Head and Neck Medicine by Alexandros G.Sfakianakis: 03/09/17

Πέμπτη 9 Μαρτίου 2017

Voice outcomes for early laryngeal cancer.

Purpose of review: Treatment options for early laryngeal cancer are well established with good local control and 5-year survival. The commonest treatments are radiotherapy or transoral laser microsurgery (TLM). There are advantages and disadvantages of the different modalities, but debate continues regarding the voice outcomes posttreatment. This review will focus on early glottic carcinoma and voice outcomes following the different treatments. Recent findings: TLM and radiotherapy are both likely to affect voice quality, but the extent of voice change depends on different factors. These factors can be divided into patient, tumour and treatment factors. Recent meta-analyses data show similar voice outcomes for either modality in the treatment of early glottic carcinoma. However, larger tumours and those involving the anterior commissure are associated with worse voice outcomes. Summary: There are various considerations for the patient and clinician before deciding on the preferred treatment for early glottic carcinoma. Although both TLM and radiotherapy will affect voice outcomes, the recent meta-analyses show similar voice outcomes for either modality in the treatment of early glottic carcinoma. There are numerous variables in the published studies hindering direct comparisons. These include heterogeneous patient groups, different treatment standardization and methods of voice analysis. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2m9leLS

Social and quality of life impact using a voice prosthesis after laryngectomy.

Purpose of review: This review is intended to give an up-to-date overview of key developments in the evidence base relating specifically to the social and quality of life (QOL) impact of using a voice prosthesis, with reflections on the impact on clinical practice. Recent findings: Recent studies have shed light on the role of social support on psychological adjustment after laryngectomy, developing the existing evidence base on psychological sequelae. Investigations into the relationship between voice intensity/intelligibility and voice handicap/QOL may suggest a relationship for some patients, and current tools for measuring these constructs are evaluated. Recent qualitative research on the lived experience and social impact of using a voice prosthesis is presented. Summary: Little research is currently available exploring the impact of using a voice prosthesis on social participation, which is reflected in the dearth of participation-focused interventions for laryngectomy patients. Further research on the lived experience of tracheoesophageal speech is required to understand this phenomenon and develop appropriate interventions for enhancing communication, participation and QOL with a voice prosthesis after laryngectomy. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2mHJ8RM

Dysphagia management in tracheostomized patients: where are we now?.

Purpose of review: Tracheostomized patients are medically complex and vulnerable. International attention is now focused on improving the safety and quality of their care. This review summarizes recent evidence in hot-topic areas pertinent to speech and language therapy (SLT) intervention for dysphagia management in tracheostomized patients. Recent findings: The management of tracheostomized patients requires a truly multidisciplinary team (MDT) approach. Without this, patients remain tracheostomized and hospitalized for longer and have slower access to MDT members. Patterns of SLT intervention are variable across the United Kingdom, and further work to achieve consensus on best practice is required. Instrumental evaluation of swallowing provides vital information and can facilitate well tolerated oral feeding even prior to cuff deflation. A systematic review suggests that sensitivity of blue-dye testing is poor, but studies are methodologically flawed. The need for tracheostomy-specific quality of life measures is being addressed by the development of a questionnaire. Summary: In this review, the main research themes relevant to speech and language therapists (SLTs) working with tracheostomized patients are discussed. This patient group poses significant challenges to robust study design. However, recent advances in uniting MDT members globally to improve standards of care are encouraging. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2m9u2Be

Voice and swallowing outcomes for adults undergoing reconstructive surgery for laryngotracheal stenosis.

Purpose of review: Adult laryngotracheal stenosis is a rare, multifactorial condition which carries a significant physical and psychosocial burden. Surgical approaches have developed in recent years, however, voice and swallowing function can be affected prior to treatment, in the immediate postoperative phase, and as an ongoing consequence of the condition and surgical intervention. In this study we discuss: the nature of the problem; surgical interventions to address airway disorders; optimal patterns of care to maximize voice and swallowing outcomes. Recent findings: Studies in this field are limited and focused on surgical outcomes and airway status with voice and swallowing a secondary consideration. Retrospective studies of swallowing have focused on factors such as the duration of dysphagia symptoms following airway surgery and made comparisons between type of surgery, use of stent, and length of swallowing problems. The literature suggests that patients are likely to return to their preoperative diet. There has been a focus on voice outcomes following cricotracheal resection which results in a postoperative decrease in the fundamental frequency. However, study comparisons are limited by the use of inconsistent outcome measures (for both voice and swallowing) which are often not validated, with heterogeneous groups and varying surgical techniques. Summary: The limited literature suggests that swallowing function is more likely to recover to presurgical status than voice function. Further prospective studies incorporating consistent instrumental, clinician, and patient-reported outcome measurement are required to understand the nature and extent of dysphagia and dysphonia resulting from this condition and its treatment. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2mHBdny

The use of practice guidelines in the management of pediatric cases of Acute Otitis Media in Amman, Jordan

Publication date: May 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 96
Author(s): Lubna Khreesha, Ali Bacharouch, R. Alexander Blackwood, Mohammed Alkhoujah, Mohamad R. Issa
ObjectivesThe widespread emergence of antimicrobial resistance has led many healthcare institutions to adopt more conservative antibiotic prescription practice guidelines for the treatment of acute otitis media (AOM). Little is known about the awareness and use of such guidelines by physicians in Jordan. Our aim was to pilot an anonymous survey instrument that would assess AOM treatment trends as well as awareness of and adherence to practice guidelines in Amman. By qualitatively assessing the management of AOM we could illuminate possible disparities in treatment trends, evaluate variability in practice guideline adherence, and help focus efforts of future educational programs that pertain to pediatric AOM management.MethodsA total of 71 practicing physicians were anonymously surveyed in Amman, Jordan. The survey assessed awareness of and adherence to practice guidelines by prompting responses to hypothetical AOM cases. Differences in performance between various physician groups were noted.ResultsIn total, participants answered 61.2% of the questions correctly. It was found that trainees would prescribe more appropriate antibiotics relative to attending physicians (p = 0.008). It was found that medical physicians followed guidelines more appropriately relative to ENT surgeons (64.2% of questions answered correctly vs. 58.1% of questions answered correctly; p = 0.015) and that physicians who report adhering to guidelines all/most of the time followed guidelines more appropriately relative to those who report adhering only sometimes or never (64.0% of questions answered correctly vs. 58.0% of questions answered correctly; p = 0.011). Also, cases that dealt with children were the most difficult for participants to diagnose as compared with cases that dealt with adults.ConclusionWe conducted the first known qualitative analysis of otitis media practices in Amman and found numerous shortcomings in AOM guideline familiarity. Awareness of practice guidelines can lead to more appropriate AOM management, but there is variability between groups in guideline familiarity and utilization. Interventions that promote more conservative antibiotic prescriptions could be targeted towards groups that prescribe antibiotics less appropriately relative to their colleagues e.g. attending physicians and ENT surgeons. Interventions could also target physicians who manage pediatric AOM cases as participants had the most difficulty in properly diagnosing cases that involved children and infants.

http://ift.tt/2mOdsdP

Self-reported postoperative recovery in children after tonsillectomy compared to tonsillotomy

Publication date: May 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 96
Author(s): Mats Eriksson, Ulrica Nilsson, Ann-Cathrine Bramhagen, Ewa Idvall, Elisabeth Ericsson
ObjectivesTonsil surgery is associated with significant morbidity during recovery. Patient-reported outcome measures (PROM) are the golden standard for the planning and follow-up of delivered care, which should also be an axiom for children. The current aims were to describe self-reported postoperative recovery in children after tonsil surgery, and to compare tonsillotomy and tonsillectomy in this respect.MethodsIn total, 238 children (4–12 years old) with a history of obstructive problems and/or recurrent tonsillitis, and undergoing tonsil surgery were included. Forty-eight per cent were operated with partial tonsil resection/tonsillotomy (TT) and 52% with total tonsillectomy (TE), all in day surgery.Postoperative recovery was assessed on days 1, 4 and 10 using the validated self-rating instrument PRiC, Postoperative Recovery in Children. This includes 23 items covering different aspects of recovery after tonsil surgery. A higher score indicates worse status in the respective items.ResultsDaily life activities (sleeping, eating and playing), physical symptoms (e.g., headache, stomach ache, sore throat, otalgia, dizziness, nausea, defecation, urination), and emotional aspects (sadness, frightening dreams) were affected during the recovery period.The TE-girls showed higher scores than the boys regarding stomach ache, defecation and dizziness.Children above 6 years of age reported higher values for the physical comfort variables, while the younger group showed worse emotional states.Postoperative recovery improved from day 1–10 in all surgical groups. The TE-group showed lower recovery compared to the TT-group (p < 0.01–0.001) in most items.ConclusionThe goal of postoperative management is to minimize or eliminate discomfort, facilitating the recovery process and avoiding complications. Children are able to describe their recovery, and thus, PRiC seems to be able to serve as a PROM to obtain patient-centered data after tonsil surgery. The recovery process after TT causes less postoperative morbidity and a quicker return to normal activity compared to TE.

