To provide physicians, researchers, and other interested health care professionals with information about how mite source materials and allergen extracts are manufactured, including the critical process parameters that can affect the final composition of allergenic extracts available for clinical use.
http://ift.tt/2n1KrvL
Τετάρτη 8 Μαρτίου 2017
Mite allergen extracts and clinical practice
Mechanisms of anaphylaxis beyond classically mediated antigen- and IgE-induced events
We have long known that events clinically indistinguishable from IgE- and mast cell–mediated anaphylaxis can occur through other mechanisms, and the term anaphylactoid was used to refer to these events as early as the 1940s,1 but our knowledge of the underlying mechanisms of anaphylactoid events has been limited until recently. However, in the past 2 decades, there have been significant advances in our understanding of the mechanisms underlying non–IgE- and mast cell–mediated anaphylactic episodes.
http://ift.tt/2m529dr
AAAAI/ACAAI Joint Venom Extract Shortage Task Force Report
This report has been developed to provide guidance for clinicians who provide venom immunotherapy services to affected patients. The intent is to provide clinicians information about the developing shortage of Hymenoptera venoms to assist them in making decisions about the appropriate care for their patients.
http://ift.tt/2modgRD
Asthma–chronic obstructive pulmonary disease overlap syndrome
The burgeoning literature on asthma phenotypes and endotypes continues to deepen our understanding of asthma and our appreciation of the complexity of this heterogeneous syndrome. Physicians in practice have long encountered patients who have features of asthma and chronic obstructive pulmonary disease (COPD). Thus, we should not be surprised that there is a new category called asthma-COPD overlap syndrome (ACOS).
http://ift.tt/2nh1TbJ
Sublingual immunotherapy
The sublingual immunotherapy (SLIT) practice parameters contain systematically developed statements with recommendations intended to optimize patient care and assist physicians and/or other health care practitioners and patients to make decisions regarding this therapy. This guideline is based on 2 published systematic reviews of the literature1,2 and publications identified by the workgroup's comprehensive literature search and the US Food and Drug Administration (FDA)–approved SLIT tablets' product information.
http://ift.tt/2mnWQII
Depression symptoms and lost productivity in chronic rhinosinusitis
Chronic rhinosinusitis (CRS) is associated with significant losses of patient productivity that cost billions of dollars every year. The causative factors for decreases in productivity in patients with CRS have yet to be determined.
http://ift.tt/2nh5feF
An obstructive sleep apnea primer
A remarkable phenomenon associated with excessive fat in young persons is an uncontrollable tendency to sleep-like the fat boy in Pickwick.—William Osler1
http://ift.tt/2mo0WRf
Is it time for asthma action plan apps?
In 1991, the National Heart, Lung, and Blood Institute published the first evidence-based guideline for the diagnosis and management of asthma.1 This guideline recommends that patients with asthma should be taught self-management skills and be given an asthma action plan (AAP) so that early loss of control could be treated by the patient at home. In 1997, an updated guideline reinforced the model of green, yellow, and red zone intervention strategies to facilitate maintenance of asthma control.2 In a Cochrane Review of self-management plans for asthma, children who have an AAP have a lower risk of an exacerbation requiring an acute care visit and reduced symptom days.
http://ift.tt/2ngL28P
Specificity and reproducibility of nasal biomarkers in patients with allergic rhinitis after allergen challenge chamber exposure
Allergic rhinitis is an inflammatory disease that causes cellular influx and mediator release in the nose. These inflammatory changes might be used as nasal biomarkers to assess the efficacy of novel anti-allergic treatments.
http://ift.tt/2mo5VRS
Decontamination tips
http://medicine-greece.blogspot.com/2017/03/decontamination-tips.html
MRSA-UV has produced several products that use UVGI for safer, more effective and more efficient decontamination of ambulances and equipment. The Turbo-UV is a compact unit (22 x 8 x 8 inches) that can be placed in the closed patient compartment of an ambulance for as little as 15 minutes. The Turbo-UV is compact enough that it can also be used for decontaminating EMS station sleeping rooms, EMS equipment and personal protective gear that may have been exposed to infectious pathogens.
VAPOR-BASED DECONTAMINATION EQUIPMENT
The AeroClave ADS is a decontamination system that can be directly integrated into a new or existing ambulance. The ADS utilizes an EPA-approved hospital disinfectant to decontaminate surfaces in the patient care compartment and equipment after every patient transport.
The ADS is a convenient, hands-off solution for decontaminating an ambulance's patient care compartment. A nozzle, installed inside the patient care compartment, disperses a mist of disinfectant solution that is designed to meet OSHA and NFPA specifications.
Zimek's Z-vac Micro-Particle Evacuator uses disinfectant misting technology to decontaminate an ambulance's interior and the equipment carried aboard the ambulance. When connected to the vehicle and activated using a window overlay, an installed port or window insert, the system automatically disperses a disinfectant vapor throughout the vehicle's interior. Upon completion of a decontamination cycle, any remaining mist is removed using the company's Z-vac Vehicle Adapter.
The Bioquell BQ-EMS uses hydrogen peroxide vapor to eradicate pathogens from exposed surfaces in the ambulance, including patient care equipment, controls for on-board electronics and the stretcher. A decontamination cycle can be done within a sealed vehicle by placing the hydrogen peroxide vapor generator and the aerators in the patient care compartment of the ambulance.
A wireless control panel is used to start and stop the process. The vehicle's contents need to be prepared before system activation to ensure decontamination of exposed surfaces.
The Ambustat atomizes Actril Cold Sterilant, a disinfectant with peracetic acid and hydrogen peroxide, into small droplets — fog, mist or spray— by shearing them in a highly turbulent section of the nozzle. A blower in the power head supplies air to create the turbulence, and the flow rate can be adjusted for desired droplet size.
COMBINATION APPROACH
The Klenitise ambulance cleaning and disinfection system uses a three-step process that employs both manual disinfection and vapor disinfection technologies. The first step in the process is to scan surfaces in the ambulance using a handheld UV light to highlight areas that have been in contact with patients and where surface residues are present. Visually identifying contaminated surfaces allows the EMS provider to manually decontaminate those surfaces with a disinfectant spray and towels. The ambulance can then be completely decontaminated using a fogger system.
ULTRAVIOLET GERMICIDAL IRRADIATION
Ultraviolet germicidal irradiation for disinfection has been used primarily in medical sanitation and sterile work facilities. In recent years UVGI has found renewed application in air and surface sanitization in medical care settings such as hospitals, clinics and laboratories.
"Ultraviolet germicidal irradiation (UVGI) is an established means of disinfection and can be used to prevent the spread of certain infectious diseases. Low-pressure mercury (Hg) discharge lamps are commonly used in UVGI applications and emit shortwave ultraviolet-C (UV-C, 100–280 nanometer [nm]) radiation, primarily at 254 nm. UV-C radiation kills or inactivates microbes by damaging their deoxyribonucleic acid (DNA)."
MRSA-UV has produced several products that use UVGI for safer, more effective and more efficient decontamination of ambulances and equipment. The Turbo-UV is a compact unit (22 x 8 x 8 inches) that can be placed in the closed patient compartment of an ambulance for as little as 15 minutes. The Turbo-UV is compact enough that it can also be used for decontaminating EMS station sleeping rooms, EMS equipment and personal protective gear that may have been exposed to infectious pathogens.
The EMS-UV air sanitizer employs UVGI to circulate and clean the interior air of an ambulance to reduce airborne viruses, bacteria, mold, allergens and odors. The EMS-UV can be mounted on a wall in the patient care compartment and allowed to run continuously. The UV-C bulb inside the unit requires minimal electricity and annual replacement.
The Rapid Razor-UV is a handheld, rechargeable UVGI device designed for decontamination of surfaces inside the ambulance. The user simply passes the device closely over the contaminated surface area, allowing the energy from the high-output UVC Emitter to rapidly decontaminate surfaces. The unit includes an internal pacer that sets the scan speed to ensure a complete and accurate scan. A recessed safety shield prevents direct exposure to UVC energy while also adding reflectance that increases its effectiveness.
Ambulance decontamination is necessary to protect EMS personnel and patients. Consider the practices and products listed above to fully eliminate dangerous pathogens from the ambulances in your fleet.
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Tumor volume as an independent predictive factor of worse survival in patients with oral cavity squamous cell carcinoma
ABSTRACT
Background
The purpose of the present study was to investigate the role of tumor volume in the prognosis of patients with oral cavity squamous cell carcinoma (SCC).
Methods
One hundred twenty-three patients with T4a oral cavity SCCs underwent surgical treatment. The volumes of the primary cancer were calculated by the multiplication of 3 macroscopic dimensions of the surgical specimen and related to recurrence and death.
Results
There were 54 recurrences (43.9%) and 75 deaths (60.9%). The mean tumor volume among the patients living without disease during the follow-up period was 28.2 cc, compared to 88.2 cc for patients living with disease, and to 78.9 cc for patients who died of the disease (p < .001). Multivariate analyses showed that volume and perineural invasion were independent factors for recurrence, whereas volume and lymph node metastasis were independent factors for death.
Conclusion
Among patients who already have advanced cancers, tumor volume can significantly impact their prognoses. © 2017 Wiley Periodicals, Inc. Head Neck, 2017
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Microsurgery approaches for local drug delivery to the inner ear : Bullostomy Versus Transtympanic Injection
http://orlhealth.blogspot.com/2017/03/microsurgery-approaches-for-local-drug.html
Bullostomy
NOTE: Bullostomy is a unilateral procedure. Operate one ear of the mouse and use the contralateral ear as the control.
Place the mouse in a decubitus supine position. Prepare the surgical area at the ventral surface of the neck using clippers to remove the fur. Clean the skin with povidone iodine based antiseptic solution, and cover it with sterile drapes.
Using a scalpel, make a 2 cm longitudinal incision from the mandible to the clavicle.
