alpha (TNFα) gene −238G/A polymorphism (rs361525) is associated with psoriasis in several populations worldwide. To the best of our knowledge, there is no information about this polymorphism in Indian psoriatic patients. This study was undertaken to fill the gap in knowledge.
Methods
This case–control study involved 72 patients with psoriasis vulgaris (PsV) and 72 age and gender matched healthy individuals. TNFα −238G/A polymorphism was genotyped by PCR-RFLP method.
Results
TNFα −238A allele was 5 times commoner in PsV patients than in the control group (P = 4.1 × 10−7; odds ratio [OR] = 6.5 [0.95 CI: 2.9–14.6]). Distribution of the genotypes in the two groups showed statistically significant difference in dominant genetic model (P = 2.3 × 10−7) and not in recessive genetic model (P = 2.5 × 10−1). Odds ratio for the occurrence of −238A genotype in PsV patients was 8.8 (0.95 CI: 3.5–20.2). The association showed no major difference when PsV patients were subgrouped into type I and type II categories and tested separately. Subgroup analysis on the basis of disease severity showed higher association with the moderate-severe subgroup (P = 2.4 × 10−9, OR 15.4 [0.95 CI: 5.8–41.0]) than with mild subgroup (P = 1.3 × 10−2, OR 3.8 [0.95 CI: 1.3–10.9]).
Conclusions
Our results indicate that TNFα gene −238G/A polymorphism increases the risk of developing psoriasis vulgaris among Indians. Also, the data show that severity and not the type affects the strength of association in this population.
http://ift.tt/2jr3OMu
Knowledge about, attitude toward, and practice of skin lightening products use and its social correlates among university students in five Association of Southeast Asian Nations (ASEAN) countries
Abstract
Background
The aim of this study was to investigate the knowledge about, attitude toward, and use of skin lightening products (SLP) and its social and psychological correlates among university students from five Association of Southeast Asian Nations (ASEAN) countries.
Methods
In a cross sectional survey, 3259 undergraduate university students (Mean age = 20.5 years, SD = 1.6) from five ASEAN countries responded to an anonymous questionnaire. Multivariate logistic regression analysis was used to identify associations between sociodemographic characteristics, knowledge, attitude, poor mental health, and SLP use.
Results
Overall, 79.1% of the students were aware that the use of SLP can harm the skin, and 30.1% knew the active ingredients of SLP. Most students had a positive perception of having a lighter skin tone and SLP. Overall, the prevalence of SLP use over the past 12 months was 30.7%, 16.7% of male, and 30.0% of female students, ranging from 13.4% in Myanmar to 69.4% in Thailand. In multivariate logistic regression analysis, among women, older age, coming from a poorer family, residing in an upper middle income country, awareness of active skin lightening ingredients, and poor mental health were associated with SLP, while among men, not aware of the negative effects of SLP and awareness of active skin lightening ingredients and poor mental health were associated with SLP use.
Conclusion
A high prevalence of SLP use was found in a large sample of ASEAN university students, and several social and mental health-related risk factors were found that may help in guiding interventions.
http://ift.tt/2jTdc8j
Intermediate outcomes of a transcutaneous bone conduction hearing device in a paediatric population
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Panagiotis A. Dimitriadis, Suzanne Carrick, Jaydip Ray
ObjectiveThe aim of this study was to review the outcomes of Bone Anchored Hearing Aid (BAHA®) Attract implantation in a cohort of paediatric patients.MethodsProspective data collection and case review were undertaken in apaediatric tertiary referral centre. We have included patients under the age of 16 years with unilateral or bilateral hearing loss that met the criteria for BAHA® Attract implantation. The main outcome measures were surgical complications and Patient Reported Outcomes including the 'Speech, Spatial and Qualities of Hearing scale' (SSQ-12) and 'Qualitative Feedback for BAHA® 5 Hearing Aids'.ResultsTwenty-five paediatric patients were implanted with the BAHA® Attract between June 2014 and July 2016. Nine of them had a conversion from a percutaneous Bone Conduction Hearing Device (BCHD). Four children had minor skin problems that settled with conservative measures. Two children with a previous percutaneous BCHD developed skin dehiscence over the magnet after conversion to the transcutaneous version. The SSQ-12 was completed by 6 children and an improvement of 22% was noted between the unaided and aided condition. The patients and their parents were generally satisfied with the BAHA® Attract.ConclusionsThe BAHA® Attract offers a good solution for hearing rehabilitation in appropriately selected and counseled patients. The complication rate was low for primary surgery but higher in cases of conversion from a percutaneous device. Large, prospective data is needed to evaluate the relative risks and benefits of this BCHD.
http://ift.tt/2iwo1kp
Early childhood otitis media and later school performance – A prospective cohort study of associations
Publication date: Available online 16 January 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Vincent Fougner, Asbjørn Kørvel-Hanquist, Anders Koch, Jesper Dammeyer, Janni Niclasen, Jørgen Lous, Preben Homøe
IntroductionOtitis media (OM) is a common disease in childhood and hearing loss (HL) is the most common complication. Prolonged HL may lead to language delay and cognitive difficulties. However, the consequences of HL due to OM are not fully understood.The aim of this study was to determine the possible association between number of OM episodes in childhood and self-rated school performance controlling for potential confounders.MethodsProspectively gathered systematic interview data on OM episodes in early childhood and school performance at 11 years of age were obtained from The Danish National Birth Cohort, involving >100 000 individual pregnancies and their offspring. We defined four exposure groups (0, 1–3, 4–6 and ≥7 OM episodes) and assessed general school performance, mathematics and literacy. Possible confounders were recognized à priori and associations were determined using proportional odds regression.ResultsOut of 94 745 successful pregnancies, 35,946 children without malformations and their parents completed a questionnaire at age 11 years. No associations were observed between number of OM episodes and school performance, even in children with ≥7 OM episodes.ConclusionThis national birth-cohort study did not support the hypothesis that the number of OM episodes in childhood is associated with reduced self-reported school performance in children at 11 years of age.
http://ift.tt/2jiY5WD
The Temporoparietal Fascia Flap for Coverage of Cochlear Reimplantation Following Extrusion
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Kaveh Karimnejad, Asad Shahab Akhter, Scott Gregory Walen, Anthony Alan Mikulec
The management of cochlear implant extrusion (CIE) can be challenging, particularly in the pediatric population in whom reconstructive options are limited. We describe the use of the temporoparietal fascia flap (TPFF) for this purpose due to its ease of use and limited morbidity. We present a case series of two pediatric patients who underwent explantation of their devices, followed by reimplantation with TPFF coverage. Our experience provides evidence that the TPFF can be used to prevent further CIE through a postauricular incision following cochlear reimplantation with successful long-term results.
http://ift.tt/2iwqA5W
The effects of cochlear implantation on vestibular function in 1–4 years old children
Publication date: Available online 16 January 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Mohammad Ajalloueyan, Masoumeh Saeedi, Mohammad Sadeghi, Farzaneh Zamiri
ObjectivesAlthough cochlear implants offer an effective hearing restoration option in children with severe to profound hearing loss, concern continues to exist regarding the possible effects of cochlear implantation on the vestibular system and balance.MethodsIn a prospective cohort study, 27 children with bilateral profound hearing loss (all candidates for cochlear implantation) were evaluated for their vestibular function before and after cochlear implantation. Vestibular evaluations consisted of Vestibular Evoked Myogenic Potentials, caloric testing and the Head-Impulse Test.ResultsMean age at the time of cochlear implantation was 27.19 months. Without considering vestibular evaluation results, one of the ears was selected for surgery. Vestibular tests after surgery were not indicative of any statistically significant change in vestibular system or balance.ConclusionThis limited data shows that cochlear implantation did not impair the vestibular system of these patients. By the results of our study we may conclude that round window implantation does not have any disturbing impact on vestibular function in children. The generalization of this result needs further research.
http://ift.tt/2iwuhbM
Bromodomain and Extraterminal Protein Inhibitor JQ1 Suppresses Thyroid Tumor Growth
http://ssccancermelanoma.blogspot.com/2017/01/bromodomain-and-extraterminal-protein_16.html
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
16 novel mutations in PNPLA1 in patients with autosomal recessive congenital ichthyosis reveal the importance of an extended patatin domain in PNPLA1 that is essential for proper human skin barrier function
Abstract
Background
Autosomal recessive congenital ichthyosis (ARCI) is a genetically heterogeneous group of rare Mendelian skin disorders characterized by cornification and differentiation defects of keratinocytes. Mutations in nine genes including PNPLA1 are known to cause non-syndromic forms of ARCI. To date, only ten distinct pathogenic mutations in PNPLA1 have been reported.
