Head and Neck Medicine by Alexandros G.Sfakianakis: 03/07/17

Τρίτη 7 Μαρτίου 2017

Allergic laryngitis: unraveling the myths.

Purpose of review: This article provides a thorough review of the literature highlighting the articles that have advanced our knowledge about the sensitivity of the larynx to allergens in the air or ones consumed. This area of inquiry requires continued interest and investigation. As the field of clinical laryngology changes, and more information is discovered about the possible causal association between allergy and vocal pathologies, practicing otolaryngologists, allergists, and other medical professionals may discover more comprehensive methods to evaluate and treat their allergic patients, particularly those who present with complaints of dysphonia, dysphagia, laryngopharyngeal reflux (LPR), and/or dyspnea. Recent findings: There continues to be epidemiological studies designed to describe the relationship of allergy to vocal symptoms and signs. Both population and smaller studies have recently attempted to link these two conditions. Unfortunately, the patient with chronic laryngeal complaints is often tagged by default with the diagnosis of LPR and treated with proton pump inhibitors, which are not always beneficial. The endoscopic assessment may not be as reliable to make the diagnosis of LPR as the examination is subjective and the inter-rater reliability is low. It has been demonstrated by direct laryngeal provocation studies that sticky-viscous endo-laryngeal mucous is the only reliable finding consistently associated with allergy potential allergic tissue reactivity. Summary: The interrelationship of allergic sensitivity and chronic laryngitis in certain individuals is becoming clearer because our knowledge of inquiry has increased and the available routine technology to diagnose these conditions has remarkably improved. Notwithstanding these advancements, much more research is needed on this subject to reduce the frequency of mis-diagnoses and mis-management of allergic patients. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Patient adherence to swallowing exercises in head and neck cancer.

Purpose of review: A younger population and improved treatments for head and neck cancer (HNC) mean that more people are now living longer with the consequences of treatment, including long-term swallowing problems (dysphagia). Exercises aim to improve swallowing function, however highly variable adherence rates are currently reported, with no standard measure of adherence. Recent findings: Measuring adherence to swallowing exercises depends on the definition of 'adherence', the tools used to measure adherence, and the acceptable threshold that is used to constitute adherence or nonadherence. Particular barriers to swallowing exercise adherence include the burden of treatment, the commitment required to undertake a home-based exercise programme and the difficulty in motivating patients to exercise before swallowing problems have become apparent. Findings from the wider literature on general exercise interventions highlight the importance of external and patient-related factors on adherence, including patient beliefs, social support, self-regulation and goal setting. Summary: Key barriers and motivators to adherence are presented, which will have implications for the design of future swallowing exercise interventions. The relevance of behaviour change theory in facilitating adherence is highlighted, with ongoing studies used to exemplify how behaviour change components and analysis of patient beliefs can be incorporated into intervention development. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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A Retrospective Analysis of the Efficacy of Pembrolizumab in Melanoma Patients With Brain Metastasis

A total of 50% of patients with melanoma will develop brain metastasis (BM). Pembrolizumab was approved for treatment of metastatic melanoma on the basis of significant systemic antitumor activity. Because of low enrollment of patients with BM in pembrolizumab trials, efficacy against melanoma BM remains unknown. We reviewed records of 89 consecutive patients with melanoma treated with pembrolizumab at our institution between May 1, 2014 and October 31, 2015 to determine the time to progression. Thirty-six (40%) patients had BM before pembrolizumab. Twenty-six (72%) patients with BM had received prior treatment for BM. With median follow-up of 17.2 months, 54 patients (61%) developed progressive disease on pembrolizumab. Intracranial progression occurred in 19 patients (21%), 3 of whom did not have BM before treatment. Median time to progression at any site was 6 months for those without BM (n=53), 5 months for those with treated BM (n=26), and 1.2 months for patients with untreated BM (n=10). Using a Cox regression model adjusted for baseline factors, there was a statistically significant (Wald χ2P=0.003) reduction in the hazard of progression for patients without BM [hazard ratio, 0.19; 90% confidence interval, 0.08–0.42) and patients with treated BM (hazard ratio, 0.27; 90% confidence interval, 0.12–0.64) compared with those with untreated BM. In conclusion, melanoma patients with pretreated BM can have durable systemic responses to pembrolizumab. Large, prospective studies are needed to evaluate the intracranial antitumor activity of pembrolizumab in melanoma patients with untreated BM.

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A Novel Fusion Antibody Exhibits Antiangiogenic Activity and Stimulates NK Cell-mediated Immune Surveillance Through Fused NKG2D Ligand

A single-chain variable fragment (scFv) targeting vascular endothelial growth factor receptor 2 was previously generated from a phage display library in our laboratory. However, it has shortened half-life and lacks Fc fragment for effector cell recognition. To address these challenges, a ligand of NK-cell receptor NKG2D was fused to the scFv and created a fusion protein scFv-major histocompatibility complex class I-related chain A (MICA), which is expected to recognize tumor cells through the scFv moiety and stimulate NK cells through the MICA. The fusion protein demonstrated specific binding to both vascular endothelial growth factor receptor 2 and NKG2D in protein-based and cell-based assays. In addition, it demonstrated antiangiogenic activities including restraining the proliferation, migration, transwell invasion, and tube formation of human umbilical vein endothelial cells. Furthermore, the fusion protein exhibited significant cytotoxicity on K562, MDA-MB-435, and B16F10 cells and triggered NK92 cell-mediated cytotoxicity on MDA-MB-435 cells by stimulating the release of significant cytokines. The fusion protein targeting strategy, therefore, provides a means to engage lymphocyte effector cells against tumor specific antigen overexpressing tumor cells.

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Use of Engineered Exosomes Expressing HLA and Costimulatory Molecules to Generate Antigen-specific CD8+ T Cells for Adoptive Cell Therapy

Dendritic cell-derived exosomes (DEX) comprise an efficient stimulator of T cells. However, the production of sufficient DEX remains a barrier to their broad applicability in immunotherapeutic approaches. In previous studies, genetically engineered K562 have been used to generate artificial antigen presenting cells (AAPC). Here, we isolated exosomes from K562 cells (referred to as CoEX-A2s) engineered to express human leukocyte antigen (HLA)-A2 and costimulatory molecules such as CD80, CD83, and 41BBL. CoEX-A2s were capable of stimulating antigen-specific CD8+ T cells both directly and indirectly via CoEX-A2 cross-dressed cells. Notably, CoEX-A2s also generated similar levels of HCMV pp65-specific and MART1-specific CD8+ T cells as DEX in vitro. The results suggest that these novel exosomes may provide a crucial reagent for generating antigen-specific CD8+ T cells for adoptive cell therapies against viral infection and tumors.

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Possible Compartmental Cytokine Release Syndrome in a Patient With Recurrent Ovarian Cancer After Treatment With Mesothelin-targeted CAR-T Cells

Cytokine release syndrome (CRS) is a potentially severe systemic toxicity seen after adoptive T-cell therapy and caused by T-cell activation and proliferation and is associated with elevated circulating levels of cytokines such as C-reactive protein, interleukin-6 (IL-6), and interferon-γ and has previously been described as a systemic response in hematologic malignancies. A 52-year-old woman with BRCA 1 mutation positive heavily pretreated advanced recurrent serous ovarian cancer was treated under a compassionate use protocol with autologous mesothelin-redirected chimeric antigen receptor T cells (CART-meso). Autologous T cells were transduced to express a receptor composed of an extracellular antimesothelin single-chain variable fragment fused to 4-1BB and TCR-zeta signaling domain. This patient was infused with 3×107 CART-meso T cells/m2 without lymphodepletion and developed compartmental CRS confined to the pleural cavities. The compartmental CRS was evidenced by an increase in IL-6 and accumulation of CART-meso T cells in pleural fluid compared with peripheral blood and was successfully treated the anti-IL6 receptor antagonist tocilizumab on D21 after the T-cell infusion. This is the first description of a compartmental CRS in a patient with solid malignancy. This response could be due to malignant pleural fluid creating an environment where T cells could interact with tumor cells and suggests localized on-target CAR-T-cell activation.

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Myasthenia Gravis After Nivolumab Therapy for Squamous Cell Carcinoma of the Bladder

Checkpoint inhibitors have become standard therapy for multiple cancers, and their use will increase in the next year as regulatory approvals for additional indications are expected. It is essential for clinicians to be aware of the potential for rare immune-related adverse effects. Here, we report the case of a new diagnosis of myasthenia gravis (MG) after the use of nivolumab for squamous cell carcinoma of the bladder. A review the literature identified 10 cases of MG diagnosed after programmed cell death protein 1 inhibitor therapy. This is the first case, to our knowledge, reported in association with bladder cancer. The precise diagnosis of MG has important implications on management, as treatment with steroids can transiently worsen myasthenia in nearly 50% of cases.

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Urban Residence, Neighborhood Poverty, race/ethnicity and Asthma Morbidity Among Children in Medicaid

Publication date: Available online 8 March 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Corinne A. Keet, Elizabeth Matsui, Meredith C. McCormack, Roger Peng
BackgroundAlthough poor-urban (inner-city) areas are thought to have high asthma prevalence and morbidity, we recently found that inner-cities do not have higher prevalent pediatric asthma. Whether asthma morbidity is higher in inner-city areas across the U.S. not known.ObjectiveTo examine relationships between residence in poor and urban areas, race/ethnicity, and asthma morbidity among children with asthma enrolled in Medicaid.MethodsChildren aged 5-19 enrolled in Medicaid in 2009-2010 were included. Asthma was defined by at least one outpatient or emergency department (ED) visit with a primary diagnosis code of asthma over the 2 year period. Urbanization status was defined at the county level and neighborhood poverty at the zip-code level. Among children with asthma, logistic models were created to examine the effects of urbanization, neighborhood poverty and race/ethnicity on rates of asthma outpatient visits, ED visits and hospitalizations.Results16,860,716 children were included (1,534,820 with asthma). Among children enrolled in Medicaid, residence in inner-city areas did not confer increased risk of prevalent asthma in either crude or adjusted analyses, but was associated with significantly more asthma-related emergency room visits and hospitalizations among those with asthma in crude analyses (RR 1.48, 95%CI:1.24-1.36 and 1.97, 95%CI:1.50-1.72, respectively) and when adjusted for race/ethnicity, age and gender (aRR 1.23, 95%CI:1.08-1.15 and 1.62, 95%CI:1.26-1.43). Residence in urban or poor areas, and non-Hispanic black race/ethnicity were all independently associated with increased risk of asthma related emergency room visits and hospitalizations.ConclusionsResidence in poor and urban areas is an important risk factor for asthma morbidity, but not prevalence, among low-income U.S. children.