Under magnification with a surgical microscope, identify the submandibular glands and separate both with forceps. Retract the submandibular glands and localize the origin of the digastric muscle and the facial nerve.
Make an incision in the origin of the digastric muscle with a scissors, and retract it ventrally, exposing the underlying inferior-medial aspect of the tympanic bulla.
Make an opening in the bulla by drilling into it with a 27 G needle (Figure 2A). Localize the stapedial artery and the RW membrane caudal to it (Figure 2B). Clean the blood from the drilled area with an absorbable gelatin sponge.
Using a 34 G catheter and a glass micro syringe, slowly inject 3-5 µL of vehicle solution (CGP-hydrogel or RL) through the bullostomy directly onto the RW niche, filling it (Figure 2C). Seal the bullostomy with 1-2 drops of tissue adhesive.
Return the submandibular glands to their initial position and close the skin incisions with 5-0 silk surgical suture. Apply a chlorhexidine-based antiseptic around the incision to avoid wound infection. NOTE: Absorbable and non-absorbable sutures could be used. Non-absorbable sutures must be removed in 2 weeks. Silk is not recommended for skin closure since its use is associated with incision infection and local tissue reactions.
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Nodular colloid milium mimicking keloid
Summary
Colloid milium is a rare cutaneous deposit disease that usually presents clinically by the development of yellowish translucent or flesh-colored papules or plaques on sun-exposed skin. Histologically, it is characterized by the presence of colloid in the dermal papillae. In this case report, we present a 52-year-old man who presented with a nodule on his upper lip that mistakenly was diagnosed and treated as keloid.
http://ift.tt/2mIIkfR
11R-VIVIT Peptide Inhibits Calvaria Osteolysis Induced by Experimental Design
Abstract: Wear particles released from prosthetic implants can cause periprosthetic osteolysis, a major cause of implant loosening. The aim of this study was to investigate the effects of the 11R-VIVIT peptide on osteolysis induced by titanium (Ti) particles in vivo. Twenty-four C57BL/J6 mice were divided into 3 groups: sham operation, Ti group, and Ti/VIVIT group. A calvarial osteolysis model was established by implanting Ti particles into mouse calvaria of the Ti and Ti/VIVIT groups. After 2 weeks, 11R-VIVIT peptide (10 mg/kg/day) was intraperitoneally injected into the mice of the Ti/VIVIT group for 14 days. The other 2 groups received saline injection. The calvarial specimens were removed and stained with van Geison staining. The calvarial sagittal suture area was measured to observe bone resorption. The calvarial new bone area was measured to observe bone formation. Compared with the sham group, the area of calvarial new bone and calvarial sagittal suture were higher in the Ti group (P http://ift.tt/2n8AKIB
Influence of Two Types of Connections in Driver-Retention Screw Assembly
Abstract: Rehabilitation with implant-supported prostheses has reached high success rates. However, mechanical failures are still reported, mainly in retention screws of abutments in single implant-supported crowns; which is designed to be the weakest structure and the first component to fail under overloading. In this sense, the aim of this in vitro study was to evaluate the influence of different joint designs (square or hexagonal) on resistance to deformation of driver-retention screw assembly of 3 commercial brands (Neodent, Singular, and Sin). A total of 42 retention screws from 3 commercial brands were used. The samples were divided into 2 joint groups, square (SQU) and hexagonal (HEX), and separated by commercial brands. Several components (implants and abutments) with standard platform (4.1 mm in diameter) were used. The resistance to deformation of the driver-retention screw assembly was measured using an accurate digital torque wrench for all commercial brands (Neodent [NEO], Singular [SGL], and Sin [SIN]) and joint designs (square or hexagonal). It was found no statistically significant difference (P
http://ift.tt/2n1dSy6
http://ift.tt/2n1dSy6
Lion Face: For the Good of Patients Like These, May We All Cooperate
No abstract availablehttp://ift.tt/2n8FcqS
Extra-Gingival Pyogenic Granuloma Displacing Teeth
Abstract: Pyogenic granuloma is a common cause of growth of soft tissue in the oral cavity, especially in the gingiva. It is mainly associated with local and chronic irritants besides hormonal changes during pregnancy. Here, the authors present an unusual patient of an extra-gingival pyogenic granuloma with large dimensions and displacing teeth arising in a male patient. This is an interesting patient to be reported due to its exacerbated and atypical clinical features.http://ift.tt/2n1nKYI
Horizontally Opposed V-Y Advancement Flaps for Surgical Reconstruction of Central Upper Lip Defects
No abstract availablehttp://ift.tt/2n8x4qb
Calvarial Mass Confused With Trichilemmal Cyst: Hepatocellular Cancer Metastasis
Abstract: The hepatocellular cancer calvarial metastasis is a rare condition that commonly presents cranial swelling. Therefore, calvarial swelling may confuse with frequent lesions of the scalp. The authors' patient was operated as trichilemmal cyst. But, intracranial extension was seen in operation. Calvarial metastasis of hepatocellular cancer was observed by examination of the patient.http://ift.tt/2n8v6pQ
Laparoscopic Free Omental Flap for Craniofacial Reconstruction: A Video Article Demonstrating Operative Technique and Surgical Applications
Abstract: The omental flap is a well described pedicled flap for surgical reconstruction of multiple body locations. As a laparoscopically harvested free flap, the omentum offers a minimally invasive solution to many reconstructive problems including extremity and head and neck wounds. This video article highlights the operative technique involved in flap harvest and inset for a cranial defect. An illustrative case involving a 23-year-old female's traumatic scalp degloving injury that was resurfaced by free omental flap and split-thickness skin graft is presented. This patient had stable long-term wound coverage for a very severe injury. Through video media we demonstrate that the laparoscopically harvested free omental flap is a minimally invasive, 2-team operation that provides soft tissue coverage of severe, remote wounds. This video demonstrates a safe operative technique and nuances specific to laparoscopic harvest of this flap.http://ift.tt/2n8v4hI
Pituitary Colloid Cyst
Abstract: Colloid cysts appear most commonly in the third ventricle, their occurrence in the sellar region is uncommon. The authors report a female patient with a pituitary colloid cyst. She was diagnosed incidentally with a sellar lesion by a routine paranasal computed tomography examination performed for planning of a dental implant surgery. Radiologic examinations revealed a pituitary lesion that was removed by transnasal transsphenoidal route. Her pathologic examination revealed that the lesion was a colloid cyst. Although rare, colloid cysts should be considered in the differential diagnosis of pituitary lesionshttp://ift.tt/2n8HhTQ
Advancing and Lengthening Genioplasty in Contouring of the Receding and Short Chin
Background: In East Asia, receding and short chin are common complaints of patients who do not have satisfied lower face. In most former studies, receding and short chin are considered and treated separately. But during the clinical work, the authors found that, in many patients, neither vertical elongation nor horizontal advancement of the chin is sufficient to achieve a harmonious result. In regards of this problem, the authors performed an advancing and lengthening genioplasty and the results were aesthetically satisfactory. Study Design: Twenty-six patients with receding and short chin were involved in this study. After presurgical computed tomography (CT) scan, advancing and lengthening genioplasty with/without other osteotomy operations were performed on all the patients. All patients underwent postoperative CT scan and had at least 3-month follow-up. Result: All patients were satisfied with the final results. According to the postoperative CT images and 3-month follow-up, no severe complications occurred. Conclusion: For patients with receding and short chin, advancing and lengthening genioplasty is a reliable therapy to obtain harmonious East Asian lower face.http://ift.tt/2n8AitW
The Shape of the Foramen Ovale: A Visualization Aid for Cannulation Procedures
Abstract: Several neurosurgical procedures, including rhizotomy for the management of trigeminal neuralgia, cannulate the foramen ovale (FO) to access intracranial structures. Cannulation procedures, including those utilizing neuronavigational technology, are occasionally complicated by anatomical variation of the FO, sometimes resulting in miscannulation and subsequent adverse events. The FO, while commonly thought of as oval-shaped, has also been described as "almond," "banana," "D shape," "pear," and "triangular." Because of the importance of the FO in neurosurgical procedures and the misunderstanding of FO shape, the aim of this study is to objectively describe the shape of the FO and its most likely shape variation. A total of 211 FO were evaluated by geometric morphometric analysis. A consensus shape is presented for the FO. No significant difference was found between the shapes of left- and right-sided FO. The most likely shape variation of the FO occurs as an inverse relationship between the anteromedial-posterolateral and anterolateral-posteromedial aspects of the foramen. The capacity to visualize the average FO shape and understand the most likely shape variance, as illustrated by this report, will aid neurosurgeons in their approach to procedures requiring cannulation of the FO.http://ift.tt/2n8t3Cp
Treatment Options for Exposed Calvarium Due to Trauma and Burns
Abstract: Wounds involving the calvarium secondary to trauma or burns are rare. However, they can present with challenging potential clinical sequelae. A wide variety of reconstructive options have evolved over the last century. Technical aspects have progressively improved as well over time. For proper surgical restoration of function and cosmesis reconstructive surgeons must have a detailed understanding of both the scalp and skull anatomy. Several factors such as etiology of the injury, including whether or not calvarial bone defects exists or simply soft tissue loss, as well as size, local tissue environment and patient comorbidities play major roles in appropriate choice for reconstruction. Currently, there is no single treatment option for scalp or calvarial reconstruction after trauma or burns. However, reconstructive alternatives are constantly emerging with promising results.http://ift.tt/2n8EkTk
Recalcitrant Invasive Skin Cancer of the Scalp: Combined Extirpation and Microsurgical Reconstruction Without Cranioplasty