Objectives
To identify new causative PNPLA1 mutations, we screened genetically unresolved cases including our ARCI collection comprising more than 700 families. Here, we report on 16 novel mutations present in patients from 17 families.
Methods
The screening for mutations was performed either by direct Sanger sequencing or in combination with a multi gene panel, followed by sequence and mutation analysis.
Results
While all previously reported mutations and most of our novel mutations are located within the core patatin domain, here we report on five novel PNPLA1 mutations, which are downstream of this domain. Thus, as recently described for PNPLA2, we hypothesize that a region larger than core domain is required for full enzymatic activity of PNPLA1 in human skin barrier formation.
Conclusions
We estimate the frequency of PNPLA1 mutations amongst ARCI patients to around 3%. Most of our patients were born as collodion babies and showed a relatively mild ichthyosis phenotype. In four unrelated patients we observed a cyclic scaling course, which seems to be a potential phenotype variation in a small percentage of patients with PNPLA1 mutations.
The variability of the clinical manifestations as well as the lack of typical clinical features are specific for patients with PNPLA1 mutations, and emphasize the importance of DNA sequencing for differential diagnosis of ARCIs.
This article is protected by copyright. All rights reserved.
http://ift.tt/2jZurJf
IL-15-deficient mice develop enhanced allergic responses to airway allergen exposure
Abstract
Background
Interleukin-15 is a pleiotropic cytokine that is critical for the development and survival of multiple hematopoietic lineages. Mice lacking IL-15 have selective defects in populations of several pro-allergic immune cells including natural killer (NK) cells, NKT cells, and memory CD8+T cells. We therefore hypothesized that IL-15-/- mice will have reduced inflammatory responses during the development of allergic airway disease (AAD).
Objective
To determine whether IL-15-/- mice have attenuated allergic responses in a mouse model of AAD.
Methods
C57BL/6 wild-type (WT) and IL-15-/- mice were sensitized and challenged with ovalbumin (OVA) and the development of AAD was ascertained by examining changes in airway inflammatory responses, Th2 responses, and lung histopathology.
Results
Here we report that IL-15-/- mice developed enhanced allergic responses in an OVA-induced model of AAD. In the absence of IL-15, OVA-challenged mice exhibited enhanced bronchial eosinophilic inflammation, elevated IL-13 production, and severe lung histopathology in comparison with WT mice. In addition, increased numbers of CD4+T and B cells in the spleens and broncholaveolar lavage (BAL) were also observed. Examination of OVA-challenged IL-15Rα-/- animals revealed a similar phenotype resulting in enhanced airway eosinophilia compared to WT mice. Adoptive transfer of splenic CD8+T cells from OVA-sensitized WT mice suppressed the enhancement of eosinophilia in IL-15-/- animals to levels observed in WT mice, but had no further effects.
Conclusion and Clinical Relevance
These data demonstrate that mice with an endogenous IL-15 deficiency are susceptible to the development of severe, enhanced Th2-mediated AAD, which can be regulated by CD8+T cells. Furthermore, the development of disease as well as allergen-specific Th2 responses occurs despite deficiencies in several IL-15-dependent cell types including NK, NKT, and γδ T cells, suggesting that these cells or their subsets are dispensable for the induction of AAD in IL-15-deficient mice.
This article is protected by copyright. All rights reserved.
http://ift.tt/2j3fmC4
Retro-Auricular Thyroidectomy: An Open Approach
Abstract
Distant access robot-assisted thyroidectomy has gained popularity in recent years. Adoption of distant access procedures has been limited by cost, need for specialized training and expertise. We report our preliminary clinical experience with our modification of the retro-auricular thyroidectomy approach that allows adequate exposure for thyroid lobectomy without robotic or endoscopic assistance. This is a retrospective chart review of ten patients who have undergone retro-auricular thyroidectomies in the absence of robotic or endoscopic assistance. Ten patients were identified to have undergone this procedure over an 18-month period. All patients were female with average age 36 years (range 27–52). Six were right sided and 4 were left sided procedures. The average gland size was 4.2 cm (range 3.7–6 cm). The average nodule size was 2.1 cm (range 1.1–3.5 cm). The average operative time was 91 min (range 76–114 min). All patients had benign pathology on final histopathology. There were no conversions to open cervical thyroidectomy. Two patients had vocal cord paresis that resolved spontaneously. The average postoperative follow up was 3 months (range 1–7 months). Our technique for retro-auricular thyroidectomy is a safe, reproducible, and cost effective option for remote access thyroidectomy.
http://ift.tt/2iyCV4U
Postoperative Pain in Adult Tonsillectomy: Is There Any Difference Between the Technique?
Abstract
Tonsillectomy is one of the most common surgical procedures performed worldwide. Several techniques have been developed to reduce morbidity and enhance recovery after tonsillectomy. Our study was designed to compare post-operative pain with three different techniques: cold dissection (CD), monopolar–bipolar dissection (MBD) and coblation dissection (CBD). 103 adults were scheduled for elective tonsillectomy from September 2014 to December 2015, and were randomized to CD, MBD and CBD. Post-operative pain was assessed using visual analogue scale (VAS) and Lattinen Test (LT). We did not find significant differences between the groups in the VAS pain scores (p > 0.05), except for the first day, when CBD tonsillectomy showed a higher pain score (p < 0.05). The differences in LT scores between the three techniques were not statistically significant (p > 0.05). Comparison of analgesic consumption between CD, MBD and CBD did not found any significant differences irrespective of the technique used. When first and second week after surgery were compared, differences in analgesics requirements were statistically significant (p < 0.05). Seventeen cases (16.5%) of secondary haemorrhage were reported, but there were no statistical differences in the rate of postoperative bleeding between the three groups (p > 0.05). We conclude that in our study comparison of the three techniques, CD, MBD and CBD, did not show significant differences in the post-tonsillectomy pain scores and bleeding rate.
http://ift.tt/2iDRS8S
Erratum
In the article entitled "Immunodominance in allergic T-cell reactivity to Japanese cedar in different geographic cohorts" (Ann Allergy Asthma Immunol 2016;117:680-689), acknowledgment of funding sources was inadvertently omitted from the article. Funding for the article was provided in part by ALK-Abello A/S (Horsholm, Denmark) and with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, under grant number U19 AI100275.
http://ift.tt/2jE6Dr1
Complications associated with the treatment of fractures of the dentate portion of the mandible in paediatric patients: a systematic review
This study aimed to answer the following question: What is the best treatment option for fractures of the dentate portion of the mandible in paediatric patients when considering the occurrence of postoperative complications? A systematic literature review was done using the PubMed, Scopus, and Cochrane Library databases, and 1186 articles on the topic were found. Twelve of these articles were included in the final review after the full texts had been read. A sample of 178 paediatric patients was obtained.
http://ift.tt/2iG3dp8
Endonasal septal perforation repair using posterior and inferiorly based mucosal rotation flaps
Repair of nasal septal perforations is challenging regardless of surgical technique due to their location and the health of surrounding tissue. There is currently no surgical procedure which is completely effective in the treatment of anteriorly located perforations.
http://ift.tt/2jqfSxu
Germinal centers: programmed for affinity maturation and antibody diversification
Oliver Bannard | Jason G Cyster
http://ift.tt/2j2Ix8i
DNA sensing and immune responses in cancer therapy
Jian Qiao | Haidong Tang | Yang-Xin Fu
http://ift.tt/2j2GKQJ
Früherkennung bei Brustkrebs
Zusammenfassung
Brustkrebs ist die häufigste Krebserkrankung und auch die häufigste krebsbedingte Todesursache von Frauen in Deutschland. Die Früherkennung für Frauen mit normalem Brustkrebsrisiko beginnt in Deutschland mit dem 30. Lebensjahr. Seit 2004 können Frauen zwischen 50 und 69 Jahren im Rahmen der Früherkennung an einem systematischen und bevölkerungsbezogenen Mammografiescreening teilnehmen. Dessen Nutzen und Schaden werden aktuell kontrovers diskutiert. Ergebnisse zur Mortalitätsreduktion aus dem deutschen Screeningprogramm sind erst ab 2018 zu erwarten. Zukünftig ist als Weiterentwicklung der Mammografie v. a. mit der Anwendung der Tomosynthese zu rechnen. Für Frauen mit erhöhtem Brustkrebsrisiko aufgrund entsprechender Genveränderungen (Mutationen in den BRCA1- und BRCA2-Genen) stehen ab dem 25. Lebensjahr oder 5 Jahre vor dem frühesten Erkrankungsalter der betroffenen Angehörigen intensivierte Früherkennungsmaßnahmen (Sonografie, Magnetresonanztomografie, Mammografie) zur Verfügung.
http://ift.tt/2j20BiZ
Thyroid High-Impact Articles
FREE ACCESS through January 30, 2017.