Teaser

Among children enrolled in Medicaid, residence in an urban area is not a risk factor for prevalent asthma, but residence in urban or poor areas, and Black race/ethnicity are each independent risk factors for asthma emergency room visits and hospitalizations.

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Fatal anaphylaxis in France: analysis of national anaphylaxis data, 1979-2011

Publication date: Available online 7 March 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Guillaume Pouessel, Claire Claverie, Julien Labreuche, Aimée Dorkenoo, Jean-Marie Renaudin, Mireille Eb, Stéphanie Lejeune, Antoine Deschildre, Stéphane Leteurtre

Teaser

The anaphylaxis mortality rate has fallen about 2% per year in France over the past 3 decades. Increased awareness of anaphylaxis treatment guidelines will hopefully continue this trend.

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Circulating Gluten-Specific FOXP3+CD39+ Regulatory T Cells Have Impaired Suppressive Function in Celiac Disease

Publication date: Available online 8 March 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Laura Cook, C. Mee Ling Munier, Nabila Seddiki, David van Bockel, Noé Ontiveros, Melinda Y. Hardy, Jana K. Gillies, Megan K. Levings, Hugh Reid, Jan Peterson, Jamie Rossjohn, Robert P. Anderson, John Zaunders, Jason A. Tye-Din, Anthony D. Kelleher
BackgroundCeliac disease is a chronic immune-mediated inflammatory disorder of the gut triggered by dietary gluten. Although the effector T-cell response in celiac disease has been well characterized, the role of regulatory T-cells (Tregs) in the loss of tolerance to gluten remains poorly understood.ObjectiveTo define if celiac disease patients have a dysfunction or lack of gluten-specific FOXP3⁺ Tregs.MethodsTreated celiac disease patients underwent oral wheat challenge to stimulate re-circulation of gluten-specific T-cells. Peripheral blood was collected pre- and post-challenge. In order to comprehensively measure the gluten-specific CD4⁺ T-cell response, we paired traditional IFN-γ ELISpot with an assay to detect antigen-specific CD4⁺ T-cells that does not rely on tetramers, antigen-stimulated cytokine production or proliferation, but rather on antigen-induced co-expression of CD25 and OX40 (CD134).ResultsThe number of circulating gluten-specific Tregs and effector T-cells both increased significantly post oral wheat challenge, peaking at day 6. Surprisingly, we found that approximately 80% of the ex vivo circulating gluten-specific CD4⁺ T-cells were FOXP3⁺CD39⁺ Tregs, which reside within the pool of memory CD4⁺CD25⁺CD127^lowCD45RO⁺ Tregs. Although we observed normal suppressive function in peripheral polyclonal Tregs from celiac patients, after a short in vitro expansion the gluten-specific FOXP3⁺CD39⁺ Tregs exhibited significantly reduced suppressive function compared to polyclonal Tregs.ConclusionThis study provides the first estimation of FOXP3⁺CD39⁺ Treg frequency within circulating gluten-specific CD4⁺ T-cells following oral gluten challenge of celiac patients. FOXP3⁺CD39⁺ Tregs comprised a major proportion of all circulating gluten-specific CD4⁺ T-cells but had impaired suppressive function, indicating that Treg dysfunction may be a key contributor to disease pathogenesis.

Teaser

We performed a novel study of gluten-specific FOXP3⁺ Tregs in patients with celiac disease and found that, although these cells comprise the majority of circulating gluten-specific CD4⁺ T-cells, they have impaired suppressive function.

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IgE and antiviral immune response in asthma

Publication date: Available online 6 March 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jonathan S. Tam, Mitchell H. Grayson

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Reply

Publication date: Available online 6 March 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): David B. Kantor, Wanda Phipatanakul, Joel N. Hirschhorn

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Prevention of Flares in Children with Atopic Dermatitis with Regular Use of an Emollient Containing Glycerol and Paraffin: A Randomized Controlled Study

Abstract

Background/Objectives

Emollients are part of the standard treatment for atopic dermatitis (AD), although there is limited evidence that regular use of emollients as management therapy reduces the frequency of flares and corticosteroid consumption. The objective of this study was to evaluate the benefit of emollient use in the management of mild to moderate AD in children by assessing the ability of two different emollients (particularly V0034CR) to prevent flares and to reduce the use of corticosteroids.

Methods

In this randomized, open-label study, patients with a current flare were treated with a potent topical corticosteroid. After flare resolution, patients were centrally randomized to V0034CR emollient, reference emollient, or no emollient (1:1:1 ratio) for 12 weeks. New flares were medically assessed before being treated with a moderately potent corticosteroid.

Results

A total of 335 children 2 to 6 years of age were randomized. At 12 weeks, the percentage of patients with one or more flares was statistically significantly lower with V0034CR (35.1%) than without emollient (67.6%; p < 0.001). Fewer patients treated with V0034CR required any corticosteroids or immunosuppressants (23.6%) than patients with no emollient (43.3%) at 12 weeks. The difference was significant at all time points (p = 0.002). Patients treated with emollients had a longer time to first flare, fewer flares, higher complete remission rates, less corticosteroid consumption, lower Investigator Global Assessment scores, and lower Scoring Atopic Dermatitis scores than those who were not. V0034CR was well tolerated, with no specific safety concerns.

Conclusion

Regular emollient use in children with mild to moderate AD reduces flares and corticosteroid consumption.

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Feasibility of Dentascan in planning of implant surgery in posterior maxilla and mandible

Publication date: Available online 6 March 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Siddhartha Chandel, Nishi Singh, Amiya Agrawal, Harmurti Singh, H. Nandakumar
ObjectivesThe present evaluate the feasibility of Computed tomography (Dentascan), in assessment of the implant site in posterior maxilla & mandible.Material and Methodsdata of total 11 patients with 20 implant sites were involved in the present study. Out of the 20 implant sites selected 10 were in posterior maxilla and 10 in posterior mandible. All the patients were routinely examined by panoramic radiography and CT. All images obtained i.e., conventional panoramic radiograph, and film based Dentascan MPR- CT images were evaluated for the detectability of mandibular canal at the mental foramen, 1cm, 2cm, and 3cm posterior to mental foramen. The judgments were then compared by using the four point grading score.ResultsBoth the statistical analysis and radiographic observation showed that Dentascan MPR CT gives significantly clearer images at the mental foramen and 1cm, 2cm , 3cm posterior to it. Dentascan also provides significantly better visualization of the vital structures along with the bone density. The panoramic and Dentascan MPR CT images did not show a significant difference in visualization of the crest of alveolar ridge in both maxillary as well as the mandibular arch.ConclusionThe Dentascan MPR- CT images revealed significantly clearer images as well as better visualization of the vital structures than conventional panoramic radiography. Apart from providing clearer images Dentascan also gives the buccopalatal/buccolingual dimension at the implant site, along with the density of the available bone.

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Papillary cystadenocarcinoma of the sublingual gland

Publication date: Available online 6 March 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Neil Giblett, Syed Farhan Ahsan, Ahmed Messahel
A 68-year-old Caucasian gentleman presented with a 6-month history of a left sided Level I/II neck swelling involving the floor of mouth. MRI revealed a large cystic lesion and histology confirmed a diagnosis of primary papillary cystadenocarcinoma of the sublingual gland.Papillary cystadenocarcinoma was first described in 1991 by the World Health Organisation [WHO], and is a rare malignant neoplasm characterised by cysts and papillary endo-cystic projections.Papillary cystadenocarcinoma arising from the sublingual glands is extremely rare and has the potential to metastasise to cervical lymph nodes. This patient we report was therefore treated with surgical excision and post-operative radiotherapy.

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Practicality analysis of the staging system proposed by the Japan Otological Society for acquired middle ear cholesteatoma: A multicenter study of 446 surgical cases in Japan

Publication date: Available online 6 March 2017
Source:Auris Nasus Larynx
Author(s): Keiji Matsuda, Tetsuya Tono, Hiromi Kojima, Yutaka Yamamoto, Masafumi Sakagami, Yasuo Mishiro, Yasuyuki Hinohira, Taeko Okuno
ObjectiveThe Objective of this study was to assess the practicality of the cholesteatoma staging system proposed by the Japan Otological Society (JOS) for acquired middle ear cholesteatoma (the 2010 JOS staging system).MethodsBetween 2009 and 2010, 446 ears with retraction pocket cholesteatoma underwent primary surgery at 6 institutions in Japan. The extent of cholesteatoma was surgically confirmed, and classified into three stages.ResultsThe cholesteatoma affected the pars flaccida in 325 ears (73%), the pars tensa in 100 ears (22%), and both regions combined in 21 ears (5%). The hearing outcome (postoperative air-bone gaps dB) worsened as follows (Stage I, II, III): 84%, 68%, 53% in pars flaccida; 71%, 62%, 30% in pars tensa, and 42% at Stage II, and 50% at Stage III in the combined group. The incidence of residual cholesteatoma increased as follows (Stage I, II, III): 2%, 12%, 23% in pars flaccida; 7%, 30%, 21% in the pars tensa group. The severity of disease was reflected in postoperative hearing and increasing incidence of recurrence rate.ConclusionThe 2010 JOS staging system is suitable for evaluating initial pathology. It is particularly practical for standardizing reporting of retraction pocket cholesteatoma and for adjusting for the severity of the condition during outcome evaluations. It may also provide information that is useful for counseling patients.

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Protective effect of an astaxanthin nanoemulsion against neomycin-induced hair-cell damage in zebrafish

Publication date: Available online 6 March 2017
Source:Auris Nasus Larynx
Author(s): Yosuke Takemoto, Yoshinobu Hirose, Kazuma Sugahara, Makoto Hashimoto, Hirotaka Hara, Hiroshi Yamashita

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Mobile tablet audiometry in fluctuating autoimmune ear disease

Abstract

Background

Autoimmune inner ear disease (AIED) is a rare condition characterized by bilateral fluctuating sensorineural hearing loss (SNHL). The labile nature of this hearing loss makes it difficult to accurately quantify with conventional methods, and therefore it is challenging to rehabilitate.