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Foreign body aspiration in children: Focus on the impact of delayed treatment

Publication date: Available online 9 March 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Xiaoxi Chen, Chunlin Zhang
ObjectiveThis study aims to analyze the impact of delayed treatment of foreign body aspiration (FBA) in children.Materials and methodsIn this study, we retrospectively reviewed 220 children who were diagnosed with FBA through rigid bronchoscopy from January 2010 to May 2016 in our hospital. The time elapsed between aspiration event and arrival at our hospital exceeded 24h was considered to have a delayed treatment. The occurrence rate of complications at admission, operation time and hospitalization time were compared between the delayed treatment group and non-delayed treatment group.ResultsA total of 220 children diagnosed with FBA by rigid bronchoscopy were enrolled in this study, including 138(62.7%) boys and 82(37.3%) girls. The median age was 20 months. Only 102 (46.4%) cases came to our hospital within 24h. The remaining 118 (53.6%) cases had a delayed treatment. The occurrence rate of complication at admission was significantly higher in the delayed treatment group than in the non-delayed treatment group (80.5% vs. 52.9%, P<0.01). Delayed treatment group also had significantly longer operation time and hospitalization time than non-delayed treatment group (median operation time: 18min vs. 10min; median hospitalization time: 4d vs. 3d; both P<0.01). In multivariate analysis, delayed treatment remained an independent risk factor for longer operation time (HR 2.47, 95% CI 1.13-5.44, P=0.02) and longer hospitalization time (HR 2.19, 95% CI 1.23-3.88, P<0.01).ConclusionDelayed treatment of FBA is not only related to higher occurrence rate of complication but also associated with longer operation and hospitalization time.

http://ift.tt/2mOhLpp

Novel endodontic sealers induce cell cytotoxicity and apoptosis in a dose-dependent behavior and favorable response in mice subcutaneous tissue

Abstract

Objectives

The objective of the present study is to evaluate the in vitro cytotoxicity and in vivo biocompatibility of two novel endodontic sealers: RealSeal XT1 and Sealapex Xpress on the subcutaneous connective tissue of mice.

Materials and methods

The cytotoxicity was assessed by cell viability using the MTT assay (one-way ANOVA), trypan blue test (Mann-Whitney) and cell apoptosis by flow cytometer. For the subcutaneous study, polyethylene tubes filled with the sealers were implanted in 70 BALB/c mice: 6 experimental groups (n = 10/group) and 2 control groups with empty tubes (n = 5/group). At the end of experimental periods (7, 21, and 63 days), the tissue was removed and histotechnically processed. Angioblastic proliferation and edema (Fisher's exact test) were evaluated, besides thickness measurement (μm) of the reactionary granulomatous tissue and neutrophil counts (Kruskal-Wallis and Dunn's post test; Mann-Whitney) (α = 0.05).

Results

MTT assay, trypan blue, and analysis of apoptotic cells showed a dose-dependent direct effect: the more diluted the sealer, the less cytotoxic. Regarding the angioblastic proliferation and edema, difference between the sealers at 7 and 63 days occurred (p < 0.05). Both endodontic sealers initially promoted perimaterial tissue reaction as a foreign body granuloma and thus stimulated favorable tissue responses.

Conclusions

Both sealers showed a dose-dependent effect and promoted satisfactory subcutaneous tissue response; the sealer Sealapex Xpress was less cytotoxic and more biocompatible than RealSeal XT.

Clinical relevance

The step of root canal filling during endodontic treatment is highly important for the preservation of the periapical tissue integrity. Subcutaneous reaction to endodontic sealers enables scientific basis for clinical use.

http://ift.tt/2m5Ttmv

Root canal morphology and variations in mandibular second molar teeth of an Indian population: an in vivo cone-beam computed tomography analysis

Abstract

Objectives

This study aims to investigate the root canal morphology of permanent mandibular second molars of an Indian population in vivo using cone-beam computed tomography (CBCT) images.

Methods

CBCT images (n = 983; males = 489, females = 494) of untreated, completely developed permanent mandibular second molar teeth were examined. CBCT scans were acquired as part of diagnosis and treatment planning for treatments unrelated to the present study. The number of roots and root canals were recorded. Canal configuration was classified based on Vertucci's and Fan's classifications.

Results

The most common configuration was two-root (79.35%) and three-root canals (53.50%). The incidence of three-rooted molars was 7.53%, whereas 13.12% of the studied teeth studied have fused roots with C-shaped canals. The predominant canal morphology in the mesial roots was Vertucci's type IV (45.17%), followed by type II (32.55%), type I (7.23%), type V (1.02%), and type III (0.91%). The distal root in contrast showed type I (61.14%) as the predominant canal configuration, followed by type II (18.21%) and type IV (7.53%). The incidence of three-rooted molars was higher in males (n = 55; 5.59%) than in females (n = 19; 1.94%) (p < 0.01). The canals in the extra roots exhibited type I (100%) root canal morphology. In teeth with C-shaped root canal (13.12%), the variations in the coronal, middle, and apical third ranged from C1 to C4.

Conclusions

Root canal systems of the mesial roots of mandibular second molars of the study population demonstrated a high degree of variability. While three roots were rare, there was a sexual predisposition. Fused roots with C-shaped canals were rare and demonstrated significant variations from the coronal to apical third.

Clinical relevance

Root canal morphology can demonstrate variations based on race and sex of patients. Clinicians must always consider the possible variations to ensure successful endodontic treatment.

http://ift.tt/2mNoH6s

Lipid parameters in obese and normal weight patients with or without chronic periodontitis

Abstract

Objective

The aim of this study was to evaluate the serum levels of lipids in patients with normal weight (NW) or obesity with or without chronic periodontitis (ChP).

Materials and methods

One hundred and sixty non-smoking patients without history of diabetes and/or cardiovascular events were allocated into one of the following groups: NW patients with periodontal health (NWH; n = 40), NW patients with ChP (NWChP; n = 40), obese patients with periodontal health (ObH; n = 40), and obese patients with ChP (ObChP; n = 40). Serum levels of total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides (TRG) were estimated.

Results

After adjustments for gender and age, both NW groups presented lower levels of TRG than both obese groups (p < 0.05). The NWH group presented lower levels of LDL than both periodontitis groups (p < 0.05) and the lowest TC/HDL ratio when compared to the other groups (p < 0.05). Females from the NWH group exhibited higher levels of HDL and lower LDL/HDL ratio than females from the ObChP group (p < 0.05). Furthermore, individuals from the ObChP group were more likely to have levels of LDL ≥130 mg/dl and HDL ≤40 mg/dl, compared to those from the NWH group (p < 0.05).

Conclusions

ChP and obesity, jointly or individually, are associated with undesirable pro-atherogenic lipid profiles.

Clinical relevance

There is interest in identifying clinical conditions associated with dyslipidemia to improve preventive and treatment strategies. This study demonstrated that ChP, obesity, and the association of both conditions might be related to pro-atherogenic lipid profiles.

http://ift.tt/2m5Rwq4

Odontogenic differentiation potential of human dental pulp cells cultured on a calcium-aluminate enriched chitosan-collagen scaffold

Abstract

Objective

The study aims to evaluate the odontogenic potential of human dental pulp cells (HDPCs) in contact with an experimental porous chitosan-collagen scaffold (CHC) enriched or not with a mineral phase of calcium-aluminate (CHC-CA).

Material and methods

To assess the chemotactic effect of the materials, we placed HDPCs seeded on transwell membranes in intimate contact with the CHC or CHC-CA surface, and the cell migration was monitored for 48 h. Additionally, cells were seeded onto the material surface, and the viability and proliferation were evaluated at several time points. To assess the odontoblastic differentiation, we evaluated ALP activity, DSPP/DMP-1 gene expression, and mineralized matrix deposition. HDPCs cultured onto a polystyrene surface (monolayer) were used as negative control group.

Results

The experimental CHC-CA scaffold induced intense migration of HDPCs through transwell membranes, with cells attaching to and spreading on the material surface after 24-h incubation. Also, the HDPCs seeded onto the CHC-CA scaffold were capable of migrating inside it, remaining viable and featuring a proliferative rate more rapid than that of CHC and control groups at 7 and 14 days of cell culture. At long-term culture, cells in the CHC-CA scaffold featured the highest deposition of mineralized matrix and expression of odontoblastic markers (ALP activity and DSPP/DMP-1 gene expression).

Conclusions

According to the results, the CHC-CA scaffold is a bioactive and cytocompatible material capable of increasing the odontogenic potential of human pulp cells. Based on analysis of the positive data obtained in this study, one can suggest that the CHC-CA scaffold is an interesting future candidate for the treatment of exposed pulps.

Clinical relevance

The experimental scaffold composed by a chitosan-collagen matrix mineralized with calcium aluminate seems to be an interesting candidate for in vivo application as a cell-free approach to dentin tissue engineering, which may open a new perspective for the treatment of exposed pulp tissue.

http://ift.tt/2mNoG2o

Failure to Diagnose an Incompetent Cervix,Premature Birth Lawsuits,Universal Cervical Length Screening,καθ' έξιν αποβολές, ανεπάρκεια τραχήλου,. πρόωρος τοκετός ... νομικό πλαίσιο−αστική−ποινική ευθύνη στη μαιευτική− γυναικολογία

http://emergencymedicinesfakianakis.blogspot.com/2017/03/premature-birth-lawsuitsuniversal.html

Every expectant mother hopes that her pregnancy will go full-term and that she will have a healthy baby to take home from the hospital. The unborn baby continues to grow throughout the entire pregnancy, and it has the best chance at being healthy when born after 37 weeks of pregnancy.