Read now:
Latest Impact Factor: 3.784
The Official Journal of: American Thyroid Association
3-Iodothyronamine Decreases Expression of Genes Involved in Iodide Metabolism in Mouse Thyroids and Inhibits Iodide Uptake in PCCL3 Thyrocytes
Nancy Schanze, Simon Friedrich Jacobi, Eddy Rijntjes, Stefan Mergler, Marta del Olmo, Carolin Stephanie Hoefig, Noushafarin Khajavi, Ina Lehmphul, Heike Biebermann, Jens Mittag, Josef Köhrle
Differences in Brain Glucose Metabolism During Preparation for 131I Ablation in Thyroid Cancer Patients: Thyroid Hormone Withdrawal Versus Recombinant Human Thyrotropin
Hyeonseok S. Jeong, Eun Kyoung Choi, In-Uk Song, Yong-An Chung, Jong-Sik Park, Jin Kyoung Oh
RAS Mutations, and RET/PTC and PAX8/PPAR-gamma Chromosomal Rearrangements Are Also Prevalent in Benign Thyroid Lesions: Implications Thereof and A Systematic Review
Alireza Najafian, Salem Noureldine, Faris Azar, Chady Atallah, Gina Trinh, Eric B. Schneider, Ralph P. Tufano, Martha A. Zeiger
Thyroglobulin Liquid Chromatography—Tandem Mass Spectrometry Has a Low Sensitivity for Detecting Structural Disease in Patients with Antithyroglobulin Antibodies
Umal Azmat, Kyle Porter, Leigha Senter, Matthew D. Ringel, Fadi Nabhan
Lessons Learned After 1000 Cases of Transcutaneous Laryngeal Ultrasound (TLUSG) with Laryngoscopic Validation: Is There a Role of TLUSG in Patients Indicated for Laryngoscopic Examination Before Thyroidectomy?
Kai-Pun Wong, Kin-Pan Au, Shi Lam, Brian Hung-Hin Lang
The post Thyroid High-Impact Articles appeared first on American Thyroid Association.
http://ift.tt/2j2hni7
Check out the ten TOP-viewed articles in 2016 for Clinical Thyroidology for the Public
1. THYROID NODULES Risk of thyroid cancer based on thyroid ultrasound findings Vol 7 Issue 1 p.6-7, Jamshid Farahiti, MD
2. HYPOTHYROIDISM Desiccated thyroid extract vs Levothyroxine in the treatment of hypothyroidism Vol 6 Issue 8 p.3, Angela M. Leung, MD, MSc
3. HYPOTHYROIDISM When is the best time to take thyroid hormone? Vol 4 Issue 5 p.7, Whitney Woodmansee, MD
4. THYROID HORMONE THERAPY Taking levothyroxine with breakfast may be fine for many patients Vol 6 Issue 11 p.4, Heather Hofflich, DO
5. THYROID CANCER High risk of thyroid cancer in patients with multinodular goiter Vol 6 Issue 11 p.6-7, Jamshid Farahiti, MD
6. THYROID AND CHOLESTEROL Does thyroid stimulating hormone (TSH) affect cholesterol levels? Vol 5 Issue 12 p.3, Angela Leung, MD
7. THYROID AND PREGNANCY First Trimester TSH levels between 2.5 and 5.0 are associated with increased pregnancy loss Vol 3 Issue 8 p.5-6, Whitney Woodmansee, MD
8. HYPERTHYROIDISM Thyroid tests on newborns within the first five days will detect neonatal hyperthyroidism Vol 7 Issue 7 p.5, Heather Hofflich, DO
9. HYPERTHYROIDISM Some patients with apparent Graves' disease do not have an autoimmune thyroid disorder Vol 7 Issue 2 p.4-5, Glenn D. Braunstein, M.D.
10. HYPOTHYROIDISM Patients with Hashimoto's thyroiditis and negative thyroid antibodies have a milder form of the disease Vol 7 Issue 9 p.10-1, Heather Hofflich, DO
The post Check out the ten TOP-viewed articles in 2016 for Clinical Thyroidology for the Public appeared first on American Thyroid Association.
http://ift.tt/2jsVueU
Commonly-used versus less commonly-used methods in the loss of resistance technique for identification of the epidural space: A systematic review and meta-analysis of randomized controlled trials
To summarize the efficacy of less-commonly used modern methods (e.g. epidrum, lidocaine, acoustic device, Macintosh balloon) compared to more commonly-used methods (i.e. air, saline, both) in the loss of resistance technique for identification of the epidural space.
http://ift.tt/2jsJKsU
Inflammatory bowel disease and cancer response due to anti-CTLA-4: is it in the flora?
Abstract
Checkpoint inhibitors blocking CTLA-4 (ipilimumab) and PD-1 (nivolumab, pembrolizumab) have transfigured our cancer treatment paradigm. However, these drugs can induce immune-related adverse events that share clinical and pathological characteristics with immune-mediated diseases. One of the most severe immune-related adverse event observed with anti-CTLA-4 is an enterocolitis that mirrors naturally occurring inflammatory bowel disease. This paper reviews the clinical, immunological, and microbiota data associated with the immune-related enterocolitis induced by the cancer immunotherapy blocking CTLA-4, ipilimumab. A parallel analysis of the mechanisms underlying inflammatory bowel diseases on the one hand, and anti-CTLA-4-induced colitis on the other hand, stresses the crucial role of the gut microbiota and of resident Treg in the genesis of both iatrogenic and spontaneous inflammatory bowel diseases.
http://ift.tt/2izJNyU
Effects of localized versus widespread TMD pain on sleep parameters in patients with bruxism: a single-night polysomnographic study.
Source:Archives of Oral Biology
Author(s): José Tadeu Tesseroli de Siqueira, Cinara Maria Camparis, Silvia Regina Siqueira, Manoel Jacobsen Teixeira, Lia Bittencourt, Sérgio Tufik
ObjectiveThe purpose of this study was to investigate whether the presence of concomitant widespread pain could influence the polysomnographic characteristics of patients with Sleep Bruxism(SB) and chronic masticatory muscle pain(TMD).Methods20 SB/TMD patients (17 women and 3 men) were evaluated according to the RDC/TMD questionnaire; and were divided into two groups according to the absence (Group A) or presence (Group B) of widespread pain. They were evaluated in a one night polysomnography paradigm.ResultsGroup B had lower sleep efficiency (p=0.034) and higher mean age (p=0.000) than Group A. Self-reported orofacial pain complaints, clinical and emotional aspects (RDC/TMD Axis I and II), and SB PSG parameters were similar in both groups; all patients had masticatory myofascial pain and the pain characteristics were bilateral location (95.0%) and tightness/pressure quality (70.0%).ConclusionsAt a single-night PSG, SB/TMD patients with widespread pain presented lower PSG sleep efficiency and higher mean age.
http://ift.tt/2iz3IOp
Effects of localized versus widespread TMD pain on sleep parameters in patients with bruxism: a single-night polysomnographic study.