Methods

Over a 9-month period one pediatric patient with severe AIED was monitored and conducted home audiograms using a previously validated testing system (Shoebox Audiometry). During this period he also underwent several clinical audiograms. The correlation between clinical and home audiograms was analyzed with a Pearson coefficient, and the range and frequency of fluctuations was recorded.

Results

Sixty-four automated home audiograms and nine clinical audiograms were conducted. When tested at home using a calibrated system the pure tone average (PTA) fluctuated between 12 dB and 72 dB indicating large variability in hearing. Fluctuations were frequent: on 28 occasions the PTA varied by at least 5 dB when retested within 4 days. The mean PTA was 50 dB and 95% of the thresholds were within 36 dB of the mean. Clinical audiograms obtained on the same day or within 1 day of home testing were highly concordant (with a Pearson coefficient of 0.93).

Conclusion

AIED can result in significant fluctuations in hearing over short periods of time. Home testing enables a more granular look at variations over time and correlates well with clinical testing, and thus facilitates rapid action and informed rehabilitation.

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Intraoperative Funktionsüberwachung des N. facialis

Zusammenfassung

Hintergrund

Bei Operationen an Vestibularisschwannomen gehören Schädigungen des N. facialis mit konsekutiven funktionellen Defiziten zu den bedeutendsten Komplikationen. Die intraoperative Funktionsüberwachung soll dazu dienen, diese Komplikation zu vermeiden.

Fragestellung

Welche Methoden zur intraoperativen Funktionsüberwachung haben sich entwickelt? Welche Methoden sind aktuell in Gebrauch, und welche Ziele können damit sinnvoll verfolgt werden?

Material und Methoden

Auswertung und Zusammenfassung der Literatur, Diskussion der vorhandenen Methoden und ihrer Fähigkeiten, die gesteckten Ziele zu erreichen.

Ergebnisse

Die intraoperative Funktionsüberwachung soll es ermöglichen, den N. facialis intraoperativ sicher zu identifizieren. Sie soll potenziell schädigende Ereignisse anzeigen und während der Operation eine Einschätzung über den zu erwartenden postoperativen Funktionszustand des Nervs erlauben. Zur Verfügung stehen die elektrische Direktstimulation, das freilaufende Elektromyogramm (EMG), evozierte Potenziale des N. facialis und das prozessierte EMG.

Schlussfolgerungen

Die Identifikation und Verfolgung des Nervs im Operationssitus mittels der elektrischen Direktstimulation ist gut möglich. Potenziell schädigende Ereignisse können mit allen anderen Methoden in Echtzeit oder nahezu in Echtzeit angezeigt werden. Die intraoperative Prognostik wird derzeit aber bei allen verfügbaren Methoden durch falsch-positive Untersuchungsergebnisse belastet und ist nur bedingt verlässlich.

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Prävalenz von Schwerhörigkeit in Nord- und Süddeutschland

Zusammenfassung

Hintergrund

Die Untersuchung HÖRSTAT im Nordwesten Deutschlands ergab, dass rund 16 % der Erwachsenen nach dem Kriterium der Weltgesundheitsorganisation (WHO) schwerhörig sind. Die Belastbarkeit landesweiter Hochrechnungen aus regional durchgeführten epidemiologischen Untersuchungen kann indes infrage gestellt werden.

Methoden

Die Studie „Wie hört Deutschland?" wurde unabhängig von HÖRSTAT im südwestdeutschen Aalen durchgeführt. Beide Querschnittstudien basierten auf stratifizierten Zufallsstichproben aus der Allgemeinbevölkerung. Der mittlere Tonhörverlust bei 500 Hz, 1, 2 und 4 kHz („pure-tone average", PTA4), die Prävalenz von Schwerhörigkeit (WHO-Kriterium: PTA4 des besseren Ohrs >25 dB HL) und die Versorgung mit Hörgeräten wurden verglichen. Die Daten aus Aalen und HÖRSTAT wurden zusammengeführt (n = 3105), um die Prävalenz von Schwerhörigkeit in ihrer graduellen Ausprägung für die Jahre 2015, 2020 und 2025 hochzurechnen.

Ergebnisse

Die beobachteten mittleren Hörverluste beider Studien stimmen sehr gut überein. Gewichtet nach Maßgabe der Bevölkerungsstatistik sind 16,2 % der Erwachsenen in Deutschland (11,1 Mio.) nach dem WHO-Kriterium schwerhörig. Aufgrund der demographischen Entwicklung ist mittelfristig ein Prävalenzanstieg von 1 % pro Jahrfünft zu erwarten. Bei vergleichbarem Hörverlust ist die Versorgung mit Hörgeräten in den Studienorten unterschiedlich.

Schlussfolgerung

Bei Adjustierung der Geschlechts- und Altersverteilung auf die europäische Standardpopulation (ESP) liegt die Prävalenz von Schwerhörigkeit in HÖRSTAT ebenso wie in der Aalener Untersuchung deutlich niedriger als in internationalen Vergleichsstudien. Die Analyse basiert ausschließlich auf Querschnittsdaten. Mögliche Kohorteneffekte sind in der Vorausberechnung der Prävalenz deshalb nicht berücksichtigt.

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Wahrnehmung von Hörproblemen bei älteren Menschen

Zusammenfassung

Hintergrund

Altersschwerhörigkeit ist eine der häufigsten chronisch-sensorischen Beeinträchtigungen in der älteren Bevölkerungsgruppe und wird verbunden mit Reduktion von kognitiven Fähigkeiten, Depression, Rückzug, Isolation und geringerem Wohlbefinden.

Ziele

Das erste Ziel war, die Selbsteinschätzung des Hörhandicaps von älteren Frauen und Männern mit Altersschwerhörigkeit (≥55 Jahre) zu erfassen sowie den Zusammenhang zwischen Hörverlust und wahrgenommenen Hörproblemen zu untersuchen. Das zweite Ziel war eine tiefgehende Auseinandersetzung mit den subjektiven Erfahrungen in Bezug auf die Folgen von Schwerhörigkeit im Alltag.

Methode

Im quantitativen Teil wurden im Zuge der schriftlichen Befragung Daten von 65 Altersschwerhörigen in Österreich gesammelt. Hierfür wurde das Instrument Hearing Handicap Inventory for the Elderly (HHIE) herangezogen. Im qualitativen Teil erfolgten problemzentrierte Interviews zur Erfassung der Erfahrungen mit Schwerhörigkeit und die Datenanalyse von weiteren 14 altersschwerhörigen Menschen.

Ergebnisse

Teilnehmende stuften ihr Hörhandicap im Durchschnitt als leichtgradig ein und nahmen Folgen auf der emotionalen und sozialen sowie Kommunikationsebene wahr. Darüber hinaus konnten Unsicherheitsgefühle identifiziert werden. Zudem weisen die Ergebnisse auf einen Zusammenhang sowie auf eine Diskrepanz zwischen Hörverlust und Hörhandicap hin; nicht alle Teilnehmenden nahmen ein Hörhandicap wahr.

Schlussfolgerung

Eine patientenzentrierte Behandlung, in der (1) objektive und subjektive Instrumente zur Erfassung von Hörproblemen zur Anwendung kommen, (2) nahestehende Personen einbezogen werden, (3) Aufklärung und Informationsaustausch stattfindet und (4) eine gemeinsame Entscheidung gefunden wird, könnte die Lebensqualität und Versorgungsqualität verbessern.

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Acute vestibular syndrome in cerebellar stroke

Abstract

The current paper reports on a patient with recurrent rotational vertigo and persistent dizziness and imbalance lasting several weeks, who underwent extensive neuro-otological and radiological examinations. Pathological findings initially included right-sided benign paroxysmal positional vertigo (BPPV), persistent horizontal spontaneous nystagmus (SPN) to the left, and a pathological bedside and video head impulse test (HIT) on the left. The pathological HIT on the left and the SPN to the left indicated a central origin. Therefore, cranial magnetic resonance imaging was performed which revealed a left-sided ischemic stroke in the territory of the medial branch of the posterior inferior cerebellar artery (mPICA).

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Update HNO

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Paired suicide in a young refugee couple on the Thai-Myanmar border

Gracia Fellmeth Sep 15, 2016; 2016:bcr2016215527-bcr2016215527 case-report

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Anabolic androgen use in the management of hereditary angioedema

Hereditary angioedema due to C1 inhibitor deficiency (HAE) is a rare, life-threatening disease that imposes a significant burden on affected patients. 17α-alkylated androgens (anabolic androgens) decrease attack frequency and severity but carry the risk of potentially serious dose-related adverse effects. Despite the emergence of targeted therapies for HAE, continued anabolic androgen use has been driven in part by their low cost.

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Survey of pediatric trainee knowledge: dose, concentration, and route of epinephrine

Epinephrine is the first medication listed in the American Heart Association's Pediatric Algorithm for Cardiac Arrest, and it is the primary medication in the treatment of anaphylaxis.1–3 It is frequently dosed and administered during stressful circumstances, and errors can result in poor patient outcomes. Epinephrine knowledge deficits are known to occur, but their prevalence in pediatric trainees is unclear.4,5 We distributed a survey of 8 test questions (Table 1) to assess knowledge gaps related to inpatient and outpatient epinephrine usage.

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Sex differences in the efficacy, safety, and tolerability of omalizumab after 1 year in Maltese patients with asthma

Omalizumab has been proven to be a safe and effective drug1 in patients with severe, persistent, allergic IgE-mediated asthma. Sex differences in asthma prevalence and severity, including IgE-mediated allergic asthma, have been recognized, with women said to be more severely affected.2,3 Studies have identified that men and women respond differently to their asthma when comparing hospital admissions, quality of life, and use of inhalers.4 It is also postulated that responses to antiasthmatic drugs differ.