Background: Recurrent invasive skin cancer of the scalp and calvarium is a difficult problem for which universally accepted treatment protocols have not been established. The authors present their 10-year experience with treatment of this specific subset of scalp reconstruction patients and present a successful treatment algorithm that is well suited to this patient population. Methods: The authors retrospectively reviewed all patients of microsurgical scalp reconstruction performed from 2005 to 2015 that involved invasive cutaneous malignancies of the scalp and calvarium. Results: Eleven patients met inclusion criteria. There were 9 squamous cell carcinoma, 1 basal cell carcinoma, and 1 melanoma. Seven received radiation prior to resection, 2 were irradiated postoperatively, and 2 were immunosuppressed. Seven had a history of prior scalp reconstruction. The median scalp defect size was 141 cm2. All the patients underwent craniectomy and the median cranial defect size was 71 cm2. Cranioplasty was not performed in any patient. There were no intraoperative complications or flap loss. Recipient site complications included hematoma in 1, 1 seroma, 2 cerebral spinal fluid leaks, 3 partial skin graft loss. There was 1 donor site seroma in a patient who had a latissimus dorsi flap. All the patients reported satisfaction with the overall result and none were limited in activities by the existing cranial defect. Conclusions: This is the largest series published to date that focuses exclusively on management of cutaneous malignancies with intracranial invasion. Wide resection with craniectomy, and reconstruction with microvascular free tissue transfer without cranioplasty provides safe and reliable treatment of recalcitrant invasive scalp skin cancers with low morbidity and without major complications. Pre and postoperative radiation is well tolerated with this approach. The patients in this series were of advanced age and of a lifestyle for which cranioplasty is unnecessary for return to regular activities.http://ift.tt/2ngWqkW
Parry–Romberg Syndrome on a Major French Revolution Leader: Mirabeau, 1791
No abstract availablehttp://ift.tt/2ngz1Ai
The Effects of Short- and Long-Term Exposure to Hyperbaric Oxygen on Nasal Mucociliary Clearance
Abstract: The aim of this study is to assess the effects of short- and long-term exposure to hyperbaric oxygen (HBO) on nasal mucociliary clearance (MCC). This study included 47 consecutive nondiabetic patients treated with hyperbaric oxygen therapy (HBOT). Participants were divided into 2 groups according to the taken number of HBOT sessions. Nineteen patients who receivedhttp://ift.tt/2ngWnWi
Tissue Fluorescence Imaging (VELscope) for Quick Non-Invasive Diagnosis in Oral Pathology
Abstract: Oral squamous cell carcinoma is the most common form of malignancy of the oral cavity; its incidence is increasing and late-stage presentation is common. It is usually predated by oral premalignant disorders. For this reason, early diagnosis is fundamental to reduce the malignant transformation of oral premalignant disorders and for increase the survival rate for oral cancer. Scraping the surface of the lesion is useful for having cytological features of the investigated tissue. The features of smears of oral premalignant lesions are the keratinization growth (red, orange, brown), the increased nuclear area and so the nuclear hyperchromatism, the nuclear pleomorphism, and the chromatin clumping. All those features are essential for doing the right diagnosis. However, the oral disease should be recognized at the first view by the clinical investigation without touching the lesions avoiding possible alteration in the cells of the tissue. The current standard of incisional biopsy with histology is painful for patients and involves a delay, although histology is completed. The aim of this article is to evaluate the effectiveness of other available tests that are unobtrusive and provide immediate results like the tissue fluorescence imaging.http://ift.tt/2mnOLny
Gene expression of miRNA-138 and cyclin D1 in oral lichen planus
Abstract
Objectives
This study aimed to evaluate microRNA-138 (miR-138) gene expression and its target cyclin D1 (CCND1) gene and protein expression in oral lichen planus (OLP) mucosa in an attempt to investigate their possible roles in OLP immunopathogenesis.
Methods
Sixty oral biopsy specimens were harvested from 30 healthy subjects and 30 OLP patients, subdivided into reticular, atrophic, and erosive groups (n = 10 each). Samples were subjected to quantitative real-time polymerase chain reaction analysis for quantification of miR-138 and CCND1 relative gene expression and immunohistochemical analysis to determine CCND1 protein expression.
Results
Samples from OLP patients had a significant underexpression of miR-138 gene and overexpression of CCND1 at both gene and protein levels compared to normal mucosa samples. The lowest levels of miR-138 expression were observed in atrophic and erosive OLP compared to reticular OLP, and the highest levels of CCND1 gene and protein expression were in atrophic OLP. An inverse correlation was demonstrated between the miR-138 expression and both CCND1 gene and protein expression in OLP patients. A significant positive correlation between CCND1 gene and protein expression was also observed.
Conclusion
Downregulation of miR-138 increases the gene and protein expression of its potential target CCND1 in OLP mucosa which might have a pivotal role in the disease pathogenesis.
Clinical relevance
This research implied that miR-138 may have a role in identification of symptomatic OLP lesions. MiR-138 might be considered as a potential tool in future OLP molecular therapy.
http://ift.tt/2n0WUjd
Permanent alopecia in patients with breast cancer after taxane chemotherapy and adjuvant hormonal therapy: Clinicopathologic findings in a cohort of 10 patients
Anagen effluvium with reversible scalp alopecia is a known side effect of chemotherapy. However, there are an increasing number of reports in the literature documenting permanent alopecia in patients treated with taxanes.
http://ift.tt/2mDeqJp
Clinical features of ectomesenchymal chondromyxoid tumors: A systematic review of the literature
Source:Oral Oncology, Volume 67
Author(s): Masanari G. Kato, Evren Erkul, Kendall S. Brewer, Emily E. Harruff, Shaun A. Nguyen, Terry A. Day
Ectomesenchymal chondromyxoid tumors are rare, benign neoplasms of the head and neck most commonly found within the oral cavity. While histopathological evaluation has been the primary focus of prior studies, clinical characterization of this rare entity currently remains sparse. Thus, this study was performed to provide insights into the clinical characteristics of ectomesenchymal chondromyxoid tumors to aid clinicians in distinguishing the lesion from other benign and malignant processes for a more accurate diagnosis and treatment. Moreover, this study includes a unique case of ectomesenchymal chondromyxoid tumor arising in the base of tongue, now the fourth to arise at that anatomic site. Including this case, a systematic review of the literature identified only 60 individual cases reported thus far. This study provides a detailed analysis of all 60 cases including demographics, clinical presentation, radiographic imaging, follow-up, and recurrence rate.
http://ift.tt/2mnoHsR
Effect of polymorphisms on TGFB1 on allergic asthma and helminth infection in an African admixed population
Allergic asthma is a complex disorder that results from a combination of genetic and environmental factors. Studies suggest that helminth infections can activate a regulatory network characterized by the production of regulatory cytokines, such as interleukin 10 and transforming growth factor β1 (TGF-β1) and subsequently protect against immune-mediated diseases, such as asthma. On the other hand, TGF-β1 is increased in the lungs of individuals with asthma and may modulate airway inflammation. The role of TGF- β 1 single-nucleotide polymorphisms (SNPs) in allergic disease remains inconclusive.
http://ift.tt/2m0HmXO
Mesalamine desensitization in a patient with treatment refractory ulcerative colitis and aspirin and nonsteroidal anti-inflammatory drug hypersensitivity
Inflammatory bowel disease is an increasingly prevalent problem worldwide.1–3 Ulcerative colitis (UC) can present with inflammation throughout the colon, always involving the rectum.2,3 The disease is characterized by relapsing and remitting flares that require lifelong maintenance therapy once remission is achieved. Common symptoms experienced by patients include abdominal pain, rectal urgency, bloody diarrhea, and tenesmus, and the diagnosis should be suspected clinically and confirmed with colonoscopy and biopsy.
http://ift.tt/2n0HJqk
The Kingston Allergy Birth Cohort
The Kingston Allergy Birth Cohort (KABC) is a prenatally recruited cohort initiated to study the developmental origins of allergic disease. Kingston General Hospital was chosen for recruitment because it serves a population with notable diversity in environmental exposures relevant to the emerging concept of the exposome.
http://ift.tt/2mDi3Pl
Sustained response of recombinant human C1 esterase inhibitor for acute treatment of hereditary angioedema attacks
Symptoms of hereditary angioedema (HAE) attacks can recur soon after initial treatment; the durability of response for recombinant human C1 esterase inhibitor (rhC1INH) treatment is unknown.
http://ift.tt/2n87KRs
Condylar geometry variation is associated with ENPP1 variant in a population of patients with dento-facial deformities
Bone remodeling is essential in maintaining bone health. Considering that ENPP1 contributes to bone geometry and bone mineralization, the aim of our study was to analyze the association between single-nucleotide polymorphisms (SNPs) of ENPP1 and condylar remodeling.
http://ift.tt/2m0HQxg
Pulmonary alveolar proteinosis and first successful whole lung lavage in Sri Lanka: a case report
Pulmonary alveolar proteinosis is a rare disease characterized by accumulation of lipoproteinaceous material within alveoli. There are three clinically distinct forms: congenital, acquired and secondary. Whole...
http://ift.tt/2n7Skwy
Oxidative stress serves as a key checkpoint for IL-33 release by airway epithelium
Abstract
Background
Interleukin (IL)-33 is implicated in the pathophysiology of asthma and allergic diseases. However, our knowledge is limited regarding how IL-33 release is controlled. The transcription factor nuclear factor-erythroid-2-related factor 2 (Nrf2) plays a key role in antioxidant response regulation.
Objective
The goal of this project was to investigate the role of cellular oxidative stress in controlling IL-33 release in airway epithelium.
Methods
Complementary approaches were used that included human bronchial epithelial cells and mouse models of airway type-2 immunity that were exposed to fungus Alternaria extract. The clinically available Nrf2 activator 2-cyano-3,12-dioxooleana-1,9-dien-28-oic acid methyl ester (CDDO-Me) was used to evaluate the role of Nrf2-induced antioxidant molecules.