Source:Archives of Oral Biology
Author(s): José Tadeu Tesseroli de Siqueira, Cinara Maria Camparis, Silvia Regina Siqueira, Manoel Jacobsen Teixeira, Lia Bittencourt, Sérgio Tufik
ObjectiveThe purpose of this study was to investigate whether the presence of concomitant widespread pain could influence the polysomnographic characteristics of patients with Sleep Bruxism(SB) and chronic masticatory muscle pain(TMD).Methods20 SB/TMD patients (17 women and 3 men) were evaluated according to the RDC/TMD questionnaire; and were divided into two groups according to the absence (Group A) or presence (Group B) of widespread pain. They were evaluated in a one night polysomnography paradigm.ResultsGroup B had lower sleep efficiency (p=0.034) and higher mean age (p=0.000) than Group A. Self-reported orofacial pain complaints, clinical and emotional aspects (RDC/TMD Axis I and II), and SB PSG parameters were similar in both groups; all patients had masticatory myofascial pain and the pain characteristics were bilateral location (95.0%) and tightness/pressure quality (70.0%).ConclusionsAt a single-night PSG, SB/TMD patients with widespread pain presented lower PSG sleep efficiency and higher mean age.
http://ift.tt/2iz3IOp
BPI-fold (BPIF) containing/plunc protein expression in human fetal major and minor salivary glands
Abstract The aim of this study was to determine expression, not previously described, of PLUNC (palate, lung, and nasal epithelium clone) (BPI-fold containing) proteins in major and minor salivary glands from very early fetal tissue to the end of the second trimester and thus gain further insight into the function of these proteins. Early fetal heads, and major and minor salivary glands were collected retrospectively and glands were classified according to morphodifferentiation stage. Expression of BPI-fold containing proteins was localized through immunohistochemistry. BPIFA2, the major BPI-fold containing protein in adult salivary glands, was detected only in the laryngeal pharynx; the lack of staining in salivary glands suggested salivary expression is either very late in development or is only in adult tissues. Early expression of BPIFA1 was seen in the trachea and nasal cavity with salivary gland expression only seen in late morphodifferentiation stages. BPIFB1 was seen in early neural tissue and at later stages in submandibular and sublingual glands. BPIFA1 is significantly expressed in early fetal oral tissue but BPIFB1 has extremely limited expression and the major salivary BPIF protein (BPIFA2) is not produced in fetal development. Further studies, with more sensitive techniques, will confirm the expression pattern and enable a better understanding of embryonic BPIF protein function.
http://ift.tt/2jh0Bwx
Effects of periodontal treatment on primary sjȫgren’s syndrome symptoms
Abstract The aim of this longitudinal prospective study was to evaluate the effects of periodontal treatment on the clinical, microbiological and immunological periodontal parameters, and on the systemic activity (ESSDAI) and subjective (ESSPRI) indexes in patients with primary Sjögren's Syndrome (pSS). Twenty-eight female patients were divided into four groups: pSS patients with or without chronic periodontitis (SCP, SC, respectively), and systemically healthy patients with or without chronic periodontitis (CP, C, respectively). Periodontal clinical examination and immunological and microbiological sample collection were performed at baseline, 30 and 90 days after nonsurgical periodontal treatment (NSPT). Levels of interleukin IL-1β, IL-8 and IL-10 in saliva and gingival crevicular fluid (GCF) were evaluated by ELISA, as well as the expression of Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans, (Aa) Tannerella forsythia (Tf), and Treponema denticola (Td), by qPCR. Systemic activity and pSS symptoms were evaluated by ESSDAI and ESSPRI. NSPT resulted in improved periodontal clinical parameters in both SCP and CP groups (p>0.05). Pg, Aa, and Tf levels decreased after NSPT only in CP patients (p<0.05). Significantly greater levels of IL-10 in GCF were verified in both SCP and CP groups (p<0.05). SCP patients showed increased salivary flow rates and decreased ESSPRI scores after NSPT. In conclusion, NSPT in pSS patients resulted in improved clinical and immunological parameters, with no significant effects on microbiological status. pSS patients also showed increased salivary flow and lower ESSPRI scores after therapy. Therefore, it can be suggested that NSPT may improve the quality of life of pSS patients.
http://ift.tt/2iucPF0
IL-6 and IL-10 gene polymorphisms in patients with aggressive periodontitis: effects on GCF, serum and clinic parameters
Abstract Genetic variations observed in cytokines affect periodontitis susceptibility. The aim of this study was to investigate interleukin(IL)-6(-174) and IL-10(-597) gene polymorphisms in generalized aggressive periodontitis (GAgP) patients. Also, we aimed to evaluate the effects of IL-6 and IL-10 gene polymorphisms on the clinical outcomes of non-surgical periodontal therapy and cytokine levels in gingival crevicular fluid(GCF) and serum. Fifty-three patients with GAgP and 50 periodontally healthy individuals were included in this study. Clinical parameters, GCF and blood samples were collected at baseline and at 6-week. Non-surgical periodontal therapy was performed in patients with GAgP. Gene analysis were determined by PCR-RFLP(polymerase chain reaction-restriction fragment length polymorphism) and cytokine levels were determined by enzyme-linked immunosorbent assay(ELISA).GAgP patients showed significant improvement on clinical parameters after periodontal therapy(p<0.05). In the GAgP group, IL-6 GG genotype and G allele frequency were higher than in the control group. GCF IL-6 level was also significantly lower at 6-week in the GAgP group. Higher GCF IL-10 levelswere observed in patients carrying the IL-6 GG genotype than in those carrying the GC+CC genotype at baseline. In conclusion, IL-6(-174) and IL-10(-597) gene polymorphisms were found to be associated with GAgP and genotype distribution did not affect the outcome of non-surgical periodontal therapy, while patients with IL-6(-174) GG genotype had higher levels of GCF IL-10 levels.
http://ift.tt/2jh0dxU
Factors for determining dental anxiety in preschool children with severe dental caries
Abstract The aim of this study was to assess the clinical and socioeconomic indicators associated with dental anxiety in preschool children with severe dental caries. A total of 100 children between 3 and 5 years of age were selected during a dental screening procedure. The selection criteria were having at least one tooth with dental caries and a visible pulpal involvement, ulceration, fistula, and abscess (PUFA) index of ≥1 in primary teeth. Before the clinical examination or any treatment procedure was performed, we evaluated the children's dental anxiety using the Facial Image Scale (FIS). Parents completed a questionnaire on socioeconomic conditions, which included the family structure, number of siblings, parental level of education, and family income. A dentist blinded to FIS and socioeconomic data performed the clinical examination. Poisson regressions associate clinical and socioeconomic conditions with the outcome. Most of the children (53%) experienced extensive dental caries (dmf-t ≥ 6), and all children had severe caries lesions, with a PUFA index of ≥1 in 41% and that of ≥2 in 59%. The multivariate adjusted model showed that older children (4–5-year old) experienced lower dental anxiety levels compared with younger children (3-year old) (RR = 0.35; 95%CI: 0.17–0.72 and RR = 0.18; 95%CI: 0.04–0.76, respectively), and children with three or more siblings were associated with higher levels of dental anxiety (RR = 2.27; 95%CI: 1.06–4.87). Older age is associated with low dental anxiety, and more number of siblings is associated with high dental anxiety in preschool children, whereas the severity or extent of dental caries is not associated with dental anxiety.
http://ift.tt/2iu84v7
Risk factors, hyposalivation and impact of xerostomia on oral health-related quality of life
Abstract To determine xerostomia-related frequency, factors, salivary flow rates and Oral Health-Related Quality of Life (OHRQoL) of patients attending the Universidad Andrés Bello Dental School Clinic, in the city of Viña del Mar, Chile. The study involved 566 patients assessed with xerostomia, based on a single standardized questionnaire. The severity and impact of xerostomia on OHRQoL was assessed using a visual analogue scale (VAS) and the short version of the Oral Health Impact Profile Questionnaire (OHIP-14sp), respectively. Stimulated and non-stimulated salivary flow rates were obtained from a sample of patients. Xerostomia was reported in 61 patients (10.8%), comprising 50 women (83.3%) and 11 men (16.7%) (p < 0.013). The prevalence was 13% among the women and 6.1% among the men. Gender, age and medication were found to be independent risk factors for the development of xerostomia. Hyposalivation was found in 10 of the 35 patients with xerostomia (28.6%) and in 2 patients without it (p < 0.011). Patients with xerostomia had a reduced OHRQoL, compared with patients without xerostomia, as shown by the total OHIP-14sp score (p < 0.001). Xerostomia was a common, potentially debilitating condition with a major impact on the OHRQoL of a patient population attending a university-based dental clinic. Hyposalivation was present in almost 30% of the patients who complained of xerostomia. It is important that general dentists be aware of this condition, so that they can provide patients with a good diagnosis, treatment and follow-up.
