Head and Neck Medicine by Alexandros G.Sfakianakis: 01/20/17

Παρασκευή 20 Ιανουαρίου 2017

Lichen myxedematosus: suggestions on the newly proposed diagnostic criteria

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ASCIA News

Thunderstorm asthma epidemic

Dec 9, 2016: The recent thunderstorm asthma epidemic in Melbourne and its tragic consequences highlight the need for more research, education and awareness in this area. Thunderstorm asthma is thought to be triggered by thunderstorms that have rapid changes in wind, temperature and humidity, which cause pollen grains to absorb moist...
ASCIA highlights from 2016 and plans for 2017

Nov 28, 2016: As the end of 2016 approaches it is timely to reflect on the significant development, achievements and collaborations of ASCIA over the past year, and plans for 2017. Thank you to ASCIA members and supporters for your greatly appreciated contributions throughout 2016. We look forward to continuing to work wi...
Allergy and Immunology Foundation of Australasia (AIFA) Research Grants

Nov 16, 2016: AIFA has provided $100,000 in research grants to support 6 projects over the past 3 years. This funding includes two $10,000 grants announced this month, one supporting research into Jack Jumper Ant immunotherapy and the second that will improve development of a drug for allergy. For information about these grants go ...
AusPollen Apps for people with allergic rhinitis (hay fever) and allergic asthma

Nov 8, 2016: Local AusPollen Apps provide information on daily levels of pollen in the air and are currently available for Brisbane, Canberra, Melbourne and Sydney at http://ift.tt/2iVezlV downloading the free App for iTunes or Google Play, and through Twitter or Facebook. Completion of a short (~5 minute) online questio...
National Allergy Strategy - KABAM survey

Nov 3, 2016: THANK YOU to all who participated in the National Allergy Strategy survey for teens and young adults (KABAM survey). The response has been overwhelming and we look forward to reviewing the information to ensure we develop suitable resources for 12-24 year olds with severe allergy. Stay tuned for updates on resource devel...
ASCIA 2016 Conference Report

Sep 21, 2016: The ASCIA 2016 conference provided more than 600 delegates with a unique opportunity to hear from 6 international experts and more than 30 local experts on a wide range of areas in allergy and clinical immunology. The conference also included 79 posters, 48 poster presentations and 16 clinical grand rounds presentations...
AIFA seed funding leads to NHMRC grant

Aug 23, 2016: We are proud to announce that the AusPollen project has been awarded $626,442 in the latest round of NHMRC Partnership Project grants with a further $653,129 in partner organisation in kind and cash support. AusPollen, the Australian Pollen Allergen Partnership, will build, implement and evaluate the first standardised ...
Updated ASCIA Action Plans for Anaphylaxis and Allergic Reactions

Aug 10, 2016: ASCIA has released updated Action Plans for Anaphylaxis and Allergic Reactions on its website: http://ift.tt/1yS3Z48 The main changes are an increased emphasis of key messages, inclusion of images to show how to position a person with anaphylaxi...
ASCIA releases guidelines for infant feeding and allergy prevention

May 18, 2016: ASCIA Guidelines for infant feeding and allergy prevention and information on how to introduce solid foods to infants have been released on the ASCIA website: http://ift.tt/2jILsWY These guidelines provide parents and health professionals with advice and recommendations relevant to...
Federal Government announces funding of $500k for National Allergy Strategy implementation

May 16, 2016: It is with great pleasure that we confirm that the federal government's funding of $500k for National Allergy Strategy implementation was announced at the launch of Food Allergy Week in Sydney on 16 May 2016, by the Minister for Health, the Hon Sussan Ley MP. The National Allergy Strategy was launched in...
Changes to adrenaline autoinjector labels

Apr 19 2016: In Australia, adrenaline is the approved name of the ingredient in autoinjector devices used for the emergency treatment of anaphylaxis. Currently, the only available autoinjector to treat anaphylaxis in Australia and New Zealand is supplied under the brand name EpiPen®. In some countries, including the USA, adrenaline i...

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Transoral surgery vs intensity-modulated radiotherapy for early supraglottic cancer: a systematic review.

Purpose of review: To provide clinicians with a critical review of outcomes for endolaryngeal surgery and intensity-modulated radiation therapy (IMRT) for early-stage supraglottic cancer. Recent findings: A total of 971 potential articles were reviewed, with inclusion of 14 studies comparing IMRT with transoral surgery. One study analyzed IMRT, one transoral robotic surgery, and the remaining were transoral laser microsurgery studies. A weighted average and 95% confidence interval of all surgery patients showed a local control of 90.36 +/- 1.14% (n = 118) for T1 lesions, 83.09 +/- 1.36% (n = 232) for T2 lesions, and 86.38 +/- 0.82% (n = 429) overall. The one study examining IMRT outcomes reported a local control of 70 +/- 10.07% and overall survival of 63% over 5 years for T2 lesions (n = 78), with no reported T1 data or secondary outcomes. Summary: Endolaryngeal surgery as definitive therapy for T1 and T2 supraglottic cancer has excellent local control. Although endolaryngeal surgery performed better than IMRT, the data are limited, and a definitive comparison with surgery cannot be made. Additional studies are required. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Adenoid cystic carcinoma evaluation and management: progress with optimism!

Purpose of review: Adenoid cystic carcinoma (ACC) when diagnosed presents several diagnostic and treatment challenges. The standard treatment of surgery and postoperative radiotherapy has remained the standard of care for the past 3 decades. The purpose of this review is to update what's been reported and what's new since the last review in 2004. Recent findings: As accurate a histological diagnosis and staging of disease should be achieved prior to commencing any treatment. Patients' prognosis, in the long term, is determined by the finding of any solid tumour component in the examined excised specimen. The continued treatment of patients with ACC by surgery and postoperative radiotherapy has not changed in the long-term tumour-free outcome of patients. The majority of patients die because of loco-regional failure and/or distant metastases. Optimism is being generated by the findings at the molecular and genetic level of ACC giving hope that nonsurgical treatment can be complemented by novel treatments that will improve patients' disease cure and improved long-term survival. Summary: The histological grading determined by optical methods has not advanced our selection of treatment and new recent research findings on molecular and genetic factors give new hopes to changing the ACC classification, determining differing treatments and thus influencing an improved and prolonged tumour-free survival for more patients. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Swallowing after transoral surgery for oropharyngeal cancer: comparison with primary chemoradiotherapy outcomes.

Purpose of review: Survival equipoise is recognized between the contemporary surgical and oncological approaches to oropharyngeal squamous cell carcinoma treatment. Primary transoral surgery (TOS) options have emerged that utilize either laser or robotic techniques. Our review presents an overview of the evidence available for swallowing outcomes following TOS approaches and compares these with outcomes following primary oncological management. Recent findings: Meta-analysis of swallow outcomes following TOS or (chemo)radiotherapy is not possible given the heterogeneity of the available data. There are suggestions of less swallowing impairment following primary TOS, but the favourable selection of patients to these case series must be considered. Summary: Minimizing swallowing impairment following oropharyngeal squamous cell carcinoma treatment, while ensuring oncological efficacy, should be a priority for head and neck healthcare providers. Primary TOS may offer an advantage to patients, but only through a team approach that considers how adjuvant oncological therapy could be tailored to individuals. High-quality clinical trials are in progress that will inform future practice. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Different branching patterns of the spinal accessory nerve: impact on neck dissection technique and postoperative shoulder function.

Purpose of review: Despite nerve-sparing surgery, postoperative shoulder morbidity remains high and significantly impacts patient's quality of life. This review will focus on recent findings of anatomical nuances of the cranial nerve XI (CN XI) along its course in the neck and possible reasons for postoperative morbidity. Recent findings: The most recent studies identified three different branching patterns of the CN XI in the neck. In type 1 (66%), the branch for trapezius muscle exits at the posterior border of the sternocleidomastoid muscle (mSCM). In type 2 (22%), the branch for trapezius muscle takes off from the common trunk of the CN XI before it enters the mSCM. In type 3 (12%), the motor branch for trapezius muscle exits behind posterior border of mSCM but takes a more medial course to form macroganglia with cervical nerves. Cervical nerves may also contribute to innervation of the trapezius muscle in up to 39% of the cases, but the clinical importance of those connections is not known. Summary: If these anatomical patterns are not recognized and if cervical nerves are resected during neck dissection, shoulder morbidity remains high. The role of cervical nerves in innervation of the trapezius muscle is still controversial and unpredictable. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Local inflammation exacerbates cutaneous manifestations in a murine autoimmune pemphigus model

Publication date: Available online 20 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Sachiko Ono, Gyohei Egawa, Akihiko Kitoh, Teruki Dainichi, Atsushi Otsuka, Saeko Nakajima, Tetsuya Honda, Kenji Kabashima

Teaser

Capsule summary: Local inflammation enhances autoantibody deposition in the skin and exacerbates murine pemphigus manifestations as a representative of autoantibody-mediated disorders, therefore prevention of excessive external stimulants might be important for the disease management.

