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Δευτέρα 27 Φεβρουαρίου 2017
Point-of-care monitoring for the management of trauma-induced bleeding.
http://ift.tt/2l7jplS
Intraoperative dermoscopic features of onychomatricoma: a review of 10 cases
Summary
Background
Amelanotic nail tumours are difficult to diagnose. Dermoscopy is an accessible tool successfully used in diagnosis of amelanotic or melanotic skin tumours. We have previously shown the usefulness of dermoscopy in the preoperative diagnosis of onychomatricoma (OM). In this study, we completed this work by identifying additional intraoperative criteria to better establish the initial diagnosis of this tumour.
Aims
Evaluation of intraoperative dermoscopy in a small series of OM cases in order to define relevant diagnostic criteria.
Methods
In total, 10 patients with OM diagnosed in our centre were enrolled in the study. Six trained dermoscopists individually evaluated each criterion, then the data were compared and a consensus reached after discussion between the observers. For each criterion, we analysed its frequency and its interobserver accordance. We defined three architectural criteria (the 'Sagrada Familia' sign, digitations and the 'mirror sign'), and three vascular criteria (sagittal vessels, dotted vessels and irregular vessels).
Results
The Sagrada Familia sign, digitations and mirror sign were found in 100%, 90% and 70% of the cases, respectively, with high interobserver agreement. The vascular criteria were less regularly observed: sagittal, dotted and irregular vessels were respectively found in 80%, 70% and 50% of the OM cases, and were more difficult to assess, as shown by the lower interobserver agreement rates.
Conclusion
Intraoperative dermoscopy of the nail matrix and bed offers useful information for the diagnosis and management of OM. Larger comparative studies should be performed to evaluate the true benefit of this approach.
http://ift.tt/2lty1IC
Multiple pilomatrixomas in children: the need for long-term follow-up and aesthetically sensitive incisions
Summary
Pilomatrixomas are benign, calcified epitheliomas of the hair follicle, predominately affecting children and commonly presenting in the head and neck region. The current literature is almost unanimous in recommending surgical excision. Reconstruction of these defects may require the need for a skin graft, resulting in poor cosmetic outcome and donor site morbidity. We present two cases demonstrating the benefits of minimal access incisions for pilomatrixomas in children. We recommend that multiple or recurrent lesions should prompt referral to a specialist for management and long-term follow-up.
http://ift.tt/2ltngG3
Expression of Rab5a correlates with tumor progression in pancreatic carcinoma
Abstract
Rab family protein Rab5a has been implicated in cancer progression. To date, its expression pattern in human pancreatic cancer has not been investigated. This study aims to examine clinical significance, biological role, and potential mechanism of action of mRab5a in human pancreatic cancer. We analyzed Rab5a protein in cancer tissue of 111 cases of pancreatic cancer using immunohistochemistry. The results show that Rab5a overexpression correlates with high T stage, positive nodal status, and advanced TNM stage. We performed knockdown of Rab5a through transfection of Rab5a-specific siRNA in the Capan-2 cell line, which shows high endogenous expression, and of Rab5a plasmid in the CFPAC-1 cell line, which shows low endogenous expression. Rab5a knockdown inhibited cell proliferation and invasion while its overexpression promoted cell proliferation and invasion. In addition, overexpression of Rab5a induced resistance to 5-FU and gemcitabine while its knockdown reduced resistance to 5-FU and gemcitabine. Furthermore, our results show that Rab5a overexpression upregulates Wnt signaling and expression of Wnt target genes including c-myc and MMP7. Blocking Wnt signaling abolished the effects of Rab5a on Wnt targets and on cancer cell proliferation. In summary, our results show that Rab5a is overexpressed in pancreatic cancer and promotes aggressive biological behavior through regulation of the Wnt/β-catenin signaling pathway.
http://ift.tt/2m0O1oD
Targeting NK-cell checkpoints for cancer immunotherapy
Aura Muntasell | Maria C Ochoa | Luna Cordeiro | Pedro Berraondo | Ascension López-Díaz de Cerio | Mariona Cabo | Miguel López-Botet | Ignacio Melero
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Italian guidelines on the systemic treatments of moderate-to-severe plaque psoriasis
Abstract
Psoriasis is a common disease, which has a considerable impact on the healthcare system. Therefore, appropriate use of therapeutic resources is very important. Management of psoriasis in daily clinical practice is highly variable because many issues are still debated and not definitely addressed by the evidence-based medicine. Moreover, the different availability and reimbursability of drugs in each country justifies national guidelines. Expert consensus can provide helpful guidelines for optimizing patient care. A total of 20 dermatologists from different areas of Italy and with large experience in the treatment of psoriasis agreed to participate in the guidelines expert panel who aimed to reach consensus on the factors influencing psoriasis severity, the indications for systemic treatments, the parameters to be considered in the choice of treatment, and the factors to be considered in the choice of biological treatment. The recommendations for the use, screening and monitoring of systemic therapies were based on the 2015 S3 European Dermatology Forum/European Academy of Dermatology and Venereology psoriasis guidelines. Recommendations on the treatment of psoriasis in special patient populations were also agreed. The final document was discussed in a meeting moderated by a facilitator with participation of the entire group and adopting a nominal group technique to reach consensus. A statement was regarded as consented when agreement was achieved by at least 75% of the voting experts according to the Delphi procedure.
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The treatment of vulval lichen sclerosus in prepubertal girls: a critically appraised topic
Summary
Lichen sclerosus is one of the dermatoses that specifically affects the anogenital skin. It has peaks of incidence in prepubertal girls and postmenopausal women. The objective of this critical appraisal was to review systematically the evidence for efficacy and safety of different treatments. There are no randomized controlled studies of treatment in prepubertal girls and most studies are small case series or case reports. There is little focus on quality of life.
http://ift.tt/2m5x5h0
Plain language summaries in Simplified Chinese
Linked Article: Thandar et al. Br J Dermatol 2017; 176:330–343.
Linked Article: Køster et al. Br J Dermatol 2017; 176:446–456.
Linked Article: Mohanty et al. Br J Dermatol 2017; 176:403–412.
Linked Article: Steinke et al. Br J Dermatol 2017; 176:363–370.