Unfortunately, 1 out of every 10 births in the U.S.—or an estimated 380,000 babies each year – are delivered too soon, often with devastating, life-changing results.

There are many factors that can contribute to a baby being born prematurely, and some are simply unavoidable in nature. However, there are some premature births that can be prevented, and may in fact be caused by a doctor's deviation from the accepted standard of care.

Some of our many multi-million-dollar recoveries have involved:

Injuries from premature delivery due to the failure to place a cervical cerclage for cervical incompetence or insufficiency
The failure to properly manage preeclampsia and delayed delivery, resulting in placental abruption and fetal bradycardia
Injuries suffered as a result of medication errors in neonatal intensive care units, or NICUs
Injuries from the failure to address non-reassuring fetal heart tracings
There are numerous causes for a premature birth, and doctors must be aware of them in order to appropriately care for expectant mothers. These are just some of the causes:

Women with a history of a second trimester miscarriage or a previous premature delivery
Women who are found to have a short cervix (a condition where the cervix is not the length that it should be) during a routine sonogram
Women with recurrent urinary tract infections
Women with diabetes – gestational or pre-gestational
Women with hypertension, which can result in preeclampsia
African American women, who, regardless of age or other conditions, are naturally at greater risk for delivering premature babies
Women with vaginal infections or sexually transmitted diseases
Because there are many things that can cause a baby to be born early, a doctor needs to ask the right questions of the expectant mother. Failure of the doctor to recognize, properly monitor and/or treat any of the factors mentioned can certainly rise to the level of negligence and malpractice. If this has occured to your baby, you should speak with an experienced premature birth attorney.

Expectant mothers should give their doctors as much information as they can about their medical history, but they may not be aware of all of the things that can contribute to premature birth. Consequently, a doctor must be prepared to ask pertinent questions to have all of the information needed to lower the chances of an early birth. If a doctor neglects to ask thorough questions and fails to act appropriately once the information is obtained and a baby is born premature as a result, it could be a case of malpractice and the mother may have grounds for a premature birth lawsuit.

When a premature birth does occur, there are many medical complications that can affect the child, and there is a higher risk of serious disability or death the earlier the baby is born. Some problems that a baby born too early may face include:

Breathing problems
Difficulty feeding
Increased risk of severe infection
Neurological problems
Cerebral palsy
Delayed development
Vision and hearing impairment
Determining whether or not a premature birth could have been prevented can be complicated, so it is imperative that you have both legal and medical experts to help and support you.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

TANTIGEN: a comprehensive database of tumor T cell antigens

Abstract

Tumor T cell antigens are both diagnostically and therapeutically valuable molecules. A large number of new peptides are examined as potential tumor epitopes each year, yet there is no infrastructure for storing and accessing the results of these experiments. We have retroactively cataloged more than 1000 tumor peptides from 368 different proteins, and implemented a web-accessible infrastructure for storing and accessing these experimental results. All peptides in TANTIGEN are labeled as one of the four categories: (1) peptides measured in vitro to bind the HLA, but not reported to elicit either in vivo or in vitro T cell response, (2) peptides found to bind the HLA and to elicit an in vitro T cell response, (3) peptides shown to elicit in vivo tumor rejection, and (4) peptides processed and naturally presented as defined by physical detection. In addition to T cell response, we also annotate peptides that are naturally processed HLA binders, e.g., peptides eluted from HLA in mass spectrometry studies. TANTIGEN provides a rich data resource for tumor-associated epitope and neoepitope discovery studies and is freely available at http://ift.tt/2mrs5D0 or http://ift.tt/2mpnNds (mirror).

http://ift.tt/2mrDLWc

Murine Th17 cells utilize IL-2 receptor gamma chain cytokines but are resistant to cytokine withdrawal-induced apoptosis

Abstract

Adoptive cellular therapy (ACT) with the Th17 subset of CD4⁺ T cells can cure established melanoma in preclinical models and holds promise for treating human cancer. However, little is known about the growth factors necessary for optimal engraftment and anti-tumor activity of Th17 cells. Due to the central role of IL-2 receptor gamma chain (IL2Rγ-chain) cytokines (IL-2, IL-7, and IL-15) in the activity and persistence of many T cell subsets after adoptive transfer, we hypothesized that these cytokines are important for Th17 cells. We found that Th17 cells proliferated in response to IL-2, IL-7, and IL-15 in vitro. However, in contrast to many other T cell subsets, including conventionally activated CD8⁺ T cells, we found that Th17 cells were resistant to apoptosis in the absence of IL2Rγ-chain cytokines. To determine whether Th17 cells utilize IL2Rγ-chain cytokines in vivo, we tracked Th17 cell engraftment after adoptive transfer with or without cytokine depletion. Depletion of IL-7 and/or IL-2 decreased initial engraftment, while depletion of IL-15 did not. Supplementation of IL-2 increased initial Th17 engraftment. To assess the clinical relevance of these findings, we treated melanoma-bearing mice with Th17 cell adoptive transfer and concurrent cytokine depletion or supplementation. We found that simultaneous depletion of IL-2 and IL-7 decreased therapeutic efficacy, depletion of IL-15 had no effect, and IL-2 supplementation increased therapeutic efficacy. Our results show that Th17 cells are responsive to IL2Rγ-chain cytokines, and provide insight into the application of these cytokines for Th17-based therapeutic strategies.

http://ift.tt/2mpnWO8

Acoustic Context Alters Vowel Categorization in Perception of Noise-Vocoded Speech

Abstract

Normal-hearing listeners' speech perception is widely influenced by spectral contrast effects (SCEs), where perception of a given sound is biased away from stable spectral properties of preceding sounds. Despite this influence, it is not clear how these contrast effects affect speech perception for cochlear implant (CI) users whose spectral resolution is notoriously poor. This knowledge is important for understanding how CIs might better encode key spectral properties of the listening environment. Here, SCEs were measured in normal-hearing listeners using noise-vocoded speech to simulate poor spectral resolution. Listeners heard a noise-vocoded sentence where low-F₁ (100–400 Hz) or high-F₁ (550–850 Hz) frequency regions were amplified to encourage "eh" (/ɛ/) or "ih" (/ɪ/) responses to the following target vowel, respectively. This was done by filtering with +20 dB (experiment 1a) or +5 dB gain (experiment 1b) or filtering using 100 % of the difference between spectral envelopes of /ɛ/ and /ɪ/ endpoint vowels (experiment 2a) or only 25 % of this difference (experiment 2b). SCEs influenced identification of noise-vocoded vowels in each experiment at every level of spectral resolution. In every case but one, SCE magnitudes exceeded those reported for full-spectrum speech, particularly when spectral peaks in the preceding sentence were large (+20 dB gain, 100 % of the spectral envelope difference). Even when spectral resolution was insufficient for accurate vowel recognition, SCEs were still evident. Results are suggestive of SCEs influencing CI users' speech perception as well, encouraging further investigation of CI users' sensitivity to acoustic context.

http://ift.tt/2m8EDMU

Verrucarin A and roridin E produced on spinach by Myrothecium verrucaria under different temperatures and CO 2 levels

Abstract

The behavior of Myrothecium verrucaria, artificially inoculated on spinach, was studied under seven different temperature conditions (from 5 to 35 °C) and under eight different combinations of temperature and CO₂ concentration (14–30 °C and 775–870 or 1550–1650 mg/m³). The isolate used for this study was growing well on spinach, and the mycotoxins verrucarin A and roridin E were produced under all tested temperature and CO₂ conditions. The maximum levels of verrucarin A (18.59 ng/g) and roridin E (49.62 ng/g) were found at a temperature of 26–30 °C and a CO₂ level of 1550–1650 mg/m³. Rises in temperature as well as in temperature and CO₂ concentrations had a significant effect by increasing Myrothecium leaf spots on spinach. The biosynthesis of verrucarin A was significantly increased at the highest temperature (35 °C), while roridin E was influenced by the CO₂ concentration. These results show that a positive correlation between climate condition and macrocyclic trichothecene production is possible. However, because of the ability of M. verrucaria to produce mycotoxins, an increase in temperature could induce the spread of M. verrucaria in temperate regions; this pathogen may gain importance in the future.

http://ift.tt/2nl1chp

Our auditory results using the Vibrant Soundbridge on the long process of the incus: 20 years of data