Results
Human bronchial epithelial cells produced reactive oxygen species (ROS) when they were exposed to Alternaria extract. ROS scavengers, such as glutathione (GSH) and N-acetyl cysteine, prevented extracellular secretion of ATP and increases in intracellular calcium concentrations that precede IL-33 release. Administration of CDDO-Me to mice enhanced expression of a number of antioxidant molecules in the lungs and elevated lung levels of endogenous GSH. Importantly, CDDO-Me treatment reduced allergen-induced ATP secretion and IL-33 release by airway epithelial cells in vitro and protected mice from IL-33 release and asthma-like pathological changes in the lungs.
Conclusions
The balance between oxidative stress and antioxidant responses plays a key role in controlling IL-33 release in airway epithelium. The therapeutic potential of Nrf2 activators needs to be considered for asthma and allergic airway diseases.
This article is protected by copyright. All rights reserved.
http://ift.tt/2m0gvLv
Prevalence of type I sensitization to alpha-gal in forest service employees and hunters
Abstract
Background
The production of IgE molecules specific to the carbohydrate galactose-α-1,3-galactose (alpha-gal) is known to induce delayed anaphylaxis against mammalian meat. Tick bites constitute the primary sensitization source, as ticks transfer alpha-gal in their saliva to a host during a bite. The reported prevalence of alpha-gal-specific IgE (alpha-gal-sIgE) positivity varies between different populations from diverse geographic regions.
Objective
To investigate the prevalence of alpha-gal-sIgE positivity in a population of forest service employees who are highly exposed to ticks in comparison with a residential population and a historic sample.
Methods
A cross-sectional study evaluating 300 forest service employees and hunters from Southwest Germany was performed. Alpha-gal-sIgE levels were assessed by ImmunoCAP assay. The prevalence of alpha-gal-sIgE-positive individuals was compared with a matched cohort composed of a residential population and blood samples from forest service employees collected 15 years ago.
Results
In the study population, the prevalence of alpha-gal-sIgE-positive (>0.10 kUA/L) individuals was 35.0%, whereas the prevalence of individuals with alpha-gal-sIgE levels >0.35 kUA/L was 19.3%. Alpha-gal-sIgE positivity was associated with total IgE levels and recent tick bites. Mammalian meat-induced delayed anaphylaxis was found in 8.6% of the participants with alpha-gal-sIgE levels >0.35 kUA/L. For forest service employees and hunters, the odds ratio for alpha-gal-sIgE positivity was 2.48 compared to the residential population. The prevalence of alpha-gal-sIgE positivity in the current and historic cohort was comparable.
Conclusion
Forest service employees and hunters compose a population with a high prevalence of alpha-gal-sIgE positivity and carry a considerable risk of red meat allergy.
This article is protected by copyright. All rights reserved.
http://ift.tt/2n0htwo
Clinical benefits of treatment with SQ house dust mite sublingual tablet in house dust mite allergic rhinitis
Summary
Treatment with SQ house dust mite sublingual tablet for 1 year resulted in a decreased probability of having an allergic rhinitis exacerbation day (from 11% (placebo) to 5% (SQ house dust mite sublingual tablet)) and an increased probability of having a mild allergic rhinitis day (from 16% (placebo) to 34% (SQ house dust mite sublingual tablet)).
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Questionable diagnostic benefit of the commercially available panel of bee venom components
Abstract
For many years, only the major allergen rApi-m-1 has been available on the ImmunoCAP system for routine diagnosis of bee venom (BV) allergy. Now, there are 5 components available and we aimed to detect sensitivity and specificity of rApi m 1, 2, 3, 5 and 10 in BV allergic patients.
We further evaluated sensitivity of rApi-m-1 and 2 of an alternative platform and investigated possible differences in the sensitization profile between monosensitization and clinically relevant double sensitization. Analysis of the whole panel of BV allergens of the CAP system still resulted in a lower sensitivity than the combination of rApi-m-1 and 2 of the Immulite (71.6 vs 85.8%). Sensitization rate of rApi-m-5 was more than doubled in double-sensitized patients, while there was no difference for Api-m-2.
The benefit of the commercially available panel of BV components is questionable, due to the insufficient sensitivity and still unavailable important cross-reacting allergens.
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mTORC2 controls Th9 polarization and allergic airway inflammation
Abstract
Background
T helper type 9 (Th9) cells, a subpopulation of CD4+ T cells, play a critical role in the pathogenesis of allergic airway inflammation. However, it remains unknown whether mTORC2 regulates Th9 differentiation or function during allergic inflammation.
Methods
T cell-specific Rictor-deficient mice, a mouse model of allergic airway inflammation induced by OVA sensitization and a mouse model of adoptive transfer of induced Th9 cells were used to address the roles of mTORC2 in the pathogenesis of allergic airway inflammation. The in vitro Th9 induction, multiple-colors flow cytometry, real-time PCR, western blots were used to investigate the molecular effects of mTORC2 in Th9 induction.
Results
The differentiation of naïve CD4+ T cells into Th9 cells was significantly diminished in the absence of Rictor, the core component of mTORC2. By using a mouse model of allergic airway inflammation induced by OVA sensitization, T cell-specific Rictor-deficient mice show much less severe allergic airway inflammation characterized by decreased pathological alterations and fibrosis of the lungs, which was accompanied with reduced Th9 differentiation and infiltration. Importantly, the isolated Rictor-deficient Th9 cells mediate less severe allergic pathogenesis upon adoptive transfer. Rictor deficiency impairs Th9 cell differentiation by reducing IRF4 expression rather than affecting Foxo1/Foxo3a transcriptional activity, which is likely due to decreased Akt or/and STAT6 activation.
Conclusions
These findings uncover a novel role of mTORC2 in Th9 cell differentiation and may have important implications for therapeutic intervention of allergic diseases.
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Omalizumab does not improve skin lesions in a patient with Hypocomplementemic Urticarial Vasculitis Syndrome
Abstract
Hypocomplementemic urticarial vasculitis syndrome (HUVS) is a rare immune complex- mediated disease being characterized by persistent urticarial lesions, hypocomplementemia and possible organ involvement [1]. Therapy of HUVS is reported to be challenging [2]. We report on a 36 year old non atopic female who first presented in our university allergy centre with 18 months history of recurrent urticarial flares.
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Identification of one Novel complex delins mutation and one recurrent mutation of ERCC8 gene in a Chinese family with Cockayne Syndrome A
Abstract
Cockayne syndrome (CS) is a rare autosomal recessive disease with diverse clinical symptoms including neurological/developmental abnormalities, premature aging, and photosensitivity. [1] Complementation assays have defined two genetic groups of CS: Cockayne syndrome A and Cockayne syndrome B, caused by mutations in ERCC8 and ERCC6 gene respectively. [2]
We investigated a family with Cockayne Syndrome A from China. The proband was a 14-year-old female who presented with on and off itchy skin rashes on face at 1 year of age (Fig. 1A).
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Characteristics of patient receiving ustekinumab compared with secukinumab for treatment of moderate-to-severe plaque psoriasis – nationwide results from the DERMBIO registry
Abstract
Background
While safety and efficacy of ustekinumab and secukinumab, monoclonal antibodies approved for psoriasis, are described in clinical trials, data on their real-life application are lacking.
Objective
We compared the characteristics of patients initiating first-time treatment with secukinumab or ustekinumab.
Methods
All Danish patients with moderate-to-severe plaque psoriasis treated with biologics are recorded in the nationwide DERMBIO registry. We compared characteristics of patients starting first-time therapy with ustekinumab and secukinumab, respectively.
Results
We identified a total of 1,037 and 142 first-time treatment series with ustekinumab and secukinumab. There was a male predominance in both groups, but patients initiating secukinumab were slightly older and with longer disease duration; in agreement with guidelines for biologic treatment in Denmark where ustekinumab has been first line for all with psoriasis without joint problems since 2012 and secukinumab first line for psoriasis with joint problems since July 2016. A total of (52.9% and 14.5%) patients receiving ustekinumab and secukinumab, respectively, were bio-naïve. The mean Dermatology Life Quality Index score was slightly higher for ustekinumab than secukinumab (11.6 vs. 10.0; p=0.0769); the mean Psoriasis Area and Severity Index score was significantly higher (10.4 vs. 7.3; p<0.0001) for ustekinumab. Prevalence of joint disease was markedly lover (22.7% vs. 44.4%) among patients receiving ustekinumab.
Conclusions
We found significant differences in characteristics of patients starting therapy with ustekinumab and secukinumab in a real-life clinical setting. These findings may aid clinicians and researchers when interpreting efficacy data derived from clinical trials and biologic registries of patients with psoriasis.
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Acrokeratosis paraneoplastica (Bazex syndrome) – a systematic review on risk factors, diagnosis, prognosis and management
Summary
Acrokeratosis paraneoplastica Bazex (Bazex syndrome) is a rare paraneoplastic skin disease defined by erythematous, violaceous, scaly plaques on the hands and feet and on other acral locations such as nose and ears. Bazex syndrome is linked to a variety of underlying malignancies. Usually the skin lesions develop prior to the diagnosis of an internal malignant neoplasm with spontaneous remission after tumor removal. The objective of this study was to review the so far reported risk factors, diagnostic work up, prognosis and treatment options for Bazex syndrome in a systematic manner. This systematic review is based on a search in Medline, Embase and Cochrane Central Register for English and German articles from 1990 to 2015. Evidence on the diagnosis and treatment of Bazex syndrome is limited predominately to case reports or to small case series. There are no randomized controlled trials. A number of underlying tumor entities, predominately oropharyngeal neoplasms and tumors of the gastroenterological tract, but other malignancies were reported. Treatment modalities including topical and systemic corticosteroids, salicylic acid, topical vitamin D analogues, etretinate and PUVA therapy are often ineffective. Due to the small number of patients and the frequent misdiagnosis of this clinical entity, the aim of this systematic review is to call attention to this rare condition and to help clinicians to diagnose and treat Bazex syndrome effectively. Due to the good prognosis of the skin lesions and the tendency to resolve spontaneously if the underlying tumor is treated early, the differential diagnosis of Bazex syndrome should be taken into consideration when dealing with atypical psoriasiform cutaneous lesions. An early diagnosis may improve the patient′s prognosis substantially.