http://ift.tt/2jgVtbE
Maladie de Fabry
Source:Annales de Dermatologie et de Vénéréologie
Author(s): F. Stephan, R. Haber
La maladie de Fabry, ou Anderson-Fabry, ou angiokeratoma corporis diffusum universale, est une sphingolipidose de transmission liée à l'X, due à un déficit total ou partiel d'une hydrolase lysosomale, l'alpha-galactosidase A. Elle aboutit dès le plus jeune âge à une accumulation progressive ubiquitaire de glycosphingolipides non dégradés par cette enzyme. Les atteintes cutanées, neurologiques, néphrologiques, cardiaques, gastro-intestinales, ophtalmologiques, respiratoires, cochléovestibulaires et hématologiques sont responsables d'une mortalité accrue et d'une altération significative de la qualité de vie des sujets atteints. Les angiokératomes représentent la manifestation cutanée la plus fréquente mais ne sont pas spécifiques de cette maladie, et doivent être distingués des angiokératomes isolés ou associés à des maladies de système. D'autres signes cutanés rencontrés dans cette maladie incluent une hypohidrose, des lésions buccales, des œdèmes des membres inférieurs, etc. Le diagnostic est surtout clinique et doit être évoqué devant une histoire personnelle et/ou familiale évocatrice ; il est confirmé par le dosage de l'activité enzymatique au sein des leucocytes ou bien par étude moléculaire. La prise en charge est multidisciplinaire ; elle implique un traitement symptomatique et un traitement spécifique, responsables d'une amélioration à la fois de la survie et de la qualité de vie des sujets atteints. L'enzymothérapie substitutive par l'alpha-galactosidase A constitue la pierre angulaire du traitement spécifique et peut être associée à d'autres types de traitements comme le galactose et les molécules chaperonnes. La thérapie génique représente elle aussi une approche en plein essor. Actuellement, ces avancées thérapeutiques importantes, au sein desquelles le dermatologue a toute sa place, pourraient transformer le pronostic des patients atteints de la maladie de Fabry.Fabry disease, also known as Anderson-Fabry disease or angiokeratoma corporis diffusum universale, is an X-linked recessive form of sphingolipidosis caused by total or partial deficiency of the lysosomal hydrolase, alpha-galactosidase A. From the youngest age, it results in a gradual ubiquitous build-up of glycosphingolipids that are not degraded by the missing enzyme. Cutaneous, neurological, nephrologic, cardiac, gastrointestinal, ophthalmological, respiratory, cochleovestibular and haematological involvement are responsible for increased mortality and significant impairment of quality of life in subjects affected by the disease. Angiokeratomas are the most common cutaneous sign of this disease, although they are not specific to it and must be distinguished from angiokeratomas either occurring in isolation or associated with systemic diseases. Other cutaneous signs encountered in this disease include hyperhidrosis, oral lesions, lower limb oedemas, etc. The diagnosis is mainly clinical and should be considered in the presence of a personal and/or familial history; it is confirmed by assay of enzyme activity within leucocytes or by molecular studies. Management is multidisciplinary and involves symptomatic treatment as well as specific treatment, resulting in improved survival and enhanced quality of life for patients presenting the disease. Enzyme replacement therapy with alpha-galactosidase A forms the cornerstone of specific treatment and may be associated with other types of treatments such as galactose and molecular chaperones. Gene therapy is now also used extensively. At present, these marked therapeutic advances, which closely involve dermatologists, could help transform the prognosis for patients presenting Fabry disease.
http://ift.tt/2jrPnaI
LED en dermatologie
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Noé, M. Pelletier-Aouizerate, H. Cartier
L'usage dermatologique des diodes électroluminescentes (light-emitting diode [LED]) fait toujours l'objet de controverses. Cela tient autant à une méconnaissance des phases physicochimiques, d'une grande variété de dispositifs non comparables entre eux et un décalage entre les preuves irréfutables publiées portant sur l'étude in vitro ou à l'étage cellulaire et les résultats cliniques discordants, dans des indications diverses et variées : rajeunissement, acné, cicatrisation, ulcères de jambe, processus inflammatoire ou auto-immun cutané. Les LED thérapeutiques peuvent émettre des longueurs d'ondes s'étendant de l'ultraviolet au visible et jusqu'au proche infrarouge (247–1300 nm), mais seules certaines bandes ont pour l'instant montré un réel intérêt. Gageons qu'en restant factuel dans cet article les lecteurs porteront un jugement différent ou tout du moins nuancé sur ces dispositifs à diodes électroluminescentes pour leur utilisation en dermatologie.The use in dermatology of light-emitting diodes (LEDs) continues to be surrounded by controversy. This is due mainly to poor knowledge of the physicochemical phases of a wide range of devices that are difficult to compare to one another, and also to divergences between irrefutable published evidence either at the level of in vitro studies or at the cellular level, and discordant clinical results in a variety of different indications: rejuvenation, acne, wound healing, leg ulcers, and cutaneous inflammatory or autoimmune processes. Therapeutic LEDs can emit wavelengths ranging from the ultraviolet, through visible light, to the near infrared (247–1300 nm), but only certain bands have so far demonstrated any real value. We feel certain that if this article remains factual, then readers will have a different, or at least more nuanced, opinion concerning the use of such LED devices in dermatology.
http://ift.tt/2iz4ESI
Postoperative Pain in Adult Tonsillectomy: Is There Any Difference Between the Technique?
Abstract
Tonsillectomy is one of the most common surgical procedures performed worldwide. Several techniques have been developed to reduce morbidity and enhance recovery after tonsillectomy. Our study was designed to compare post-operative pain with three different techniques: cold dissection (CD), monopolar–bipolar dissection (MBD) and coblation dissection (CBD). 103 adults were scheduled for elective tonsillectomy from September 2014 to December 2015, and were randomized to CD, MBD and CBD. Post-operative pain was assessed using visual analogue scale (VAS) and Lattinen Test (LT). We did not find significant differences between the groups in the VAS pain scores (p > 0.05), except for the first day, when CBD tonsillectomy showed a higher pain score (p < 0.05). The differences in LT scores between the three techniques were not statistically significant (p > 0.05). Comparison of analgesic consumption between CD, MBD and CBD did not found any significant differences irrespective of the technique used. When first and second week after surgery were compared, differences in analgesics requirements were statistically significant (p < 0.05). Seventeen cases (16.5%) of secondary haemorrhage were reported, but there were no statistical differences in the rate of postoperative bleeding between the three groups (p > 0.05). We conclude that in our study comparison of the three techniques, CD, MBD and CBD, did not show significant differences in the post-tonsillectomy pain scores and bleeding rate.
http://ift.tt/2iDRS8S
Retro-Auricular Thyroidectomy: An Open Approach
Abstract
Distant access robot-assisted thyroidectomy has gained popularity in recent years. Adoption of distant access procedures has been limited by cost, need for specialized training and expertise. We report our preliminary clinical experience with our modification of the retro-auricular thyroidectomy approach that allows adequate exposure for thyroid lobectomy without robotic or endoscopic assistance. This is a retrospective chart review of ten patients who have undergone retro-auricular thyroidectomies in the absence of robotic or endoscopic assistance. Ten patients were identified to have undergone this procedure over an 18-month period. All patients were female with average age 36 years (range 27–52). Six were right sided and 4 were left sided procedures. The average gland size was 4.2 cm (range 3.7–6 cm). The average nodule size was 2.1 cm (range 1.1–3.5 cm). The average operative time was 91 min (range 76–114 min). All patients had benign pathology on final histopathology. There were no conversions to open cervical thyroidectomy. Two patients had vocal cord paresis that resolved spontaneously. The average postoperative follow up was 3 months (range 1–7 months). Our technique for retro-auricular thyroidectomy is a safe, reproducible, and cost effective option for remote access thyroidectomy.
http://ift.tt/2iyCV4U
The impact of liver disorders on perioperative management of reoperative cardiac surgery: a retrospective study in adult congenital heart disease patients
Abstract
Purpose
We evaluated the preoperative prevalence of risk factors for liver disorders and the relationship between the liver disorders and perioperative outcomes in adult congenital heart disease (ACHD) patients.
Methods
This retrospective study included 32 ACHD patients who underwent reoperative cardiac surgery.