Linked Article: Kohl et al. Br J Dermatol 2017; 176:352–362.
http://ift.tt/2m5GB3J
Efficacy of Acellular Nerve Allografts in Trigeminal Nerve Reconstruction
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Andrew Yampolsky, Vincent Ziccardi, Sung-Kiang Chuang
PurposeDuring trigeminal nerve repair, a gap is sometimes encountered preventing the tension free apposition of nerve endings. The use of a processed acellular nerve allograft is one novel technique that shows promise in overcoming this problem. The goal of this study is to support the slowly evolving body evidence that (Avance®, Axogen, Alachua, FL.) acellular processed nerve allografts are a viable alternative to autogenous nerve grafting and the use of conduits for reconstructing defects of the trigeminal nerve.Materials and MethodsThe study design consisted of a retrospective chart review of patients referred to Rutgers School of Dental Medicine for management of trigeminal nerve injuries during a period of July 2008 to August 2014. 16 patients met the inclusion criteria of this study. All patients underwent nerve grafting using a processed nerve allograft all operations were performed by the same surgeon (VZ).Serial neurosensory testing was performed by one clinician (VZ) in a standardized fashion. The primary outcome variable was the duration of time to progress to functional sensory recovery as defined by the Medical Research Council Scale. (MRCS)ResultsParticipants age ranged from 16 to 62 with a mean age of 32. 12(75%) patients were female and 4 (25%) were male, 3 (18.75%) were smokers and 13 (81.25%) non-smokers. 8 (50%) patients underwent surgery on the inferior alveolar nerve and 8 (50%) patients underwent surgery on the lingual nerve. The most common mechanism of injury was impacted third molar removal, 9 (56.25%) 15/16 (93.75%) patients had achieved functional sensory recovery during the study period.ConclusionThe results of the present study support the hypothesis that processed nerve allograft are effective in reconstructing small (<2cm) trigeminal nerve defects.
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Nerve Damage from Bone Allografts and Xenografts – A Case Series
Source:Journal of Oral and Maxillofacial Surgery
Author(s): M. Anthony Pogrel
The concept of socket preservation, by placing a particulate bone allograft or xenograft into a tooth socket or on the alveolar ridge following tooth removal remains a somewhat controversial topic. The concept is that it will preserve the ridge from resorption and make subsequent implant insertion easier, with fewer complications. However, one particular issue is that these materials, though not directly neurotoxic, appear to be irritant to nerves if they come in contact with them. We present a case series demonstrating this complication.
http://ift.tt/2l6FS2C
Imaging of the endolymphatic space in patients with Ménière’s disease
Source:Auris Nasus Larynx
Author(s): Tadao Yoshida, Satofumi Sugimoto, Masaaki Teranishi, Hironao Otake, Masahiro Yamazaki, Shinji Naganawa, Tsutomu Nakashima, Michihiko Sone
ObjectiveTo examine endolymphatic hydrops (EH) using magnetic resonance imaging (MRI) in patients with definite Ménière's disease (MD) and those with nonotological diseases.MethodsWe studied 32 patients with unilateral MD, 10 patients with bilateral MD and 21 patients with control ears who had other benign diseases not associated with hearing or vestibular dysfunction. The mean age of the subjects was 54.0 years (range 27–74) in the MD group and 56.1 years (range 24–79) in the control group. Using MRI, the degree of EH was classified as none, mild and significant in the cochlea and vestibule separately. The ratio of the area of endolymphatic space to the vestibular fluid space was calculated for the vestibule. The duration of MD was defined as the months between the first attack of MD and the MRI study.ResultsEH was present in the cochlea of 45/52 affected ears of patients with MD (87%) and in 16/42 control ears (38%). Significant cochlear hydrops was present in 37/52 affected ears (71%) and in 4/42 control ears (10%). EH in the vestibule was present in 49/52 affected ears (94%) and in 3/42 control ears (7%). Significant vestibular hydrops was present in 40/52 affected ears (77%) and in none of the 42 control ears. There was no relationship between the degree of EH and its duration. Using a cut off value for the relative size of EH in the vestibule of 41.9%, the test had a sensitivity of 88.5% and a specificity of 100% to diagnose definite MD.ConclusionCochlear EH was occasionally observed in control ears on MRI, as in normal temporal bone specimens. The presence or absence and degree of vestibular EH were significantly different between ears with MD and control ears. EH in the vestibule might be a specific predictor of definite MD.
http://ift.tt/2l6RZwF
Use of maxillofacial laboratory materials to construct a tissue-equivalent head phantom with removable titanium implantable devices for use in verification of the dose of intensity-modulated radiotherapy
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): K. Morris
The dose of radiotherapy is often verified by measuring the dose of radiation at specific points within a phantom. The presence of high-density implant materials such as titanium, however, may cause complications both during calculation and delivery of the dose. Numerous studies have reported photon/electron backscatter and alteration of the dose by high-density implants, but we know of no evidence of a dosimetry phantom that incorporates high density implants or fixtures. The aim of the study was to design and manufacture a tissue-equivalent head phantom for use in verification of the dose in radiotherapy using a combination of traditional laboratory materials and techniques and 3-dimensional technology that can incorporate titanium maxillofacial devices. Digital designs were used together with Mimics® 18.0 (Materialise NV) and FreeForm® software. DICOM data were downloaded and manipulated into the final pieces of the phantom mould. Three-dimensional digital objects were converted into STL files and exported for additional stereolithography. Phantoms were constructed in four stages: material testing and selection, design of a 3-dimensional mould, manufacture of implants, and final fabrication of the phantom using traditional laboratory techniques. Three tissue-equivalent materials were found and used to successfully manufacture a suitable phantom with interchangeable sections that contained three versions of titanium maxillofacial implants. Maxillofacial and other materials can be used to successfully construct a head phantom with interchangeable titanium implant sections for use in verification of doses of radiotherapy.
http://ift.tt/2m5jkPu
Comparison of the clinical effects of treatment of osteochondroma by two types of vertical ramus osteotomy
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): H. Zhou, C. Liao, J. Hu, W. Fei
The purpose of this retrospective study was to evaluate 10 patients with osteochondroma of the mandibular condyle who were treated by vertical ramus osteotomy. Three patients had resection of the condyle and reconstruction with free vertical ramus osteotomy grafts (free graft group) and seven had pedicled vertical sliding ramus osteotomy grafts (pedicled graft group). The mean (range) observation period was 30 months. All patients had satisfactory clinical outcomes, and facial symmetry and good occlusion were achieved during the first 10 months. However, slight facial asymmetry was observed in patients treated by free grafts at 11 months, as the mandible deviated to the operated side when the mouth was opened. Postoperative radiographs showed varying degrees of neocondylar resorption and reduction in height. Patients treated with pedicled grafts did not develop these symptoms, and had no bony resorption to speak of on radiographs taken during the follow-up period. In conclusion, the advantages of the pedicled graft over the free graft include less bony resorption and better long-term clinical outcomes.
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Secondary bone grafting of alveolar clefts: a review of outcome at two centres in Australia and the UK
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): R. Kumar, A. Heggie, J. Shand, S. Dominguez-Gonzalez, N. Kilpatrick, J. Shah
Secondary alveolar bone grafting is a key procedure in comprehensive cleft services, the main objective of which is to allow the canine to erupt through the bone. We have assessed the outcomes of the procedure at two units, one in Australia and one in the UK. Success was measured using standardised indexes for radiological assessment (Bergland and Kindelan) and clinically by noting eruption of canines through the grafted sites. The two-year review indicated that the two units had comparably high success rates. Canines erupted through cleft sites in 27/28 sites in patients in the UK, and 26/28 in patients in Australia, and the radiological success using the indexes was also high. These rates are in line with international benchmarks.