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Oral Pyoderma Gangrenosum: Diagnosis, Treatment and Challenges: A Systematic Review
Abstract
Pyoderma gangrenosum (PG) is a distinctive ulcerative skin disorder of unknown etiology, associated with an underlying systemic disease in up to 70% of cases. The condition is characterized by the appearance of one or more necrotic ulcers with a ragged undermined violaceous border and surrounding erythema. Lesions are often initiated by minor trauma. The condition can affect any anatomical site, however the head and neck are rarely involved. Although the oral cavity is subject to recurrent minor trauma through everyday activities such as mastication and oral hygiene, as well as during dental treatment, oral lesions appear to be extremely rare. In an effort to provide a detailed explanation of the oral manifestations of PG, a systematic search was conducted using medical databases. A total of 20 cases of PG with oral involvement were reported in the English and French literature. The objectives of this article are to present the pertinent diagnostic criteria and to discuss the differential diagnosis and therapeutic modalities.
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Probiotic consumption decreases the number of osteoclasts during orthodontic movement in mice
Publication date: July 2017
Source:Archives of Oral Biology, Volume 79
Author(s): Camila Alessandra Pazzini, Luciano José Pereira, Tarcília Aparecida da Silva, Carina Cristina Montalvany-Antonucci, Soraia Macari, Leandro Silva Marques, Saul Martins de Paiva
AimsThe aim of the present study was to investigate the effect of probiotic (Bacillus Subtilis) supplementation on bone remodelling induced by mechanical loading.MethodsC57BL/6 mice were divided in two groups: (1) Probiotic and (2) Vehicle (water). The probiotic (1.5×108CFU/mL) was administered orally for 14 days, starting two days before the induction of orthodontic tooth movement (OTM). OTM was determined by histomorphometric analysis by comparing the right to the left side of the maxilla. The number of osteoclasts was determined by counting TRAP-positive cells. Osteoblasts were counted on Masson's trichrome-stained slides.ResultsOTM was similar between groups (with and without probiotic supplementation) (p=0.46). The number of TRAP-positive cells increased (p<0.01) on the experimental side (where the spring coil was installed) in comparison to the control side in both groups. However, the number of osteoclasts decreased (p˂0.01) in the probiotic group, in comparison to the vehicle group. There was an increase in the number of osteoblasts (p˂0.05) in both the Vehicle and Probiotic groups on the side under OTM, independent of probiotic supplementation.ConclusionOral Supplementation with a probiotic influenced the number of osteoclasts adjacent to the tooth root during orthodontic movement in mice.
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Prediction of Waitlist Mortality in Adult Heart Transplant Candidates: The Candidate Risk Score.
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Risk Factors and Outcomes of De novo Cancers (Excluding Nonmelanoma Skin Cancer) after Liver Transplantation for Primary Sclerosing Cholangitis.
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Od Redaktora Naczelnego
Publication date: Available online 8 March 2017
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Rafał Pawliczak
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Probiotic consumption decreases the number of osteoclasts during orthodontic movement in mice
Publication date: July 2017
Source:Archives of Oral Biology, Volume 79
Author(s): Camila Alessandra Pazzini, Luciano José Pereira, Tarcília Aparecida da Silva, Carina Cristina Montalvany-Antonucci, Soraia Macari, Leandro Silva Marques, Saul Martins de Paiva
AimsThe aim of the present study was to investigate the effect of probiotic (Bacillus Subtilis) supplementation on bone remodelling induced by mechanical loading.MethodsC57BL/6 mice were divided in two groups: (1) Probiotic and (2) Vehicle (water). The probiotic (1.5×108CFU/mL) was administered orally for 14 days, starting two days before the induction of orthodontic tooth movement (OTM). OTM was determined by histomorphometric analysis by comparing the right to the left side of the maxilla. The number of osteoclasts was determined by counting TRAP-positive cells. Osteoblasts were counted on Masson's trichrome-stained slides.ResultsOTM was similar between groups (with and without probiotic supplementation) (p=0.46). The number of TRAP-positive cells increased (p<0.01) on the experimental side (where the spring coil was installed) in comparison to the control side in both groups. However, the number of osteoclasts decreased (p˂0.01) in the probiotic group, in comparison to the vehicle group. There was an increase in the number of osteoblasts (p˂0.05) in both the Vehicle and Probiotic groups on the side under OTM, independent of probiotic supplementation.ConclusionOral Supplementation with a probiotic influenced the number of osteoclasts adjacent to the tooth root during orthodontic movement in mice.
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Review of Sympathetic Blocks: Anatomy, Sonoanatomy, Evidence, and Techniques.
The autonomic nervous system is composed of the sympathetic and parasympathetic nervous systems. The sympathetic nervous system is implicated in situations involving emergent action by the body and additionally plays a role in mediating pain states and pathologies in the body. Painful conditions thought to have a sympathetically mediated component may respond to blockade of the corresponding sympathetic fibers. The paravertebral sympathetic chain has been targeted for various painful conditions. Although initially injected using landmark-based techniques, fluoroscopy and more recently ultrasound imaging have allowed greater visualization and facilitated injections of these structures. In addition to treating painful conditions, sympathetic blockade has been used to improve perfusion, treat angina, and even suppress posttraumatic stress disorder symptoms. This review explores the anatomy, sonoanatomy, and evidence supporting these injections and focuses on ultrasound-guided/assisted technique for the performance of these blocks. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.
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The Erector Spinae Plane Block Provides Visceral Abdominal Analgesia in Bariatric Surgery: A Report of 3 Cases.
Postoperative pain after bariatric surgery can be significant and yet difficult to manage. These patients frequently have associated obstructive sleep apnea and are at risk of respiratory depression with opioid analgesia. Abdominal wall blocks such as the subcostal transversus abdominis plane block are not of significant benefit, probably in part because they provide only somatic analgesia. The ultrasound-guided erector spinae plane (ESP) block is a recently described regional anesthetic technique for providing thoracic analgesia when performed at the level of the T5 transverse process. Local anesthetic injected into the fascial plane deep to the erector spinae muscle spreads in a craniocaudal fashion over several levels. Local anesthetic also penetrates anteriorly through the intertransverse connective tissue and enters the thoracic paravertebral space where it can potentially block not only the ventral and dorsal rami of spinal nerves but also the rami communicantes that transmit sympathetic fibers. Coupled with the fact that the erector spinae muscle and ESP extend down to the lumbar spine, this suggests that the ESP block could result in both visceral and somatic abdominal analgesia if the injection were performed at a lower thoracic level. We describe a series of 3 cases that illustrate the efficacy of bilateral ESP blocks performed at the level of the T7 transverse process for relieving visceral abdominal pain following bariatric surgery. Further investigation is recommended to establish the potential of the ESP block as an analgesic modality in abdominal surgery. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.
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A Double-Blind Randomized Comparison of Continuous Interscalene, Supraclavicular, and Suprascapular Blocks for Total Shoulder Arthroplasty.
Background and Objectives: Continuous brachial plexus blocks at the interscalene level are associated with known diaphragm dysfunction from phrenic nerve paresis. More distal blocks along the brachial plexus may provide postsurgical analgesia while potentially having less effect on diaphragm function. Continuous interscalene, continuous supraclavicular, and continuous suprascapular nerve blocks were evaluated for respiratory function and analgesia after total shoulder arthroplasty. Methods: After ethics board approval, subjects presenting for total shoulder arthroplasty were planned for randomization in a 1:1:1 ratio of a continuous interscalene, supraclavicular, or suprascapular block. The primary outcome was the assessment of vital capacity after 24 hours of continuous nerve block infusion (6 mL/h; 0.2% ropivacaine), without an initial bolus of local anesthetic during catheter placement. Additional outcomes included diaphragm excursion, pain scores, opioid consumption, and adverse effects. Results: Seventy-five subjects, 25 per group, completed the study. At 24 hours of continuous infusion only (no initial block bolus), the mean vital capacity reduction in the continuous interscalene control group was 991 mL (95% confidence interval [CI], 820-1162). Compared to the interscalene group, the continuous supraclavicular group had a mean vital capacity reduction of 803 mL (95% CI, 616-991; P = 0.322). The continuous suprascapular group had a significantly improved mean vital capacity reduction of 464 mL (95% CI, 289-639; P
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A new mechanism shapes the naïve CD8+ T cell repertoire: The selection for full diversity
Source:Molecular Immunology, Volume 85
Author(s): Pedro Gonçalves, Marco Ferrarini, Carmen Molina-Paris, Grant Lythe, Florence Vasseur, Annik Lim, Benedita Rocha, Orly Azogui
During thymic T cell differentiation, TCR repertoires are shaped by negative, positive and agonist selection. In the thymus and in the periphery, repertoires are also shaped by strong inter-clonal and intra-clonal competition to survive death by neglect. Understanding the impact of these events on the T cell repertoire requires direct evaluation of TCR expression in peripheral naïve T cells. Several studies have evaluated TCR diversity, with contradictory results. Some of these studies had intrinsic technical limitations since they used material obtained from T cell pools, preventing the direct evaluation of clone sizes. Indeed with these approaches, identical TCRs may correspond to different cells expressing the same receptor, or to several amplicons from the same T cell. We here overcame this limitation by evaluating TCRB expression in individual naïve CD8+ T cells. Of the 2269 Tcrb sequences we obtained from 13 mice, 99% were unique. Mathematical analysis of this data showed that the average number of naïve peripheral CD8+ T cells expressing the same TCRB is 1.1 cell. Since TCRA co-expression studies could only increase repertoire diversity, these results reveal that the number of naïve T cells with unique TCRs approaches the number of naïve cells. Since thymocytes undergo multiple rounds of divisions after TCRB rearrangement; and 3–5% of thymocytes survive thymic selection events; the number of cells expressing the same TCRB was expected to be much higher. Thus, these results suggest a new repertoire selection mechanism, which strongly selects for full TCRB diversity.