Publication date: Available online 9 March 2017
Source:Auris Nasus Larynx
Author(s): Anaïs Grégoire, Jean-Philippe Van Damme, Chantal Gilain, Benoit Bihin, Pierre Garin
ObjectiveAfter 20 years of experience with different types of middle ear implants, we analyzed our database about the Vibrant Soundbridge (VSB) to know the rate of complications, the effect on the residual hearing and the audiometric gain in our center.MethodThe study was retrospective and included all VSB implants bound to the long process of the incus in our tertiary medical center between january 1999 and february 2015. We observed the effect of surgery on residual hearing by comparing bone and air conduction thresholds before and after implantation. The functional results of the implant were quantified by measuring, at several post-operative intervals, the thresholds with the VSB in pure tone audiometry and speech audiometry, in quiet and in noise.Results53 VSB were implanted in 46 patients aged between 22 and 81 years old (average 53.9). 48 patients (90%) suffered from a sensorineural hearing loss, and 5 patients from a mixed hearing loss due to an otosclerosis (but only 3 of them have undergone stapedotomy). There were no major complications (e.g. facial palsy, dead ear or postoperative infection). The placement of the implant created an insignificant deterioration of the air conduction thresholds (5,6 dB HL) and bone conduction thresholds (2.2 dB HL) at 6 weeks post-implantation. The bone conduction thresholds increased by 4.7 dB HL 2.5 years after surgery in comparison with the preoperative results, which is also considered clinically insignificant. With the implant turned on, the pure tone audiometry thresholds in open field, in quiet, were significantly improved (gain of 13.9 dB on average on frequencies from 250 to 8000 Hz), particularly at frequencies of 1000, 2000 and 4000 Hz as the average gain on these frequencies amounted to 19.4 dB. The speech intelligibility in a cocktail party noise was also improved by 18.3% on average at 6, 52 and 104 weeks post-implantation.ConclusionThe Vibrant Soundbridge with the electromagnetic vibrator fixed to the long process of the incus is a safe active middle ear implant with no major complications; it has no significant impact on the residual hearing. The VSB is particularly suitable for patients who are unable to wear conventional hearing aids due to anatomical or infectious problems in the external ear canal, or in case of poor audiometric results with conventional hearing aids. The VSB brings significant hearing gain, as it is particularly efficient in frequencies for the speech range and higher, resulting especially in better speech intelligibility in noisy environments.

http://ift.tt/2m68hSd

The clinical manifestations of vestibular migraine: A review

Publication date: Available online 9 March 2017
Source:Auris Nasus Larynx
Author(s): Ashley P. O'Connell Ferster, Adrian J. Priesol, Huseyin Isildak
ObjectivesTo provide an overview of vestibular migraines presentation, pathology, and diagnosis, as well as an update on current diagnostic criteria.MethodsA review of the most recent literature on vestibular migraines was performed.ResultsVestibular migraine is a process with significant impact on the quality of life for those afflicted with the disease, with attacks of spontaneous or positional vertigo and migraine symptoms lasting several minutes to 72h. Inner ear disease can co-exist with migraine and the vestibular symptoms occurring with vestibular migraine can mimic inner ear disorders providing a challenge for clinicians in establishing diagnosis. Recent diagnostic criteria for vestibular migraine proposed by a joint committee of the Bárány Society and the International Headache Society provide an important standard for clinical diagnosis and research endeavor.ConclusionVestibular migraine is a challenging disease process to both diagnose and treat. Proper diagnosis and treatment requires a thorough understanding of the current literature.

http://ift.tt/2mNw79z

Comparing performance of Fastrach ILMA vs flexible bronchoscope for awake intubation

In the recent article by Hanna et al. [1] comparing the performance of Fastrach intubating laryngeal mask airway (ILMA) and flexible bronchoscopy (FB) for awake intubation in patients with difficult airways, they showed that the Fastrach ILMA compared to the FB provided a higher first-pass success rate (95% vs 58%) and a shorter mean time to intubation (92 vs 246s). Given that awake intubation is a cornerstone for safe management of predicted or known difficult airways, their findings have potential implications.

http://ift.tt/2mpoaER

New in vivo model to analyse the expression of angiogenic genes in the borders of a cleft lip

Defects in the fusion of facial buds can result from an anomaly in tissue development or apoptosis, or both. Our working hypothesis was that anomalies in the development of tissues could be caused by a genetic angiogenic defect. Our main objective was to design a reproducible experimental model to study the expression of angiogenic genes in the borders of cleft lips with or without cleft palate. We therefore prospectively studied seven non-syndromic patients, three with a cleft lip (2 right, 1 left), and four with a cleft lip and palate (1 bilateral, 2 right, 1 left), with no CGH (comparative genomic hybridisation) array, who had primary operations to repair their clefts.

http://ift.tt/2m65aJM

Our auditory results using the Vibrant Soundbridge on the long process of the incus: 20 years of data

After 20 years of experience with different types of middle ear implants, we analyzed our database about the Vibrant Soundbridge (VSB) to know the rate of complications, the effect on the residual hearing and the audiometric gain in our center.

http://ift.tt/2mplRSg

Addiction: an underestimated problem in psoriasis healthcare

Abstract

Background

Psoriasis is a disease of enormous socio-economic impact. Despite approval of numerous highly efficient and costly therapies, a minor proportion of severely affected patients actually receives sufficient treatment.

Objective

To investigate whether addictions are associated with psoriasis and to develop evidence-based recommendations for dermatologists in their daily clinical practice in order to improve medical assessment of psoriasis and patients' quality of life.

Patients and Methods

Psoriasis patients at the University Department of Dermatology were asked to fill out a paper-based self-reported anonymous questionnaire with 92 questions of validated screening tests for the six most common addictions in Germany (alcohol, nicotine, drugs and illegal drugs, gambling, food). Body weight and height as well as current Psoriasis Area and Severity Index (PASI) were documented as well.

Results

Between October 2015 and February 2016 102 patients (65 males, 37 females; mean age 49.7 years (SD 13.4), range 18 - 83 years) participated in the study. Fifty-seven of the 102 patients showed addictive behavior. Of these 23.8% were high risk drinkers, 41% regular smokers, 11% at risk of drug abuse, 4.1% at risk of food dependency, and 19% compulsive gamblers. Compared to the general population, these results are significantly higher for alcohol abuse (p < 0.005), nicotine (p < 0.001) and gambling (p < 0.001). Body-mass-index was significantly higher in the study population (p < 0.001).

Conclusion

Addictions and gambling are more prevalent in patients with psoriasis compared to the general population. Respective screening measures are recommended in daily practice for doctors treating psoriasis patients and PeakPASI is suggested as a score to document patients' lifetime highest PASI. Parallel to new drug approvals and even more detailed insights into the pathomechanism of psoriasis, public health strategies and interdisciplinary approaches are essential for a general sustained psoriasis treatment.

http://ift.tt/2nccgym

The clinical manifestations of vestibular migraine: A review

To provide an overview of vestibular migraines presentation, pathology, and diagnosis, as well as an update on current diagnostic criteria.

http://ift.tt/2mrvS2Z

Hypofractionated radiotherapy in older patients with non-melanoma skin cancer: Less is better

Abstract

Radiotherapy is a non-surgical option for patients with non-melanoma skin cancer. Lesions in middle-aged to older patients with good performance status are typically prescribed 4–5 weeks of outpatient weekday treatment. Daily radiotherapy fraction sizes of 2–3 Gy are recommended to decrease the late cutaneous consequences such as in-field hypopigmentation and telangiectasia. In elderly, often unwell patients, these concerns are less of an issue and larger fraction sizes (5–7 Gy), referred to as hypofractionation, can be delivered over a shorter time yet still achieve excellent in-field control and improve a patient's quality of life and avoid the need for surgery. The three case studies presented illustrate this approach along with a review of the evidence to support this.

http://ift.tt/2n5kkE3

New in vivo model to analyse the expression of angiogenic genes in the borders of a cleft lip

Publication date: Available online 9 March 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): C. François, M.L. Poli-Merol, C. Tournois, P. Cornillet-Lefebvre, T. Guillard, Z. Djerada, M. Doco Fenzy, P. Nguyen
Defects in the fusion of facial buds can result from an anomaly in tissue development or apoptosis, or both. Our working hypothesis was that anomalies in the development of tissues could be caused by a genetic angiogenic defect. Our main objective was to design a reproducible experimental model to study the expression of angiogenic genes in the borders of cleft lips with or without cleft palate. We therefore prospectively studied seven non-syndromic patients, three with a cleft lip (2 right, 1 left), and four with a cleft lip and palate (1 bilateral, 2 right, 1 left), with no CGH (comparative genomic hybridisation) array, who had primary operations to repair their clefts. We also used four controls (cultured fibroblasts from healthy skin samples). The mean (range) age at operation was 44 (13-77) days. We studied the lateral and medial borders histologically and did qPCR (quantitative real-time polymerase chain reaction) analysis for gene expression with 22 genes of interest (and two housekeeping genes) involved in cleft lip and angiogenesis. The qPCR analysis found significant (p<0.05) overexpression of eight genes in the medial border and seven in the lateral border, and underexpression of nine genes in the medial, and ten in the lateral border. The difference in expression between the two borders was not significant. This preliminary study has enabled us to develop a new method to analyse the expression of angiogenic genes in the borders of cleft lips.

http://ift.tt/2m8tQ5p

Incidence of hidradenitis suppurativa in the United States: A sex- and age-adjusted population analysis

The true incidence of hidradenitis suppurativa (HS) is unknown.

http://ift.tt/2nkIqaf

Calciphylaxis: Comparison of radiologic imaging and histopathology

The current gold standard for diagnosis of calciphylaxis is a skin biopsy specimen demonstrating calcification of small-caliber arteries or arterioles.

http://ift.tt/2lJmqcK

Pediatric Stevens-Johnson syndrome and toxic epidermal necrolysis in the United States

Little is known about the epidemiology of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in children.

http://ift.tt/2nl4Fwm

Histopathological changes in morphea and their clinical correlates: Results from the Morphea in Adults and Children Cohort V

Histopathological features in morphea (localized scleroderma) and their clinical correlates are poorly described.