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A STAT1-gain-of-function mutation causing Th17 deficiency with chronic mucocutaneous candidiasis, psoriasiform hyperkeratosis and dermatophytosis

Jakob Nielsen Oct 22, 2015; 2015:bcr2015211372-bcr2015211372 case-report

http://ift.tt/2mjLMMX

Large retroperitoneal low-grade extraskeletal osteosarcoma

Jiten Jaipuria Mar 22, 2014; 2014:bcr-2014-203745-bcr-2014-203745 case-report

http://ift.tt/2ncmtd0

Eosinophilic enteritis: a rare cause of diarrhoea

Ana Lladó
Sep 30, 2013; 2013:bcr2013201125-bcr2013201125
case-report

http://ift.tt/2mjLFki

Acute kidney injury requiring haemodialysis following ingestion of mephedrone

Rhys Rhidian Mar 1, 2013; 2013:bcr2012007974-bcr2012007974 case-report

http://ift.tt/2nchcT6

Cirrhosis, cellulitis and cats: a 'purrfect' combination for life-threatening spontaneous bacterial peritonitis from Pasteurella multocida

Penelope Hey Nov 12, 2012; 2012:bcr2012007397-bcr2012007397 case-report

http://ift.tt/2mk7pwz

Efficacy and cost of micronutrient treatment of childhood psychosis

Megan Rodway Nov 9, 2012; 2012:bcr2012007213-bcr2012007213 case-report

http://ift.tt/2nc3xLA

A microbiological hazard of rural living: Clostridium septicum brain abscess in a child with E coli 0157 associated haemolytic uraemic syndrome

Eleri J Williams Jun 26, 2012; 2012:bcr2012006424-bcr2012006424 case-report

http://ift.tt/2mjz4hg

A rare presentation of myxofibrosarcoma as a Pancoast tumor: a case report

Myxofibrosarcoma is an aggressive soft tissue neoplasm, classified as a variant of malignant fibrous histiocytoma. Most often, it occurs in middle to late adult life peaking in the seventh decade and involving...

http://ift.tt/2m04MNY

JAK Inhibitors Show Promise for Alopecia, Eczema, Vitiligo

A researcher at the forefront shares promising results from small studies. Clinical trials are in progress and he predicts FDA approval for a JAK inhibitor for alopecia and eczema within 3 years.
Medscape Medical News

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New Biologic is 'Potential Blockbuster' for Eczema Treatment

Dupilumab safely and effectively controls the symptoms of moderate to severe eczema over the long-term, 1-year data show. FDA approval of the biologic is expected soon, the lead investigator reports.
Medscape Medical News

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F-spondin negatively regulates dental follicle differentiation through the inhibition of TGF-β activity

Publication date: July 2017
Source:Archives of Oral Biology, Volume 79
Author(s): Ai Orimoto, Misaki Kurokawa, Keisuke Handa, Masaki Ishikawa, Eisaku Nishida, Makoto Aino, Akio Mitani, Miho Ogawa, Takashi Tsuji, Masahiro Saito
ObjectiveF-spondin is an extracellular matrix (ECM) protein that belongs to the thrombospondin type I repeat superfamily and is a negative regulator of bone mass. We have previously shown that f-spondin is specifically expressed in the dental follicle (DF), which gives rise to the periodontal ligament (PDL) during the tooth root formation stage. To investigate the molecular mechanism of PDL formation, we investigated the function of f-spondin in DF differentiation.DesignThe expression patterning of f-spondin in the developing tooth germ was compared with that of periodontal ligament-related genes, including runx2, type I collagen and periostin, by in situ hybridization analysis. To investigate the function of f-spondin during periodontal ligament formation, an f-spondin adenovirus was infected into the bell stage of the developing tooth germ, and the effect on dental differentiation was analyzed.ResultsF-spondin was specifically expressed in the DF of the developing tooth germ; by contrast, type I collagen, runx2 and periostin were expressed in the DF and in the alveolar bone. F-spondin-overexpresssing tooth germ exhibited a reduction in gene expression of periostin and type I collagen in the DF. By contrast, the knockdown of f-spondin in primary DF cells increased the expression of these genes. Treatment with recombinant f-spondin protein functionally inhibited periostin expression induced by transforming growth factor-β (TGF-β).ConclusionOur data indicated that f-spondin inhibits the differentiation of DF cells into periodontal ligament cells by inhibiting TGF-β. These data suggested that f-spondin negatively regulates PDL differentiation which may play an important role in the immature phenotype of DF.

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The local administration of parathyroid hormone encourages the healing of bone defects in the rat calvaria: Micro-computed tomography, histological and histomorphometric evaluation

Publication date: July 2017
Source:Archives of Oral Biology, Volume 79
Author(s): Caroline Moreira Auersvald, Felipe Rychuv Santos, Mayara Mytie Nakano, Graziela Bianchi Leoni, Manoel Damião de Sousa Neto, Rafaela Scariot, Allan Fernando Giovanini, Tatiana Miranda Deliberador
ObjectiveTo evaluate the effect of a single-dose local administration of PTH on bone healing in rat calvarial bone defects by means of micro-computed tomography, histological and histomorphometric analysis.DesignCritical-size cranial osteotomy defects were created in 42 male rats. The animals were randomly divided into 3 groups. In the C Group, the bone defect was only filled with a blood clot. In the S Group, it was filled with a collagen sponge and covered with bovine cortical membrane. In the PTH Group, the defect was filled with a collagen sponge soaked with PTH and covered with bovine cortical membrane. The groups were further split in two for euthanasia 15 and 60days post-surgery. Data was statistically analyzed with t-tests for independent samples or the nonparametric Mann-Whitney test when applicable. Intragroup comparisons were analyzed with paired t-tests (p<0.05).ResultsMicro-CT analysis results did not demonstrate statistically significant intergroup differences. At 15days post-surgery, the histomorphometric analysis showed that the PTH Group exhibited a significantly higher percentage of bone formation compared with the S Group. At 60days post-surgery, a higher percentage of new bone was observed in the PTH group.ConclusionThe results suggest that the local administration of PTH encouraged the bone healing in critical-size calvarial defects in rats.

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Assessment of gingival biotype and facial hard/soft tissue dimensions in the maxillary anterior teeth region using cone beam computed tomography

Publication date: July 2017
Source:Archives of Oral Biology, Volume 79
Author(s): Reza Amid, Mahdieh Mirakhori, Yaser Safi, Mahdi Kadkhodazadeh, Mahshid Namdari
ObjectiveThis study sought to assess the relationship between facial gingival and bone dimensions in maxillary anterior teeth region using cone beam computed tomography (CBCT).DesignThis study assessed 621 maxillary anterior teeth in 144 patients. In the sagittal plane, facial bone thickness (BT) and gingival thickness (GT) were measured at the crestal level and at 2, 4 and 6mm apical to the cementoenamel junction (CEJ). The dentogingival complex (DGC) dimensions and the distance from the CEJ to bone crest were also measured on CBCT scans. To determine the gingival biotype, GT at 2mm apical to the gingival margin was measured and GT <1.5mm was categorized as thin while GT ≥1.5mm was categorized as thick. The data were analyzed using SPSS version 21 via repeated measures ANOVA and the Cochrane's Q, chi-square and independent samples t-tests.ResultsThe BT around the maxillary central and lateral incisors and canine teeth at 4 and 6mm apical to the CEJ was significantly different in thick and thin gingival biotypes (P<0.05). The mean GT at 2 and 4mm apical to the CEJ was significantly different around central and lateral incisors (P<0.05). Thickness of crestal bone was significantly different between the two gingival biotypes around central and lateral incisors (P<0.05).ConclusionThe two gingival biotypes had significantly different mean BT; different biotypes and their relationship to BT varied around anterior maxillary teeth.

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Distribution of hemokinin-1 in the rat trigeminal ganglion and trigeminal sensory nuclear complex

Publication date: Available online 6 March 2017
Source:Archives of Oral Biology
Author(s): Kaori Igawa, Hideki Funahashi, Yu Miyahara, Rumi Naono-Nakayama, Hisae Matsuo, Yoshihiro Yamashita, Sumio Sakoda, Toshikazu Nishimori, Yasushi Ishida
Objective: A new mammalian tachykinin peptide encoded in a TAC4 gene was identified and designated as hemokinin-1 (HK-1). A representative of the tachykinin peptide family is substance P (SP), and the function of SP has been well characterized as a pain transmitter or modulator, while it is possible that HK-1 is involved in pruriceptive processing, but, as yet, the distribution of HK-1 peptide in the trigeminal sensory system is still unknown. Thus, the aim of the present study was to elucidate the distribution of HK-1, while comparing the expression of SP, in the trigeminal ganglion and trigeminal sensory nuclear complex.DesignThe trigeminal ganglion and the brain stem of male SD rats were used in the immunohistochemical study. Since the amino acid sequence in the carboxyl-terminal regions of HK-1 and SP is common, polyclonal antibodies of HK-1 and SP derived from 6 amino acids consisting of amino-terminal regions of these peptides were produced in guinea pig and rabbit, respectively. The immunohistochemical staining of HK-1 and SP was conducted using frozen sections of the trigeminal ganglion and brain stem in rats.ResultsImmunohistochemical studies revealed the expression of HK-1 in small- and medium-sized trigeminal ganglion neurons, in the paratrigeminal nucleus, and in lamina I of the trigeminal nucleus caudalis, while there was no immunoreactivity of HK-1 in the trigeminal nucleus principalis, trigeminal nucleus oralis, and trigeminal nucleus interpolaris.ConclusionThese findings indicate that HK-1 is a target molecule for treatment of itch in the orofaicial regions.

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The anti-oxidant effects of melatonin derivatives on human gingival fibroblasts

Publication date: Available online 7 March 2017
Source:Archives of Oral Biology
Author(s): Chawapon Phiphatwatcharaded, Ploenthip Puthongking, Ponlatham Chaiyarit, Nutjaree Pratheepawanit Johns, Sumon Sakolchai, Pramote Mahakunakorn
ObjectivesAim of this in vitro study was to evaluate the anti-oxidant activity of indole ring modified melatonin derivatives as compared with melatonin in primary human gingival fibroblast (HGF) cells.MethodsAnti-oxidant activity of melatonin (MLT), acetyl-melatonin (AMLT) and benzoyl-melatonin (BMLT) was evaluated by5 standard methods as follows:2, 2-diphenyl-1-picrylhydrazyl (DPPH); ferric ion reducing antioxidant power (FRAP); superoxide anion scavenging; nitric oxide (NO) scavenging; and thiobarbituric acid reactive substances (TBARs).Evaluation of cellular antioxidant activity (CAA) and protectivity against H2O2 induced cellular damage was performed via MTT assay in HGF cells.ResultsAccording to the standard anti-oxidant assays, the antioxidant power of AMLT and BMLT were slightly less than MLT in FRAP and superoxide scavenging assays. In the NO scavenging and TBARs assays, BMLT and AMLT were more potent than MLT, whereas DPPH assays demonstrated that MLT was more potent than others. BMLT and AMLT had more potent anti-oxidant and protective activities against H2O2in HGF cells as compared with MLT.ConclusionsMLT derivatives demonstrated different anti-oxidant activities as compared with MLT, depending upon assays. These findings imply that N-indole substitution of MLT may help to improve hydrogen atom transfer to free radicals but electron transfer property is slightly decreased. Anti-oxidant and protective effects of melatonin derivatives (AMLT and BMLT) on human gingival fibroblasts imply the potential use of these molecules as alternative therapeutics for chronic inflammatory oral diseases.