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A Rare Case of Stroke Secondary to Iron Deficiency Anemia in a Young Female Patient
Ischemic strokes occur when there is a sudden obstruction of an artery supplying blood flow to an area of the brain, leading to a focal neurological deficit. Strokes can be thrombotic or embolic in etiology and are associated with underlying conditions such as hypertension and atherosclerosis. Possible etiologies of strokes include cardioembolic disease, hematologic disorders, connective tissue disorders, and substance abuse or can be cryptogenic. Most stroke cases are seen in patients over 65 years of age. However, about one-fourth of strokes occur in young adults. Iron deficiency anemia (IDA) has been described as a known cause for strokes in children, but very few case reports describe this association in adults. We describe a 20-year-old female who presented with sudden onset left side weakness. Magnetic Resonance Imaging (MRI) of the brain demonstrated ischemic infarctions. Patient was also found to be severely anemic. Patient had a thorough work-up including Magnetic Resonance Angiography (MRA) of the brain, echocardiogram, and an extensive screen for thrombophilia disorders. This, however, did not demonstrate a clear etiology. As it has been suggested that IDA is a potential cause for stroke, it is possible the stroke in this young patient was attributable to severe IDA.
http://ift.tt/2m5dL3x
Gene therapy for primary immune deficiencies: a Canadian perspective
The use of gene therapy (GT) for the treatment of primary immune deficiencies (PID) including severe combined immune deficiency (SCID) has progressed significantly in the recent years. In particular, long-term...
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Interleukin 21 inhibits cancer-mediated FOXP3 induction in naïve human CD4 T cells
Abstract
IL-21 is known to promote anti-tumour immunity due to its ability to promote T cell responses and counteract Treg-mediated suppression. It has also been shown to limit Treg frequencies during tumour-antigen stimulations. However, whether this represents inhibition of FOXP3 induction in naïve CD4 T cells or curtailed expansion of natural Treg remains unclear. Moreover, whether this effect is maintained in an environment of tumour-derived immunosuppressive factors is not known. Here, we show that in the context of a number of cancers, naïve CD45RA+ CD4 T cells are induced to express high levels of FOXP3, and that FOXP3 expression correlates with inhibition of T cell proliferation. FOXP3 expression was most potently induced by tumours secreting higher levels of total and active TGFβ1 and this induction could be potently counteracted with IL-21, restoring T cell proliferation. We conclude that Treg induction in naïve T cells is a common phenomenon amongst a number of different cancers and that the ability of IL-21 to counteract this effect is further evidence of its promise in cancer therapy.
http://ift.tt/2lX85Io
Intratumoral administration of cGAMP transiently accumulates potent macrophages for anti-tumor immunity at a mouse tumor site
Abstract
Stimulator of IFN genes (STING) spontaneously contributes to anti-tumor immunity by inducing type I interferons (IFNs) following sensing of tumor-derived genomic DNAs in the tumor-bearing host. Although direct injection of STING ligands such as cyclic diguanylate monophosphate (c-di-GMP) and cyclic [G(2′,5′)pA(3′,5′)p] (cGAMP) into the tumor microenvironment exerts anti-tumor effects through strong induction of type I IFNs and activation of innate and adaptive immunity, the precise events caused by STING in the tumor microenvironment remain to be elucidated. We describe here our finding that a CD45+ CD11bmid Ly6C+ cell subset transiently accumulated in mouse tumor microenvironment of 4T1 breast cancer, squamous cell carcinomas, CT26 colon cancer, or B16F10 melanoma tissue after intratumoral injection of cGAMP. The accumulated cells displayed a macrophage (M ) phenotype since the cells were positive for F4/80 and MHC class II and negative for Ly6G. Intratumoral cGAMP treatment did not induce Mφ accumulation in STING-deficient mice. Depletion of CD8+ T cell using anti-CD8 mAb impaired the anti-tumor effects of cGAMP treatment. Depletion of the Mφ using clodronate liposomes impaired the anti-tumor effects of cGAMP treatment. Functional analysis indicated that the STING-triggered tumor-migrating Mφ exhibited phagocytic activity, production of tumor necrosis factor alpha TNFα), and high expression levels of T cell-recruiting chemokines, Cxcl10 and Cxcl11, IFN-induced molecules, MX dynamin-like GTPase 1 (Mx1) and 2′-5′ oligoadenylate synthetase-like 1 (Oasl1), nitric oxide synthase 2 (Nos2), and interferon beta 1 (Ifnb1). These results indicate that the STING-triggered tumor-migrating Mφ participate in the anti-tumor effects of STING-activating compounds.
http://ift.tt/2mCTija
Securing an OTL-HNS residency: how competitive is it? Comparing medical student perceptions to actual Canadian statistics
Abstract
Background
The residency match is an important event in an aspiring physician's career. Otolaryngology – Head and Neck Surgery (OTL-HNS) is a surgical specialty that has enjoyed high numbers of applicants to its residency programs. However, recent trends in Canada show a decline in first-choice applicants to several surgical fields. Factors thought to influence a medical student's choice include role models, career opportunities and work-life balance. The notion of perceived competitiveness is a factor that has not yet been explored. This study sought to compare competitiveness of OTL-HNS, as perceived by Canadian medical students to residency match statistics published yearly by CaRMS (Canadian Residency Matching Service), with the hope of informing future decisions of surgical residency programs.
Methods
An electronic survey was created and distributed to all medical students enrolled in the 17 Canadian medical schools. After gathering demographic information, students were asked to rank what they perceived to be the five most competitive disciplines offered by CaRMS. They were also asked to rank surgical specialties from most to least competitive. Publically available data from CaRMS was then collected and analyzed to determine actual competitiveness of admissions to Canadian OTL-HNS residency programs.
Results
1194 students, from first to fourth year of medical school, completed the survey. CaRMS statistics over the period from 2008 to 2014 demonstrated that the five most competitive specialties were Plastic Surgery, Dermatology, Ophthalmology, Emergency Medicine and OTL-HNS. Among surgical disciplines, OTL-HNS was third most competitive, where on average 72% of students match to their first-choice discipline. When students were questioned, 35% ranked OTL-HNS amongst the top five most competitive. On the other hand 72%, 74% and 80% recognized Opthalmology, Dermatology and Plastic Surgery as being among the five most competitive, respectively. We found that fourth-year medical students were significantly more knowledgeable about the competitiveness of both OTL-HNS and Plastic Surgery compared to first-year students (p < 0.01).
Conclusion
Overall, Canadian medical students may underestimate the competitiveness of OTL-HNS. Furthermore, competitiveness would appear to be a concept that resonates with medical students during the match process.
http://ift.tt/2m4FGk0
New drug development in head and neck squamous cell carcinoma: The PI3-K inhibitors
Source:Oral Oncology, Volume 67
Author(s): Francesca De Felice, Teresa Guerrero Urbano
Over the last few years a number of new different compounds have been developed. They include phosphatidylinositol 3-kinase (PI3-K) inhibitors. Deregulation within the PI3-K pathway is common in head neck squamous cell carcinoma (HNSCC) and it represents a growing area of research. PI3-K inhibitors, including BKM120, PX-866 and BYL719, are being tested in several phase I and phase II studies in patients with locally advanced, recurrent or metastatic disease.This review provides an update of published clinical trials and highlights the challenges of PI3-K inhibitors in HNSCC.