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Notch signaling in T cells is essential for allergic airway inflammation, but expression of Notch ligands Jagged1 and Jagged2 on dendritic cells is dispensable

Publication date: Available online 19 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Irma Tindemans, Melanie Lukkes, Marjolein J.W. de Bruijn, Bobby W.S. Li, Menno van Nimwegen, Derk Amsen, Alex KleinJan, Rudi W. Hendriks
BackgroundAllergic asthma is characterized by a T helper 2 (Th2) response induced by dendritic cells (DCs) that present inhaled allergen. Although the mechanisms by which they instruct Th2 differentiation are still poorly understood, expression of the Notch ligand Jagged on DCs has been implicated in this process.ObjectiveTo establish whether Notch signaling, induced by DCs, is critical for house-dust mite (HDM) driven allergic airway inflammation (AAI) in vivo.MethodsThe induction of Notch ligand expression on DC subsets by HDM was quantified by qRT-PCR. We used a HDM-driven asthma mouse model to compare the capacity of Jagged1 and Jagged2 single and double-deficient DCs to induce AAI. In addition, we studied AAI in mice with a T cell-specific deletion of RBPJκ, a downstream effector of Notch signaling.ResultsHDM exposure promoted the expression of Jagged1, but not Jagged2, on DCs. In agreement with published findings, in vitro differentiated and HDM-pulsed Jagged1 and Jagged2 double-deficient DCs lacked the capacity to induce AAI. However, following in vivo intranasal sensitization and challenges with HDM, DC-specific Jagged1, Jagged2 single or double-deficient mice developed an eosinophilic airway inflammation and Th2 cell activation phenotype that was not different from that in control littermates. In contrast, RBPJκ-deficient mice failed to develop AAI and airway hyperreactivity.ConclusionOur results show that the Notch signaling pathway in T cells is crucial for the induction of Th2-mediated AAI in a HDM-driven asthma model, but that expression of Jagged1 or Jagged2 on DCs is not required.Clinical ImplicationsThe Notch signaling pathway in T cells is critical for development of house-dust mite driven allergic airway inflammation in mice, indicating it could be a potential therapeutic target in asthma.

Teaser

Although Notch signaling in T cells is critical for development of T helper2 cell-driven house-dust mite mediated allergic airway inflammation in mice, expression of the Notch ligands Jagged1 and Jagged2 on dendritic cells is dispensable.

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Allergen-dependent oxidant formation requires purinoceptor activation of ADAM 10 and prothrombin

Publication date: Available online 19 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jie Chen, Jihui Zhang, Theresa Tachie-Menson, Neha Shukla, David R. Garrod, Clive Robinson

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Cysteinyl leukotriene E4 activates human ILC2s and enhances the effect of prostaglandin D2 and epithelial cytokines

Publication date: Available online 20 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Maryam Salimi, Linda Stöger, Wei Liu, Simei Go, Ian Pavord, Paul Klenerman, Graham Ogg, Luzheng Xue
BackgroundGroup 2 innate lymphoid cells (ILC2) are a potential innate source of type-2 cytokines in the pathogenesis of allergic conditions. Epithelial cytokines (IL-33, IL-25 and TSLP) and mast cell mediators (PGD2) are critical activators of ILC2s. Cysteinyl leukotrienes (cysLTs) including leukotriene C4 (LTC4), D4 and E4 are metabolites of arachidonic acid and mediate inflammatory responses. Their role in human ILC2s is still poorly understood.ObjectivesWe sought to determine the role of cysLTs and their relationship with other ILC2 stimulators in the activation of human ILC2s.MethodsFor ex vivo studies, fresh blood from patients with atopic dermatitis and healthy controls was analyzed with flow cytometry. For in vitro studies, ILC2s were isolated and cultured. The effects of cysLTs, PGD2, IL-33, IL-25, TSLP, IL-2 alone or in combination on ILC2s were defined using chemotaxis, apoptosis, ELISA, luminex, qPCR and flow cytometric assays. The effect of endogenous cysLTs was assessed using human mast cell supernatants.ResultsHuman ILC2s expressed the leukotriene receptor, CysLT1, and this was increased in atopic individuals. CysLTs, particularly LTE4, induced migration, reduced apoptosis and promoted cytokine productions in human ILC2s in vitro. LTE4 enhanced the effect of PGD2, IL-25, IL-33 and TSLP resulting in increased production of type-2 and other pro-inflammatory cytokines. The effect of LTE4 was inhibited by montelukast, a CysLT1 antagonist. Interestingly, addition of IL-2 to LTE4 and epithelial cytokines significantly amplified the activation of ILC2s and upregulated expression of the receptors for IL-33 and IL-25.ConclusionCysLTs, particularly LTE4, are important contributors to the triggering of human ILC2s in inflammatory responses, particularly when combined with other ILC2 activators.

Teaser

The investigation on the role of cysLTs in human ILC2s leads to improved understanding of the mechanism of ILC2 activation. In environments where multiple activators of ILC2s occur simultaneously, these studies help to identify potential therapeutic strategies for allergic disorders.

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Niacin intake and incident adult-onset atopic dermatitis in women

Publication date: Available online 19 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Aaron M. Drucker, Wen-Qing Li, Min Kyung Park, Tricia Li, Abrar A. Qureshi, Eunyoung Cho

Teaser

Supplemental nicotinamide, a derivative of niacin, has been reported to decrease transepidermal water loss. However, in this analysis including 67,643 women from the Nurses' Health Study 2, niacin intake was not protective for atopic dermatitis.

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JAK1 gain-of-function causes an autosomal dominant immune dysregulatory and hypereosinophilic syndrome

Publication date: Available online 19 January 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Kate L. Del Bel, Robert J. Ragotte, Aabida Saferali, Susan Lee, Suzanne M. Vercauteren, Sara A. Mostafavi, Richard A. Schreiber, Julie S. Prendiville, Min S. Phang, Jess Halperin, Nicholas Au, John M. Dean, Emily Jewels, Anne K. Junker, Paul C. Rogers, Michael Seear, Margaret L. McKinnon, Stuart E. Turvey

Teaser

Germline JAK1 gain-of-function mutations cause autosomal dominant immune dysregulation and hypereosinophilia with eosinophilic infiltration of the gastrointestinal tract, massive hepatosplenomegaly and severe atopic dermatitis that can be successfully treated with ruxolitinib, an oral JAK1/2 inhibitor.

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Introducción a la sociolingüística hispánica Manuel Díaz-Campos (2014), Malden and Oxford: Wiley-Blackwell Pp332 ISBN 978-0-470-65802-4

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Effect-for-cause inferencing in the evaluation of loudness among Toba Batak people

The paper presents evidence for an effect-for-cause inferencing process underlying the general style of using loud speech voice among Toba Batak speakers (Indonesia). A subjective reaction test was conducted to find out their perception towards the use of loud voice in three relational settings having different combinations of bipolarity: 1) vertical social distance and horizontal social distance; 2) vertical social distance only; and 3) horizontal social distance only. The results showed that in contexts where horizontal social distance remains, the absence of vertical distance significantly weakens the perception of impoliteness and unacceptability towards the use of loud voice. This indicates that Toba Bataks assume a pseudo social proximity when they are speaking to people with whom they have no horizontal social closeness. This method of inferencing is consistent with an effect-for-cause relational structure, being metonymic in nature.

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Languages in East Africa: Policies, practices and perspectives

The study provides an account of the prevailing linguistic situation in the three traditional countries of the East African Community (Kenya, Tanzania and Uganda), since they have more or less the same colonial and postcolonial history as well as being territorially coterminous with each other – a landmark phenomenon that has a bearing on the dynamics of the postcolonial linguistic landscape in these countries. The study examines the circumstances that underlie the triglossic linguistic situation in these countries, i.e. a situation where there are three languages with distinct but complementary functions (namely English, Kiswahili and languages of intra-ethnic communication). While some of the dimensions of the linguistic situation are similar in the three countries, others are different. Entangled in the quagmire of vacillating decisions on language policies, East Africa has had to grapple with the question of language choice for some time. The study examines the language policies that promote or relegate, at varying degrees, the languages of the three countries. Generally, while Kenya and Uganda are making considerable strides in promoting languages other than English and Kiswahili, Tanzania, on the other hand, has stuck to its guns in relation to stifling the development of such languages.

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Intergroup language attitudes and their sources: The case of Tehrani and Jonoub-Shahri Tehrani

The current study was aimed at investigating the language attitudes of Tehrani speakers (N = 188) toward an ingroup (Tehrani) and outgroup (JS Tehrani) variety. In doing so, a questionnaire of 10 scales was utilized. The 10 scales were later factor-analyzed into status, solidarity, and ethnic pride. Statistical analyses (i.e. ANOVA and Tukey) revealed that, firstly, each variety was rated differently across the 3 scales, and, on all three individual clusters, the two ingroup and outgroup varieties were judged differently. Whereas Tehrani was evaluated more favorably on status and ethnic pride scales, JS Tehrani was rated more positively on solidarity. The results were finally explained in light of the participants' interview responses and sociocultural context of Tehran. The results of the present study might be useful in illustrating the under-explored area of language attitudes in Iran.

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(No) English interference on U.S. Southwest Spanish? A look at variable subject expression in Phoenix Spanish-English bilinguals

Subject pronoun expression (SPE) is one of the most studied variables in Spanish sociolinguistics, in the production of both monolingual and bilingual speakers. In the case of U.S. Spanish-English bilinguals, some studies suggest that the almost categorical use of English overt subject personal pronouns (SPPs) boosts the SPP rate in the Spanish of these speakers, whereas some other studies do not support such claim. Aiming to shed light on this subject, the present analysis of SPE in Phoenix is a variationist contribution to the literature on bilingual SPE in the U.S. Although the factors favoring SPP occurrence in the Spanish of Phoenix coincide for the most part with those attested across Spanish varieties, compared to other U.S.-bilingual Spanish varieties accounted for, it shows the lowest rate of overt SPPs: 17.8%, even lower than monolingual Mexican varieties. In addition, Spanish-dominant speakers in Phoenix favor overt SPPs, whereas English-dominant bilinguals disfavor them. When separate regression analyses were run for each proficiency group, it was found that both share virtually the same constraints contributing to the presence of the overt variant. These results do not support the contact claim. Since the Phoenix bilinguals pattern with other U.S. Southwest communities with regard to the aforementioned trends, it is suggested that proximity to the border may neutralize the SPE English effect in the Spanish of these communities, in contrast to communities that lack such regional traits, like New York and Florida.