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Evidence of phenotypic stability after transduction of fluorescent proteins in two human tongue cancer cell lines

Publication date: Available online 6 March 2017
Source:Archives of Oral Biology
Author(s): Wei-Xin Cai, Li-Wu Zheng, Hong-Zhang Huang, Roger A. Zwahlen
ObjectivesThis study investigated the phenotypic stability and biological properties of two human tongue cancer cell lines after transduction of fluorescent proteins.DesignThe human tongue cancer cell lines UM1 and UM2 were cultured with GFP and RFP lentiviral particles stock for 72hours. Cells with successful transduction of fluorescent proteins were selected in a medium containing G418 antibiotics for two weeks. The proliferation rates of parental and transduced cell lines were evaluated by their population doubling time (PDT). Transduction efficiency was assessed by fluorescence microscope and flow cytometry. The transduced cells in passage 1, 2, 10, 20 and 30 were collected to check the stability of fluorescent protein expression. Phenotypic stability of the transduced cells was detected by means of cell morphology, cell surface markers and cell function evaluating essay.ResultsThe proliferation rates of the transduced cell lines showed no significant difference compared to their parental cells. Successful transduction with high efficiency (99% up) was demonstrated. High fluorescence expression on both transduced cells was detected until the thirtieth generation. UM1 and UM1-GFP displayed mesenchymal cell characteristics, while UM2 and UM2-RFP cell lines showed properties characteristic of epithelial.ConclusionsTwo human tongue cancer cell lines of epithelial and mesenchymal phenotype respectively, have been successfully labelled with green and red fluorescent proteins. The fluorescence maintained a high expression rate over thirty generations without influencing the original morphological phenotype and cadherin expression.

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F-spondin negatively regulates dental follicle differentiation through the inhibition of TGF-β activity

The local administration of parathyroid hormone encourages the healing of bone defects in the rat calvaria: Micro-computed tomography, histological and histomorphometric evaluation

Assessment of gingival biotype and facial hard/soft tissue dimensions in the maxillary anterior teeth region using cone beam computed tomography

Distribution of hemokinin-1 in the rat trigeminal ganglion and trigeminal sensory nuclear complex

The anti-oxidant effects of melatonin derivatives on human gingival fibroblasts

Evidence of phenotypic stability after transduction of fluorescent proteins in two human tongue cancer cell lines

Minimalna różnica istotna klinicznie (MCID) dla zmniejszenia częstości zaostrzeń przewlekłej obturacyjnej choroby płuc – czyli, która terapia jest w rzeczywistości odczuwana przez chorego

Publication date: Available online 6 March 2017
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Tomasz Dębowski
Exacerbations of COPD are associated with accelerated loss of lung function, declining health status, and increased mortality, and the key objective in the management of COPD is preventing exacerbations or at least reducing their number and severity. New interventions should be examined in reference to the minimal clinically important difference (MCID), a theoretical numerical value which reflects the real, felt by patients and perceived by physician as a meaningful change in measures describing patient's health status. The MCID for COPD exacerbations had been established and set on the level of 20% reduction in exacerbation frequency.

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Central and Peripheral Neural Targets for Neurostimulation of Chronic Headaches

Abstract

Purpose of Review

Chronic headache sufferers are estimated to be around 3% of the population. These patients have a high disease burden. When prophylactic treatments have low efficacy and tolerability, patients are in need of alternative therapeutic strategies and options.

Recent Findings

In the last decade, a number of neuromodulation procedures have been introduced as treatment of chronic intractable headache patients when pharmacological treatments fail or are not well tolerated. Neurostimulation of peripheral and central nervous system has been carried out, and now, various non-invasive and invasive stimulation devices are available. Non-invasive neurostimulation options include vagus nerve stimulation, supraorbital stimulation and single-pulse transcranial magnetic stimulation; invasive procedures include occipital nerve stimulation, sphenopalatine ganglion stimulation and hypothalamic deep brain stimulation. In many cases, results supporting their use derive from open-label series and small controlled trial studies. Lack of adequate placebo hampers adequate randomized controlled trials.

Summary

In this paper, we give an overview on the main neurostimulation procedures in terms of results and putative mechanism of cation.

http://ift.tt/2mjfkKv

Non-invasive Neuromodulation in Primary Headaches

Abstract

Purpose of Review

There is growing interest in neuromodulation for primary headache conditions. Invasive modalities such as occipital nerve stimulation, deep brain stimulation and sphenopalatine ganglion stimulation are reserved for the most severe and intractable patients. Non-invasive options such as vagal nerve stimulation (nVNS), supraorbital nerve stimulation (nSONS) and transcranial magnetic nerve stimulation (TMS) have all emerged as potentially useful headache treatments. This review examines the evidence base for non-invasive neuromodulation in trigeminal autonomic cephalalgias and migraine.

Recent Findings

Although a number of open-label series of non-invasive neuromodulation devices have been published, there is very little controlled evidence for their use in any headache condition. Open-label evidence suggests that nVNS may have a role in the prophylactic treatment of cluster headache and there is limited evidence to suggest it may be useful in the acute treatment of cluster and potentially migraine attacks. There is limited controlled evidence to suggest a role for nSONS in the prophylactic treatment of episodic migraine but there is no evidence to support its use in cluster headache. TMS may be efficacious in the acute treatment of episodic migraine has no controlled evidence to support its use as a preventative in any headache condition.

Summary

Non-invasive neuromodulation techniques are an attractive treatment option with excellent safety profiles but their use is not yet supported by high-quality randomised controlled trials.

http://ift.tt/2nbGBMI

The Relationship Between Headaches with Epileptic and Non-epileptic Seizures: a Narrative Review

Abstract

Purpose of Review

The purpose of this review is to examine the relationship between headaches and epilepsy as well as headaches and psychogenic non-epileptic seizures (PNES). Emphasis was placed on clinical characteristics, pathophysiology, and treatment.

Recent Findings

Epilepsy and headaches are common disorders that co-occur more often than would be expected by chance. There are some overlapping clinical features between migraine and epilepsy as well as evidence for shared underlying mechanisms. Proposed theories for a shared etiology include ion channel dysfunction, glutamatergic mechanisms, and mitochondrial dysfunction. Some, but not all, recent diagnostic classification systems have recognized the relationship between headaches and epilepsy. Ictal headaches are rare and should raise suspicion for PNES. Headaches in patients with epilepsy are undertreated despite evidence for efficacy of abortive headache medications.

Summary

Comorbid headaches and epilepsy are relatively common in the population presenting to a neurologist. Patients who have headaches and epilepsy and/or PNES should receive appropriate treatment that often includes mutually beneficial preventative therapy and includes abortive headache treatment.

http://ift.tt/2mjaWvf

Exparel/Peripheral Catheter Use in the Ambulatory Setting and Use of Peripheral Catheters Postoperatively in the Home Setting

Abstract

Purpose of Review

With the increasing number of ambulatory surgeries being performed, regional anesthesia has become an increasingly popular anesthetic modality, and many choices exist to provide efficient, effective quality perioperative analgesia. In this paper, we will review the various regional anesthesia options in addition to the advantages and disadvantages of each. Lastly, we will discuss liposomal bupivicaine, a long acting local anesthetic, and its future role in the anesthesiologist's armamentarium. The aim of the publication is to provide a general overview of regional anesthesia as well as to discuss the advantages and disadvantages of this modality. Additionally, we sought to review the basics of liposomal bupivicaine as well as the relevant literature.

Recent Findings

The results regarding liposomal bupivicaine are mixed and mainly focuses on local infiltration and intra-articular injections. There are no known studies specifically comparing liposomal bupivicaine to bupivicaine hydrochloride in ultrasound-guided nerve blocks.

Summary

There is some encouraging data regarding liposomal bupivicaine, but further studies are needed before it is adopted as a mainstay of treatment. In addition to efficacy, additional investigations are needed to evaluate cost as this could be a major impediment to its implementation.

http://ift.tt/2nbzKTv

Topical Treatments for Localized Neuropathic Pain

Abstract

Purpose of Review

Topical therapeutic approaches in localized neuropathic pain (LNP) syndromes are increasingly used by both specialists and general practitioners, with a potentially promising effect on pain reduction. In this narrative review, we describe the available compounds for topical use in LNP syndromes and address their potential efficacy according to the literature.

Recent Findings

Local anaesthetics (e.g., lidocaine, bupivacaine and mepivacaine), as well as general anaesthetic agents (e.g., ketamine), muscle relaxants (e.g., baclofen), capsaicin, anti-inflammatory drugs (e.g., diclofenac), salicylates, antidepressants (e.g., amitriptyline and doxepin), α2 adrenergic agents (e.g., clonidine), or even a combination of them have been tested in various applications for the treatment of LNP. Few of them have reached a sufficient level of evidence to support systematic use as treatment options.