http://ift.tt/2lJe3he

A Comparative Study of Pharyngeal Repair in Two Layers Versus Three Layers, Following Total Laryngectomy in Carcinoma of Larynx

Abstract

Larynx is the second most common site for cancer in the upper aerodigestive tract. One of the dreaded complications following total laryngectomy has been pharyngo cutaneous fistula (PCF). PCF merits special attention due to its significant negative impact on the recovery process. Total laryngectomy profoundly alters speech. Effective voice restoration is essential for the rehabilitation of these patients. Inadequate consensus exists as to the best technique of pharyngeal repair to decrease incidence of PCF and ensure good quality voice following total laryngectomy. 21 patients were included in the study for total laryngectomy with trachea oesophageal voice prosthesis placement. Patients were randomised into 2 groups. Group A had their pharynx repaired in two layers and Group B had it done in three layers. Post operatively the patients were followed up for a period of 12 months to look for incidence of PCF. Subjective and objective evaluation of voice was done. 9.52% of patients developed PCF. All of the cases of PCF were in the group repaired in three layers. In cases with repair by two layers the mean Voice Handicap Index 10 (VHI 10) score was 19.27 and those with three layers pharyngeal repair was 23.20. Average maximum phonation time amongst the study population was 13.09. In three layers and two layers pharyngeal repair the average maximum phonation time was 12.56 and 13.58 respectively. Surgical repair of pharynx in two layers excluding the third layer of pharyngeal musculature reduces the chance of PCF. Two layers pharyngeal repair supplemented by cricopharyngeal myotomy led to significantly better voice outcome.

http://ift.tt/2niLgw9

Urothelial carcinoma in first histological diagnosis of patients over 80 years has distinctive histological features: a retrospective single-institution study of 185 patients

Abstract

Few histological data are known about patients with a first diagnosis of bladder cancer (BC) at the age ≥80 years. We describe the largest series in this patient group and their distinctive histological features. This unicentric retrospective study included patients at the age ≥80 years with a first diagnosis of bladder cancer between 2005 and 2015. All diagnosis was made by one senior uropathologist according to the WHO 2016 classification, pTNM 7th edition 2009. We examined samples of 185 patients, sex ratio M:W = 2.49:1, with ≥80 years at the time of first diagnosis of BC. The mean age was 85.1 years (84.8 for men and 85.8 for women). One hundred sixteen patients were diagnosed with NMIBC (non-muscle invasive bladder cancer) (62.7%). Sixty-nine patients were detected with MIBC (muscle invasive bladder cancer) (37.3%). In the MIBC, 20 (29.0%) cases, a divergent differentiation was reported. No patient had primary carcinoma in situ (Cis) at time of diagnosis, and concomitant Cis was observed in 18.9% (35 cases). According to our results, the histopathological findings are different from those of other patients' groups. The study shows a higher number of MIBC and a high percentage of histological variants. We could show distinctive pathological features in this patient group.

http://ift.tt/2moVWtR

Physiologie der Kopfhaut

Zusammenfassung

Hintergrund

Die menschliche Kopfhaut unterscheidet sich grundlegend von behaarter Haut anderer Körperregionen. Strukturell bietet die Kopfhaut einen effektiven Schutz vor Wasserverlust und trägt aufgrund der ausgeprägten Vaskularisation zur Regulation des Wärmehaushaltes bei. Die Innervation der Kopfhaut erfolgt über den Trigeminus-Nerv.

Fragestellung

Ein Großteil der Bevölkerung beklagt „empfindliche" Kopfhaut. Dazu beitragende sensorische, regionale, ethnische und pathologische Parameter sind weitestgehend ungeklärt.

Material und Methoden

Es erfolgten quantitative sensorische Tests und oberflächliche Substanzapplikation.

Ergebnisse

Es bestehen besonders hohe sensorische Schwellenwerte auf thermische und mechanische Reize in der Scheitelmitte im Vergleich zur Region des Hinterhauptes oder behaarter Haut von Rumpf und Extremität. Vermehrt überempfindliche Kopfhaut kommt in asiatischer Bevölkerung und unter pathologischen Bedingungen, z. B. bei Alopezie, Schuppenflechte oder Migräne, vor.

Schlussfolgerungen

Mögliche Ursachen „empfindlicher" Kopfhaut sind eine erleichterte transdermale Penetration von Irritanzien, eine veränderte neuronale Innervationsdichte, Rezeptorexpression für Reize oder periphere und zentrale Sensibilisierungsprozesse sensorischer Afferenzen.

http://ift.tt/2mGmkBI

The efficacy of resection of an intradural extramedullary foramen magnum cavernous malformation presenting with repeated subarachnoid hemorrhage: a case report

Intradural extramedullary cavernous angiomas of the central nervous system are a rare type of cavernous angioma, but they can cause fatal subarachnoid hemorrhage. The efficacy of resection for this type of cav...

http://ift.tt/2mqZopz

Children with atopic dermatitis and frequent emollient use have increased urinary levels of low molecular weight phthalate metabolites and parabens

Abstract

Background

Parabens may be added to cosmetic and personal care products for preservation purposes. Low-molecular weight (LMW) phthalate diesters function as plasticizers, fixatives or solvents in such products, but may also be found in small quantities as contaminants from plastic containers.

Objective

To evaluate the association between emollient use, atopic dermatitis and FLG mutations, respectively, with urinary concentrations of phthalate metabolites and parabens in Danish children.

Methods

845 Danish children 4-9 years of age were studied. Urinary concentrations of phthalate metabolites and parabens were determined, and children were genotyped for common FLG loss-of-function mutations. Information about atopic dermatitis and use of emollients was obtained from questionnaires completed by parents.

Results

The prevalence of atopic dermatitis was 16.1%. Phthalate metabolite and paraben levels were generally higher in children with frequent use of emollients compared to uncommon users, reaching statistical significance for some LMW phthalates and parabens. While there was no association with common FLG mutations, children with atopic dermatitis had significantly higher urinary levels of one LMW phthalate and two parabens, respectively, when compared to children without atopic dermatitis.

Conclusion

Emollient use and atopic dermatitis were associated with modestly increased internal LMW phthalate and paraben exposure in 4-9 year old children. It is unknown whether the difference is explained by increased use of the specific emollients that are used to treat pruritic and inflamed skin, and/or whether the impaired skin barrier allows chemicals to penetrate more easily. Moreover, the putative toxicological burden is unknown.

http://ift.tt/2mMD8HF

Isolated malleus handle fracture: Two case reports

Publication date: Available online 9 March 2017
Source:Egyptian Journal of Ear, Nose, Throat and Allied Sciences
Author(s): Abdou Sy, Eric Joël Regonne, Malick Ndiaye, Marie Paule Thill
An isolated malleus handle fracture is a rare ossicular injury; around 83 cases have been reported in the literature. We report two cases of isolated malleus handle fracture received in our department and review the main causes, the current diagnostic work-up and treatment options.

http://ift.tt/2lIM0OI

Expression of neprilysin in periodontitis-affected gingival tissues

Publication date: July 2017
Source:Archives of Oral Biology, Volume 79
Author(s): A. Nezu, T. Kubota, S. Maruyama, M. Nagata, K. Nohno, T. Morozumi, H. Yoshie
ObjectiveAlthough the pathogeneses of Alzheimer's disease (AD) and periodontal diseases have overlapping features, including ageing and chronic inflammation, the association between AD and periodontitis remains unclear. To explore the pathogenesis of periodontitis, a comprehensive gene expression/transcriptome analysis in periodontitis-affected gingival tissues found that the AD pathway was significantly up-regulated in periodontitis-affected gingival tissues. AD-related genes, amyloid beta precursor protein (APP), interleukin-1 beta and compliment 1QA, were significantly elevated in periodontitis. In the present study, balance between mRNA expression of APP and a potent amyloid degradation enzyme, neprilysin (NEP), as well as protein localisation of APP and NEP were analysed.DesignEighteen periodontitis-affected and 18 clinically healthy control gingival tissues were taken from patients with severe chronic periodontitis or undergoing tooth extraction. Total RNA was purified and used for quantitative reverse transcription real-time polymerase chain reaction (qRT-PCR). The localisation of APP and NEP was analysed by immunohistochemistry (IHC).ResultsBoth APP and NEP genes were up-regulated in periodontitis-affected gingival tissues. APP-expressing macrophages and NEP-expressing neutrophils and fibroblasts, reflecting inflammatory stages, were detected in inflamed gingival tissues by IHC.ConclusionThe up-regulation of APP and NEP mRNA levels in periodontitis-affected gingival tissues compared with healthy controls was confirmed by qRT-PCR analyses. Since NEP is one of the primary enzymes that degrades amyloid beta, increased NEP mRNA levels in periodontitis may act as an inhibitor of amyloid beta accumulation in gingival tissues, balancing increased APP mRNA expression. However, NEP has several effects including degradation of vasoactive substances; therefore, further sresearch is needed.

http://ift.tt/2mMhseE

Expression of neprilysin in periodontitis-affected gingival tissues

Inside EMS Podcast: The difference between CPAP and BiPAP

&amp;lt;!--cke_bookmark_120S--&amp;gt;&amp;lt;!--cke_bookmark_120E--&amp;gt; Download this podcast on iTunes, SoundCloud or via RSS feed In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson are joined at the guest table with Paul Werfel. Werfel has 14 years of experience as a paramedic and is the paramedic program director at ...