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Plurilingual corpora and polylanguaging, where corpus linguistics meets contact linguistics

Language contact and multilingualism issues are addressed by such diverse research traditions that we consider corpora and data exchange as good ways to make these traditions speak to one another. In this paper, we describe a methodology for detailed analysis of heterogeneous corpora which can be used to take into account both sychronic phenomena (linguistic variation and instances of polylanguaging or code switching) and diachronic phenomena. We point out the epistemological questions that arise in the analysis of plurilingual data and discuss the choices made with respect to the current norms and standards followed in corpus linguistics with a view to providing multi-factoral explanations in the field of language contact and multilingualism. We rely here on the methodology developed in the research project CLAPOTY.

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Brokering communication in sacred spaces: Bilingual youth interpreters in religious settings

Although research on 'language brokering' has grown steadily over the past two decades, the specific characteristics and challenges of this type of interpretation work have yet to be fully explored. The present analysis examines the specific practices involved when bilingual youth interpret in religious services. Although underexplored in the language-brokering scholarship, religious services present a novel and revalatory context for the examination of non-professional interpretation practices. Framed through a discourse-analytic lens, this analysis explores how two youths demonstrate problem-solving skills and linguistic expertise in the interpretation process. I argue that the problem-solving activity in which the youth are participating is multifaceted and collaborative, and that the youth themselves must necessarily exercise great skill to solve each problem. I then position this analysis within the broader scholarship on language brokering and demonstrate how these practices expand our knowledge regarding the linguistic abilities of bilingual youth.

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A Grammar of Bhadarwahi, Amitabh Vikram Dwivedi (2013) Munich: Lincom Europa ISBN 9783862884353

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The semiotics of clown and clowning: Rituals of Rituals of transgression and the theory of laughter. Paul Buissac (2015) London and New York: Bloomsbury p218 ISBN 978-1-4725-3278-7

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The linguistic landscape of the Mediterranean: French and Italian coastal cities, Robert Blackwood and Stefania Tufi (2015) Houndmills, Basingstoke: Palgrave Macmillan Pp246 ISBN 978-0-230-29098-3

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The Th2 gene cluster unraveled: Role of RHS6

Abstract

Although the transcription factors that regulate T helper (Th) type 2 cytokine production (IL-4, IL-5, and IL-13) are possible novel therapeutic targets, we lack a detailed understanding of the mechanisms that regulate the transcription of these cytokines. In this issue of Allergy, Hwang et al. studied the role of a specific DNA region (a cis-acting element called Rad50 hypersensitive site 6) RHS6, in the development of allergic airway inflammation. RHS6 is found in the Th2 cytokine "locus control region" but its role in activation of the IL-4, IL-5, and IL-13 genes was unknown. The authors here showed that RHS6 recruited the transcription factors GATA3, SATB1, and IRF4, each of which are involved in transcription of all three Th2 cytokine genes. Indeed genetic deficiency in RHS6 inhibited expression of IL-4, IL-5, and IL-13 and reduced allergic airway inflammation in a murine model of ovalbumin-induced sensitization. Deletion of RHS6 also inhibited formation of the transcription factor complex of GATA3, SATB1, and IRF4 that reduced the transcription of IL-4, IL-5, and IL-13. This study suggests that RHS6 is critical for the development of allergic airway inflammation and that the GATA3, SATB1, IRF4 and RHS6 complex maybe a potential therapeutic target for the treatment of asthma.

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Re: Re: Patients experience of temporary tracheostomy after microvascular reconstruction for cancer of the head and neck

Coyle et al1 raise an important issue in their letter in response to our recent paper.2 It is essential to include patient-reported outcomes (PRO) when decisions are made. This supports informed consent in situations when various options are to be considered. When there is a balance of risks, it is essential to explain them in terms that the patient and carer understand, and PRO should also shape protocols of care. Unfortunately, in the two papers published in 2012 and 2013 by Coyle et al1,3 there are no such PRO data.

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Implementation of an oral and maxillofacial surgery trauma team in a major trauma centre

In 2010, King's College Hospital in London was designated as a major trauma centre. To deal with the increasing number of patients, an integrated oral and maxillofacial team of the week was established in 2012 to provide a consultant-led, emergency service dedicated to acute care, and it was anticipated that this would reduce the duration of stay by 0.3 bed-days. To assess the effect of the new system, we compared the duration of stay between 1 October and 31 January 2011-2012 with the same period in 2012-2013.

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Bedeutung von Krebsregistern für die Versorgungsforschung

Zusammenfassung

Hintergrund

Die Routineversorgung bei Krebs unterscheidet sich vom klar strukturierten Setting randomisierter Studien, denn sie schließt alle Patienten ein, auch diejenigen mit multiplen Komorbiditäten. Deshalb können die Ergebnisse klinischer Studien nicht immer direkt auf die alltägliche Versorgung übertragen werden. Ziel dieses Beitrags ist, die Daten klinischer Krebsregister zur Klärung von Fragen zur Behandlungsqualität und zur Versorgungsforschung zu nutzen.

Methoden

Daten zur Ergebnisqualität wurden von 31 klinischen Krebsregistern aus 11 Bundesländern zusammengeführt und auf der 6. bundesweiten onkologischen Qualitätskonferenz in Berlin vorgestellt. Die Implementierung sowie der Überlebensvorteil auf der Grundlage operativer Vorgehensweisen, v. a. laparoskopischer vs. offen chirurgischer Verfahren, wurden untersucht. Ebenso wurde das Ergebnis der Gabe adjuvanter Chemotherapie beim Kolokarzinom im Stadium II auf der Basis bevölkerungsbezogener Register aufgezeigt.

Ergebnisse

Die bundesweite Analyse ergab ein signifikant besseres Überleben bei minimalinvasiver operativer Therapie in den Stadien I–III. Dies entspricht den Daten anderer Register, aber nicht den Ergebnissen randomisierter Studien. In einer weiteren Analyse zeigte sich ein signifikanter Benefit für Patienten mit Kolonkarzinom im Stadium II T 4, die eine adjuvante Chemotherapie erhielten. Das beste Überleben konnte im Stadium III erreicht werden, wenn die notwendige adjuvante Chemotherapie innerhalb von 19–44 Tagen erfolgte.

Resümee

Registerdaten können für die Darstellung der Behandlungsqualität und für Versorgungsforschung genutzt werden. In Zukunft sollten mehr registerbasierte Studien durchgeführt werden, um die Ergebnisse der realen Versorgung darzustellen.

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Transoral surgery vs intensity-modulated radiotherapy for early supraglottic cancer: a systematic review.

Adenoid cystic carcinoma evaluation and management: progress with optimism!

Swallowing after transoral surgery for oropharyngeal cancer: comparison with primary chemoradiotherapy outcomes.

Different branching patterns of the spinal accessory nerve: impact on neck dissection technique and postoperative shoulder function.

Parenclitic Network Analysis of Methylation Data for Cancer Identification

by Alexander Karsakov, Thomas Bartlett, Artem Ryblov, Iosif Meyerov, Mikhail Ivanchenko, Alexey Zaikin

We make use of ideas from the theory of complex networks to implement a machine learning classification of human DNA methylation data, that carry signatures of cancer development. The data were obtained from patients with various kinds of cancers and represented as parenclictic networks, wherein nodes correspond to genes, and edges are weighted according to pairwise variation from control group subjects. We demonstrate that for the 10 types of cancer under study, it is possible to obtain a high performance of binary classification between cancer-positive and negative samples based on network measures. Remarkably, an accuracy as high as 93−99% is achieved with only 12 network topology indices, in a dramatic reduction of complexity from the original 15295 gene methylation levels. Moreover, it was found that the parenclictic networks are scale-free in cancer-negative subjects, and deviate from the power-law node degree distribution in cancer. The node centrality ranking and arising modular structure could provide insights into the systems biology of cancer.

http://ift.tt/2iLewhu

Immunosuppressive myeloid-derived suppressor cells are increased in splenocytes from cancer patients

Abstract

Myeloid-derived suppressor cells (MDSCs) are a heterogeneous population of myeloid cells that are increased in the peripheral blood of cancer patients and limit productive immune responses against tumors. Immunosuppressive MDSCs are well characterized in murine splenic tissue and are found at higher frequencies in spleens of tumor-bearing mice. However, no studies have yet analyzed these cells in parallel human spleens. We hypothesized that MDSCs would be increased in the spleens of human cancer patients, similar to tumor-bearing mice. We compared the frequency and function of MDSC subsets in dissociated human spleen from 16 patients with benign pancreatic cysts and 26 patients with a variety of cancers. We found that total MDSCs (Lin^neg CD11b^pos CD33^pos HLA-DR^neg), granulocytic MDSCs (additional markers CD14^neg CD15^pos), and monocytic MDSCs (CD14^pos CD15^neg) were identified in human spleen. The monocytic subset was the most prominent in both spleen and peripheral blood and the granulocytic subset was expanded in the spleen relative to matched peripheral blood samples. Importantly, the frequency of CD15^pos MDSCs in the spleen was increased in patients with cancer compared to patients with benign pancreatic cysts and was associated with a significantly increased risk of death and decreased overall survival. Finally, MDSCs isolated from the spleen suppressed T cell responses, demonstrating for the first time the functional capacity of human splenic MDSCs. These data suggest that the human spleen is a potential source of large quantities of cells with immunosuppressive function for future characterization and in-depth studies of human MDSCs.

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Soft tissue substitutes in non-root coverage procedures: a systematic review and meta-analysis

Abstract

Objectives

The present systematic review compared the effectiveness of soft tissue substitutes (STSs) and autogenous free gingival grafts (FGGs) in non-root-coverage procedures to increase keratinized tissue (KT) width around teeth.

Materials and methods

Included studies fulfilled the following main eligibility criteria: (a) preclinical in vivo or human controlled trials using FGG as control, (b) non-root-coverage procedures, and (c) assessment of KT width. Meta-analysis was performed on the gain in KT width (primary outcome variable) and several secondary variables.