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Versatile carboxyl-terminus of capsid protein of porcine circovirus type 2 were recognized by monoclonal antibodies with pluripotency of binding
Source:Molecular Immunology, Volume 85
Author(s): Ling-Chu Hung, Ivan-Chen Cheng
We designed the peptide (C3) mimetic carboxyl-terminus (Cterminus) of capsid protein of porcine circovirus type 2b (PCV2b-1A/1B) inducing humoral immunity and generating hybridomas. The positive reactivity of the mAbs to PCV2 capsid protein was demonstrated by Western blot assay. Those mAbs also showed positive signals on PCV2b infected swine lymphocytes by indirect immunofluorescence staining. The mAb 1H3 bound to three minimal linear epitopes (P62, DPPLNP; P67, DPPLNPK; P73, LKDPPLKP), which was located at Cterminus of the capsid protein of PCV2b-1A/1B, PCV2b-1C, and PCV2a-2A respectively. The mAbs 3B2 bound to only one minimal linear epitopes (P59, KDPPLNP). The mAbs 6B8 bound to two minimal linear epitopes (P59 and P67). Our data demonstrate the core motif (P62) within the P59 could be recognized by mAbs (3B2 and 6B8) in the free status by liquid phase blocking immunoassay (LPBI) but not be recognized by these mAbs in the fixed form on the plate by indirect ELISA (iELISA). However, the P73 could be recognized by mAb 1H3 by iELISA but no inhibition of the interactive binding of C3 and mAb 1H3 by LPBI. This study also indicated that IgM mAbs and defective Ig mAb have broad binding, moderate specificity and low affinity. This study confirm that mAbs have pluripotency of binding. It might be a phenomenon of antibody response to Cterminus of capsid protein of PCV2b.
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Ionic tethering contributes to the conformational stability and function of complement C3b
Source:Molecular Immunology, Volume 85
Author(s): Andrés López-Perrote, Reed E.S. Harrison, Marta Subías, Martín Alcorlo, Santiago Rodríguez de Córdoba, Dimitrios Morikis, Oscar Llorca
C3b, the central component of the alternative pathway (AP) of the complement system, coexists as a mixture of conformations in solution. These conformational changes can affect interactions with other proteins and complement regulators. Here we combine a computational model for electrostatic interactions within C3b with molecular imaging to study the conformation of C3b. The computational analysis shows that the TED domain in C3b is tethered ionically to the macroglobulin (MG) ring. Monovalent counterion concentration affects the magnitude of electrostatic forces anchoring the TED domain to the rest of the C3b molecule in a thermodynamic model. This is confirmed by observing NaCl concentration dependent conformational changes using single molecule electron microscopy (EM). We show that the displacement of the TED domain is compatible with C3b binding to Factor B (FB), suggesting that the regulation of the C3bBb convertase could be affected by conditions that promote movement in the TED domain. Our molecular model also predicts mutations that could alter the positioning of the TED domain, including the common R102G polymorphism, a risk variant for developing age-related macular degeneration. The common C3b isoform, C3bS, and the risk isoform, C3bF, show distinct energetic barriers to displacement in the TED that are related to a network of electrostatic interactions at the interface of the TED and MG-ring domains of C3b. These computational predictions agree with experimental evidence that shows differences in conformation observed in C3b isoforms purified from homozygous donors. Altogether, we reveal an ionic, reversible attachment of the TED domain to the MG ring that may influence complement regulation in some mutations and polymorphisms of C3b.
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Nab2 maintains thymus cellularity with aging and stress
Source:Molecular Immunology, Volume 85
Author(s): K.Taraszka Hastings, Diana Elizalde, Leela Muppana, Sarah Levine, Christy M. Kamel, Wendy M. Ingram, Jennifer T. Kirkpatrick, Chengcheng Hu, Matthew P. Rausch, Amelia L. Gallitano
Thymic cellularity is influenced by a variety of biological and environmental factors, such as age and stress; however, little is known about the molecular genetic mechanisms that regulate this process. Immediate early genes of the Early growth response (Egr) family have critical roles in immune function and response to environmental stress. The transcription factors, Egr1, Egr2 and Egr3, play roles in the thymus and in peripheral T-cell activation. Nab2, which binds Egrs 1, 2, and 3 as a co-regulator of transcription, also regulates peripheral T-cell activation. However, a role for Nab2 in the thymus has not been reported. Using Nab2-deficient (KO) mice we found that male Nab2KO mice have reduced thymus size and decreased numbers of thymocytes, compared with age-matched wildtype (WT) mice. Furthermore, the number of thymocytes in Nab2KO males decreases more rapidly with age. This effect is sex-dependent as female Nab2KO mice show neither reduced thymocyte numbers nor accelerated thymocyte loss with age, compared to female WT littermates. Since stress induces expression of Nab2 and the Egrs, we examined whether loss of Nab2 alters stress-induced decrease in thymic cellularity. Restraint stress induced a significant decrease in thymic cellularity in Nab2KO and WT mice, with significant changes in the thymocyte subset populations only in the Nab2KO mice. Stress reduced the percentage of DP cells by half and increased the percentage of CD4SP and CD8SP cells by roughly three-fold in Nab2KO mice. These findings indicate a requirement for Nab2 in maintaining thymocyte number in male mice with age and in response to stress.
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Preliminary study of an oral vaccine against infectious hematopoietic necrosis virus using improved yeast surface display technology
Source:Molecular Immunology, Volume 85
Author(s): Jing-Zhuang Zhao, Li-Ming Xu, Miao Liu, Yong-Sheng Cao, Scott E. LaPatra, Jia-Sheng Yin, Hong-Bai Liu, Tong-Yan Lu
Infectious hematopoietic necrosis virus (IHNV) is a common pathogen that causes severe disease in the salmonid aquaculture industry. Because oral vaccines induce more efficient mucosal immunity than parenteral immunization, an oral vaccine was developed with an improved yeast cell surface display technology to induce an immune response to IHNV. The oral yeast vaccine, designated EBY100/pYD1-bi-G, was delivered orally to rainbow trout (Oncorhynchus mykiss) on days 1 and 32, and the nonspecific and specific immune responses were measured 50days after the first vaccination. In the hindgut, spleen, and head kidney, the expression of IFN-1 and Mx-1 was significantly upregulated after oral vaccination with EBY100/pYD1-bi-G, and the highest expression of IFN-1 and Mx-1 was observed in the spleen (7.5-fold higher than the control group) and head kidney (3.9-fold higher than the control group), respectively. Several markers of the adaptive immune response (IgM, IgT, CD4, and CD8) were also significantly upregulated, and the highest expression of these markers was observed in the hindgut, suggesting that the mucosal immune response was successfully induced by oral vaccination with EBY100/pYD1-bi-G. Sera from the orally vaccinated rainbow trout showed higher anti-IHNV neutralizing antibody titers (antibody titer 81±4) than the control sera (antibody titer 7±3), and the relative percentage survival after IHNV challenge was 45.8% compared with 2% in the control group. Although the protection afforded by this orally delivered vaccine was lower than that of a DNA vaccine (83%–98%), it is a promising candidate vaccine with which to protect larval fish against IHNV, which are most susceptible to the virus and difficult to inject with a DNA vaccine.
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Editorial Board
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 4
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Society Page
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 4
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Information for Readers
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 4
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Contents
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 4
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The relationship of Candida colonization of the oral and vaginal mucosae of mothers and oral mucosae of their newborns at birth
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 4
Author(s): Rund M. Al-Rusan, Azmi M.G. Darwazeh, Isam M. Lataifeh
ObjectiveVaginal Candida colonization is common during pregnancy. Vaginal Candida may transmit vertically to the mouth of newborns during labor. The aim of this study was to assess and compare oral Candida colonization between vaginally born newborns and cesarean-born newborns and to investigate the association of the mother's vaginal and oral Candida colonization and the newborn's oral colonization at the time of delivery.Study DesignCulture swabs were collected from the oral and vaginal mucosae of 100 pregnant women and from the oral mucosa of their 100 full-term newborns. Fifty (50%) of the mothers gave birth vaginally and the other 50 (50%) by cesarean section.ResultsThe prevalence of oral and vaginal Candida in pregnant mothers was 49% and 40%, respectively. Oral Candida colonization in newborns was 7%. Oral Candida was isolated from 5 of 50 (10%) in the vaginally born group and from 2 of 50 (4%) in the cesarean-born group (P = .44). In vaginally born group, oral Candida was isolated from 5 of 20 (25%) in those born to mothers with vaginal colonization of Candida, and 0 of 30 (0.0%) in mothers without vaginal colonization of Candida (P = .007).ConclusionsThe mother's vaginal Candida may constitute an important source of oral Candida in the newborns, particularly in those delivered vaginally.
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Is it Sjögren's syndrome or burning mouth syndrome? Distinct pathoses with similar oral symptoms
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 4
Author(s): Hawra Aljanobi, Amarpreet Sabharwal, Bralavan Krishnakumar, Jill M. Kramer
Sjögren's syndrome (SS) and burning mouth syndrome (BMS) typically occur in postmenopausal women. Although these conditions have significantly different etiopathogeneses, patients with SS or BMS often present with analogous oral complaints. The similarities between the two conditions have led to considerable confusion on the part of medical and dental practitioners, and those with BMS or SS often wait years to receive a diagnosis. Therefore, it is imperative for clinicians to understand the characteristic subjective and objective features of each disease and how these can be used to distinguish them. This review will discuss the proposed etiology, clinical manifestations, histopathology, diagnostic criteria, and patient management of SS and BMS. We also identify key differences between the two pathoses that aid in establishing the correct diagnosis. Recognition of the defining features of each condition will lead to reduced time to diagnosis and improved patient management for these poorly understood conditions.