Summary

Relatively few systemic side effects or drug–drug interactions and satisfactory efficacy seem to be the benefits of topical treatments. More well-organized and tailored studies are necessary for the further conceptualization of topical treatments for LNP.

http://ift.tt/2mj6sod

Inhalation of progesterone inhibits chronic airway inflammation of mice exposed to ozone

Publication date: May 2017
Source:Molecular Immunology, Volume 85
Author(s): Xia Fei, Wuping Bao, Pengyu Zhang, Xue Zhang, Guoqing Zhang, Yingying Zhang, Xin Zhou, Min Zhang
Chronic ozone exposure leads to a model of mice with lung inflammation, emphysema and oxidative stress. Progesterone plays an important role in attenuating the neuroinflammation. We assume that progesterone will reduce the chronic airway inflammation exposed to ozone and evaluate whether combination of progesterone with glucocorticoids results in synergistic effects. C57/BL6 mice were exposed to ozone (2.5ppm, 3h) 12 times over 6 weeks, and were administered with progesterone (0.03 or 0.3mg/L; inhaled) alone or combined with budesonide (BUD) (0.2g/L) after each exposure until the tenth week. Mice were studied 24h after final exposure, cells and inflammatory mediators were assessed in bronchoalveolar lavage fluid (BALF) and lungs used for evaluation of glucocorticoids receptors (GR), p38 mitogen-activated protein kinase (MAPK) phosphorylation and nuclear transcription factor κB (NF-κB) activation. Exposure to ozone resulted in a marked lung neutrophilia. Moreover, in ozone-exposed group, the levels of oxidative stress-related interleukin (IL)-1β, IL-6, IL-8, IL-17A, activated NF-κB and p38MAPK, airway inflammatory cells infiltration density, mean linear intercept (Lm) were greatly increased, FEV25 and glucocorticoids receptors (GR) were markedly decreased. Comparable to BUD, progesterone treatment dose-dependently led to a significant reduction of IL-1β, IL-6, IL-8, IL-17A, activated NF-κB and p38MAPK, and an increase of FEV25 and GR. Progesterone combined with BUD resulted in dramatic changes, compared to monotherapy of BUD or progesterone. Therefore, these results demonstrate that chronic ozone exposure has profound airway inflammatory effects counteracted by progesterone and progesterone acts synergistically with glucocorticoids in attenuating the airway inflammation dose-dependently.

http://ift.tt/2nbiLQW

Climate change, allergy and asthma, and the role of tropical forests

Tropical forests cover less than 10 per cent of all land area (1.8 × 107 km2) and over half of the tropical-forest area (1.1 × 107 Km2) is represented by humid tropical forests (also called tropical rainforests)....

http://ift.tt/2my3kFo

Analysis of the skin of mice humanized for the immune system

http://ift.tt/2mCh5nc

Effects of Coexistent BRAFV600E and TERT Promoter Mutations on Poor Clinical Outcomes in Papillary Thyroid Cancer: A Meta-Analysis

Thyroid , Vol. 0, No. 0.

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Measuring Cochlear Duct Length – a historical analysis of methods and results

Abstract

Background

Cochlear Duct Length (CDL) has been an important measure for the development and advancement of cochlear implants. Emerging literature has shown CDL can be used in preoperative settings to select the proper sized electrode and develop customized frequency maps. In order to improve post-operative outcomes, and develop new electrode technologies, methods of measuring CDL must be validated to allow usage in the clinic.

Purpose

The purpose of this review is to assess the various techniques used to calculate CDL and provide the reader with enough information to make an informed decision on how to conduct future studies measuring the CDL.

Results

The methods to measure CDL, the modality used to capture images, and the location of the measurement have all changed as technology evolved. With recent popularity and advancement in computed tomography (CT) imaging in place of histologic sections, measurements of CDL have been focused at the lateral wall (LW) instead of the organ of Corti (OC), due to the inability of CT to view intracochlear structures. After analyzing results from methods such as directly measuring CDL from histology, indirectly reconstructing the shape of the cochlea, and determining CDL based on spiral coefficients, it was determined the three dimensional (3D) reconstruction method is the most reliable method to measure CDL. 3D reconstruction provides excellent visualization of the cochlea and avoids errors evident in other methods. Due to the number of varying methods with varying accuracies, certain guidelines must be followed in the future to allow direct comparison of CDL values between studies.

Conclusion

After summarizing and analyzing the interesting history of CDL measurements, the use of standardized guidelines and the importance of CDL for future cochlear implant developments is emphasized for future studies.

http://ift.tt/2my03WV

Comparison of ease of administration of intranasal midazolam spray and oral midazolam syrup by parents as premedication to children undergoing elective surgery

Abstract

Background

The efficacy of midazolam as premedication in children for providing pre-operative sedation and reducing parental separation anxiety has been well established. Many studies have compared the effectiveness and medication acceptance of midazolam via oral and intranasal routes. In this study, we have compared the ease of administration of oral midazolam syrup and intranasal midazolam spray as premedication, administered by parents to children.

Methods

Ninety children were randomly allocated into one of the two groups: group N received nasal midazolam spray 0.2 mg/kg and group O received oral midazolam syrup 0.5 mg/kg administered by the parent. The parent recorded ease of administration score and facial hedonic score. The observer recorded modified medication acceptance score. Vitals and sedation scores were assessed at specific intervals. Thirty minutes after drug administration the child was separated from the parent, and parental separation anxiety score was recorded. Mask acceptance score was recorded after application of mask upon arrival in the OT.

Results

Oral midazolam syrup was found to have better ease of administration than intranasal midazolam spray as felt by the parent. Medication acceptance was better for oral midazolam. Both the groups had similar sedation scores at 15 and 30 min. Children in the oral group had a better reduction in parental separation anxiety at 30 min after drug administration and better mask acceptance than the nasal group.

Conclusion

Oral midazolam syrup is easier for parents to administer and has better medication acceptance in children when compared to intranasal midazolam spray.

http://ift.tt/2mBOHRT

Clinical safety and effectiveness of transversus abdominis plane (TAP) block in post-operative analgesia: a systematic review and meta-analysis

Abstract

Transversus abdominis plane (TAP) blocks can provide analgesia postoperatively for a range of surgeries. Abundant clinical trials have assessed TAP block showing positive analgesic effects. This systematic review assesses safety and effectiveness outcomes of TAP block in all clinical settings, comparing with both active (standard care) and inactive (placebo) comparators. PubMed, EMBASE, The Cochrane Library and the University of York CRD databases were searched. RCTs were screened for their eligibility and assessed for risk of bias. Meta-analyses were performed on available data. TAP block showed an equivalent safety profile to all comparators in the incidence of nausea (OR = 1.07) and vomiting (OR = 0.81). TAP block was more effective in reducing morphine consumption [MD = 13.05, 95% CI (8.33, 51.23)] and in delaying time to first analgesic request [MD = 123.49, 95% CI (48.59, 198.39)]. Postoperative pain within 24 h was reduced or at least equivalent in TAP block compared to its comparators. Therefore, TAP block is a safe and effective procedure compared to standard care, placebo and other analgesic techniques. Further research is warranted to investigate whether the TAP block technique can be improved by optimizing dose and technique-related factors.

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Oral manifestations of dengue viral infection

Publication date: Available online 6 March 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Beuy Joob, Viroj Wiwanitkit

http://ift.tt/2miBPzn

Soft palate fistula after radiofrequency ablation for primary snoring: a case report and literature review

Publication date: Available online 7 March 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Lauren K. Reckley, Camilo Fernandez-Salvador, Edward T. Chang, Macario Camacho

http://ift.tt/2lTv3N2

Trousseau syndrome

Description

A 45-year-old woman was admitted to our hospital because of impaired consciousness. She had a huge tumour measuring 10 inches in diameter on the left breast (figure 1A). Although the tumour had been increasing in size since 3 years, the patient had adamantly refused to visit a hospital. She had no history of hypertension or atrial fibrillation. Symmetrical high-intensity lesions in the thalamus were observed on MRI (diffusion-weighted images) (figure 1B, arrow). Enhanced chest CT imaging revealed a large tumour on the left breast (figure 1C, arrowheads) with metastases in the lymph nodes and lungs (figure 1C, arrows) as well as cardiac invasion. Breast mass biopsy revealed the tumour to be a mucinous carcinoma. Impaired consciousness was considered to be caused by bilateral paramedian thalamic infarction.

Figure 1

(A) A huge tumour measuring 10x10 inches in diameter with pigmentary...

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Pulmonary vein mass with extension to the left atrium diagnosed by echocardiography

We report a case of a man aged 65 years presenting with chronic cough, haemoptysis and intermittent atrial tachyarrhythmias on ECG. On 2D transthoracic echocardiography, an incidental left atrial mass was seen, initially thought to be a thrombus predisposed by intermittent atrial fibrillation. Transoesophageal echocardiography confirmed that this left atrial mass originated from a fixed, non-homogenous, right superior pulmonary vein mass with an extracardiac extension. Because of this finding, a thorough search for a primary focus lead to the discovery of a contiguous posterior mediastinal mass, which was a round cell neoplasm on histology. Management was deemed palliative. Although rare, left-sided cardiac masses should prompt the physician to search for a malignancy in the lung in high-risk patients, as haematogenous spread via the pulmonary vein is a potential mechanism for spread.

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Tuberculous periprosthetic infection precipitated by infliximab therapy

Biological therapy with TNF-α inhibitors have been increasingly used in the treatment of inflammatory arthritis. Systemic tuberculosis infections are often known to occur following treatment with these biological agents. However, no case of periprosthetic tuberculous infection of the hip following this therapy has been reported. We report a case of a 45-year-old man who developed periprosthetic tuberculous infection soon after infliximab injection. We also discuss the need of pretreatment awareness, high index of suspicion, early diagnosis and management of such case.

http://ift.tt/2lYMSLl

Fever, rash and agranulocytosis

Description

A Caucasian woman aged 74 years successfully underwent laminectomy and decompression surgery for spinal stenosis, which was complicated by wound infection with community-acquired methicillin-resistant Staphylococcus aureus (MRSA), MRSA bacteraemia and endocarditis. MRSA was resistant to clindamycin, erythromycin and oxacillin. The patient was started on intravenous ceftaroline 600 mg two times per day. Four weeks later, she presented to the emergency room with fever and rash for 1 week. Physical examination revealed diffuse erythematous rash involving the hands, thighs and legs (figure 1A, B). Laboratory investigations revealed WCC 1000/mm³ (normal range: 4000–11 000), absolute neutrophil count 0, haemoglobin 8.2 g/dL (normal range: 12–16 g/dL) and platelets 279 000/mm³ (normal range: 150 000–400 000/mm³). Peripheral blood smear confirmed agranulocytosis (figure 1C) without abnormal blood cells. Ceftaroline-induced reaction was suspected. Therefore, she was admitted to hospital and ceftaroline was immediately discontinued. The patient was started on vancomycin to complete her antibiotic course and filgrastim...