Results

Eight human trials with short observation time evaluating five different STSs were identified. FGG yielded consistently significantly (p < 0.001) larger increase in KT width irrespective whether the comparison regarded an acellular matrix or a tissue-engineered STS. Further, FGG yielded consistently ≥2 mm KT width postoperatively, while use of STS did not, in the few studies reporting on this outcome. On the other hand, STSs resulted in significantly better aesthetic outcomes and received greater patient preference (p < 0.001).

Conclusions

Based on relatively limited evidence, in non-root-coverage procedures, FGG (1) resulted consistently in significantly larger increase in KT width compared to STS and (2) yielded consistently ≥2 mm KT width postoperatively, while STSs did not. STSs yielded significantly better aesthetic outcomes, received greater patient preference, and appeared safe.

Clinical relevance

Larger and more predictable increase in KT width is achieved with FGG, but STSs may be considered when aesthetics is important. Clinical studies reporting relevant posttreatment outcomes, e.g., postop KT width ≥2 mm, on the long-term (>6 months) are warranted.

http://ift.tt/2iKpOST

Hemoperitoneum secondary to intercostal arterial bleeding in a trauma patient

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<span class="paragraphSection"><div class="boxTitle">Abstract</div>Blunt trauma resulting in rib fractures can be associated with hemothorax, pneumothorax, pulmonary contusions or less frequently chest and abdominal wall hematomas. Our case describes the first report of hemoperitoneum secondary to intercostal arterial bleeding from blunt trauma in a patient on anticoagulation.</span>

http://ift.tt/2jWlopa

Rectal colonic mural hematoma following enema for constipation while on therapeutic anticoagulation

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<span class="paragraphSection"><div class="boxTitle">Abstract</div>Causes of colonic and recto-sigmoid hematomas are multifactorial. Patients can present with a combination of dropping hemoglobin, bowel obstruction and perforation. Computed tomography imaging can provide clues to a diagnosis of intramural hematoma. We present a case of rectal hematoma and a review of current management literature. A 72-year-old male on therapeutic anticoagulation for a pulmonary embolism, was administered an enema resulting in severe abdominal pain unresponsive to blood transfusion. A sigmoid colectomy with end colostomy was performed. Although rare, colonic and recto-sigmoid hematomas should be considered as a possible diagnosis for adults with abdominal pain on anticoagulant therapy.</span>

http://ift.tt/2jWA6N1

Follicular thyroid carcinoma presenting with pathological fracture of the humerus at initial diagnosis

$X-ray showed lytic lesion and pathological fracture of left proximal humerus. Plain radiographs of the left.$

<span class="paragraphSection"><div class="boxTitle">Abstract</div>Differentiated carcinomas of the thyroid gland usually have a good prognosis with prognosis often discussed in terms of 20 year survival. Nevertheless its 10-year-survival rate decreases when accompanied by distant metastasis. Follicular thyroid cancer (FTC) is the second most common thyroid cancer and usually presents with a solitary thyroid nodule with or without cervical lymphadenopathy. Distance metastasis at initial diagnosis is seldom observed with incidence range from 1 to 9%. In cases of bone metastasis, the incidence is only 2–3% and weight-bearing skeleton is preferentially affected. In our case, we present a patient with FTC that metastasized to the upper limb causing severe pain and pathological fracture at the initial presentation.</span>

http://ift.tt/2j3y0fB

Patient satisfaction in dermatology

Abstract

We are pleased that there is a growing interest from doctors in patient'satisfaction. According to PubMed data and the key words 'patient' AND 'satisfaction', we found an impressive increase of the number of articles, from 179 in 1985 to 7,211 in 2015. We were highly interested by the lecture of the letter « Patient satisfaction and the waiting room in Mohs surgery: appropriate pre-warning may abrogate boredorm » from F.R. Ali, F. Al-Niaimi, E.E. Craythorne, R. Patalay and R. Mallipeddi and thank them for their interest in our paper.

The Mohs micrographic surgery is a specific condition because a good cooperation with patients is required and the waiting time is longer than in usual consultations.

http://ift.tt/2j3DpDq

Is palmoplantar pustulosis simply a variant of psoriasis or a distinct entity?

Abstract

We read with interest the comment of Brunasso and Massone to our review article.¹ We agree that palmoplantar pustulosis (PPP) shares many features with palmoplantar pustular psoriasis (PPPP), and about 1/3 patients with PPP present with psoriasis lesions (skin, nail or joint changes). The close relationship and coexistence of PPP and psoriasis was confirmed in many studies. ^3-5

http://ift.tt/2jWmGAk

Creating Immunocompromised Districts

Abstract

We read the letter to the editor, Viral warts and seborrheic keratosis on tattoos: a review of 9 cases with great interest.¹ Dermatologists see only what they know! Once we recognized the possibility that warts might grow preferentially in black and blue tattoo dye, we collected 7 cases over a 10-year period from one solo private practice. In this report, a patient with a pre-existing viral wart on skin adjacent to a new tattoo appears to have preferentially spread onto the immunocompromised district (Ruocco, 2009)² created by black ink nanoparticles.

http://ift.tt/2j3AXNv

Experience of skin cancer and contact with health professionals is associated with increased skin cancer knowledge, but not sun safety knowledge or behaviour

Abstract

The mortality and morbidity associated with melanoma is unquestionable, but its global incidence is greatly outnumbered by that of non-melanoma skin cancer (NMSC). The economic burden of NMSC is significant, falling within the US' top five most costly cancers ¹. In Australia, a high level of skin cancer awareness has been reported ². Public health campaigns and advice provided by individual health professionals seek to increase knowledge about skin cancer, risk factors and protective sun–safety behaviours.

http://ift.tt/2iKJqGu

Viral warts and seborrheic keratoses on tattoos: a review of 9 cases

Abstract

We wish to add to the recent article by Ramley et al¹ our experience on 8 cases of viral warts and one case of seborrheic keratosis (SK) on tattoos. Those cases were collected with the help of dermatologists and family doctors between 2007 and 2016. We reviewed the demographic data, delay of onset after tattooing, clinical presentation and outcomes whenever possible. The number of lesions was counted manually from the available pictures.

http://ift.tt/2jWfK6t

Patient satisfaction and the waiting room in Mohs surgery: appropriate pre-warning may abrogate boredom

Patient satisfaction in dermatology consultations has rightly been afforded attention by De Salins and colleagues.¹ When considering the patient journey through an outpatient appointment, a significant proportion of time is spent in the waiting room, a period which is poorly understood and may contribute to patient anxiety and perceived satisfaction with treatment.² In our outpatient Mohs micrographic surgery (MMS) unit, patients may be waiting for several hours in total whilst histological specimens are processed and analysed, prior to reconstruction, particularly if multiple MMS stages are needed.

http://ift.tt/2j3E2Nf

Spanish Version of Actinic Keratosis Quality of Life Questionnaire (AKQoL)

Abstract

Background

Patient Reported Outcome Measures are very important outcomes. For specific diseases Health Related Quality of Life-instruments (HRQoL) are increasingly used to provide data on patients' overall perceptions of the course of a given disease. Actinic keratoses (AKs) are common keratotic lesions that occur on chronically sunlight-exposed skin. Only few studies regarding HRQoL in AKs have been made.

Objective

In order to be able to compare HRQoL among different countries and cultures we aimed to translate and validate the Actinic Keratosis Quality of Life (AKQoL) questionnaire into Spanish and quantify the impairment caused by AKs in Spanish patients.

Methods

The AKQoL was translated. Then 15 patients with AKs were interviewed to ensure cultural adaption before it was tested in one hundred patients with AK lesions at the Melanoma Unit of Hospital Clinic in Barcelona.

Results

Validation showed high inter-item correlations, as well as a high correlation of each item and the total score. Internal consistency (Cronbachs coefficient alpha) was also high at 0.91 and an alpha value of 0.90 at retest. The test-retest correlation was 0.96 and the intra class coefficient was 0.98.

Conclusion

The presented data support the AKQoL Spanish version as a valid and reliable HRQoL questionnaire for the description of AK-related QoL, and may provide a method for comparison of AK specific QoL between different cultures and countries.

http://ift.tt/2k9DL9e

Non-invasive anaesthetic methods for dermatological laser procedures - a systematic review

Abstract

Pain is a common side-effect of dermatological laser procedures. Non-invasive anaesthetic drugs and anaesthetic procedures can be used to provide pain relief and increase patient satisfaction and treatment efficacy. However, it remains unclear which method provides the best pain relief. The objective of this systematic review was therefore to assess the efficacy and safety of non-invasive anaesthetic methods during dermatological laser procedures. A systematic literature search was conducted. Randomized and non-randomized controlled clinical trials (RCTs and CCTs) were included. Two authors independently assessed study eligibility, extracted data and assessed the risk of bias. The quality of evidence was rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Twenty RCTs and 12 CCTs were included, involving nine different laser indications: hair removal (n=9), resurfacing/rejuvenation (n=5), port wine stains (n=8), leg telangiectasia (n=3), facial telangiectasia (n=2), tattoo removal (n=2), nevus of Ota (n=1), solar lentigines (n=1), and HPV lesions (n=1). The non-invasive anaesthetic methods (i.e. topical anaesthetic drugs, skin cooling, and pneumatic skin flattening [PSF]), types of lasers, laser settings, application time, and types of pain scales varied widely among the included studies. All of the studies had an unclear or high risk of bias and the overall quality of evidence was rated as low. In general, active non-invasive anaesthetic methods seemed to provide favourable results compared to placebo or no anaesthesia, and topical anaesthetic drugs and PSF seemed to result in a better pain reduction than skin cooling. However, the current evidence is insufficient to provide recommendations for daily clinical practice. There is a need for more high quality (head-to-head) RCTs. Future studies should also evaluate sex differences in pain perception, have uniformity with regard to validated pain measurement scales, and address clinically significant differences in pain reduction besides statistically significant differences.

http://ift.tt/2jWdwDY

A randomized, double-blind, placebo-controlled, dose-escalation first-in-man study (phase 0) to assess the safety and efficacy of topical cytosolic phospholipase A2 inhibitor, AVX001, in patients with mild to moderate plaque psoriasis

Abstract

Background

Cytosolic Phospholipase A2 (cPLA2α) is an enzyme suggested as a therapeutic target in inflammatory skin diseases. AVX001, a cPLA2α-inhibitor was investigated in a randomized, double-blind, placebo-controlled, split-design, first-in-man study in patients with mild to moderate psoriasis.