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MicroRNAs in human tongue squamous cell carcinoma: From pathogenesis to therapeutic implications
Source:Oral Oncology, Volume 67
Author(s): Omer Faruk Karatas, Muhammet Oner, Alican Abay, Ali Diyapoglu
Being one of the most aggressive cancers of oral cavity, tongue squamous cell carcinoma (TSCC) constitutes 41% of all oral carcinomas. Despite considerable improvements in multimodal diagnosis and treatment techniques, TSCC still remains to be one of the most lethal cancer types in the head and neck region.MicroRNAs are endogenously synthesized, small, non-coding RNAs, which are responsible for post-transcriptional regulation of mRNA expression. They are involved in regulation of almost all biological processes through their spatial and temporal expression. Their deregulation participates in pathogenesis of various diseases, including human TSCC, where they can act as potent oncogenes or tumor suppressors.Extensive microRNA profiling in TSCC samples and further in vitro and in vivo functional characterization of differentially expressed microRNAs revealed their contribution to the underlying molecular mechanisms of TSCC initiation, development, progression, metastasis, chemo-radioresistance, and recurrence. They are suggested as diagnostic and prognostic biomarkers for TSCC due to their differential expression in tumor tissues and their stability in body fluids like plasma, oral cytology, and saliva. MicroRNAs are, therefore, considered amongst the most promising candidates for development of novel therapeutic approaches against TSCC.In this review, we summarized important findings including our own works on microRNAs as implicated in TSCC and the new insights into the roles of microRNAs in squamous cell carcinoma of tongue.
http://ift.tt/2lsnhuc
Role of cancer stem-cell marker doublecortin-like kinase 1 in head and neck squamous cell carcinoma
Source:Oral Oncology, Volume 67
Author(s): Lorenz Kadletz, Dietmar Thurnher, Robert Wiebringhaus, Boban M. Erovic, Ulana Kotowski, Sven Schneider, Rainer Schmid, Lukas Kenner, Gregor Heiduschka
BackgroundSo far, no data is available on the role of the tumor stem cell marker doublecortin-like kinase 1 (DCLK1) in head and neck squamous cell carcinoma (HNSCC). The purpose of this study was to evaluate DCLK1 expression in HNSCC patients that underwent surgery and postoperative radiotherapy, and to assess its potential as a therapeutic target in vitro.MethodsWe immunohistochemically stained for DCLK1 in 127 sections of HNSCC samples obtained during surgery of HNSCC patients and correlated the expression to patients' overall- and disease-free survival, as well as human papilloma virus (HPV) status. Additionally, we compared our survival data with data obtained from The Cancer Genome Atlas (TCGA). The effects of the DCLK1 inhibitor LRRK-2-in-1 on HNSCC cell lines alone and in combination with irradiation.ResultsExpression of DCLK1 in 127 patients was associated with poor survival. In particular, DCLK1 expression had a significant impact on survival of oropharyngeal carcinoma patients. Specifically, DCLK1+/HPV− patients had the worst prognosis after simultaneous assessment of DCLK1 and HPV status in comparison to the other three possible DCLK1/HPV constellations. Higher levels of DCLK1 mRNA were also associated with poor clinical outcome. Inhibition of DCLK1 in our HNSCC cell lines led to growth arrest and induction of apoptosis. The combination of DCLK1 inhibition with irradiation had a synergistic effect.ConclusionFirstly, DCLK1 is a prognostic biomarker for shortened survival. Secondly, through inhibition of DCLK1, it may serve as a therapeutic target as well.
http://ift.tt/2l6jjLk
A 13-year old girl with pancytopenia at the presentation of a Borrelia hispanica infection: a case report and review of the literature
It is not uncommon that a child with a febrile illness of unknown etiology is admitted to the hospital. When the complete blood count reveals a pancytopenia, the diagnostic process can be a real challenge.
http://ift.tt/2lsxYMY
Reliability of preoperative descriptive airway assessment tests in prediction of the Cormack-Lehane score: Methodological issues
I was interested to read the paper by Selvi O and colleagues published in J Clin Anesth 2017 Feb. The aim of the authors was to compare predictive value of thyromental height measurement test (TMH), which has been recently suggested, modified Mallampati test (MMT), upper lip bite test (ULBT), and thyromental distance measurement test (TMD) in difficult laryngoscopy (Cormack and Lehane [C-L] scores 3 and 4). Final C-L scores were compared with intubation difficulty scale (IDS) in terms of predicting difficult intubation.
http://ift.tt/2lZIvT6
Recent Advances in Face Lift to Achieve Facial Balance
Abstract
Introduction
Facial balance is achieved by correction of facial proportions and the facial contour. Ageing affects this balance in addition to other factors. We have strived to inform all the recent advances in providing this balance.
Method
The anatomy of ageing including various changed in clinical features are described. The procedures are explained on the basis of the upper, middle and lower face.
Results
Different face lift, neck lift procedures with innovative techniques are demonstrated.
Conclusion
The aim is to provide an unoperated balanced facial proportion with zero complication.
http://ift.tt/2lPwXje
Pilot study comparing post-anesthesia care unit length of stay in moderately and severely obese children
Abstract
Objective
Obesity is a risk factor for surgical complications in adults and children. Differences in postsurgical outcomes according to severity of obesity [moderate: 95–98th age-gender-specific body mass index (BMI) percentile versus severe: ≥99th percentile] in children remain unclear. This study compared post-anesthesia care unit (PACU) stay and hospital admission between severely obese children and moderately obese children undergoing surgery.
Methods
In a retrospective review over a 6-month period, obese children, 2–18 years of age undergoing surgery were identified. Multivariate mixed-effects regression was used to compare PACU length of stay (LOS) need for opioid analgesia, and hospital admission between moderately and severely obese patients.
Results
There were 1324 records selected for inclusion. PACU LOS did not significantly differ between moderately obese (50 ± 36 min) and severely obese patients (55 ± 38 min). There were no differences between moderately and severely obese patients in use of opioids in the PACU. Yet, severely obese patients were more likely to require inpatient admission than moderately obese patients.
Conclusions
The duration of PACU stay still averaged less than 1 h in our cohort, suggesting that the majority of these patients can be cared for safely in the outpatient setting. Future studies should focus on identifying the co-morbid conditions that may prolong postoperative PACU stay or result in unplanned hospital admission in moderately and severely obese patients. Our preliminary data suggest that these factors may include a younger age and the complexity or duration of the surgical procedure.
http://ift.tt/2lhIshw
Sivelestat sodium and mortality in pneumonia patients requiring mechanical ventilation: propensity score analysis of a Japanese nationwide database
Abstract
Purpose
Sivelestat is widely used in Japan for the treatment of acute respiratory distress syndrome caused by pneumonia. Although the efficacy of sivelestat was reported in several Japanese studies in the early 2000 s, a multinational randomized control trial did not support these findings. We therefore conducted the present study to examine the association between the use of sivelestat and mortality in pneumonia patients requiring mechanical ventilation.