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Time-dependent effect of E. coli LPS in spleen DC activation in vivo: Alteration of numbers, expression of co-stimulatory molecules, production of pro-inflammatory cytokines, and presentation of antigens

Publication date: May 2017
Source:Molecular Immunology, Volume 85
Author(s): Li Xu, Minseok Kwak, Wei Zhang, Peter Chang-Whan Lee, Jun-O. Jin
Lipopolysaccharide (LPS) is a well-known stimuli of dendritic cells (DCs). However, in vivo spleen DC maturation by Escherichia coli (E.coli) LPS has not been fully investigated. In this study, we examined the effect of LPS on the activation of spleen DCs and its subsets in a time-dependent manner on mice in vivo. The frequency, number and migration of spleen conventional DCs (cDCs) were increased 6 and 12h after completion of LPS treatment. Those increased DC numbers in spleen were then gradually decreased with apoptosis of the DCs. The highest levels of co-stimulatory molecule expression in the spleen cDCs and their subsets occurred 18h after LPS treatment, while the pro-inflammatory cytokines reached their maximum in the intracellular levels of the spleen cDCs and their subsets 3h after LPS treatment. The antigen presentation of the spleen cDCs and their subsets increased gradually from 3 to 12h after LPS treatment, but those levels decreased rapidly after 18h post-LPS treatment. Thus, by highlighting the importance of time in the stimulation of spleen DCs by LPS in mice in vivo, our data provided a model that could be used by immunologists when considering the manipulation of DC functions in vivo for experimental and clinical applications.

http://ift.tt/2mo7xte

Evaluation of the Efficacy of A Metal Artifact Reduction Algorithm in Different CBCT Scanning Parameters

Publication date: Available online 9 March 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Polyane Mazucatto Queiroz, Francisco Carlos Groppo, Matheus Lima Oliveira, Francisco Haiter-Neto, Deborah Queiroz Freitas
ObjectiveThe aim of this study was to evaluate the efficacy of a metal artifact reduction (MAR) algorithm in CBCT images of dental materials obtained with different field-of-view (FOV) and voxel sizes.MethodologyTwo imaging phantoms were custom-made of acrylic resin. Each phantom had three cylinders made of the same dental material: dental amalgam or copper-aluminum alloy. CBCT scans were obtained separately for each of the imaging phantoms using the Picasso-Trio CBCT unit at four FOV sizes and two voxel sizes. Each imaging phantom was scanned with and without MAR. All images were evaluated in the OnDemand3D software and image noise (gray value variability) was calculated as the standard deviation of the gray values of regions of interest around the dental material cylinders. Data were compared by the Friedman test and Dunn's post hoc test (α=0.05). Intraclass correlation coefficient (ICC) was calculated to assess intra-observer reliability.ResultsMAR significantly reduced (p<0.05) image noise around the dental materials, irrespective of FOV and voxel sizes, with an ICC of 0.997.ConclusionThe efficacy of MAR was similar for the different FOV and voxel sizes studied. Hence, imaging protocols and the use of MAR algorithm should be based on the selection criteria.

http://ift.tt/2njBLg7

Are dental and jaw bone changes more prevalent in a Brazilian population with sickle cell anemia?

Publication date: Available online 9 March 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Halinna Larissa Cruz Correia de Carvalho, José Yagoh Saraiva Rolim, Érika Bárbara Abreu Fonseca Thomaz, Soraia de Fátima Carvalho Souza
ObjectiveTo analyze the prevalence of dental and jaw bone changes in individuals with sickle cell anemia (SCA) compared to a control group from a Brazilian population.Study designThis was a retrospective cross-sectional study. Participants were divided into two groups: SCA and control (123 patients per group). Intraoral periapical radiographs were taken. Changes in bone pattern and dental changes were investigated using the following radiographic parameters: 1) trabecular bone (step-ladder or spider web); 2) integrity of the lamina dura (loss of sharpness and continuity, partial or complete absence, and increased thickness); and 3) dental changes (pulp chamber, root surface, periapex, dental form, number, and position). Fisher's exact and chi-square tests were used to compare frequencies and the Mann-Whitney test was used to compare medians (P<0.05).ResultsStep-ladder (P<0.001) and spider-web patterns (P<0.001) in jaw trabecular bone were more common in individuals with SCA than in the control group. Loss of lamina dura was more frequent in SCA than in control individuals (P=0.021). Dental changes were not different between groups (P>0.05), even though the prevalence of hypotaurodontism was twice as high in SCA as in controls (P=0.086).ConclusionsThe prevalence of jaw bone changes is higher in SCA individuals.

http://ift.tt/2lInVaM

Computational fluid dynamics and trigeminal sensory examinations of empty nose syndrome patients

Objective

The precise pathogenesis of empty nose syndrome (ENS) remains unclear. Various factors such as nasal aerodynamics and sensorineural dysfunction have been suspected, although evidence is limited. This study reported the first examination of both nasal aerodynamics and trigeminal sensory factors in actual ENS patients.

Study Design

Prospective case control.

Methods

We enrolled six patients diagnosed with ENS. Three patients had pre- and post-inferior turbinate (IT) reduction computed tomography scans, which allowed comparison of their nasal aerodynamics changes through computational fluid dynamic (CFD) simulation. Their symptoms were confirmed through Sino-nasal Outcome Test-22, ENS 6-item Questionnaire, acoustic rhinometry, and rhinomanometry findings. Nasal trigeminal sensitivity that potentially mediates their perception of airflow was assessed via menthol lateralization detection thresholds (LDT) and compared with 14 healthy controls.

Results

Post-surgical reductions in nasal resistance were observed and significantly lower than normal (P < 0.05). Computational fluid dynamic analysis showed that, paradoxically for all ENS patients, IT reduction did not draw more airflow to the airway surrounding the ITs, but rather resulted in nasal airflow forming into a narrow jet toward the middle meatus region, leaving the airway surrounding the IT with significantly reduced airflow intensity and air–mucosal interactions (inferior region flow percentage reduced from 35.7% ± 15.9% to post-surgery 17.7% ± 15.7%, P < 0.05; inferior wall-shear-stress reduced from 7.5 ± 4.2 × 10⁻² Pa to 3.4 ± 3.1 × 10⁻² Pa, P < 0.01). Empty nose syndrome patients also had significantly impaired menthol LDT compared to healthy controls (P < 0.005).

Conclusion

The results indicated that a combinatory of factors, including paradoxically distorted nasal aerodynamic, impaired sensorineural sensitivity, and potential predisposing conditions, may contribute to the development of ENS.

Level of Evidence

3b. Laryngoscope, 2017

http://ift.tt/2naT3wH

5 essential tips for managing pediatric airways

The following is paid content sponsored by Ambu. By Jonathan Lee for EMS1 BrandFocus Prehospital providers of all levels take tremendous pride in their airway skills. But that confidence and expertise does not always extend to managing children. Children make up a fraction (7 to 13 percent) of most normal 911 call volume, and only 4.5 percent of those require airway management. Follow these five tips ...

http://ift.tt/2njrpgD

A Systematic Review and Critical Evaluation of Reported Pathogenic Sequence Variants in Hidradenitis Suppurativa

Abstract

Introduction

Hidradenitis Suppurativa (HS) is a severe chronic inflammatory disorder characterised by recurrent painful deep seated nodules with a predilection to the apocrine bearing areas of skin. A minority of cases of HS are due to mutations in the gamma secretase complex. Contention exists surrounding the pathogenicity of sequence variants and their effects upon notch signalling.

Methods

This systematic review was registered with PROSPERO (CRD42016041425) and was conducted in line with the PRISMA statement. Eligibility criteria for this review included published case reports, case series and reviews which identified sequence variants or protein/functional studies from patients with HS.

Results

62 articles reporting a total of 41 sequence variants (heterozygous missense (9 variants), splice site (9 variants), insertion resulting in frameshift (1 variant) Premature Termination Codons (19 variants), promoter region PSTPIP1 (3 variants)) with 18 associated protein/functional studies. The American College of Medical Genetics (ACMG) standards and guidelines on the interpretation of sequence variants were applied to each identified variant to assess evidence for pathogenicity. 23 variants were assessed as likely pathogenic, 17 were of uncertain significance and 1 benign.