Objectives

The primary objective was to evaluate cutaneous safety and tolerability of AVX001 in doses from 0.002%-5.0%. Safety was assessed as local skin reaction adverse events (LSRAE) grade 3-4. The secondary objective was assessment of efficacy on modified PASI (mPASI) score compared with placebo.

Methods

Of 94 randomized men, 88 completed treatment with AVX001 and placebo. The treatment period was four weeks with two weeks follow-up with assessment at screening, randomization and once weekly until study end. AVX001 and placebo was applied blinded at symmetrically affected areas once daily.

Results

VX001 was safe with no grade 3-4 LSRAE. A 29% reduction of mPASI was seen at the 5% dose level at week four. Post hoc analysis of combined doses of 3 and 5% showed a clinical relevant effect with 31% reduction in mPASI (p=0.058) and statically significant reduction of the infiltration (p=0.036). The actively treated side showed improvement in mPASI score after one week of treatment and the observed improvement continued throughout the four weeks of treatment.

Conclusions

Treatment with AVX001 is well-tolerated in doses up to 5%, and showed placebo adjusted, clinical effects at a level of statistical significance. The improvement throughout the treatment period suggests that longer treatment could conceivably result in superior efficacy.

http://ift.tt/2j3DTJH

Psoriasis and palmoplantar pustulosis: an endless debate?

Abstract

Since 2007, palmoplantar pustulosis (PPP) has been classified as a separate entity and not a clinical variant of psoriasis despite the presence of certain phenotypes common in both diseases.¹ We read with interest the review by Misiak-Galazka et al., and we found that even after the extensive work (inclusion of 65 articles), some relevant data are missing.^1-3

The clue question remains the following: Is palmoplantar pustulosis (PPP) closely related to psoriasis or is PPP a separate condition? Herein we will systematically review the literature searching for frequency of psoriasis in PPP patients and we will discuss new genetic insights that connect PPP and psoriasis vulgaris.

http://ift.tt/2jWw2Mr

iDermatoPath – A novel software tool for mitosis detection in H&E stained tissue sections of malignant melanoma

Abstract

Background

Malignant Melanoma (MM) is characterized by a growing incidence and a high malignant potential. Beside well defined prognostic factors such as tumor thickness and ulceration, the Mitotic Rate (MR) was included in the AJCC recommendations for diagnosis and treatment of MM. In daily routine, the identification of a single mitosis can be difficult on Hematoxylin&Eosin slides alone. Several studies showed a big inter- and intra-individual variability in detecting the MR in MM even by very experienced investigators, thus raising the question for a computer assisted method.

Objective

The objective was to develop a software system for mitosis detection in MM on H&E slides based on machine learning for diagnostic support.

Methods

We developed a computer-aided staging support system based on image analysis and machine learning on the basis of 59 MM specimens. Our approach automatically detects tumor regions, identifies mitotic nuclei, and classifies them with respect to their diagnostic relevance. A convenient user interface enables the investigator to browse through the proposed mitoses for fast and efficient diagnosing.

Results

A quantitative evaluation on manually labelled ground truth data revealed that the tumor region detection yields a medium spatial overlap index (dice coefficient) of 0.72. For the mitosis detection we obtained high accuracies of above 83%.

Conclusion

On the technical side, the developed iDermatoPath software tool provides a novel approach for mitosis detection in MM, which can be further improved by using more training data such as dermatopathologist annotations. On the practical side, a first evaluation of the clinical utility was positive, albeit this approach provides most benefit for difficult cases in a research setting. Assuming all slides to be digitally processed and reported in the near future, this method could become a helpful additional tool for the pathologist.

http://ift.tt/2iKJpCq

Efficacy and safety of interleukin-17 antagonists in patients with plaque psoriasis: a meta analysis from phase 3 randomized controlled trails

Abstracts

Background

The interleukin-17 (IL-17) cytokine pathway plays a key role in the development of psoriasis. Antibodies targeting IL-17 or blocking its receptor may be a new therapeutic approach for psoriasis. To assist treatment selection in daily practice it is essential to understand the benefit and risk profile of IL-17 antagonists.

Objective

We performed a meta-analysis to evaluate the efficacy and safety of IL-17 antagonists in patients with psoriasis.

Methods

We searched a number of databases for relevant randomized clinical trials (RCTs) published before May 2016. The following outcomes were evaluated: Psoriasis Area and Severity Index (PASI) 75, 90, 100 response, Investigator's Global Assessment (IGA) score of 0 or 1 response, adverse events (AEs) and withdrawals. The meta-analysis was performed using Review Manager 5.2 software.

Results

Nine RCTs with 5951 patients were included. IL-17 antagonists achieved higher PASI 75, 90, 100 response rates and DLQI 0 or 1 response rates than placebo and a lower incidence of discontinuations due to lack of efficacy. In the safety analysis, no significant differences were found between the IL-17 antagonists and placebo in the proportion of patients with serious AEs, cardiovascular disease and discontinuations due to AEs. However, IL-17 antagonists were associated with a higher proportion of patients with any AEs and infections than placebo.

Conclusion

IL-17 antagonists were effective, with an acceptable safety profile, for patients with plaque psoriasis. Vigilance because of the potential for infection will be necessary for IL-17 antagonists.

http://ift.tt/2j3Csel

Tattoo removal by Q-switched YAG laser: Client satisfaction

Abstract

Background

Tattoo removal by Q-switched lasers is golden standard; however, clients' satisfaction with treatment is little known.

Objective

To determine clients' satisfaction with tattoo removal.

Methods

154 tattoo removal clients who had attended the private clinic "Centre for Laser Surgery", Hellerup, Denmark from 2001-2013 completed a questionnaire concerning outcome expectations, level of pain experiences and satisfaction with tattoo removal. The laser surgeon and his team were blinded from data handling. The study design included a minimum 2-year post-laser treatment observation period from 2013-2015.

Results

Overall, clients were satisfied with their laser treatment; 85% assessed their treatment and results to be acceptable to superb, while 15% assessed their treatment and results to be inferior to unacceptable. Effectiveness relative to colour of tattoo on a scale from 0 (no effect) to 10 (complete removal) scored a mean of: blue 9.5, black 9.4, yellow 8.9, red 8.8 and green 6.5.

Clients were dissatisfied with green pigment remnants, which could mimic bruising. 129 clients (84%) experienced moderate to extreme pain during treatment. 28 (20%) developed minor scarring. There were many reasons for tattoo removal; e.g. stigmatisation (33%), conspicuousness (29%) and poor artistic quality (22%). 102 clients had expected complete removal of tattoos without a blemish, expectations that were only partly fulfilled. During the treatment period, clients adjusted expectations and adapted more realistic views of outcomes.

Conclusion

The majority of clients were satisfied with Q-switched YAG laser removal of tattoos despite high pre-treatment expectations were only partly met. The study supports YAG lasers for tattoo removal as acceptable therapy of today, with room for new approaches.

http://ift.tt/2jW3C5c

Adaptation and validation of the Singing Voice Handicap Index into Polish

Abstract

Objective

To translate and adapt the original SVHI for the Polish population and to evaluate the psychometric properties of the Polish SVHI version, such as internal consistency, reliability and construct validity in different groups of dysphonic singers.

Study design

Prospective case-control study.

Setting

Patients treated at a single institute.

Participants

60 singers with voice disorders and 57 healthy singers completed the Singing Voice Handicap Index (SVHI) and the Voice Handicap Index (VHI). Thirty singers completed the SVHI twice within a 2 - 4 week interval.

Main outcome measures

internal consistency, test-retest reliability, discriminant validity, criterion-related validity

Results

A strong Cronbach alpha coefficient (0.96) indicates that the SVHI items are measuring the same construct. Evaluating the test-retest reliability, the r –Spearman correlation coefficient was r=0.797 for the total score of SVHI, which shows a good level of reproducibility. There were significant differences between the control group (CG) and patients with benign vocal fold lesions (p<0.001), CG and singers with muscle tension dysphonia (p<0.001), CG and coexistence of muscle tension dysphonia and chronic laryngitis (p<0.001). There was a positive statistically significant correlation between SVHI and VHI (r=0.753, p=0.000*).

Conclusions

The Polish version of SVHI serves as a valid health status instrument, as well as discriminating between singers with voice disorders and singers without voice problems. The SVHI is easy to perform in clinical practice.

http://ift.tt/2j3B8bz

The increased expression of TCF3 is correlated with poor prognosis in Chinese patients with nasopharyngeal carcinoma

Abstract

Objectives

Regulatory factors controlling stem cell identity and self-renewal are often active in aggressive cancers and are thought to promote cancer growth and progression. B-cell-specific transcription factor 3 (TCF3/E2A) is a member of the T-cell factor/lymphoid enhancer factor (TCF/LEF) transcription factor family that is central to regulating epidermal and embryonic stem cell identity. It has been reported that TCF3 was connected with the development and progression of a number of human cancers. In this study, we aimed to identify the expression of TCF3 in human NPC and evaluate its clinical significance.

Design

To investigate the expression of TCF3 in nasopharyngeal carcinoma (NPC) and its relationship to prognosis.

Setting

An in vitro study.