Methods
We conducted a retrospective observational study using the Diagnosis Procedure Combination database, a national inpatient database in Japan. We identified pneumonia patients requiring mechanical ventilation who were hospitalized between April 2012 and March 2014. Propensity score matching was performed to compare 7- and 30-day mortality between patients with and without sivelestat use.
Results
The eligible patients (n = 16,471) were categorized into the sivelestat (n = 1707) and control (n = 14,764) groups. The unmatched comparison showed significant differences between the sivelestat and control groups in both 7-day mortality (11.0 vs. 7.6%, p < 0.001) and 30-day mortality (29.9 vs. 19.7%, p < 0.001). In the 1516 pairs of propensity-matched patients, there were no significant differences in 7-day mortality (sivelestat vs. control: 10.2 vs. 10.9%, p = 0.516) and 30-day mortality (sivelestat vs. control 29.0 vs. 29.0%, p = 1.000).
Conclusions
The propensity-matched analyses revealed that the use of sivelestat was not associated with decreased mortality for pneumonia patients requiring mechanical ventilation.
http://ift.tt/2mnggyO
Pronounced effect of hapten binding on thermal stability of an anti-(4-hydroxy-3-nitrophenyl)acetyl antibody possessing a glycine residue at position 95 of the heavy chain
Source:Molecular Immunology, Volume 85
Author(s): Yusui Sato, Satomi Inaba, Harumi Fukada, Takachika Azuma, Masayuki Oda
Immune response to T-cell-dependent antigens is highly dynamic; several B-cell clones responsible for antibody production appear alternately during immunization. It was previously shown that at least two-types of antibodies are secreted after immunization with (4-hydroxy-3-nitrophenyl)acetyl (NP); one has Tyr and another has Gly at position 95 of the heavy chain (referred to as Tyr95- and Gly95-type). The former appeared at an early stage, while the latter appeared at a late stage, i.e., after secondary immunization, although Fv domains of these antibodies were encoded by same genes of variable heavy and light chains. We examined whether any biophysical properties of antigen-combing sites relate to this shift in B-cell clones by preparing single-chain Fv (scFv). Thermodynamic and kinetic parameters of the interaction of scFv with various haptens are in accordance with those of intact antibodies, indicating that scFvs are appropriate models for the study on structure and function of antibodies. Next, we measured thermal stability of scFvs using differential scanning calorimetry and found that the apparent melting temperature of free Tyr95-type was 64–66°C,while that of Gly95-type was 47–48°C, indicating that the latter was highly unstable. However, Gly95-type greatly gained thermal stability because of hapten binding. We discussed the relationship between thermal stability resulted by hapten binding and dynamism of antibody response during immunization.
http://ift.tt/2m45jl2
The results of newborn hearing screening by means of transient otoacoustic emissions – has anything changed over 10 years?
Source:International Journal of Pediatric Otorhinolaryngology, Volume 96
Author(s): Katarzyna Wroblewska-Seniuk, Grazyna Greczka, Piotr Dabrowski, Witold Szyfter, Jan Mazela
ObjectivesUniversal newborn hearing screening (UNHS) has become the standard of care in many countries. The aim of this study was to evaluate the results of UNHS after ten years of the program in Poland and to compare them with the results of 2003.MethodsIn the study, we analyze the results of UNHS in the University Hospital in Poznan, Poland. Between 01.01.2013 and 31.12.2013, 6827 children were examined by means of otoacoustic emissions.ResultsRisk factors (RF) were identified in 772 (11.3%) newborns, which is significantly less than 10 years ago (p < 0.05). The most frequent RF were: ototoxic medications, treatment in neonatal intensive care unit (NICU) and prematurity < 33 weeks of gestation. In 2003, the most frequent were ototoxic medications and prematurity, less frequent was treatment in NICU and more common was low Apgar score.In 51 (6.6%) newborns with RF, the result of OAE was positive either unilaterally or bilaterally. In infants without RF the result was positive unilaterally in 22 (0.4%) and bilaterally in 14 (0.2%) patients. These results are significantly lower than in our former study.The relative risk of positive result was the highest in infants with complex congenital anomalies (RR = 44.99), craniofacial anomalies (RR = 17.46) and mechanical ventilation for > 5 days (RR = 10.69). In our previous study, the highest RR of positive test results was in infants with family history, congenital malformations and low Apgar score.We found that most predictive as to the final diagnosis was bilaterally positive OAE test. In most patients, the second check confirmed the diagnosis, independently of RF.The number of false positive tests at the 1st level of screening is significantly lower now than 10 years ago, probably due to better staff training.ConclusionsLong term monitoring and the appropriate management of hearing deficit in children is essential. UNHS seems to be the most efficient way of finding children who require treatment of hearing impairment. The prevalence of most risk factors of hearing deficit has significantly changed over the years. The number of false positive results has significantly decreased over the years thanks to better staff training.
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Das neue Krebsregistergesetz
Zusammenfassung
Hintergrund
Zum Ende des Jahres 2017 läuft die gesetzlich vorgeschriebene Übergangsfrist zur bundesweiten Etablierung klinischer Krebsregister ab. Der aktuelle Umsetzungsstand soll daher kritisch bewertet werden.
Ziel
Rechtliche, organisatorische und technische Aspekte der Umsetzung des Krebsfrüherkennungs- und -registergesetz (KFRG) werden vor dem Hintergrund der ursprünglichen Ziele des Nationalen Krebsplans (NKP) bewertet.
Ergebnisse
Klinische Krebsregister haben auch in den letzten Jahren gezeigt, dass bei funktionierenden Melde- und Erfassungsstrukturen ein großer praktischer Nutzen in vielen Bereichen erzielt werden kann. Deren Etablierung ist jedoch durch regional sehr unterschiedliche Fortschritte sowie ausgeprägte politische Einflussnahme kennzeichnet. Der angestrebte Nutzen für die unmittelbare patientenbezogene Versorgung sowie die Nutzung für die Versorgungsforschung sind gegenwärtig gefährdet.