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Superior mesenteric artery syndrome in a young woman

Description

Vascular structures in the abdomen and pelvis can be compressed by anatomical structures or cause the compression of adjacent hollow viscera. Superior mesenteric artery syndrome (SMAS) consists of obstruction of the third portion of the duodenum due to compression between the superior mesenteric artery (SMA) and the aorta.1 The SMA typically arises at the L1–L2 level with an anterior and inferior course, and the third portion of the duodenum crosses between the aorta and the SMA at L3. The normal aorto-mesenteric angle (AMA) and aorto-mesenteric distance (AMD) are considered to be 28°–65° and 10–34 mm,23 respectively. Our images demonstrate the classic findings of SMAS in a woman aged 31 years experiencing rapid weight loss with epigastric pain and fullness, showing the CT duodenal obstruction with an abrupt cut-off in the third portion (figure 1), abnormally low origin of the...

http://ift.tt/2lYJiko

Floppy eyelid syndrome: delayed diagnosis is not desired

Description

A 52-year-old obese man presented with the history of redness, watering, photophobia and decreased vision in the left eye (hand movement close to face in the left eye and 20/40 in the right eye) for the past 6 months. History revealed that the patient had undergone surgical intervention twice for the left upper eyelid (surgical details not available) without successful outcome. Examination showed bilateral lax upper and lower eyelids, palpebral conjunctival congestion and papillary reaction (figure 1A–C). Right side cornea was normal, but left side cornea showed perforated central cornea with shallow anterior chamber along with normal corneal sensations. Ultrasonography of the left eye posterior segment was anechoic; therefore for the left eye, the patient underwent glue application with bandage contact lens under topical anaesthesia followed by left-sided upper eyelid lateral tarsal strip under local anaesthesia in the same setting along with tightening of lower eyelid...

http://ift.tt/2lADMbm

Multiple primary malignancies of laryngeal cancer, small cell lung cancer and squamous cell lung cancer in a patient: how to approach MPMs

Lung malignancies presenting in association with head and neck cancers are well documented, while laryngeal cancers presenting with simultaneous small cell lung cancer and squamous cell lung cancer have been rarely reported. We report a case of a man aged 65 years with a triple primary malignancy of the lung and larynx. Without a meticulous approach, the patients may not receive curative aim treatment due to incomplete staging. The patient underwent concurrent chemoradiotherapy for locally advanced laryngeal cancer, small cell lung cancer and squamous cell lung cancer followed by combination chemotherapy with etoposide and cisplatin for synchronous double primary lung cancer. Following this therapy, he achieved a complete response of larynx cancer, but a partial response of small cell lung cancer and a stable disease of squamous cell lung cancer. A meticulous diagnostic approach should be encouraged to pursue the possibility of curative treatment and achieve better outcomes for such patients.

http://ift.tt/2lYyWBb

The value of cone beam computed tomography imaging in surgically assisted rapid palatal expansion: a systematic review of the literature

This study aimed to evaluate the reliability of cone-beam computed tomography (CBCT) imaging of the maxillary structures and the postoperative dentoskeletal, nasal airway, periodontal, and facial soft tissue changes after surgically assisted rapid palatal expansion (SARPE). A systematic review of the literature on CBCT analysis of SARPE was performed. The PubMed, Embase, and Cochrane Library databases were searched. Nine articles were included, involving a total of 228 patients. The general trend was tooth-borne distraction with pterygomaxillary dysjunction.

http://ift.tt/2mxCH3r

Chymotrypsin with sialendoscopy-assisted surgery for the treatment of chronic obstructive parotitis

Chronic obstructive parotitis (COP) is a common disease of the parotid gland. A total of 104 patients with COP were identified and randomized into a treatment group (52 cases) and a control group (52 cases). All patients underwent sialography and salivary gland scintigraphy (SGS) examinations before surgery. The patients in the treatment group received chymotrypsin combined with gentamicin via interventional sialendoscopy to irrigate the duct, and the control group received gentamicin alone. All patients were asked to record their pain on a visual analogue scale (VAS) before treatment and at 1 week, 2 weeks, 1 month, 3 months, and 6 months after surgery.

http://ift.tt/2lYHgkd

Comorbid association of antiphospholipid antibodies and migraine: A systematic review and meta-analysis

Publication date: Available online 7 March 2017
Source:Autoimmunity Reviews
Author(s): Md. Asiful Islam, Fahmida Alam, Kah Keng Wong
BackgroundAntiphospholipid antibodies (aPLs) namely anticardiolipin (aCL) antibody, anti-β2-glycoprotein I (β2GPI) antibody and lupus anticoagulant (LA) are autoantibodies produced against anionic phospholipids and proteins on plasma membranes. Migraine is a primary headache disorder which has growing evidences of autoimmune-mediated pathogenesis and previous studies suggested the presence of aPLs in migraine patients.AimsTo evaluate the comorbid association between aPLs (aCL, anti-β2GPI and LA) and migraine compared to healthy controls.MethodsStudies were searched through PubMed, ISI Web of Science and Google Scholar databases without restricting the languages and year (up to October 2016) and were selected based on the inclusion criteria. Two authors independently extracted data from the included studies. All analyses were conducted by using random effects model to calculate the odds ratio (OR) and 95% confidence interval (CI). Quality assessment was carried out by using the modified Newcastle-Ottawa Scale (NOS). Publication bias was evaluated via visualization of funnel plots, Begg's and Egger's tests.ResultsThe database searches produced 1995 articles, 13 of which were selected (912 migraineurs and 822 healthy controls). 8.59%, 15.21% and 4.11% of the migraineurs exhibited aCL, anti-β2GPI and LA which was 4.83, 1.63 and 3.03 times higher, respectively, than healthy controls. A significant presence of aCL (OR: 3.55, 95% CI: 1.59–7.95; p=0.002) or anti-β2GPI antibodies (OR: 2.02, 95% CI: 1.20–3.42; p=0.008) were observed in migraine patients, however, LA was not significantly associated (OR: 2.02, 95% CI: 0.50–8.37; p=0.320). Majority of the studies (n=10 of 13) demonstrated NOS score of 7 or above and no significant publication bias was observed.ConclusionMigraine might be an autoimmune-associated neurologic disorder. The presence of aCL or anti-β2GPI antibodies were significant in migraine patients compared to healthy controls, suggesting an involvement of these antibodies in migraine attack.

http://ift.tt/2mB9xRr

Modulation of sphingosine-1-phosphate in inflammatory bowel disease

Publication date: Available online 7 March 2017
Source:Autoimmunity Reviews
Author(s): Laurent Peyrin-Biroulet, Ronald Christopher, Dominic Behan, Cheryl Lassen
Inflammatory bowel diseases (IBD), including ulcerative colitis and Crohn's disease, involve an inappropriate immune reaction in the digestive tract, causing a variety of disabling symptoms. The advent of monoclonal antibodies (anti-tumor necrosis factor, anti-integrin, anti-interleukin −23) has revolutionized IBD management. Nevertheless, these agents, with potential for immunogenicity, are associated with high rates of response loss and disease relapse over time. They are also associated with high production costs.Sphingosine-1-phosphate (S1P), a membrane-derived lysophospholipid signaling molecule, is implicated in a vast array of physiological and pathophysiological processes, primarily via extracellular activation of S1P1-S1P5 receptors. S1P1, S1P4 and S1P5 are involved in regulation of the immune system, while S1P2 and S1P3 may be associated with cardiovascular, pulmonary, and theoretical cancer-related risks. Targeting S1P receptors for inflammatory conditions has been successful in clinical trials leading to approval of the non-selective S1P modulator, fingolimod, for relapsing forms of multiple sclerosis. However, the association of this non-selective S1P modulator with serious adverse events provides the rationale for developing more selective S1P receptor modulators. Until recently, three S1P modulators with differing selectivity for S1P receptors were in clinical development for IBD: ozanimod (RPC1063), etrasimod (APD334) and amiselimod (MT-1303). The development of amiselimod has been stopped as Biogen are currently focusing on other drugs in its portfolio. Following encouraging results from the Phase 2 TOUCHSTONE trial, a Phase 3 trial of the S1P modulator ozanimod in patients with moderate-to-severe ulcerative colitis is ongoing. Etrasimod is also being tested in a phase 2 trial in ulcerative colitis. These pipeline medications can be administered orally and may avoid the formation of anti-drug antibodies that can lead to treatment failure with injectable biologic therapies for IBD. Data from ongoing clinical trials will establish the relationship between the selectivity of S1P modulators and their safety and efficacy in IBD, as well as their potential place in the clinical armamentarium for IBD.

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Autologous Hematopoietic Stem Cell Transplantation in Systemic Lupus Erythematosus and Antiphospholipid Syndrome: A systematic review

Publication date: Available online 7 March 2017
Source:Autoimmunity Reviews
Author(s): Alessia Leone, Massimo Radin, Ahlam M Almarzooqi, Jamal AlSaleh, Dario Roccatello, Savino Sciascia, Munther Khamashta
BackgroundHematopoietic stem cell transplantation (HSCT) has been proposed as a therapeutic option for patients with Systemic Lupus Erythematosus (SLE) refractory to standard therapy. This therapeutic approach has been applied to other severe autoimmune diseases refractory to standard therapy with promising results.AimTo systematically review the literature and analyze the available evidence on HSCT therapy in patients with SLE and antiphospholipid syndrome (APS), with a focus on therapy efficacy and occurrence of adverse events.MethodsA detailed literature search, applied to Ovid MEDLINE, In-Process and Other Non-Indexed Citation and Ovid Medline 1986 to 2014, has been developed a priori to identify articles that reported findings from clinical and laboratory studies that investigated the effect of HCT in patients with SLE.Results25 studies met all inclusion criteria, including a total of 279 SLE patients; of those, 54 patients also fulfilled the classification criteria of APS. The majority of the studies reported an improvement after HSCT in terms of diseases activity control (assessed with SLEDAI, or time-free from diseases) or overall survival. However, one study reported no net benefit of HSCT when compared to immunosuppression alone. One retrospective study reported an overall survival at 5years of 81% in 28 SLE patients.Of note, 5 cases (9.3%) of aPL negativization were reported after HSCT in the APS patients. When combining these studies and analyzing these patients with APS, 32 out of 44 (73%) were able to discontinue anticoagulation after HSCT. Our findings also demonstrate a total of 86 infections in the pool of patients (30.8%), 3 of which resulted in the death of the patient (1.3%). We observed an annual incidence of infection of 11.9% with a mean follow up of 36.2months.ConclusionPreliminary results of HSCT as a therapeutic option for SLE appear promising. Further studies are warranted in order to assess the safety of the procedure for both the occurrence of secondary autoimmune disease and the rate of infection. However, the rate of adverse effects confines this option to very selected cases of SLE patients resistant or refractory to standard approaches.

http://ift.tt/2mBfrSP

European multicentre pilot survey to assess vitamin D status in rheumatoid arthritis patients and early development of a new Patient Reported Outcome questionnaire (D-PRO)