Main outcome measures

We analyzed the expression of TCF3 in NPC and in non-tumorous nasopharyngeal tissues by quantitative RT-PCR and Western blotting. The expression patterns of TCF3 in 117 archived paraffin-embedded NPC specimens were characterized by immunohistochemistry (IHC), and the correlation between of the TCF3 protein expression and the clinicopathological features of NPC was analyzed.

Results

We observed that TCF3 had a higher expression in nasopharyngeal carcinoma than in non-tumorous nasopharyngeal tissues of 117 archived paraffin-embedded NPC specimens, and 80 (68.4%) biopsy tissues revealed high levels of TCF3 expression. Furthermore, statistical analyses demonstrated that the increased expression of TCF3 was closely related to clinical stage, locoregional recurrence and distant metastasis of NPC. NPC patients with high levels of TCF3 expression had a shorter survival time, whereas patients with lower levels of TCF3 expression survived longer. Moreover, multivariate analysis suggested that the upregulation of TCF3 was a critical prognostic factor for NPC.

Conclusions

Our observations suggest, for the first time, that TCF3 is significantly associated with the development and progression of NPC, which can be used as an important prognostic marker for NPC patients and may be an effective target for the treatment of NPC.

http://ift.tt/2jWdvA8

Association between day and time of admission to critical care and acute hospital outcome for unplanned admissions to adult general critical care units: cohort study exploring the ‘weekend effect’

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<span class="paragraphSection"><strong>Background.</strong> We aimed to identify any association between day and time of admission to critical care and acute hospital outcome.<strong>Methods.</strong> We conducted a cohort study using prospectively collected data from the national clinical audit of adult critical care. We included 195 428 unplanned admissions from 212 adult general critical care units in England, Wales and Northern Ireland, between April 1, 2013 and March 31, 2015 in the analysis.<strong>Results.</strong> Hourly admission rates for unplanned admissions varied more than three-fold during the 24 h cycle. Overall acute hospital mortality was 26.8%. Before adjustment, acute hospital mortality was similar between weekends and weekdays but was significantly lower for admissions at night compared with the daytime (−3.4%, −3.8 to −3.0%; <span style="font-style:italic;">P</span><0.001). After adjustment for casemix, there remained no difference between weekends and weekdays (−0.0%, −0.4 to +0.3%; <span style="font-style:italic;">P</span>=0.87) or between nighttime and daytime (−0.2%, −0.5 to +0.1%; <span style="font-style:italic;">P</span>=0.21). Delays in admission were reported for 4.3% of admissions and were slightly more common during weekdays than weekends and in the daytime than at night. Delayed admission was associated with a small increase in acute hospital mortality, but adjusting for this did not affect the estimates of the effect of day and time of admission.<strong>Conclusions.</strong> The day of week and time of admission have no influence on patient mortality for unplanned admissions to adult general critical care units within the UK. Ways to improve critical care and hospital systems to minimize delays in admission and potentially improve outcomes need to be ascertained in future research.</span>

http://ift.tt/2kbnRzr

Immunoexpression of HDAC1, HDAC2 and HAT1 in actinic cheilitis and lip squamous cell carcinoma

Abstract

Background

Acetylation/deacetylation are the most studied covalent histone modifications resulting in transcriptional regulation with histone deacetylases (HDAC) and histone acetyltransferases (HAT) as the main associated enzymes. These enzymes overexpression induces abnormal transcription of key genes that regulate important cellular functions, such as proliferation, cell cycle regulation, and apoptosis. Thus, the expression of different HATs and HDACs has been evaluated in various cancers. OBJECTIVE: to investigate HDAC1, HDAC2 and HAT1 expression in lip squamous cell carcinoma (LSCC) and actinic cheilitis (AC) and to demonstrate their correlation with DNA metyltransferases (DNMTs).

Material And Methods

Thirty cases of lip squamous cell carcinoma (LSCC), thirty cases of actinic cheilitis (AC), and 28 cases of non-neoplastic epithelium as control, were selected for immunohistochemical investigation. RESULTS: Nuclear HDAC2 immunopositivity was significantly higher in AC (75.07%±29.70) when compared with LSCC (51.06%±39.02). HDAC1 and HAT1 nuclear immunostaining were higher in AC, with no statistical significance. When comparing data with our previous study, we found a positive correlation between HDAC1 X DNMT1/DNMT3b, HDAC2 X DNMT3b, and HAT1 X DNMT1/DNMT3b for certain studied groups.

Conclusion

This study showed higher levels of nuclear HDAC2 immunopositivity in AC, possibly indicating that this enzyme plays a key role in lip photocarcinogenesis early stages.

http://ift.tt/2j3COlh

Long-term outcomes of endolymphatic sac shunting with local steroids for Meniere's disease

Publication date: Available online 20 January 2017
Source:American Journal of Otolaryngology
Author(s): Cameron C. Wick, Nauman F. Manzoor, Caileigh McKenna, Maroun T. Semaan, Cliff A. Megerian
ObjectivesTo evaluate the long-term efficacy of endolymphatic sac shunt techniques with and without local steroid administration.Study designRetrospective case series and patient survey.SettingTertiary university hospital.PatientsMeniere's disease (MD) patients that failed medical therapy and subsequently underwent an endolymphatic sac shunt procedure. All patients had definitive or probable MD and at least 18-months of follow-up.InterventionsThree variations on endolymphatic sac decompression with shunt placement were performed: Group A received no local steroids, Group B received intratympanic dexamethasone prior to incision, and Group C received dexamethasone via both intratympanic injection and direct endolymphatic sac instillation.Main outcome measure(s)Vertigo control, hearing results, and survey responses.ResultsBetween 2002 and 2013, 124 patients with MD underwent endolymphatic sac decompression with shunt placement. 53 patients met inclusion criteria. Groups A, B, and C had 6 patients, 20 patients, and 27 patients, respectively. Mean follow-up was 56months. Vertigo control improved in 66%, 83%, and 93% of Groups A, B, and C. Functional level improved for Group B (−2.0) and Group C (−2.2) but was unchanged in Group A. Pure-tone average and speech discrimination scores changed by +22dB and −30%, +6dB and −13%, and +6dB and −5% in Groups A, B, and C. The long-term hearing results were significantly better with steroids (Groups B and C) according to the AAO-HNS 1995 criteria but did not meet significance on non-parametric testing.ConclusionsEndolymphatic sac shunt procedures may benefit from steroid instillation at the time of shunt placement.

http://ift.tt/2iTC2E0

Cochlear implantation in an NPC patient post-irradiation presenting with electrode array extrusion through the posterior canal wall

Publication date: Available online 19 January 2017
Source:American Journal of Otolaryngology
Author(s): Celeste Ann Chua, David Low, Tiong-Yong Tan, Heng-Wai Yuen

http://ift.tt/2j3frIy

Surgical timing for facial paralysis after temporal bone trauma

Publication date: Available online 19 January 2017
Source:American Journal of Otolaryngology
Author(s): Peng Xu, Aiyan Jin, Baoqiang Dai, Ruijie Li, Yefeng Li
ObjectivesTo explore surgical timing of facial paralysis after temporal bone trauma.MethodsThe clinical data of the patients with facial paralysis after temporal bone trauma who underwent subtotal facial nerve decompression were retrospectively collected, and 80 cases followed-up for one year were enrolled in the study. They were divided into different subgroups according to the age, onset, and interval between facial paralysis and surgery, and the outcomes of facial nerve between different subgroups were compared.ResultsThe number of patients who achieved good recovery of HB Grade I or II was 52 of 80 (65.0%). 43 of 66 cases (65.2%) in the younger group had good recovery of facial nerve in contrast to 9 of 14 cases (64.3%) in the elderly group, without significant difference (p>0.05). 9 of 13 cases (69.2%) in the delayed onset group had good recovery, while 43 of 67 cases (64.2%) in the immediate onset group had good recovery, without significant difference (p>0.05). The good recovery rate of the <1month group was statistically higher compared to the 3–6months group or the >6months group (P<0.05), while the good recovery rate of the <1month group was not statistically higher than that of the 1–2months group or the 2–3months group (P>0.05).ConclusionThis study demonstrated that the good recovery rate of facial paralysis after temporal bone trauma was uncorrelated with age and onset. It was better to perform surgical decompression within 3months after facial paralysis.

http://ift.tt/2iTKXWf

Expansion of CD11b+Ly-6C+ myeloid-derived suppressor cells (MDSCs) driven by galectin-9 attenuates CVB3-induced myocarditis

Publication date: March 2017
Source:Molecular Immunology, Volume 83
Author(s): Yingying Zhang, Mengying Zhang, Xueqin Li, Zongsheng Tang, Ling He, Kun Lv
Galectin-9 is known to play a role in the modulation of innate and adaptive immunity to ameliorate CVB3-induced myocarditis. In the present study, we found that galectin-9 induced the expansion of CD11b⁺Ly-6C⁺ myeloid-derived suppressor cells (MDSCs) in the heart from CVB3-infected mice. Adoptive transfer of CD11b⁺Ly-6C⁺ MDSCs significantly alleviated myocarditis accompanied by increased Th2 and Treg frequency and anti-inflammatory cytokines expression in the heart tissue. Moreover, Ly6C⁺ MDSCs, but not Ly6G⁺ cells, expressed Arg-1 and NOS2, and suppressed CD4⁺ T cell proliferation in vitro in an Arg-1-dependent mechanism; an event that was reversed with treatment of either an Arg-1 inhibitor or addition of excess l-arginine. Furthermore, Ly6C⁺ MDSCs co-expressed higher levels of F4/80, Tim-3, and IL-4Rα, and had the plasticity to up-regulate NOS2 or Arg-1 in response to IFN-γ or IL-4 treatment. The present results indicate that galectin-9 expands CD11b⁺Ly-6C⁺ MDSCs to ameliorate CVB3-induced myocarditis.