Schlussfolgerungen
Die Umsetzung der klinischen Krebsregistrierung muss sich stärker als bisher an deren Prozesscharakter orientieren. Der Nutzen für die Patienten sollte intensiver in den Mittelpunkt gerückt werden.
http://ift.tt/2mmWCmx
Uncommon mutation in mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS)
A 26-year-old man presented to the emergency department with new-onset generalised tonic–clonic seizures. His clinical picture suggested either autoimmune or infectious encephalitis while his brain imaging raised the possibility of a stroke. A detailed developmental and childhood medical history added suspicion of a mitochondrial defect to the differential. After several molecular genetic analyses, an uncommon mitochondrial mutation was confirmed, unequivocally consistent with mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome.
http://ift.tt/2mCP1w0
Duodenal variceal bleed: an unusual cause of upper gastrointestinal bleed and a difficult diagnosis to make
We present a case of recurrent upper gastrointestinal (GI) bleeding in a man aged 57 years with primary biliary cholangitis who was ultimately diagnosed with an isolated duodenal variceal bleed, which was successfully treated with histoacryl glue injection. Duodenal varices are an uncommon presentation of portal hypertension and can result in significant GI bleeding with a high mortality. Diagnosis can be difficult and therapeutic options limited. Endoscopic variceal sclerotherapy with histoacryl glue provides an effective treatment, though endoscopists need to remain aware of and vigilant for the serious complications of this treatment option.
http://ift.tt/2m2TQlV
Collapsing glomerulopathy in systemic lupus erythematosus
Collapsing glomerulopathy (CG) is a rare disease that can be associated with multiple other disorders. It usually leads to poor prognosis with a high percentage of patients progressing to end-stage renal disease. In this article, we illustrate a clinical case of CG associated with systemic lupus erythematosus that had a prompt response to mycophenolate and prednisone. The condition started after sudden cessation of the already established mycophenolate treatment regimen. The patient then presented with acute kidney injury due to kidney biopsy-proven CG. In that circumstance, we hypothesised that mycophenolate may play a role in prevention and development of CG.
http://ift.tt/2mD2Cn7
Antithyroid arthritis syndrome
Antithyroid arthritis syndrome is a constellation of symptoms of myalgia, arthralgia, arthritis, fever and rash associated with the use of antithyroid medications. We report a case of a patient with severe hyperthyroidism likely secondary to Graves' disease who presented with the abovementioned symptoms after being treated with methimazole (antithyroid medication). Our aim is to increase awareness regarding this uncommon but disabilitating and life-threatening adverse effect of antithyroid medications among clinicians. We also discuss the proposed pathophysiology for this immunological reaction as well as management options in these patients.
http://ift.tt/2m2Osiq
Duodenal perforation by an inferior vena cava filter
Description
A woman aged 47 years presented to the emergency department with symptoms of fever, sudden-onset severe stabbing epigastric pain accompanied by nausea and non-bloody vomiting emesis. The patient had a medical history of recurrent abdominal pain and reflux which was treated with proton pump inhibitors. Owing to recurrent deep vein thrombosis and contraindications to anticoagulants, an inferior vena cava (IVC) filter was implanted 20 years prior. CT scan revealed IVC filter with prongs in the duodenum. Oesophagogastroduodenoscopy revealed a metallic foreign body projecting through the posterior wall of the duodenum, into the lumen, with surrounding erythema and oedema with minimal bleeding at the site of perforation (figure 1).
Figure 1
Upper gastrointestinal endoscopy revealing metallic struts projecting through the posterior wall of the duodenum, into the lumen, with surrounding erythema and oedema.
The patient underwent laparotomy and venotomy. The IVC filter...
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Rupture of the extensor hood of the fifth toe: a rare injury
Closed injuries of the extensor hood of the lesser toes are rare and seldom reported in the literature. We present the case of a woman aged 25 years who presented to the orthopaedic fracture clinic with a 2-week history of pain in the left fifth toe and inability to extend following a ballet dancing session. Investigations showed no fracture on plain radiographs, but an ultrasound scan demonstrated rupture to the extensor hood of the little toe. Successful surgical repair of the extensor hood was performed, and the patient made a good recovery with return to dancing activities.
http://ift.tt/2m2VunE
Study of the Pan-ERBB Inhibitor Neratinib Given in Combination With Everolimus, Palbociclib or Trametinib in Advanced Cancer Subjects With EGFR Mutation/Amplification, HER2 Mutation/Amplification or HER3/4 Mutation
Conditions: Malignant Neoplasm of Breast; Malignant Neoplasms of Digestive Organs; Malignant Neoplasms of Female Genital Organs; Malignant Neoplasms of Ill-defined Secondary and Unspecified Sites; Malignant Neoplasms of Independent (Primary) Multiple Sites; Malignant Neoplasms of Lip Oral Cavity and Pharynx; Malignant Neoplasms of Mesothelial and Soft Tissue; Malignant Neoplasms of Respiratory and Intrathoracic Organs; Malignant Neoplasms of Thyroid and Other Endocrine Glands; Malignant Neoplasms of Urinary Tract; Neoplasms of Uncertain or Unknown Behavior
Interventions: Drug: Neratinib; Drug: Everolimus; Drug: Palbociclib; Drug: Trametinib
Sponsors: M.D. Anderson Cancer Center; Pfizer; Puma Biotechnology, Inc.
Not yet recruiting - verified February 2017
http://ift.tt/2lOor46
Interventions: Drug: Neratinib; Drug: Everolimus; Drug: Palbociclib; Drug: Trametinib
Sponsors: M.D. Anderson Cancer Center; Pfizer; Puma Biotechnology, Inc.
Not yet recruiting - verified February 2017
http://ift.tt/2lOor46
Endoscopic Resection Multicenter Registry
Conditions: Gastrointestinal Neoplasms; Gastrointestinal Disease; Gastric Cancer; Gastric Neoplasm; Gastric Polyp; Esophageal Neoplasms; Duodenal Neoplasms; Duodenal Polyp; Stomach Neoplasm; Stomach Polyp; Neoplasms; Colon Polyp; Colon Neoplasm
Intervention: Procedure: Endoscopic Resection
Sponsor: Weill Medical College of Cornell University
Not yet recruiting - verified February 2017
http://ift.tt/2l4CYeB
Intervention: Procedure: Endoscopic Resection
Sponsor: Weill Medical College of Cornell University
Not yet recruiting - verified February 2017
http://ift.tt/2l4CYeB
Study of the CDK4/6 Inhibitor Palbociclib (PD-0332991) in Combination With the PI3K/mTOR Inhibitor Gedatolisib (PF-05212384) for Patients With Advanced Squamous Cell Lung, Pancreatic, Head & Neck and Other Solid Tumors
Conditions: Lung Cancer Squamous Cell; Solid Tumors; Head & Neck Cancer; Pancreatic Cancer
Interventions: Drug: Palbociclib; Drug: Gedatolisib
Sponsors: Dana-Farber Cancer Institute; Pfizer
Not yet recruiting - verified February 2017
http://ift.tt/2lOoqNA
Interventions: Drug: Palbociclib; Drug: Gedatolisib
Sponsors: Dana-Farber Cancer Institute; Pfizer
Not yet recruiting - verified February 2017
http://ift.tt/2lOoqNA
Sestamibi Scans In Thyroglobulin Positive Scan Negative Differentiated Thyroid Cancer Patients
Condition: Thyroid Cancer
Intervention: Radiation: 99mTc sestamibi
Sponsor: Washington Hospital Center
Recruiting - verified February 2017
http://ift.tt/2l4MrTn
Intervention: Radiation: 99mTc sestamibi
Sponsor: Washington Hospital Center
Recruiting - verified February 2017
http://ift.tt/2l4MrTn
Trigen InterTAN vs Sliding Hip Screw RCT
Condition: Hip Fractures
Interventions: Device: Trigen Intertan; Other: Post-Surgery Follow Up; Device: Sliding Hip Screw
Sponsor: Smith & Nephew Orthopaedics AG
Recruiting - verified February 2017
http://ift.tt/2lqVFpi
Interventions: Device: Trigen Intertan; Other: Post-Surgery Follow Up; Device: Sliding Hip Screw
Sponsor: Smith & Nephew Orthopaedics AG
Recruiting - verified February 2017
http://ift.tt/2lqVFpi
Topical Treatment of Rosacea with Ivermectin Inhibits Gene Expression of Cathelicidin Innate Immune Mediators, LL-37 and KLK5, in Reconstructed and Ex Vivo Skin Models
Abstract
Introduction
Numerous intrinsic and extrinsic factors have been associated with the pathophysiology of rosacea, including dysregulation of innate immunity. A high level of cathelicidin antimicrobial peptides (e.g., LL-37) has been shown in the facial skin of patients with rosacea. Excessive production of both LL-37 and KLK5, the serine protease responsible for its cleavage, has been suggested to play a role in the pathophysiology of rosacea. Ivermectin 10 mg/g cream, indicated for the treatment of inflammatory lesions of rosacea, is reported to have dual anti-parasitic and anti-inflammatory properties. However, the exact mechanism of action of ivermectin cream in the treatment of rosacea is unknown.