Discussion and Conclusions

The large number of variants of 'uncertain significance' is largely due to the variable number of functional studies. Four studies used notch as a proxy for gamma secretase function with conclusions of non-pathogenicity based upon the assumption of Notch signalling as the sole pathogenic process. The role of notch independent signalling mechanisms requires further research. Limitations to this study include identification of variants of Mendelian inheritance and not complex polygenic traits.

http://ift.tt/2naNBtI

Beyond the BRAFV600E hotspot - Biology and clinical implications of rare BRAF gene mutations in melanoma patients

Abstract

BRAF mutations can be found in approximately 50% of melanomas, whereas the most common BRAF mutation is the substitution of a valine residue at codon 600 to glutamic acid. BRAF^V^600E occurs in up to 95% of all melanoma cases and can be successfully blocked by using a combination of BRAF- and MEK-inhibitors. Due to the wider availability of next-generation sequencing, more non-V600 BRAF mutations are emerging, and the clinical implications of these mutations are widely unknown. In this review, we will discuss the biology of the MAPK-pathway and its different types of BRAF mutations as well as their effect on MEK activation. Current literature will be reviewed including in-vitro data, case reports and case series.

http://ift.tt/2n4qJ2B

Treatment of Laryngopharyngeal Reflux May Decrease Subjective Symptoms of Nasal Congestion and Objective Measures of Nasal Resistance

Gastroesophageal reflux disease (GERD) is highly prevalent, and its most common symptoms, including heartburn and regurgitation, may be present in up to 45% of the population. Laryngopharyngeal reflux (LPR) is an extraesophageal manifestation of GERD that may be present in up to 10% of patients presenting for ambulatory otolaryngology visits. Typical symptoms that have been attributed to LPR include globus sensation, laryngospasm, throat clearing, and hoarseness. Moreover, it has been postulated that mucosal inflammation due to LPR may extend beyond the larynx and oropharynx to the nasopharynx and nasal cavity, contributing to the pathogenesis of sinonasal diseases. For example, an association between chronic rhinosinusitis (CRS) and GERD has been shown through epidemiologic studies that have found high rates of pharyngeal reflux in CRS, as well as the finding of digestive enzymes in the nasal secretions of patients with CRS. Despite this, few studies have objectively examined the effect of treatment of LPR on sinonasal symptoms.

http://ift.tt/2mFnQnG

Antireflux Medication and Laryngopharyngeal Reflux in Nasal Resistance

This case-control study describes the association of oral antireflux medication with laryngopharyngeal reflux and nasal resistance.

http://ift.tt/2m6WmV4

Definition of Close Surgical Margins in SCC of the Oral Tongue

This study evaluates specimens of squamous cell carcinoma of the oral tongue and compares close resection margins of less than 5.0 mm vs less than or equal to 2.2 mm for determination of risk for local recurrence as a positive margin.

http://ift.tt/2mFsmCy

Experience of US Patients Who Self-identified Overdiagnosed Thyroid Cancer

This qualitative study describes the experience of US patients who independently self-identify as having an overdiagnosed cancer and elect not to intervene.

http://ift.tt/2m7dauU

Novel risk factors related to cancer in scleroderma

Publication date: Available online 8 March 2017
Source:Autoimmunity Reviews
Author(s): David Bernal-Bello, Jaime García de Tena, Alfredo Guillén-del Castillo, Albert Selva-O'Callaghan, Eduardo L. Callejas-Moraga, Ana María Marín-Sánchez, Vicent Fonollosa-Pla, Carmen Pilar Simeón-Aznar
ObjectiveEmerging data have shown an increased risk of malignancy among patients diagnosed with systemic sclerosis (SSc) so identification of risk factors linking both disorders might have prognostic implications. The aim of this study was to assess the clinical and treatment-related risk factors for cancer in a single-center cohort of patients with SSc.MethodsDemographic, clinical, capillaroscopic, immunological and treatment-related data from 432 consecutive SSc patients were retrospectively analyzed. Variables that reached significant association in the univariate analysis were entered into a logistic regression in order to identify independent risk factors for cancer.ResultsMalignancy was diagnosed in 53 patients (12.2%). Fifty-eigth neoplasms were identified, among which breast (n=15), lung (n=10) and hematologic (n=9) malignancies were the most prevalent. In 19 patients the diagnosis of both scleroderma and tumour was made in <3years apart. Cancer significantly decreased the probability of survival (OR=2.61; 95%CI 1.46–4.69; p=0.001). No association with age, sex, smoking, cutaneous subset or RNA polymerase-III antibodies was found. However, risk of cancer was directly associated with the presence of anti-PM/Scl antibodies (OR=3.90; 95%CI 1.31–11.61; p=0.014), and inversely related to aspirin use (OR=0.33; 95%CI 0.12–0.90; p=0.031), which remained as independent risk factors for cancer on multivariate analysis.ConclusionsPM/Scl antibodies seem to be associated with a higher risk of cancer in scleroderma. In contrast, the use of aspirin is related to a lower risk of cancer in our series. More studies are needed to ascertain the role of anti PM/Scl antibodies and aspirin in the development of malignancy among patients with SSc.

http://ift.tt/2mKSGfd

Case 7-2017: A 73-Year-Old Man with Confusion and Recurrent Epistaxis

Presentation of Case. Dr. Jeffrey L. Greenwald: A 73-year-old man with multiple chronic medical illnesses was admitted to this hospital because of confusion and irritability. Two days before this admission, increasing weakness, lethargy, chills, and diarrhea developed. The patient became less…

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International Journal of Otolaryngology and Head & Neck SurgeryVol.6,No.1 (January 2017)

Primary Laryngeal Amyloidosis: A Case Report
Laryngeal Amyloidosis, Amyloid, Localized Amyloidosis
Paper Information Full Paper: PDF (Size:590KB)
DOI: 10.4236/ijohns.2017.61001

Incidence of Malignancy in Asymmetrical Tonsillar Enlargement
Tonsil, Asymmetry, Enlargement, Malignancy, Tonsillectomy
Paper Information Full Paper: PDF (Size:831KB)
DOI: 10.4236/ijohns.2017.61002

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International Journal of Otolaryngology and Head & Neck SurgeryVol.5,No.6 (November 2016)

Pleomorphic Adenoma of the Hard and Soft Palate: A Case Presentation and Literature Review of Minor Salivary Gland Neoplasms
Minor Salivary Glands, Palate Tumor, Intraoral Tumors, Pleomorphic Adenoma
Paper Information Full Paper: PDF (Size:495KB)
DOI: 10.4236/ijohns.2016.56033

Correlations between Videostroboscopy and Constant Light Examination with Intraoperative Findings and Histopathology—Our Experience
Stroboscoby, Video Laryngoscopy, Fibreopticlaryngo-Pharyngoscopy, Histology
Paper Information Full Paper: PDF (Size:1219KB)
DOI: 10.4236/ijohns.2016.56034

Giant Fibrous Epulis: A Case Report of a Benign Mass of the Oral Cavity
Epulis, Pedunculated Mass, Gingival Disease, Oral Pathology, Diagnosis
Paper Information Full Paper: PDF (Size:427KB)
DOI: 10.4236/ijohns.2016.56035

Radiation-Induced Spinal Glioblastoma Multiforme: A Rare Complication in the Management of Head and Neck Cancer
Central Nervous System, Spinal Cord, Glioblastoma Multiforme, Radiation Induced, Head and Neck Cancer
Paper Information Full Paper: PDF (Size:706KB)
DOI: 10.4236/ijohns.2016.56036

http://ift.tt/2m3QcEl

Anomalous origin of the circumflex coronary artery presenting with ventricular fibrillation cardiac arrest

We report a case of an incidental finding of an anomalous left circumflex coronary artery arising from the right pulmonary artery that effectuated a ventricular fibrillation cardiac arrest in a woman aged 34 years. This rarity was detected during routine work-up to delineate the cause of this arrhythmia. Our patient had a background of double-outlet right ventricle and a ventricular septal defect, which was repaired with a Dacron patch and a left ventricle patch over to the aorta at age 14 months. Angiographic study at the time of her presentation showed anomalous origin of the left circumflex artery originating from the right pulmonary artery; this was discussed in multispecialty team meeting and surgical intervention was recommended; eventually, surgery was performed with reimplantation of the anomalous circumflex artery into the ascending aorta. We highlight the importance of early angiographic studies in patients with known congenital heart defects and emphasise the optimal strategy of treatment.

http://ift.tt/2m3Dkhk

Bumpy road to the diagnosis of polycythaemia vera

Polycythaemia vera (PV) is the most common myeloproliferative neoplasm, characterised by increased red cell mass that can present as an unspecified symptom or a thrombohaemorrhagic event. Its diagnosis is based on the presence of erythrocytosis, the identification of the Janus kinase 2 mutation and bone marrow aspirate or biopsy alterations. The challenge of this disease lies on the treatment approach. Its cornerstone is phlebotomy, but depending on the vascular risk, it can include cytoreductive agents, low-dose aspirin or even anticoagulation. We present the case of a 75-year-old woman, whose inaugural presentation of PV was an arterial peripheral occlusion followed by three recurrent events in the same arterial region and a pulmonary embolism. A phlebotomy was initially performed and, after the diagnosis was made, the patient was initiated on low-dose aspirin and anticoagulation with favourable outcome.

http://ift.tt/2lHD2RX

Phentermine induced acute interstitial nephritis

Acute interstitial nephritis (AIN) has a number of medication-related aetiologies. Antibiotics, proton pump inhibitors and non-steroidal anti-inflammatory drugs are common causes; however, any medication has the potential to cause drug-induced AIN. We report the first case of phentermine-induced AIN. A Caucasian woman aged 43 years presented with a 5-week history of lethargy, left-sided lower abdominal pain, nausea and vomiting. She had been taking phentermine for weight loss for 9 months and had recently ceased the medication. The patient underwent a renal biopsy that showed a predominantly lymphohistiocytic interstitial infiltrate with a moderate number of eosinophils consistent with AIN. Phentermine is increasingly used for weight loss in obese patients. This is the first case implicating phentermine as the causative agent for drug-induced AIN. While rare, phentermine-induced AIN is a possible adverse reaction of phentermine. Physicians and patients need to be aware of this risk.