http://ift.tt/2iTLTd4

IL-12 and IL-23 modulate plasticity of FoxP3+ regulatory T cells in human Leprosy

Publication date: March 2017
Source:Molecular Immunology, Volume 83
Author(s): Mohd Tarique, Chaman Saini, Raza Ali Naqvi, Neena Khanna, Alpana Sharma, D.N. Rao
Leprosy is a bacterial disease caused by M. leprae. Its clinical spectrum reflects the host's immune response to the M. leprae and provide an ideal model to investigate the host pathogen interaction and immunological dysregulation. Tregs are high in leprosy patients and responsible for immune suppression of the host by producing IL-10 and TGF-β cytokines. In leprosy, plasticity of Tregs remain unstudied. This is the first study describing the conversion of Tregs into Th1-like and Th17-like cells using in vitro cytokine therapy in leprosy patients. Peripheral blood mononuclear cells from leprosy patients were isolated and stimulated with M. leprae antigen (MLCwA), rIL-12 and rIL-23 for 48h. Expression of FoxP3 in CD4⁺CD25⁺ Tregs, intracellular cytokines IFN-γ, TGF-β, IL-10 and IL-17 in Tregs cells were evaluated by flow cytometry (FACS) after stimulation. rIL-12 treatment increases the levels of pStat4 in Tregs and IFN-γ production. In the presence of rIL-23, pStat3⁺ and IL-17A⁺ cells increase. rIL-12 and r—IL-23 treatment downregulated the FoxP3 expression, IL-10 and TGF-β production by Tregs and enhances the expression of co-stimulatory molecules (CD80, CD86). In conclusion rIL-12 converts Tregs into IFN-γ producing cells through STAT-4 signaling while rIL-23 converts Tregs into IL-17 producing cells through STAT-3 signaling in leprosy patients. This study may helpful to provide a new avenue to overcome the immunosuprression in leprosy patients using in vitro cytokine.

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Histopathological findings of extra-ileal manifestations at initial diagnosis of Crohn’s disease-related ileitis

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Laudatio auf Professor Dr. med. Uwe-Frithjof Haustein zum 80. Geburtstag

http://ift.tt/2jxsBfk

DLX3 mutation negatively regulates odontogenic differentiation of human dental pulp cells

Publication date: Available online 19 January 2017
Source:Archives of Oral Biology
Author(s): Li Zeng, Na Zhao, Dong Han, Haochen Liu, Yang Liu, Yixiang Wang, Hailan Feng
ObjectivesThe purpose of this study was to investigate the role of a novel mutant DLX3 on the odontogenic differentiation of human dental pulp cells (hDPCs) in tricho-dento-osseous (TDO) syndrome.DesignhDPCs were obtained from the healthy premolars, stably-expressing wild-type DLX3 (WT), novel mutant DLX3 (Mu) and control vector (NC) cells were generated using recombinant lentiviruses. The proliferation rates of WT-hDPCs and Mu-hDPCs were measured by CCK8 assay. Odonto-differentiation of hDPCs was assessed by alkaline phosphatase (ALP) activity assay, and mineralization ability was assessed by Alizarin red staining. Odontogenic markers, including DMP-1, DSPP, Nes, ALP, and DLX5, were analyzed using real-time polymerase chain reaction (qPCR). DMP-1 and DSPP expressions were further confirmed by Western blotting.ResultsCCK8 results showed that the novel mutant DLX3 decreased the proliferation rate of hDPCs compared with wild-type DLX3. qPCR showed that the novel mutant DLX3 weakened odontogenic differentiation by downregulating the expression of odontogenic genes. These results were further confirmed by Western blotting and ALP activity assay. Additionally, Alizarin red staining showed that the novel mutant DLX3 decreased the mineralization of hDPCs compared with wild-type DLX3.ConclusionsNovel de novo mutation of DLX3 significantly decreases the proliferation rate and inhibits the odontogenic differentiation and mineralization of hDPCs, suggesting that this novel mutation of DLX3 can influence the dentinogenesis in TDO syndrome.

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Effects of glucocorticoid-induced osteoporosis on bone tissue of rats with experimental periodontitis

Publication date: Available online 20 January 2017
Source:Archives of Oral Biology
Author(s): Luzia Hermínia Teixeira Sousa, Eveline Valeriano Moura, Ana Larissa Queiroz, Danielle Val, Hellíada Chaves, Mario Lisboa, Flávia Furlaneto, Gerly Anne Brito, Paula Goes
Objective: To evaluate the effects of osteoporosis induced by glucocorticoid (GIOP) on bone tissue of rats with experimental periodontitis (EP).Design48 male Wistar rats divided into groups: Naïve, EP, GIOP and GIOP+EP. Rats of GIOP and GIOP+EP groups received 7mg/kg of dexamethasone intramuscularly once a week for 5 weeks. Following, EP and GIOP+EP groups were subjected to ligature-induced periodontitis. Naïve group experienced no manipulation. After 11 days, the animals were euthanized and left maxillae collected for macroscopic, radiographic, micro-tomographic and microscopic analysis of alveolar bone loss (ABL). Blood samples were collected for determination of bone-specific alkaline phosphatase (BALP) levels and the right femurs were removed for radiographic and biomechanical analysis.ResultsEP caused ABL and reduced BALP levels (p<0,05), but it did not change the architecture or biomechanics of femur, compared to Naïve. GIOP did not cause ABL, but it significantly decreased alveolar bone mineral density (ABMD), bone percentage and trabecular thickness (Tb.Th) and increased alveolar bone porosity (p<0.05) and significantly reduced BALP serum levels, as well as radiographic density and Young's module of femur, compared to Naïve. There was a greater ABL in group GIOP+EP when compared to EP (p<0.05). GIOP+EP caused a greater decrease on ABMD, Tb.Th, bone percentage and increased bone porosity (p<0.05) and also presented a significant reduction in BALP levels (p<0.05), in radiographic density and in Young's module of femur compared to EP (p<0.05).ConclusionsGIOP can potentiate the destructive effects of EP on alveolar bone and alter the systemic bone loss, by promoting bone resorption and reducing osteoblast activity.

http://ift.tt/2jxwGjJ

DLX3 mutation negatively regulates odontogenic differentiation of human dental pulp cells

Effects of glucocorticoid-induced osteoporosis on bone tissue of rats with experimental periodontitis

Angioedema in a patient with neuroendocrine tumour

Description

We present a case of a man aged 60 years, who was transferred to intensive care unit (ICU) due to labile blood pressure and a failed extubation trial after right carotid endarterectomy. His medical history was remarkable for symptomatic right carotid artery disease and recently diagnosed asymptomatic large cell neuroendocrine tumours (LCNETs) of the rectum with liver metastasis (figure 1A, B), currently on chemotherapy. In the recovery room, he had stridor with hypoxia after extubation and was noticed to have marked swelling of lips, tongue and eyelids (figure 2A). He was given epinephrine and steroids and subsequently reintubated with some difficulty. During ICU stay, he was given steroids, racemic epinephrine nebulisers and H1 blockers. The next day, he had improvement of the swelling and was extubated successfully. ENT evaluation showed residual laryngeal swelling with surrounding soft tissue swelling. CT scan of the head...

http://ift.tt/2jVeWP4

Novel approach for independent control of brain hypothermia and systemic normothermia: cerebral selective deep hypothermia for refractory cardiac arrest

A 38-year-old man was found unconscious, alone in the driver's seat of his car. The emergency medical team identified his condition as pulseless ventricular tachycardia. Defibrillation was attempted but failed. Extracorporeal membrane oxygenation (ECMO) was started in the emergency room 52 min after the estimated arrest following the extracorporeal cardiopulmonary resuscitation (ECPR) protocol in our center. The initial prognosis under the standard protocol was <25% chance of survival. A novel adjunctive to our ECPR protocol, cerebral selective deep (<30°C) hypothermia (CSDH), was applied. CSDH adds a second independent femoral access extracorporeal circuit, perfusing cold blood into the patient's common carotid artery. The ECMO and CSDH circuits demonstrated independent control of cerebral and core temperatures. Nasal temperature was lowered to below 30°C for 12 hours while core was maintained at normothermia. The patient was discharged without significant neurological deficit 32 days after the initial arrest.

http://ift.tt/2j2J0tV

Pouch pseudoaneurysm: a rare cause of recurrent haemorrhage following ileal pouch-anal anastomosis

Bleeding following restorative proctocolectomy for chronic ulcerative colitis is an uncommon complication. Usually bleeding occurs from the ileal pouch-anal anastomotic site in the early postoperative period. Significant pouch bleeding in the late postoperative course is rarely encountered. A mesenteric artery pseudoaneurysm along the ileal pouch staple line may be a cause of late-presenting massive per-rectal bleed. Although a rare phenomenon, it must be considered to be a differential in such a situation.

http://ift.tt/2jVjzZk

De novo 2p16.1 microdeletion with metastatic esophageal adenocarcinoma

Microdeletions involving chromosome 2p15-16.1 are a rare genetic abnormality and have been reported in 18 separate patients, mainly children, since 2007. This microdeletion syndrome is characterised by a heterogeneous expression of intellectual impairment, dysmorphic facies, musculoskeletal abnormalities and potential neurodevelopmental anomalies. We report the first case of natural progression in an adult patient who died at a young age of metastatic esophageal adenocarcinoma. Important learning points include the variable phenotypic expression of this microdeletion syndrome and the fact that clinicians must be thorough in investigating objective discrepancies in patients who cannot endorse classical symptoms.