Methods
This study aimed to evaluate the effect of ivermectin on the expression of KLK5 and the subsequent effect on the maturation process of cathelicidins. Experimental studies were performed either on normal human epidermal keratinocytes (NHEK), reconstructed human epidermis (RHE) or on human skin ex vivo stimulated with calcitriol (1α,25-dihydroxyvitamin D3), which is known to induce KLK5 and LL-37 expression.
Results
The results show that ivermectin is able to inhibit KLK5 and CAMP gene expression and protein secretion in NHEK cells stimulated with calcitriol. Those results were confirmed in 3D models of the skin (RHE and skin ex vivo). The anti-inflammatory effects of ivermectin were associated with an inhibition of IL-8, IL-6 and MCP-1 (CCL2) secretion from NHEK cells.
Conclusions
These results suggest that ivermectin can prevent the inflammatory effects of rosacea triggered by abnormal LL-37 processing, through the inhibition of KLK5 gene expression in the epidermis.
Funding: Nestlé Skin Health R&D.
http://ift.tt/2lgDdPj
Comparative study between biodegradable nasopore (BNP) and Merocel hemox 10 cm after septo-turbinoplasty procedure
OBJECTIVE: The purpose of our study was to compare Merocel (Merocel Hemox 10 cm) and BNP (biodegradable nasopore) during a septoturbinoplasty procedure in terms of efficiency and patient comfort.
PATIENTS AND METHODS: We carried out a retrospective review of 72 patients who had undergone septoturbinoplasty between January 2015 and January 2016. Each group, packed with BNP or Merocel Hemox 10 cm was composed of 36 patients. A standard visual analogue scale ranging from zero (no symptoms) to 10 (the most severe symptoms) was used to assess subjective symptoms. To compare the usefulness of materials we evaluated the postoperative bleeding, infection and adhesion after the removal of packing with and endoscopic examination using a 5-point scale (zero, absent; 1, mild; 2, moderate; 3, severe; and 4, very severe). Secretions and crusts were evaluated 1 week and 4 weeks after surgery in both groups using a 5-point scale (zero, absent; 1, mild; 2, moderate; 3, severe; and 4, very severe).
RESULTS: A total of 72 patients were enrolled in the study, 45 women and 27 men; age range 15-78 with a mean age of 47 years. In the group A (Merocel group), 21 cases showed grade 1 bleeding (58%), 11 cases grade 2 (30%) and 4 patients grade 0 (11.1%). In the group B (BNP group), 29 cases showed grade 0 bleeding (80.56%) and 7 cases showed grade 1 bleeding (19.44%). There was a statistical significant difference between the Merocel group and the BNP group in terms of bleeding after removal of packing material (p < 0.05). In the group A, 16 patients developed mild adhesion (44%), 8 patients moderate adhesion (22.2%), 3 patients severe adhesion (8.33%) and 1 patient very severe adhesion (2.77%). BNP nasal packing didn't cause any adhesion in 25 patients (69.4%), 11 patients developed mild adhesion (30.5%). So there was a statistical significant difference between group A and group B regarding the adhesion (p < 0.05). There was a statistically significance reduction of nasal secretions and crusts at a week after surgery in the BNP group vs. Merocel group. The difference is not statistically significant 4 weeks after surgery. About the severity of symptoms related to nasal packing, we found a statistically significant difference (p < 0.05) between Merocel and BNP group regarding the pain during packing removal, the general satisfaction and the pressure.
CONCLUSIONS: Biodegradable nasopore reduced pain and patient discomfort during packing removal and causes less bleeding compared to Merocel hemox 10 cm. This type of material can be used after septoturbinolplasty.
L'articolo Comparative study between biodegradable nasopore (BNP) and Merocel hemox 10 cm after septo-turbinoplasty procedure sembra essere il primo su European Review.
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Upregulated expression of La ribonucleoprotein domain family member 6 and collagen type I gene following water-filtered broad-spectrum near-infrared irradiation in a 3-dimensional human epidermal tissue culture model as revealed by microarray analysis
Abstract
Background/Objectives
Water-filtered broad-spectrum near-infrared irradiation can induce various biological effects, as our previous clinical, histological, and biochemical investigations have shown. However, few studies that examined the changes thus induced in gene expression. The aim was to investigate the changes in gene expression in a 3-dimensional reconstructed epidermal tissue culture exposed to water-filtered broad-spectrum near-infrared irradiation.
Methods
DNA microarray and quantitative real-time polymerase chain reaction (PCR) analysis was used to assess gene expression levels in a 3-dimensional reconstructed epidermal model composed of normal human epidermal cells exposed to water-filtered broad-spectrum near-infrared irradiation. The water filter allowed 1000–1800 nm wavelengths and excluded 1400–1500 nm wavelengths, and cells were exposed to 5 or 10 rounds of near-infrared irradiation at 10 J/cm2.
Results
A DNA microarray with over 50 000 different probes showed 18 genes that were upregulated or downregulated by at least twofold after irradiation. Quantitative real-time PCR revealed that, relative to control cells, the gene encoding La ribonucleoprotein domain family member 6 (LARP6), which regulates collagen expression, was significantly and dose-dependently upregulated (P < 0.05) by water-filtered broad-spectrum near-infrared exposure. Gene encoding transcripts of collagen type I were significantly upregulated compared with controls (P < 0.05).