Results
Preoperatively, 38% of the study patients had risk factors, including congestive liver (CL) due to right heart failure (31%), chronic hepatitis C (HC) (22%), and both CL and HC (16%). The numbers of patients with Child-Pugh scores 5, 6, 7 and 8 were 22, 7, 2 and 1. Median (range) preoperative platelet count and fibrinogen values were 155 (61–330) × 103/μl and 250 (145–367) mg/dl, respectively. The patients with higher Child-Pugh scores tended to have longer duration of anesthesia and surgery (p = 0.078, 0.078, respectively), and had significantly higher platelet transfusion (p = 0.031). Lower platelet count was associated with longer duration of anesthesia, surgery and cardio pulmonary bypass (CPB), and larger amount of blood loss and platelet transfusion (p = 0.01, 0.011, 0.024, 0.033, 0.021). Lower fibrinogen value was associated with longer duration of anesthesia, surgery and CPB, and larger amount of platelet transfusion (p = 0.015, 0.009, 0.009, 0.023).
Conclusion
ACHD patients who underwent reoperative cardiac surgery had a high prevalence of risk factors for liver disorders preoperatively, and liver disorders aggravated some intraoperative outcomes. These findings suggest that the prevention of liver disorders is important for reducing the occurrence of poor outcomes, and that ACHD patients with liver disorders need attentive perioperative management.
http://ift.tt/2jBwuQ5
High-dose BAFF receptor specific mAb-siRNA conjugate generates Fas-expressing B cells in lymph nodes and high-affinity serum autoantibody in a myasthenia mouse model
Source:Clinical Immunology
Author(s): Naazneen Ibtehaj, Karl E. Anderson, Ruksana Huda
We investigated potential therapeutic effects of a conjugate of BAFF receptor specific- monoclonal antibody and short interference RNA in a mouse model of myasthenia gravis (EAMG). Whereas high-dose siRNA conjugate resulted in significant accumulation of Fas expressing CD19+/ B220+ cells and concurrent expression of type 1 interferon in lymph nodes, low-dose conjugate did not induce FAS expression but caused marked BAFF receptor deficiency in lymph nodes that was further associated with improved MG symptoms. Unexpectedly, despite inhibiting BAFF receptor significantly in PBMCs and secondary lymphoid organs, conjugate treatment did not reduce the levels of autoantibody. Rather, at high dose, it caused robust increase in high affinity anti-AChR antibody and increased levels of serum IL10 and IL-4 cytokines. Our findings reveal a previously undocumented, dose dependent, immunomodulatory distant effect resulting from BAFF receptor specific mAb-siRNA conjugate treatment in an in vivo model of autoimmune disease.
http://ift.tt/2jWJh34
Longitudinal variation of serum periostin in adults with stable asthma
Source:Journal of Allergy and Clinical Immunology
Author(s): Ruth Semprini, Rachel Caswell-Smith, James Fingleton, Cecile Holweg, John Matthews, Mark Weatherall, Richard Beasley, Irene Braithwaite
We have shown that serum periostin levels are stable within an individual with well-controlled asthma and have little seasonal variation. These are desirable characteristics if serum periostin is to be used as a biomarker in asthma.
http://ift.tt/2jo8WBa
Abnormal CD161+ Immune Cells and RORΓT Mediated Enhanced IL-17F Expression in Genetic Hypertension
Publication date: Available online 16 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Madhu V. Singh, Michael Z. Cicha, Santosh Kumar, David K. Meyerholz, Kaikobad Irani, Mark W. Chapleau, François M. Abboud
BackgroundHypertension is considered an immunological disorder. However, the role of IL-17 family in genetic hypertension of the spontaneously hypertensive rat (SHR) has not been investigated.ObjectiveWe tested the hypothesis that enhanced Th17 programming and IL-17 expression in abundant CD161+ immune cells in SHR represent an abnormal proinflammatory adaptive immune response. Furthermore, we propose that this response is driven by the master regulator RORγt and a nicotinic proinflammatory innate immune response.MethodsWe measured the expression of CD161 surface marker on splenocytes in SHR and normotensive control Wistar-Kyoto (WKY) rats from birth to adulthood. We compared expression of IL-17A and IL-17F in splenic cells under different conditions. We then determined the functional effect of these cytokines on vascular reactivity. Finally, we tested whether pharmacological inhibition of RORγt can attenuate hypertension in SHR.ResultsThe SHR exhibited an abnormally large population of CD161+ cells at birth that increased with age reaching more than 30% of the splenocyte population at 38 weeks. The SHR splenocytes constitutively expressed more RORγt than WKY and produced more IL-17F upon induction. Exposure of WKY aorta to IL-17F impaired endothelium-dependent vascular relaxation whereas IL-17A did not. Moreover, in vivo inhibition of RORγt by digoxin lowered systolic blood pressure in SHR.ConclusionsSHR has a markedly enhanced potential for RORγt –driven expression of proinflammatory, pro-hypertensive IL-17F in response to innate immune activation. Increased RORγt and IL-17F contribute to SHR hypertension and may be potential therapeutic targets.
Graphical abstract
Teaser
Hypertension is considered to be an autoimmune dysfunction. We show in a genetic hypertension model that inhibition of RORγt, the master regulator transcription factor that promotes Th17 differentiation and IL-17F production, reduces hypertension.http://ift.tt/2jo7IpB
Airbag-Associated Severe Blunt Eye Injury Causes Choroidal Rupture and Retinal Hemorrhage: A Case Report
A case of choroidal rupture caused by airbag-associated blunt eye trauma and complicated with massive subretinal hemorrhage and vitreous hemorrhage that was successfully treated with intravitreal injection of expansile gas and bevacizumab is presented. A 53-year-old man suffered from loss of vision in his right eye due to blunt eye trauma by a safety airbag after a traffic accident. On initial examination, the patient had no light perception in his right eye. Dilated ophthalmoscopy revealed massive subretinal hemorrhage with macular invasion and faint vitreous hemorrhage. We performed intravitreal injection of pure sulfur hexafluoride twice for displacement, after which visual acuity improved to 0.03. For persistent subretinal hemorrhage and suspicion of choroidal neovascularization (CNV), intravitreal bevacizumab (1.25 mg/0.05 mL) injection was administered. After 3 weeks, the visual acuity of his right eye recovered to 0.4. For early-stage choroidal rupture-induced subretinal hemorrhage and complications of suspected CNV, intravitreal injection of expandable gas and intraocular injection of antiangiogenesis drugs seem to be an effective treatment.
Case Rep Ophthalmol 2017;8:13–20
http://ift.tt/2jQdkWd
The Limitation of Applying Heat to the External Lid Surface: A Case of Recalcitrant Meibomian Gland Dysfunction
The effects on the inner surface temperatures of the upper and lower eyelids of four commercial heat therapies were compared for an individual with recalcitrant meibomian gland dysfunction. Three therapies (Bruder mask, Blephasteam, and MiBoFlo) involved the application of heat to the external lid surface, and the fourth (LipiFlow) applied heat to the internal lid surface. Only LipiFlow was effective in elevating the inner surface temperatures to the reported 40°C therapeutic threshold for melting obstructed meibum.
Case Rep Ophthalmol 2017;8:7–12
http://ift.tt/2jofbom
A Mystery of Bilateral Annular Choroidal and Exudative Retinal Detachment with No Systemic Involvement: Is It Part of Vogt-Koyanagi-Harada Disease Spectrum or a New Entity?
A 65-year-old Caucasian male presented to the eye emergency department with bilateral significant visual loss. He was otherwise healthy with no significant past medical history. Ophthalmic history was significant for chronic open-angle glaucoma, for which the patient was using latanoprost once daily to both eyes. There was no preceding history of trauma or ocular surgery and the patient was emmetropic. Two weeks prior to his presentation, he reported a headache, which settled spontaneously. Slit-lamp examination demonstrated bilateral keratic precipitates, bilateral significantly shallow anterior chamber, and bilaterally normal intraocular pressures of 16 mm Hg. Fundal examination was significant for bilateral 360-degree choroidal detachments with exudative retinal detachment involving the maculae. These findings were confirmed using wide-field fundus photography, B-scan ultrasonography, and optical coherence tomography. Fundus fluorescein angiography did not reveal any evidence of retinal vasculitis. Indocyanine green chorioangiography of the posterior pole showed multiple areas of focal choroidal hypoperfusion. Extensive systemic investigation demonstrated no infectious, neoplastic, or inflammatory cause, and the patient did not complain of any systemic symptoms. Treatment with high-dose intravenous methylprednisolone was administered and this brought about complete resolution of both choroidal and retinal detachments, with partial visual recovery.