http://ift.tt/2j2zE0Y

Cephalic tetanus as a differential diagnosis of facial nerve palsy

Cephalic tetanus is defined as a combination of trismus and paralysis of one or more cranial nerves. Since it is a rare cause of facial nerve palsy, it is often overlooked as a differential diagnosis. We present the case of a 75-year-old man admitted to our emergency department with left facial nerve palsy, left ptosis and dysphagia 2 weeks after a head laceration. Soon after admission, he was orally intubated because of massive aspiration. A delayed diagnosis of cephalic tetanus was reached only when he was extubated and trismus and risus sardonicus were identified in addition to facial nerve palsy. The patient was re-intubated and successfully extubated on day 20 postadmission. In orally intubated patients, trismus and risus sardonicus may be overlooked, and although rare, cephalic tetanus should be considered to be a differential diagnosis of facial nerve palsy.

http://ift.tt/2jVmJwm

Child with multiple fractures: a rare presentation of a common disease

Bone fractures are not uncommon in paediatric age. However, when recurrent, an underlying clinical condition must not be excluded. We describe the case of a boy aged 7 years, referred for investigation of recurrent bone fractures. Personal and family histories were unremarkable. Physical examination was normal. Almost all primary bone disorders were excluded. Additional laboratory investigations ruled out the majority of secondary causes of bone fragility. Coeliac disease (CD) serologies, however, were positive, and duodenal biopsies confirmed this diagnosis (Marsh III B). On a gluten-free diet, he suffered no more fractures and the bone mineral density improved. CD was also confirmed in his asymptomatic older brother. It is essential to diagnose CD as early as possible in order to minimise the compromise in bone health and prevent other complications of the disease. First-degree relatives should always be screened for the disease, even asymptomatic ones.

http://ift.tt/2jVil0b

Autoimmune hepatitis and eosinophilic granulomatosis with polyangiitis: a rare association

We describe a case of 40-year-old woman who presented to our hospital with symptoms of non-radiating epigastric pain for 4–5 days associated with nausea and vomiting. Her history was significant for asthma with recurrent exacerbations, polyneuropathy and recurrent sinus infections. Liver function tests revealed cholestasis. Antinuclear antibody and antismooth muscle cell antibody were positive. Liver biopsy revealed active chronic hepatitis with cholestasis. A diagnosis of autoimmune hepatitis was made. All other causes of cholestatic jaundice were ruled out. Her history of recurrent asthma exacerbations, eosinophilia, recurrent sinus infections and positive myeloperoxidase antibodies was suggestive of eosinophilic granulomatosis with polyangiitis. She was found to have combination of autoimmune hepatitis and eosinophilic granulomatosis with polyangiitis, a rarely reported association in the medical literature. She was started on prednisone for her autoimmune hepatitis. On follow-up with her gastroenterologist, her transaminases were trending down and she was symptomatically better.

http://ift.tt/2j2DxTR

Vascular endothelial growth factor–targeted paclitaxel-loaded liposome microbubbles and inhibition of human epidermoid-2 cell proliferation

ABSTRACT

Background

Vascular endothelial growth factor (VEGF) plays an important role in the formation of capillary blood vessels. The purpose of this study was to evaluate the inhibitory effect of VEGF-targeted paclitaxel (PTX)-loaded liposome microbubbles (VTPLLMs) on the proliferation of human epidermoid (Hep-2) laryngeal squamous cell carcinoma (SCC).

Methods

Six groups were randomly divided. The inhibitory effects on Hep-2 proliferation were assessed by a methylthiazol tetrazolium (MTT) method. The cell cycle distributions were investigated by flow cytometry. The expression variations of VEGF and caspase-3 were compared by Western blotting.

Results

Proliferation of Hep-2 in the VTPLLM+ultrasound group was significantly inhibited, and flow cytometry showed that the Hep-2 cells were significantly blocked at stage G2/M compared with other groups. Moreover, Western blotting showed VEGF expression was downregulated and caspase-3 expression was upregulated.

Conclusion

http://ift.tt/2jHIfrm

Chirurgische Indikation und Komplikationsmanagement beim Vestibularisschwannom

Zusammenfassung

Hintergrund

Moderne chirurgische Behandlungskonzepte für Patienten mit Vestibularisschwannomen (VS) setzen ein interdisziplinäres Herangehen sowie das Erkennen und Beherrschen von Komplikationen voraus.

Ziel der Arbeit

Die Arbeit gibt einen Überblick über Indikationen, Möglichkeiten des Funktionserhalts und Komplikationsmanagement bei der chirurgischen Tumorresektion.

Methoden

Aktuelle Behandlungskonzepte und chirurgische Indikationen wurden nach Tumorgröße und -ausdehnung differenziert. Die Häufigkeit wesentlicher Komplikationen wurde aus der Literatur extrahiert. Technische Möglichkeiten zur Vermeidung und Korrektur von Komplikationen wurden aus eigener Erfahrung und nach Literaturbefunden zusammengestellt.

Ergebnisse

Vor allem bei älteren Patienten sind Komplikationen, die nicht die Hirnnerven betreffen, nicht selten. Kleine und mittelgroße, nicht den Fundus und die Fossa cochlearis erreichende Tumoren lassen sich mit guten Chancen auf Hörerhalt vollständig entfernen. Solange sie nicht wachsen, profitieren die Patienten von einer Beobachtung. Große Tumoren sind in chirurgischen Serien im Vergleich zur Prävalenz überrepräsentiert. Die postoperative Fazialisfunktion korreliert mit dem Tumorvolumen. Ein Hörerhalt ist hier nur in seltenen Fällen möglich. Intraoperative elektrophysiologische Verfahren sind eine wichtige Unterstützung beim Funktionserhalt der betroffenen Hirnnerven. Persistierende Fazialisparesen können mit dynamischen und statischen Methoden der Gesichtsreanimation gemildert werden.

Schlussfolgerungen

Mortalität und Morbidität bei der chirurgischen Behandlung der VS halten sich in sehr annehmbaren Grenzen. Das Therapiekonzept sollte dem konkreten Fall individuell angepasst sein, um ein Höchstmaß an Lebensqualität zu sichern.

http://ift.tt/2j2pC07

Akustische Informationen von Schnarchgeräuschen

Zusammenfassung

Hintergrund

Mehr als ein Drittel aller Menschen schnarchen regelmäßig. Schnarchen ist ein häufiges Begleitsymptom einer obstruktiven Schlafapnoe (OSA) und wirkt zusätzlich störend auf den Bettpartner.

Ziel der Arbeit

Diese Arbeit gibt eine Übersicht über die Historie und den Stand der Forschung hinsichtlich der akustischen Analyse des Schnarchens zur Klassifizierung des OSA-Schweregrads, zur Detektion obstruktiver Ereignisse, zur Messung der Lästigkeit und zur Identifikation des Schallentstehungsorts.

Material und Methoden

Mit Blick auf die genannten Zielsetzungen wurden Recherchen in den Literaturdatenbanken PubMed und IEEE Xplore durchgeführt und aus den Suchergebnissen diejenigen Publikationen ausgewählt, die sich laut Titel und Abstract mit der jeweiligen Zielstellung befassen.

Ergebnisse

Es wurden insgesamt 48 Publikationen zu den genannten Zielstellungen berücksichtigt. Limitierender Faktor vieler Arbeiten ist die geringe Anzahl der Probanden, auf denen die Untersuchungen basieren.

Schlussfolgerung

Jüngere Forschungsergebnisse zeigen vielversprechende Ergebnisse, sodass akustische Analysen in der Zukunft einen Platz im Rahmen der Schlafdiagnostik als Ergänzung der anerkannten Standardverfahren finden können.

http://ift.tt/2j2pUEd

Therapie rückenlagebezogener obstruktiver Schlafapnoe mittels Smartphone-App

Zusammenfassung

Hintergrund

Die rückenlagebezogene obstruktive Schlafapnoe („positional obstructive sleep apnea", POSA) tritt häufig bei der leicht- und mittelgradigen Form der obstruktiven Schlafapnoe (OSA) auf. Zur Therapie werden 2 „smartphone applications" (Apps) angeboten, welche vorgeben, die Rückenlage zu verhindern, indem sie bei auf der Brust fixiertem Smartphone die Rückenlage erkennen und einen Vibrationsalarm auslösen: für Android „Apnea Sleep Position Trainer" und für iOS „SomnoPose – Sleep Position Monitor". Dies soll die Patienten zu einem Wechsel der Schlafposition veranlassen. Diese Apps wurden jedoch bisher nicht systematisch evaluiert.

Methoden

Erwachsenen Patienten mit polysomnographisch gesicherter POSA wurde die Teilnahme an der Studie angeboten. Die POSA wurde hierbei als ein Apnoe-Hypopnoe-Index (AHI) in Rückenlage (RL) >10 mit einem AHI in Seitenlage <10 und einer Verdopplung des AHI in RL definiert. Nach einem Monat erfolgte eine erneute Polysomnographie (PSG), die Compliance (mindestens 4 h/Nacht an 5 von 7 Tagen) wurde nach 6 Monaten telefonisch ermittelt. Als Therapieerfolg galt eine Reduktion der RL auf <10 % der gesamten Schlafzeit sowie auf einen Gesamt-AHI von <10.

Ergebnisse

An der Studie nahmen 57 Patienten teil, 24 Patienten erschienen jedoch nicht zur Kontroll-PSG. Es beendeten 33 Patienten die Studie wie geplant, wovon 25 erfolgreich therapiert wurden. Der Gesamt-AHI der 33 Patienten wurde von 14,5 ± 9,0 auf 9,5 ± 12,6, die Zeit in Rückenlage von 71,1 ± 50,5 min auf 25,4 ± 65,0 min signifikant gesenkt. Die Compliance der dauerhaft versorgten 25 Patienten betrug nach 6 Monaten 79,2 %.

Schlussfolgerung

Beide Smartphone-Apps können die Rückenlage bei POSA-Patienten verhindern und eine mögliche kostengünstige therapeutische Option der POSA darstellen.

http://ift.tt/2jUXYR6

Αρχειοθήκη ιστολογίου

Παρασκευή 20 Ιανουαρίου 2017

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