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Cribriform adenocarcinoma of the soft palate with multiple lymph node metastasis and long-term follow-up
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 4
Author(s): Fernanda Viviane Mariano, Renata Freitas Varanda, Luciana Schultz, Marcelo Brum Correa, Oslei Paes de Almeida, Albina Altemani, Márcio Ajudarte Lopes
IntroductionCribriform adenocarcinoma of the tongue and minor salivary glands (CATMSG) is a recently described entity, with most cases previously published as polymorphous low-grade adenocarcinoma (PLGA). Typical cases share some main characteristics, such as oral sites (mainly tongue), regional lymph node metastasis, and morphology resembling solid and follicular variants of papillary thyroid carcinoma.ObjectiveTo present a CATMSG and emphasize the importance of reclassifying PLGAs with unusual behavior.Case reportA 78-year-old male presented with an ulcerated mass in the soft palate treated as PLGA. The patient developed 5 regional metastases over 11 years of follow-up, all diagnosed as PLGA. He died due to the disease, and because of the very aggressive behavior of PLGA, all histopathologic slides were revised and the tumor was reclassified as CATMSG.ConclusionThis report emphasizes the importance of reevaluating aggressive PLGA and contributes to a better understanding of CATMSG.
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Impact of routine open-mouth osseous temporomandibular joint tomography on diagnosis and therapeutic options
Publication date: April 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 4
Author(s): Asma'a Abdurrahman Al-Ekrish, Eman A. AlKofide, Maysara Dawood Al-Shawaf, Nasser S. Nooh, Rawan Dammak Daabash, Munerah Alsanouni, Dania Tamimi
ObjectivesThe aim of this study was to evaluate the impact of routine open mouth osseous temporomandibular joint (TMJ) tomography on diagnosis and treatment planning of TMJ conditions. Investigating the need for such images is important to justify the additional radiation exposure imparted by such procedures.Study DesignThe records of patients who underwent closed- and open-mouth osseous TMJ tomography (planar film tomography up to the beginning of 2006; cone beam computed tomography from 2006 onward) were reviewed. Three examiners formulated a diagnosis and treatment plan based on the history, clinical findings, and tomography interpretation reports of closed-mouth images. Then they reviewed the interpretations of the open-mouth images and recorded whether they would change their original diagnosis and/or treatment plan on the basis of the findings. Descriptive analysis of the results was performed.ResultsThe impact of routine open-mouth imaging on diagnosis and treatment planning was variable among the examiners. Examiners 1, 2, and 3 had a change in diagnosis in 7%, 5%, and 3% of cases, respectively, and a change in treatment plan in 1%, 1%, and 8%, respectively.ConclusionsRoutine open-mouth osseous TMJ tomography had a minimal impact on diagnosis and treatment planning of TMJ conditions, which varied according to the treating clinician.
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The effect of image enhancements and dual observers on proximal caries detection
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 123, Issue 4
Author(s): Benjamin M. Gray, Andre Mol, Andrea Zandona, Don Tyndall
ObjectivesThe aim of this study was to determine if the use of certain image enhancements and dual observers had an effect on the detection of caries, dentin extension, and cavitation.Study DesignSeven observers viewed unenhanced and enhanced images taken on photostimulable phosphor plates (PSP) and Schick 33 sensors and were asked to determine whether proximal caries lesions, dentin extension, and cavitation were present. Pairs of observers also evaluated the unenhanced PSP images and recorded their confidence. Micro-computed tomography was used as the gold standard.ResultsFor caries lesion detection, PSP outperformed Schick sensors, although the differences are most likely not clinically significant. Observers (single and dual) and filters had no effect on any of the diagnostic tasks. Schick sensors and unfiltered images were more specific for dentin extension.ConclusionsCaries detection was statistically greater with the PSP plate, but both detectors allowed for high accuracy. Expensive software or time-consuming consultations did not improve outcomes.
http://ift.tt/2mZAa39
Screening of deafness-causing DNA variants that are common in patients of European ancestry using a microarray-based approach
by Denise Yan, Guangxin Xiang, Xingping Chai, Jie Qing, Haiqiong Shang, Bing Zou, Rahul Mittal, Jun Shen, Richard J. H. Smith, Yao-Shan Fan, Susan H. Blanton, Mustafa Tekin, Cynthia Morton, Wanli Xing, Jing Cheng, Xue Zhong Liu
The unparalleled heterogeneity in genetic causes of hearing loss along with remarkable differences in prevalence of causative variants among ethnic groups makes single gene tests technically inefficient. Although hundreds of genes have been reported to be associated with nonsyndromic hearing loss (NSHL), GJB2, GJB6, SLC26A4, and mitochondrial (mt) MT-RNR1 and MTTS are the major contributors. In order to provide a faster, more comprehensive and cost effective assay, we constructed a DNA fluidic array, CapitalBioMiamiOtoArray, for the detection of sequence variants in five genes that are common in most populations of European descent. They consist of c.35delG, p.W44C, p.L90P, c.167delT (GJB2); 309kb deletion (GJB6); p.L236P, p.T416P (SLC26A4); and m.1555A>G, m.7444G>A (mtDNA). We have validated our hearing loss array by analyzing a total of 160 DNAs samples. Our results show 100% concordance between the fluidic array biochip-based approach and the established Sanger sequencing method, thus proving its robustness and reliability at a relatively low cost.http://ift.tt/2mC1OCf
Carlos Chagas and His Unique Approach to Trypanosomiasis
Born in 1878 in the state of Minas Gerais, Brazil, Carlos Justiniano Riberio das Chagas completed his medical education at the School of Medicine of Rio de Janeiro. In 1907, Chagas moved nearly 500 miles away to Lassance, a small tropical town near the Sao Francisco River in Brazil, where a malaria outbreak was ongoing. He noticed numerous hematophagous bugs in the walls of the cottages in the town, which he proceeded to isolate. This led to Chagas' most notable achievement: his discovery of the parasite Trypanosoma cruzi, the cause of American trypanosomiasis or Chagas disease.
http://ift.tt/2mGofXA
http://ift.tt/2mGofXA
Rethinking How We Select Dermatology Applicants
This Viewpoint makes 6 recommendations for rethinking the selection of dermatology residents and moving away from quantitative assessment toward community and intellectual engagement.
http://ift.tt/2hwOKwG
http://ift.tt/2hwOKwG
Regional and State Differences in Melanoma Rates in the United States
This study analyzed the death and incidence rates of melanoma in each state and by geographic region.
http://ift.tt/2hNX2wk
http://ift.tt/2hNX2wk
The Role of Rifampin in Leprosy
This Viewpoint considers the role of rifampin in the substantial decline in the prevalence of leprosy.
http://ift.tt/2k3qYtz
http://ift.tt/2k3qYtz
Transparent Reporting of Demographic Characteristics of Study Participants
By 2060, the US Census Bureau projections indicate that the United States will no longer have a single majority population; rather, the nation will be composed of a "plurality" of races and ethnic groups. In the early 1990s, congressional legislation set forth guidelines to include women and encourage the inclusion of members of racial and ethnic minority groups in federally sponsored human participant research. While substantial gains have been made regarding the participation of women in clinical research, the number of minorities appears to be lagging. Compliance with congressional mandates as well as valid analysis of differences between sexes or races/ethnicities requires an accurate system of inclusion data tracking.
http://ift.tt/2kSBIYw
http://ift.tt/2kSBIYw
Prurigo Pigmentosa in White Monozygotic Twins
This case report describes prurigo pigmentosa in white monozygotic twins.
http://ift.tt/2igS0b4
http://ift.tt/2igS0b4
Screening for Genital Herpes
Primum non nocere, the old maxim meant to guide physician conduct, translates as "first, do no harm." Physicians too often stop following the maxim, as translated, halfway through.
http://ift.tt/2h8EavL
http://ift.tt/2h8EavL
Dermatologic Applications of Medical Moulage
The application of medical moulage is most commonly associated with training health care professionals in simulated disaster drills or as an aid in emergency preparedness education. Similarly, silicon prosthetic makeup is more widely known for the central role it plays in front of the camera lens, applied meticulously to Hollywood's stars. While these better-known examples of the application of moulage take the center stage, this Notable Note sheds the spotlight on the rich but lesser-known history of the use of medical moulage in dermatology.
http://ift.tt/2mGeg4g
http://ift.tt/2mGeg4g
Optimizing Outcomes for Cutaneous Head and Neck Melanoma
In this issue, Moyer and colleagues report long-term follow-up of a large cohort of patients with head and neck melanoma treated with a "square" staged excision technique using permanent sections for comprehensive margin assessment. The median follow-up of 9.3 years demonstrated excellent long-term disease control of 834 lesions with projected local recurrence rate of 2.2% at 10 years. The mean margin required for histologic clearance of tumor was 9.3 mm for melanoma in situ and 13.7 mm for invasive melanoma. The authors demonstrated that lesion size, presence of invasion, and prior incomplete excision were associated with larger surgical margins required for histologic clearance.
http://ift.tt/2hVymVL
http://ift.tt/2hVymVL
Partner-Assisted Skin Self-examination for Melanoma
This study assesses patient- and partner-reported levels of embarrassment, comfort, and self-confidence in performing skin self-examinations for melanoma.
http://ift.tt/2hvZ0BE
http://ift.tt/2hvZ0BE
Precision Treatment for Pediatric Atopic Dermatitis
Atopic dermatitis (AD) is a common inflammatory skin disorder, and its prevalence in the pediatric population has tripled in the past several decades alone. Atopic dermatitis is characterized by xerotic or scaly patches of skin with intense pruritus, resulting in eczematous lesions. Loss-of-function (LOF) mutations for the skin gene filaggrin (FLG [OMIM 135940]) are the most significant and widely replicated risk factors for AD. Immunologically, AD is characterized by type 2 inflammation through type 2 interleukin 4 (IL-4), IL-5, and IL-13 cytokine production. Together, the evidence supports a prevailing paradigm of AD pathogenesis originating with a skin barrier deficiency that results in downstream immune dysregulation and triggers a chronic and relapsing inflammatory cascade.