Case Rep Ophthalmol 2017;8:1–6
http://ift.tt/2jQbRPr
Computational fluid dynamic modeling of nose-to-ceiling head positioning for sphenoid sinus irrigation
Background
After sinus surgery, patients are commonly instructed to irrigate with saline irrigations with their heads over a sink and noses directed inferiorly (nose-to-floor). Although irrigations can penetrate the sinuses in this head position, no study has assessed whether sphenoid sinus penetration can be improved by irrigating with the nose directed superiorly (nose-to-ceiling). The purpose of this study was to use a validated computational fluid dynamics (CFD) model of sinus irrigations to assess the difference in sphenoid sinus delivery of irrigations after irrigating in a nose-to-floor vs nose-to-ceiling head position.
Methods
Bilateral maxillary antrostomies, total ethmoidectomies, wide sphenoidotomies, and a Draf III frontal sinusotomy were performed on a single fresh cadaver head. CFD models were created from postoperative computed tomography maxillofacial scans. CFD modeling software was used to simulate a 120-mL irrigation to the left nasal cavity with the following parameters: flow rate 30 mL/second, angle of irrigation 20 degrees to the nasal floor, and either nose-to-floor or nose-to-ceiling head positioning.
Results
In the postoperative CFD models, the sphenoid sinuses were completely penetrated by the irrigation while in a nose-to-ceiling head position. However, no sphenoid sinus penetration occurred in the nose-to-floor position. Other sinuses were similarly penetrated in both head positions, although the ipsilateral maxillary sinus was less penetrated in the nose-to-ceiling position.
Conclusion
CFD modeling demonstrated that the nose-to-ceiling head position was superior to the nose-to-floor position in delivering a 120-mL irrigation to the sphenoid sinuses.
http://ift.tt/2ittUyW
A systematic review of sinonasal oncocytomas and oncocytic carcinomas: Diagnosis, management, and technical considerations
Background
Oncocytomas and oncocytic carcinomas are rare tumors of the sinonasal cavity with the propensity for local invasion. This report and systematic review details a case of a nasal oncocytoma involving the lacrimal sac and provides an update of the current literature.
Methods
A systematic literature review was performed using PubMed and Ovid databases. The data obtained from published articles with sinonasal oncocytoma/oncocytic carcinoma as the primary diagnosis included patient demographics, presentation, radiographic and histologic findings, management, and recurrence rates.
Results
Twenty cases were identified. The most common symptoms were epistaxis (n = 11) and nasal obstruction (n = 11). Involvement of the nasal cavity was most common (n = 17), followed by the paranasal sinuses (n = 13) and nasolacrimal apparatus (n = 4). Recurrence occurred in 55% of cases. Recurrence was associated with invasion or infiltration found on histology or the presence of both invasion/infiltration and mitotic figures/pleomorphism (p < 0.05), with no significant relationship between recurrence and age at diagnosis (p = 0.42), sex (p = 0.65), and location of tumor (p = 0.14). The authors present the case of a 73-year-old woman with a 5-month history of worsening epistaxis and biopsy-proven oncocytoma. Complete surgical resection of the tumor using combined endonasal endoscopic and anterior orbitotomy approach is described.
Conclusion
Oncocytomas and oncocytic carcinomas are rare tumors of the sinonasal cavity with a high rate of local recurrence and orbital involvement. Surgical resection is the treatment of choice and complete resection can be achieved with an endoscopic endonasal approach.
http://ift.tt/2jgtKbi
Stability of a novel corticosteroid nasal irrigation solution: betamethasone 17-valerate added to extemporaneously prepared nasal irrigation solutions
Background
There are no commercially available nasal irrigation solutions containing corticosteroids. Instead, such preparations are extemporaneously prepared by adding existing corticosteroid formulations to nasal irrigation solutions. The stability of the corticosteroid betamethasone 17-valerate (B17V), in nasal irrigation solutions of different compositions and pH and stored under different temperatures, was studied to determine the optimal choice of solution and storage conditions.
Methods
Triplicate extemporaneous preparations made with B17V were prepared by adding a predetermined volume of B17V lotion to each nasal irrigation solution: normal saline (NS), sodium bicarbonate (NaHCO3) powder dissolved in tap water, and a commercially available powder mixture (FLO Sinus Care Powder), dissolved in tap water or pre-boiled tap water. Preparations were stored at 30°C and 4°C. Sampling was carried out at 0, 1, 2, 6, and 24 hours. The concentrations of B17V and its degradation compound, betamethasone 21-valerate (B21V), were determined by high-performance liquid chromatography.
Results
Preparations stored at 30°C contained a lower amount of B17V and higher amount of B21V than those stored at 4°C. B17V stability in nasal irrigation solutions decreased in the following order: NS, FLO in fresh tap water, FLO in pre-boiled tap water, and NaHCO3. The degradation rate of B17V increased with higher storage temperature and higher pH.
Conclusion
B17V is most stable when added to NS and least stable in NaHCO3 solution. FLO solution prepared with either cooled boiled water or tap water is an alternative if administered immediately. Storage at 4°C can better preserve stability of B17V, over a period of 24 hours.
http://ift.tt/2itE8zg
Direct bladder hernia after indirect hernia repair in extremely low birth weight babies: two case reports and a review of the literature
Inguinal hernia repair is the most common surgical procedure in babies. Despite a meticulous technique, relapses may occur. The occurrence of a direct bladder wall hernia in relapses has never before been repo...
http://ift.tt/2jAV5Vn
Pediatric peritonsillar abscess: Outcomes and cost savings from using transcervical ultrasound
Objectives
1) To analyze clinical outcomes of children stratified by ultrasound into three diagnoses: acute tonsillitis, peritonsillar phlegmon, and abscess; and 2) To compare clinical outcomes and financial impact between children who underwent ultrasound protocol to those who did not.
Study Design
Retrospective analysis between two cohorts: ultrasound protocol group and control group.
Methods
Children with peritonsillar abscess (PTA) diagnosed in the emergency department (ED) were enrolled during a 2-year period for transcervical ultrasound evaluation of bilateral tonsillar fossae. Data from a cohort of patients with PTA prior to ultrasound screening were also collected from retrospective chart review. Outcome variables were analyzed using multivariate logistic regression.
Results
Seventy-eight children (mean 12.3 years) were enrolled in the ultrasound protocol, compared to 101 children (mean 13.6 years) evaluated using traditional methods of examination and/or computed tomography (CT) imaging. Demographics between the two groups were not significantly different.
Only one-third of patients presumed to have PTA by ED staff had ultrasound findings consistent with abscess. Overall treatment failure rate was 8%, requiring readmission or surgical intervention for abscess. Length of stay, surgical drainage, and radiation exposure from CT scans were reduced significantly in the ultrasound group (P < 0.006). Differences in readmission rates and mean charges between the two groups did not reach significance.
Conclusion
Peritonsillar abscess is a common infection in the pediatric population, but diagnosis can be challenging. Transcervical ultrasound is a safe, cost-effective, and accurate modality to help stratify patients into medical and surgical treatment arms.
Level of Evidence
3b. Laryngoscope, 2017
http://ift.tt/2jPYUFo
Complications and parent satisfaction in pediatric osseointegrated bone-conduction hearing implants
Objective
To assess long-term complication rate and parental satisfaction of osseointegrated bone conduction hearing implants (OBCHIs).
Study Design
Retrospective chart review of children undergoing OBCHIs.
Methods
A retrospective chart review of children undergoing OBCHIs for the treatment of conductive, mixed, and single-sided sensorineural hearing loss in children.
Results
Forty-five subjects were identified with 0.3 to 10.4 years of follow-up. The mean/median age and age range at implant were 9.0/7.8 and 1.7 to 19.1 years. The underlying hearing loss for the cohort included conductive (N = 30), sensorineural (N = 7), and mixed (N = 8) hearing loss. Conductive hearing loss, caused by aural atresia (62.9), was the most common indication for implantation. Fifty-eight complications occurred in 29 subjects, most related to skin infection or overgrowth. Seventeen events required revision surgery, and 18 required oral antibiotics and/or office-based cauterization. Children under the age of 5 years were more likely to have failure of osseointegration or require revision surgery. Parents of 33 subjects underwent a phone interview; 76% rated the overall satisfaction as satisfied or very satisfied.