Conclusions
This study demonstrates the ability of water-filtered broad-spectrum near-infrared irradiation to stimulate the production of type I collagen.
http://ift.tt/2lqL39M
Acne necrotica (necrotizing lymphocytic folliculitis): An enigmatic and under-recognised dermatosis
Abstract
Acne necrotica is a disorder of adults of obscure aetiology, featuring repeated cropping of inflammatory papulonodules which rapidly necrotise, leaving varying degrees of superficial scarring with pathological features in early lesions of a necrotising lymphocytic folliculitis. A perceived diminishing interest in this entity in recent years prompted a prospective study of patients presenting to a dermatology practice over a 3-year period to reassess the prevalence of this disorder in general dermatological patients, leading to the identification of 47 patients (35 female) with features of acne necrotica, with histopathology undertaken in atypical cases. We identified the importance of the recognition of primary lesions (1–2 mm umbilicated erythematous papules), often difficult to find in excoriated areas, as being paramount in the diagnosis both clinically and histologically in our study, which reveals a significantly more prevalent and clinically diverse disorder than featured in previous textbook and academic journal descriptions.
http://ift.tt/2lXaSkY
Efficacy of smartphone applications in high-risk pigmented lesions
Abstract
Background/Objectives
Melanoma apps are smartphone applications that assess risk of pigmented lesions using a smartphone camera and underlying algorithm. We aimed to assess the capability of melanoma smartphone applications (apps) in making clinical decisions about risk, compared with lesion assessment by specialist trained dermatologists.
Methods
A prospective study of 3 melanoma apps was conducted between 2015 and 2016, recruiting 30 patients with 57 pigmented lesions. Risk categories assigned by the apps were compared with the clinical decisions of two consultant dermatologists classifying lesions as 'suspicious' or 'benign'.
Results
Of the 42 lesions deemed clinically suspicious to a dermatologist, from 9 to 26 were classified as suspicious by the apps; of the 15 clinically benign lesions 3 to 15 were correctly classified as benign by the apps. The apps' sensitivity and specificity ranged from 21 to 72% and 27 to 100.0%, respectively, when compared with the specialists' decisions. Two apps were unable to analyse 14 and 18% of lesions submitted, respectively. Interrater agreement between dermatologists and apps was poor (κ = −0.01 SE = 0.16; P = 0.97) to slight (κ = 0.16 SE = 0.09; P = 0.12).
Conclusions
None of the melanoma apps tested had high enough agreement with the dermatologist's clinical opinion to be considered to provide additional benefit to patients in assessing their skin for high-risk pigmented lesions. The low sensitivity in detecting lesions that are suspicious to a trained specialist may mean false reassurance is being given to patients. Development of highly sensitive and specific melanoma apps remains a work in progress.
http://ift.tt/2m1V8NP
Factors influencing cardiometabolic risk profile in patients with psoriasis
Abstract
Background
Psoriasis has been associated with metabolic syndrome and with an increased cardiovascular risk especially in patients with severe disease. The goal of this study was to estimate the prevalence of metabolic syndrome and other cardiovascular risk factors and its association with the psoriasis severity, sex and age.
Methods
Consecutive patients with psoriasis were enrolled in a prospective study over a 1-year period. Blood samples were collected. Psoriasis area and severity index (PASI) and body surface area scores and two dermatology quality of life (DQOL) questionnaires were used to evaluate psoriasis severity and the impact of the disease.
Results
Altogether 178 patients were included, of whom 44% had moderate–severe psoriasis. The overall prevalence of metabolic syndrome was 30% (men 34%, women 26%) without significant differences between patients with severe and mild disease. Age and menopause appeared to increase the risk for metabolic syndrome. Patients with severe psoriasis smoked more heavily, were more likely to have diabetes or insulin resistance and had higher homocysteine and lower high density lipoprotein cholesterol (HDL-C) levels than patients with mild psoriasis (P < 0.05). In women, a higher waist circumference was observed. Women had higher HDL-C levels and lower smoking and alcohol consumption rates. In accordance with the systematic coronary risk evaluation system, 18% of the patients had a high 10-year risk of fatal cardiovascular disease.
Conclusions
Psoriasis severity was associated with diabetes, insulin-resistance, smoking habit and higher cardiovascular risk. Metabolic syndrome was related to age and menopause but not to psoriasis severity.
http://ift.tt/2mv6xmX
Verrucae Planae Within Previous Xenograft Sites of Burn Wounds
Abstract
Burn injuries are known to compromise host immune defenses through disruption of mucocutaneous barriers and suppression of cell-mediated immune responses, which may render patients with burn injuries susceptible to viral infections in the days to years after an initial insult. We report a case of verrucae planae developing as a secondary condition confined to former xenograft sites in a child, appearing more than 3.5 years after initial second-degree burn injuries. Only a few reports have previously described the development of verrucae in former burn sites, with most reporting latency to onset of verrucae appearance of months rather than years. Current hypotheses suggest that the postburn immune response shifts from an early proinflammatory to a late antiinflammatory response characterized by altered cytokine profiles and diminished cellular cytotoxicity mediated by cytotoxic T-lymphocytes, natural killer cells, and epidermal antigen-presenting cells, which together likely contribute to an enduring postburn regional immunosuppression that allows for the seeding and proliferation of viral agents.
http://ift.tt/2m1lzmJ
“Sky Full of Stars” Pattern: Dermoscopic Findings in a Desmoplastic Giant Congenital Melanocytic Nevus
Abstract
Desmoplastic giant congenital melanocytic nevus (DGCN) is an uncommon variant of congenital nevus, presenting as a progressive induration and hypopigmentation of the lesion that occasionally causes hair loss and even total or partial disappearance of the nevus. A 6-month-old girl with a giant congenital melanocytic nevus that involved the entire posterior side of the right thigh was seen in our department. Nine months later, the peripheral area of the nevus presented as a marked induration with hypopigmentation. Dermoscopy demonstrated a reticular pattern exclusively located in the perifollicular areas, with a radial distribution from the follicular ostium that mimicked a "sky full of stars." We report a case of DGCN, including a dermoscopic description of the findings noted in the indurated and hypopigmented areas that appear as a "sky full of stars" image.
http://ift.tt/2muyfQu
Subcutaneous Midline Nasal Mass in an Infant due to an Intramuscular Lipoma
Abstract
Intramuscular lipomas are rare, benign, mesenchymal tumors occurring deep in the fascia, typically involving large muscle groups in adults. We report a case of an intramuscular lipoma occurring as a subcutaneous midline nasal mass in a 3-month-old infant. The differential diagnosis of a midline mass on the glabella of an infant is important and should include developmental anomalies such as nasal glioma, nasal dermoid cyst, and encephalocele, so neuroimaging is an essential first step in evaluating these lesions to exclude intracranial extension.
http://ift.tt/2m1mGTO
Dietary intake is associated with respiratory health outcomes and DNA methylation in children with asthma
Asthma is an increasingly common chronic disease among children, and data point toward a complex mechanism involving genetic, environmental and epigenetic factors. Epigenetic modifications such as DNA hypo- or...
http://ift.tt/2lfkMu7
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