http://ift.tt/2gptIy2
http://ift.tt/2gptIy2
Potential Mediators of Cancer Pain in Cutaneous SCC
This study identifies possible mediators of pain in squamous cell carcinoma (SCC) to elucidate potential mechanism of SCC-associated pain in organ transplant recipients.
http://ift.tt/2h8zAKe
http://ift.tt/2h8zAKe
Genetic Variation Associated With Treatment Use in Atopic Pediatric Dermatitis
This cohort study sought to determine whether variations in FLG and TSLP genotype were associated with differences in treatment use for atopic dermatitis in children over time.
http://ift.tt/2gpyBH8
http://ift.tt/2gpyBH8
Demodectic Frost of the Ear
This case report describes a patient with demodectic frost of the ear.
http://ift.tt/2hO7XGo
http://ift.tt/2hO7XGo
Staged Excision With Permanent Section Margin Control for Melanoma
This cohort study of patients with melanoma on the head and neck investigates the local recurrence rates and margin to clearance end points using staged excision with comprehensive hematoxylin-eosin–stained permanent section margin control.
http://ift.tt/2i1odEu
http://ift.tt/2i1odEu
John Tyndall’s Effect on Dermatology
When dermatologists see the muted indigo discoloration of dermal melanosis or an old tattoo, they knowingly murmur sotto voce, "Ah, witness the Tyndall effect." But can they explain it?
http://ift.tt/2mGgY9T
http://ift.tt/2mGgY9T
Photodynamic Therapy With and Without Ablative Fractional Laser
This randomized clinical trial examines the efficacy of 1 session of ablative fractional laser-primed photodynamic therapy compared with 2 sessions of conventional methyl aminolevulinate photodynamic therapy for the treatment of microinvasive squamous cell carcinoma.
http://ift.tt/2kyvhYY
http://ift.tt/2kyvhYY
Skin Cancer in Organ Transplant Recipients
This cohort study examines the incidence of and risk factors for posttransplant skin cancer, including squamous cell carcinoma, melanoma, and Merkel cell carcinoma, among US solid organ transplant recipients.
http://ift.tt/2jjQ7vM
http://ift.tt/2jjQ7vM
Response to the Letter to the Editor regarding “Comparison of temporalis fascia muscle and full-thickness cartilage grafts in type 1 pediatric tympanoplasties” by Yegin et al. (Braz J Otorhinolaryngol. 2016;82:695–701)
Publication date: Available online 8 March 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Yakup Yegin, Mustafa Çelik
http://ift.tt/2mYYSjZ
Atezolizumab and Bevacizumab in Rare Solid Tumors
Conditions: Malignant Neoplasms of Digestive Organs; Malignant Neoplasms of Lip Oral Cavity and Pharynx; Malignant Neoplasms of Mesothelial and Soft Tissue; Malignant Neoplasms of Respiratory and Intrathoracic Organs
Interventions: Drug: Atezolizumab; Drug: Bevacizumab; Behavioral: Phone Call
Sponsors: M.D. Anderson Cancer Center; Genentech, Inc.
Not yet recruiting - verified March 2017
http://ift.tt/2mm0qD8
Interventions: Drug: Atezolizumab; Drug: Bevacizumab; Behavioral: Phone Call
Sponsors: M.D. Anderson Cancer Center; Genentech, Inc.
Not yet recruiting - verified March 2017
http://ift.tt/2mm0qD8
Reversal of isolated 20q deletion with vitamin B12 replacement in a patient with pernicious anaemia
Severe vitamin B12 deficiency is well known to cause morphological alterations in bone marrow. In rare instances, these myelodysplastic and megaloblastic changes can coexist with cytogenetic abnormalities. Here, we report a case of a 38-year-old African-American woman with pernicious anaemia, who was found to have an isolated 20q deletion and which resolved after vitamin B12 replacement. We also discuss various mechanisms in which vitamin B12 deficiency can lead to chromosomal abnormalities. A literature review is also performed to evaluate various other chromosomal aberrations associated with B12 deficiency.
http://ift.tt/2m2zvtG
Bilateral fixation of a periprosthetic intertrochanteric hip fracture below Birmingham hip resurfacing
This case report involves a 59-year-old woman with a traumatic right intertrochanteric hip fracture below a previous Birmingham hip resurfacing (BHR). This woman had almost an identical fracture on the left hip 3 years before which was treated with a proximal femoral locking compression plate. Of note periprosthetic fractures following hip resurfacing are usually subcapital and treated with a revision or conservative management. We present an unusual surgical problem that has occurred twice in the same patient and has been treated effectively on both occasions using proximal femoral plating. To the best of our knowledge, there have been no other reports of bilateral periprosthetic fractures being treated in this way.
http://ift.tt/2mYXgXJ
Severe lead toxicity attributed to bullet fragments retained in soft tissue
A man aged 30 years presented to an emergency department with a 1 month history of severe abdominal pain, jaundice, constipation, lower extremity weakness and weight loss. A peripheral blood smear was performed that showed basophilic stippling of erythrocytes prompting a blood lead level (BLL) evaluation. The patient had a BLL of >200 µg/dL. Retained bullet fragments were identified in the left lower extremity from a previous gunshot wound 10 years prior. Lead from the excised bullet fragment was consistent with the patient's blood lead by isotope ratio analysis. This case is a rare example of a severely elevated BLL attributed to bullet fragments in soft tissue. Bullets retained in soft tissue are not often considered a risk factor for a markedly elevated BLL because they become encapsulated within the tissue over time.
http://ift.tt/2m2GZgf
Müllerianosis of the urinary bladder: a rare and problematic bladder tumour
Müllerianosis of the bladder is an extremely rare and highly symptomatic bladder tumour comprising of at least two types of Müllerian derived tissues. We present the case of a 59-year-old woman presenting with painful macroscopic haematuria associated with urgency, frequency and incontinence. She is a nulliparous postmenopausal woman without malignancy risk factors or previous abdominal surgery. Initially identified on ultrasound scan, she was taken for transurethral resection of bladder tumour (TURBT). Histology confirms the diagnosis. Repeat TURBT was required for non-resolution of symptoms. Despite a thorough resection, symptoms recurred within months necessitating partial cystectomy. Although a 'benign' lesion, this lesion proved a difficult condition to treat requiring partial cystectomy.
http://ift.tt/2mYVypf
Good response of an aggressive rare variant of signet ring cell carcinoma of prostate with hormonal therapy
Primary signet ring cell carcinoma (SRCC) of the prostate is a rare entity, characterised by its aggressive nature and dismal prognosis. We report a case of an advanced SRCC of the prostate presenting as a large pelvic mass with obstructive uropathy and rectal involvement managed by complete androgen blockade. At 24 months follow-up, the patient has no evidence of progression or metastasis. Aggressive management with multimodality approach combining surgery, radiation and hormonal ablation can result in long disease-free survival in some patients, despite the aggressive nature of this disease.
http://ift.tt/2m2TFne
Brunner's gland hamartoma: a rare cause of iron deficiency anaemia and report of an adapted colonic polyp resection technique
A man aged 65 years presented with symptomatic anaemia without overt gastrointestinal bleeding. An oesophagogastroduodenoscopy (EGD) was performed and he was found to have a large ulcerated pedunculated Brunner's gland hamartoma in the duodenal bulb. The polyp was resected using snare cautery in forward and retroflexed positions. Colonoscopy was also performed and a few diminutive polyps were resected. A year later, the patient returned for a surveillance EGD, and no residual polyp was noted. Haemoglobin and iron studies normalised within a few months after polypectomy, with resolution of symptoms.
http://ift.tt/2mYHZpQ
Gastric volvulus: a potentially fatal cause of acute abdominal pain
A woman aged 67 years attended the emergency department with acute abdominal and back pain of 1-day duration with associated vomiting. The patient had multiorgan failure. Resuscitation was started with intravenous fluids and vasopressors. An abdominal CT scan was completed which confirmed the diagnosis of acute gastric volvulus. The patient was successfully resuscitated from a cardiorespiratory arrest during transfer to the operating theatre. The patient subsequently underwent a total gastrectomy with stapling of the oesophageal and duodenal stumps. The abdomen was packed and left open as a laparostomy with a planned relook 48 hours later was to be performed. Unfortunately, the patient continued to deteriorate postoperatively in the intensive care unit despite maximum organ support for multiorgan failure. A decision was made to withdraw treatment and the patient died 10 hours postoperative. This case illustrates the presentation of acute gastric volvulus at a late stage and the high mortality rate associated with it.
http://ift.tt/2m2BL4h
Intellectual disability complicated by sexual addiction: an uncommon presentation of a common condition
A young man presented with high libido for 3 years, associated with preoccupation with sexual thoughts combined with his pursuit of pornographic materials. He had strong psychological cravings for and had spent large amount of money on sex, resulting in a dispute with his family. There were no mood or psychotic symptoms. Medical history revealed recent diagnosis of gonococcal urethritis. Cognitive assessment showed subtle deficiencies in reasoning and executive functions. There was occasional use of alcohol. Sexual addiction with comorbid mild intellectual disability was diagnosed, and pharmacological as well as psychological management were started.
http://ift.tt/2mYHZ9k
Heroin-associated anthrax with minimal morbidity
In 2010, during an outbreak of anthrax affecting people who inject drugs, a heroin user aged 37 years presented with soft tissue infection. He subsequently was found to have anthrax. We describe his management and the difficulty in distinguishing anthrax from non-anthrax lesions. His full recovery, despite an overall mortality of 30% for injectional anthrax, demonstrates that some heroin-related anthrax cases can be managed predominately with oral antibiotics and minimal surgical intervention.
http://ift.tt/2m2QXOs
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