Publication date: Available online 6 March 2017
Source:Autoimmunity Reviews
Author(s): Jelena Vojinovic, Angela Tincani, Alberto Sulli, Stefano Soldano, Laura Andreoli, Francesca Dall'Ara, Ruxandra Ionescu, Katarina Simic Pasalic, Inete Balcune, Ivan Ferraz-Amaro, Małgorzata Tlustochowicz, Irena Butrimiene, Egle Punceviciene, Natalia Toroptsova, Simeon Grazio, Jadranka Morovic-Vergles, Pavol Masaryk, Kati Otsa, Miguel Bernardes, Vladimira Boyadzhieva, Fausto Salaffi, Maurizio Cutolo
ObjectiveTo collect data on vitamin D (25(OH)D) serum levels in a large number of rheumatoid arthritis (RA) patients from different European countries, to investigate their relation with disease activity, disability, quality of life, and possibly to construct a new Patient Reported Outcome (PRO) questionnaire in order to self-estimate if they are at risk for vitamin D insufficiency/deficiency-related clinical implications (D-PRO).MethodsThis was a European League Against Rheumatism (EULAR) supported cross-sectional study (project No CLI064) which involved 625 RA patients (mean age 55±11 years, mean disease duration 11±9 years), 276 age and sex matched healthy subjects, and rheumatologists working in academic institutions or hospital centres, as well as PARE organizations (patient representatives) from 13 European countries. Serum samples for 25(OH)D level measurement were collected during winter time and analyzed in a central laboratory using chemiluminescence immunoassay (DiaSorin). Patient past medical history was recorded. RA patients were provided with three questionnaires: the Rheumatoid Arthritis Impact Diseases score (RAID), the Health Assessment Questionnaire (HAQ), and the new D-PRO questionnaire at the time of 25(OH)D serum sampling. D-PRO questionnaire consisted of three domains, Symptom Risk Score (SRS), Habitus Risk Score (HRS) and Global Risk Score (SRS+HRS=GRS), constructed with items possibly related to vitamin D deficiency. D-PRO was correlated with both clinical and PRO scores. DAS28-CRP was also evaluated. Statistical analysis was performed by non parametric tests.ResultsMean serum concentration of 25(OH)D in RA patients (17.62±9.76 ng/ml) was found significantly lower if compared to the levels obtained in matched controls (18.95±9.45 ng/ml) (p=0.01), with statistically significant differences among several European countries. Negative correlations were found between 25(OH)D serum levels and DAS28-CRP (p<0.001), RAID (p=0.05) and HAQ (p=0.04) scores in the RA patients group. Negative correlations were also found in the cohort of enrolled RA patients between 25(OH)D serum concentrations and SRS (p=0.04), HRS (p=0.02) and GRS (p=0.02) domains of the D-PRO questionnaire.ConclusionsThis first multicentre European survey add new evidences that vitamin D insufficiency/deficiency is frequent in RA patients with statistically significant differences among several countries. Vitamin D serum concentrations seem to correlate negatively and significantly with the D-PRO Global Risk Score, clinimetric indexes for quality of life, disease activity and disability in present cohort of RA European patients.

http://ift.tt/2mf25su

The utility of monitoring peripheral blood lymphocyte subsets by flow cytometric analysis in patients with rheumatological diseases treated with rituximab

Publication date: Available online 6 March 2017
Source:Autoimmunity Reviews
Author(s): Jessica Day, Vidya Limaye, Susanna Proudman, John D. Hayball, Pravin Hissaria

http://ift.tt/2mBo13S

Relevance of diagnostic investigations in patients with uveitis: Retrospective cohort study on 300 patients

Publication date: Available online 7 March 2017
Source:Autoimmunity Reviews
Author(s): Jérôme Hadjadj, Agnès Dechartres, Thibaut Chapron, Manal Assala, Sawsen Salah, Bertrand Dunogué, Lucile Musset, Bruno Baudin, Matthieu Groh, Philippe Blanche, Luc Mouthon, Dominique Monnet, Claire Le Jeunne, Antoine Brézin, Benjamin Terrier
ObjectiveThe diagnostic workup of uveitis is a challenge due to the wide range of diagnoses and the lack of a well-codified diagnostic procedure. We aimed to evaluate the relevance of diagnostic investigations for the etiological diagnosis of uveitis.MethodsRetrospective cohort study of patients referred for etiological diagnosis of uveitis. Uveitis related to ophthalmological diseases or occurring during the course of previously diagnosed diseases were not included.ResultsThree hundred patients were included. Chest CT-scan was suggestive of sarcoidosis in 83 (29%). Features associated with abnormal CT-scan were: snowballs and/or peripheral multifocal choroiditis (PMC) upon ocular examination (P=0.004), blood lymphopenia (P<0.0001), angiotensin converting enzyme (ACE) level>1.5 ULN (P=0.0003). Bronchoscopy showed granuloma in 18 (11%) while alveolar lymphocytosis suggestive of sarcoidosis was reported in 45 (27%). Presence of granuloma on bronchial biopsies was always associated with chest CT-scan abnormalities, whereas 31% of patients with alveolar lymphocytosis had normal CT-scans. Features associated with contributive bronchoscopy were: snowballs and/or PMC (P=0.003), ACE>1.5 ULN (P=0.007), abnormal chest-CT scan (P<0.0001). Salivary gland biopsy revealed granuloma in 12 patients (5%). Cerebral MRI was abnormal in 15 patients (9%) who mostly presented with snowballs and/or retinal vasculitis. Finally, the main causes of uveitis were latent tuberculosis (25%) and sarcoidosis (22%), but 34% remained of undetermined origin. Uveitis relapses were observed in 31% and did not differ between patients with an identified diagnosis and those with idiopathic uveitis.ConclusionIdentification of factors associated with abnormal investigations might improve the optimal diagnostic workup adapted to each patient.

http://ift.tt/2meX6rL

Pembrolizumab in Recurrent or Metastatic Medullary Thyroid Cancer

Condition: Medullary Thyroid Cancer (MTC)
Intervention: Drug: Pembrolizumab
Sponsor: National Cancer Institute (NCI)
Not yet recruiting - verified February 23, 2017

http://ift.tt/2lYI0G0

A Study of the Safety, Tolerability and Pharmacokinetics of ABBV-368 as a Single Agent and Combination in Subjects With Locally Advanced or Metastatic Solid Tumors

Condition: Advanced or Metastatic Solid Tumors
Interventions: Drug: ABBV-368; Drug: Nivolumab
Sponsor: AbbVie
Not yet recruiting - verified February 2017

http://ift.tt/2lAs7JH

CTC Detection Rate in SCCHN With a in Vivo Device

Conditions: Circulating Tumor Cell; Squamous Cell Carcinoma of the Head and Neck
Intervention: Diagnostic Test: circulating tumor cell analysis
Sponsor: Nanjing Tongren Hospital
Recruiting - verified March 2017

http://ift.tt/2lYIMTp

Comment on “Mediator of DNA Damage Checkpoint Protein 1 (MDC1) as a prognostic marker for patients with oral squamous cell carcinoma”

Abstract

The article by Dave et al. (1) aimed to correlate the expression of Mediator of DNA Damage Checkpoint Protein 1 (MDC1) with clinicopathological parameters and to evaluate its prognostic significance in 100 patients with oral squamous cell carcinoma (OSCC). Today, the main goal of oncological research remains the translation of newly discovered biochemical and histopathological biomarkers into clinical practice. Biomarkers can be mainly included in four classes: a) diagnostic biomarkers, b) prognostic biomarkers, c) predictive biomarkers, and d) surveillance biomarkers. During the last two decades, several authors have investigated potential prognostic and predictive biomarkers for OSCC (2, 3).

http://ift.tt/2lSRW35

Decreased expression of SOX7 induces cell proliferation and invasion and correlates with poor prognosis in oral squamous cell carcinoma

Abstract

Background

SOX7, a member of the SOX family of transcription factors, acts as a tumor suppressor in multiple cancers. Downregulation of SOX7 has been reported in advanced tumors and correlates with poor prognosis. The aims of this study were to investigate the effects of SOX7 on cell proliferation, invasion, and colony formation in oral squamous cell carcinoma (OSCC) cells and to evaluate the effectiveness of SOX7 protein as a prognostic indicator for OSCC patients.

Methods

OSCC cell lines were treated with SOX7 small interfering RNA or SOX7 peptide, and their effects on cell proliferation, invasiveness, and colony formation were investigated by proliferation, in vitro invasion, and clonogenic assays. SOX7 protein expression in OSCC and normal oral mucosal tissues was examined by immunohistochemistry. Associations between SOX7 protein expression and clinicopathological parameters of OSCC patients were statistically analyzed.

Results

SOX7 silencing induced cell proliferation and invasion in SCC-4 cells. SOX7 peptide treatment inhibited cell proliferation, colony formation, and invasion in SCC-9 and SCC-25 cells. Expression of SOX7 protein was decreased in OSCC tissues compared with normal oral mucosal tissues (P < 0.001). Negative SOX7 expression in OSCC patients was significantly associated with positive lymph node metastasis (P = 0.041), advanced TNM stage (P = 0.024), and poor prognosis (P = 0.017).

Conclusions

These results suggest that SOX7 inhibits cell proliferation, colony formation, and invasion in OSCC as a tumor suppressor and that negative SOX7 expression could be a poor prognostic indicator for OSCC patients.

http://ift.tt/2mxgZMT

Fusarium verticillioides and fumonisin contamination in Bt and non- Bt maize cultivated in Brazil

Abstract

Fusarium verticillioides is one of the main pathogens of maize, causing ear and stalk rots. This fungus is also able to produce high levels of fumonisins, which have been linked to various illnesses in humans and animals. Previous studies have shown that maize hybrids genetically modified with the cry genes from the bacterium Bacillus thuringiensis (Bt) presented lower incidence of F. verticillioides and fumonisin levels, presumably through the reduction of insects, which could act as vectors of fungi. The aim of this study was to assess the incidence of F. verticillioides and the concentration of fumonisins in Bt and isogenic non-Bt hybrids (2B710Hx, 30F35YG, 2B710, and 30F35, respectively). The samples of 2B710Hx and 30F35YG presented lower F. verticillioides frequency than 2B710 and 30F35 samples. However, there was no statistical difference between fumonisin contamination when Bt and non-Bt samples were compared (P > 0.05). The results suggest that other environmental parameters could possibly trigger fumonisin production during plant development in the field; consequently, other management strategies should be applied to aid controlling fumonisin contamination in maize.

http://ift.tt/2meIgSm

Αρχειοθήκη ιστολογίου

Τρίτη 7 Μαρτίου 2017

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