Conclusion
A large percentage of children undergoing OBCHI develop postoperative complications, and up to 44% require revision surgery—a figure higher than generally reported and higher than in adults. No factors were found to adequately explain the higher complication rates in children compared to adults. Despite the occurrence of complications, parents viewed this device as satisfactory from many perspectives.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2jolEj5
Directed balloon cytology of the esophagus: A novel device for obtaining circumferential cytologic sampling
Objective
Current methods of obtaining esophageal cytology include brush biopsy and blind balloon sampling, among others. These methods can be time-consuming if performed in accordance with acknowledged standards. Further, exact site localization can prove to be difficult. We describe a novel device for esophageal sampling using an esophageal balloon with debriding strips contained within the pleats of the balloon. Inflation brings the latter in contact with the surface to be sampled. Cell capture was compared with the commonly used brush technique in a pig model.
Methods
Separate balloon and standard brush cytology samples were collected from a pig model. Smear and cell pellet preparations were compared regarding cell density and total volume.
Results
Adequate samples were obtained with both the brush and balloon. On the cell smear preparations, the cell density was greater when obtained with balloon sampling. Further, the cell pellet volume was significantly greater with the latter as well. The intact morphology of individual rafts of squamous epithelial cells also was comparable between the two methods. In addition, the balloon provided precise mapping of the cytology sites in contrast to the standard brush technique.
Conclusion
We present an innovative new balloon technology for esophageal sampling, which demonstrated a decreased sampling time interval, precise mapping, and increased cellular volume when compared to a commonly used brush technique.
Level of Evidence
NA. Laryngoscope, 2017
http://ift.tt/2jPYUoS
Sleep-disordered breathing in pediatric head and neck vascular malformations
Objectives
To determine the prevalence of sleep-disordered breathing (SDB) symptoms among children with head and neck vascular malformations and to compare obstructive sleep apnea (OSA)-18 scores between children with head and neck vascular malformations and children with non-head and neck vascular malformations.
Study Design
Retrospective cohort and prospective cross-sectional studies
Methods
Forty-three pediatric subjects with head and neck vascular malformations evaluated at a tertiary-care multidisciplinary vascular anomalies center were included in a retrospective cohort study. Eighty-three consecutive pediatric subjects with vascular malformations evaluated at the same center were included in the prospective cross-sectional study.
Results
In the retrospective cohort study, 20 (47%) subjects with head and neck malformations had documented SDB symptoms. Of those with SDB symptoms, five (25%) required long-term tracheotomy. The children with SDB symptoms had greater vascular malformation size, more extensive pharyngeal involvement, greater vascular malformation mass effect on airway, and closer proximity of malformation to airway when compared to children without SDB symptoms.
For the prospective cross-sectional study, 23% of pediatric subjects had malformations of the head and neck. Those with head and neck malformations had a higher OSA-18 score and a lower overall quality of life (QOL) score when compared to subjects with non-head and neck malformations.
Conclusion
Nearly half of children with head and neck vascular malformations have SDB symptoms. Children with head and neck vascular malformations have a higher OSA-18 score and lower overall QOL score when compared to children with non-head and neck vascular malformations.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2jobfUC
Changes in thyroid cancer incidence, post-2009 American Thyroid Association guidelines
Background
The thyroid cancer incidence rate has tripled in the United States since the 1980s, especially among women and small-sized tumors. This trend has been attributed to increased detection due to the availability of ultrasound and fine-needle aspiration technology. In 2009, the American Thyroid Association (ATA) released revisions to their guidelines for well-differentiated thyroid cancers.
Objective
To examine trends in thyroid cancer incidence rates by tumor size and gender following the 2009 ATA guideline revisions.
Methods
Cases of differentiated thyroid cancer diagnosed from 2000 to 2012 were analyzed from the National Cancer Institute Surveillance Epidemiology and End Results program, 18 registries. Trends in incidence rates based on gender (males, females) and tumor size (< 1.0 cm, 1.0–2.9 cm, 3.0–3.9 cm, ≥ 4.0 cm) were analyzed using Joinpoint Regression and reported as the annual percentage change (APC).
Results
From 2000 to 2009, overall thyroid cancer incidence rates increased rapidly by about 8% per year in both sexes. Incidence rates increased across all tumor sizes, but especially in tumors 1.0 to 2.9 cm (men, APC = 7.7; women, APC = 7.8) and < 1.0 cm (men, APC = 7.8; women = 10.9) for both genders. Since 2009, the trend slowed in men (APC = 3.0) and women (APC = 2.8). The deceleration among females was confined to tumors less than 2.9 cm. Trends for all size groups in males remained constant from 2000 to 2012.
Conclusion
The rapid increase in thyroid cancer incidence rates over the past three decades has recently slowed, especially among small-sized cancers and women, which coincides with the 2009 ATA guideline revisions.
Level of Evidence
2c. Laryngoscope, 2017
http://ift.tt/2itrkZK
Bilateral presence of radix entomolaris in first and second permanent mandibular molars identified in a Caucasian woman
Description
A healthy Caucasian girl aged 12 years was referred to the dental clinic by a general dentist who failed to completely instrument canals in the mesial and distal root of tooth 36 (FDI system). In the first session, supernumerary root radix entomolaris (RE) was identified and cone beam CT (CBCT) scan was taken. Afterwards, several ledges in the root canals were successfully negotiated and treatment was completed in the third session (figure 1). CBCT revealed the presence of RE also on tooth 37 and deep longitudinal grooves and C-shaped canal pattern in roots of both neighbouring premolars (figure 2). Additionally, panoramic radiograph indicated the presence of RE on the contralateral first and second molars (figure 3). Roots of mandibular third molars have not yet been developed. Clinically, the crowns of both mandibular second premolars were mesiodistally enlarged; the right one exhibiting...
http://ift.tt/2jgaZEL
Unexpected complication of colonoscopy
The authors present a rare case of a 71-year-old man presenting with large bowel obstruction after attempted colonoscopy. The procedure was impossible to complete due to a tight sigmoid stricture and the patient presented with an acute abdomen the following day. He was managed conservatively and discharged before returning for an elective laparoscopic sigmoid colectomy. The potential differentials of an acute abdomen post-colonoscopy are discussed and the literature reviewed on this rare complication. Finally, the authors review whether there is pressure on endoscopists to 'complete' colonoscopies (by achieving caecal intubation) based on regulatory indices in quality, and how this might have to be disregarded in unfavourable circumstances.
http://ift.tt/2jg6Dh7
Strongyloides hyperinfection syndrome and VRE pneumonia
Immunocompromised patients have high risk of infections from bacteria, viruses, fungi and parasites. One of these infections is those caused by Strongyloides stercoralis. Immunocompromised patients are at risk of hyperinfection syndrome which is characterised with more systemic manifestation and a higher risk of morbidity and mortality. This can be complicated by coinfection with enteric organisms, specifically Gram-negative. Enterococci are Gram-positive cocci which are inhabitants of the human gastrointestinal tract. Even though enterococci can cause serious infections in multiple sites, they are a rare cause of pneumonia. We present a case of disseminated strongyloides with vancomycin-resistant enterococcus causing pneumonia. The patient had a complicated course with respiratory failure and septic shock. He died eventually due to his severe infections. After a literature review, we could not find a similar case of coinfection of disseminated strongyloides with vancomycin-resistant enterococcus pneumonia in immune-compromised patients.
http://ift.tt/2itec6B
Oesophageal presentation of Crohn's disease
Crohn's disease (CD) is characterised by a transmural inflammatory process, which can affect any part of the digestive tract; however, CD with oesophageal presentation is rare. We report a case of a previously healthy young woman with symptoms of dysphagia, odynophagia, chest pain and weight loss, who presented oesophageal ulcers at upper endoscopy and whose histology revealed granulomatous oesophagitis. After complementary study, a mild ileocaecal involvement of CD was demonstrated. The patient became asymptomatic with proton pump inhibitor and a course of prednisolone. Mucosal healing was obtained after maintenance therapy with azathioprine. In the absence of extraoesophageal symptoms, oesophageal CD may be overlooked. CD must always be considered as differential diagnosis in the presence of oesophageal ulcers.
http://ift.tt/2jg0mBL
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