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Paediatric chronic recurrent multifocal osteomyelitis

Description

A previously healthy girl aged 15 years presented with a 3-month history of low back pain, lethargy, morning stiffness and nocturnal back discomfort. She had no significant history of weight loss, infective symptoms or neurological symptoms, including bladder or bowel incontinence. There was no recent travel history.

Examination revealed normal temperature and mild focal tenderness over the midline lumbar spine, with normal range of motion. There was isolated weakness in left hip flexion, and no other neurological findings. Blood tests showed a normal white cell count (6.6x10⁹/L), elevated erythrocyte sedimentation rate (38 mm/hour) and slightly elevated C reactive protein (11 mg/L, normal<10 mg/L). X-rays were unremarkable. A limited CT of L3 showed diffuse sclerosis of its spinous process with areas of lytic destruction and mild effacement of the paravertebral fat pads (figure 1). Serial blood cultures were negative for microorganisms. Subsequent empirical antibiotics with intravenous flucloxacillin were initiated...

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Segmental upper mid-basilar artery sacrifice in a child using a Micro Vascular Plug device for treatment of a basilar arteriovenous fistula compressing the brainstem

Summary

This case demonstrates a rare pathology of basilar artery pial arteriovenous shunting presenting with acutely progressive symptoms of brainstem compression, in which we applied a polytetrafluoroethylene-coated embolic device to achieve short-segment upper mid-basilar artery sacrifice. In addition to presenting a rare form of basilar arteriovenous fistula (AVF) (likely related to hereditary hemorrhagic telangiectasia) and discussing the extreme management challenges, this case demonstrates the unusual but successful application of a novel neurovascular device. Unanswered questions include the mechanism of development of this pathology and the optimum post-embolization anticoagulation plan.

Background

Reports of pial arteriovenous fistulas (AVFs) that occur in the posterior fossa are quite rare, occasionally appearing in general pial AVF case series or as individual case reports;1–6 in particular, direct AVFs originating off the basilar artery have not previously been reported. We present...

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Unilateral cutaneous congestion induced by Valsalva manoeuvre due to vascular malformation

Description

A man aged 37 years presented with hip osteoarthritis with avascular femoral head necrosis due to chronic alcohol use. He had spinal arteriovenous fistula (AVF) which was diagnosed with spinal angiography (figure 1A, B) and spinal MRI (figure 2) 30 years prior. The lesion was not completely treated by surgical intervention at that time. On examination, Valsalva manoeuvre showed a reversible and rapid change in colour of his unilateral chest wall (figure 3A, B and video 1). Contrast-enhanced CT of the chest on the same location revealed cutaneous vascular malformation (figure 4). The dermatome level exactly also corresponded to the dermatome level of spinal AVF.

Figure 1

Spinal angiography revealed spinal arteriovenous fistula (AVF) (A) before and (B) after.

Figure 2

Spinal MRI showed spinal arteriovenous fistula.

...

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Myxoedema in a patient with achondroplasia in rural area of Guatemala

A 43-year-old indigenous Guatemalan woman with achondroplasia presented to our clinic with chronic fatigue and generalised oedema. She had limited contact with the formal healthcare system. However, 1 year prior, she had sought medical evaluation from a private physician. Her symptoms had been attributed to a combination of heart failure and physical disability due to the musculoskeletal complications of her achondroplasia. She was lost to follow-up due to inability to pay for further testing or treatment. On initial laboratory evaluation in our clinic, she was found to have a thyrotropin level greater than assay. With initiation of oral levothyroxine supplementation, her dyspnoea and oedema completely resolved. The case illustrates how indigenous patients in rural Guatemala experience many barriers to accessing high-quality medical care. As a result, presentations of common illnesses are often very advanced and definitive diagnoses and treatments are frequently delayed.

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A Trial to Evaluate the Safety of Once Weekly Dosing of Somapacitan (NNC0195-0092) and Daily Norditropin® FlexPro® for 52 Weeks in Previously Human Growth Hormone Treated Japanese Adults With Growth Hormone Deficiency

Conditions: Growth Hormone Disorder; Adult Growth Hormone Deficiency
Interventions: Drug: somapacitan; Drug: Norditropin
Sponsor: Novo Nordisk A/S
Recruiting - verified March 2017

http://ift.tt/2n3wmxY

Dacomitinib (PF-00299804) in Advanced/Metastatic Squamous Cell Carcinoma of the Penis

Conditions: Penile Neoplasms; Carcinoma, Squamous Cell
Intervention: Drug: Dacomitinib
Sponsors: Fondazione IRCCS Istituto Nazionale dei Tumori, Milano; Pfizer
Recruiting - verified March 2017

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Effective spray for topical anesthesia with fiberscope

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Perioperative risk factors for death among patients with symptomatic pulmonary thromboembolism

Abstract

Perioperative pulmonary thromboembolism (PTE) is a fatal complication that may occur in patients who are undergoing surgery. This study aimed to identify risk factors for PTE-related death. This study evaluated data for the most recent 5-year period (2007–2011) from the Japanese Society of Anesthesiologists' database of patients who experienced perioperative PTE. We compared patients who died within 30 days of onset and patients who survived for > 30 days, and used logistic regression analysis to identify the independent risk factors. We identified 1894 patients who experienced PTE; 294 patients died within 30 days and 1600 patients survived for > 30 days. Univariate analyses revealed that PTE-related death was significantly associated with male sex, an age of ≥ 80 years, bedridden status, and trauma or heart failure. Survival was significantly associated with the use of anticoagulant therapy, obesity, and a recent history of venous thromboembolism. Logistic regression analyses revealed that male sex, an age of ≥ 80 years, bedridden status, heart failure, and the non-use of anticoagulant therapy were independent risk factors for PTE-related death. We found that male sex, an age of ≥ 80 years, bedridden status, heart failure, and the non-use of anticoagulant therapy were independent risk factors for perioperative PTE-related death. Therefore, appropriate interventions for bedridden patients and thromboprophylaxis using anticoagulants may help reduce the incidence of perioperative PTE-related mortality.

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Neue Aspekte bei der Entwicklung von Sonnenschutzmitteln

Zusammenfassung

Das Sonnenlicht ist für das Leben unersetzlich. Die Hautalterung wird durch genetische Aspekte bestimmt, aber auch durch den Einfluss der Sonnenstrahlung, die in allen Spektralbereichen freie Radikale in der menschlichen Haut erzeugt. Freie Radikale unterhalb einer kritischen Konzentration haben wichtige Aufgaben bei Signalprozessen innerhalb des menschlichen Organismus. Übersteigt die Konzentration der gebildeten freien Radikale jedoch einen kritischen Wert (FRTV), so kommt es zu Schädigungen im zellulären Bereich. Hautalterung, Immunsuppression und sogar Hautkrebs können die Folgen sein. Kürzlich konnte gezeigt werden, dass 50 % der freien Radikale, die durch die Sonnenstrahlung in der menschlichen Haut gebildet werden, im sichtbaren und infraroten Spektralbereich entstehen. Bedenkt man, dass Personen, die durch Sonnenschutzmittel geschützt sind, sich deutlich länger in der Sonne aufhalten, so können im sichtbaren und infraroten Spektralbereich Radikalkonzentrationen entstehen, die den kritischen Wert deutlich übersteigen. Filtersubstanzen wie sie zum Schutz der Haut im UV-Bereich bei Sonnenschutzmitteln eingesetzt werden, sind im sichtbaren und infraroten Spektralbereich nicht bekannt. Orientiert man sich jedoch an den natürlichen Schutzmechanismen der menschlichen Haut, so kann man durch den Einsatz von streuenden und reflektierenden Pigmenten, wie z. B. Titandioxid und durch Antioxidanzien, die die freien Radikale neutralisieren, einen sehr guten Schutzeffekt von Sonnenschutzmitteln erzielen. Sonnenschutzmittel durchlaufen derzeit eine Entwicklung vom UV-Schutz hin zum Schutz im gesamten Spektralbereich der Sonnenstrahlung.

http://ift.tt/2n3A6zp

Erstmanifestation eines Ulcus cruris

Zusammenfassung

Hintergrund

In Deutschland leiden mindestens 1 Mio. Menschen an einem Ulcus cruris. Unter dieser Diagnose werden sehr viele verschiedene Krankheitsbilder zusammengefasst. Die Therapie des Ulcus cruris ist eine interdisziplinäre und interprofessionale Herausforderung, da eine Vielzahl verschiedener Berufsgruppen involviert ist und eine frühzeitige Diagnose und kausale Therapie essenziell für den Heilungsverlauf sind.

Ziel der Arbeit

Ziele der Arbeit waren die Untersuchung des Erstmanifestationsalters von Patienten mit einem kausal sicher zugeordneten Ulcus cruris und die anschließende Berechnung der häufigsten Ätiologien nach Dekaden.

Material und Methoden

Die zugrunde liegenden Daten wurden monozentrisch prospektiv in einer Datenbank in dem Zeitraum von 2002 bis 2014 erhoben. Insgesamt konnten die Daten von 1000 Patienten mit einem Ulcus cruris aus der zertifizierten Wundambulanz der Hautklinik am Universitätsklinikum Essen ausgewertet werden.

Ergebnisse

Es konnten insgesamt 29 verschiedene Ätiologien differenziert werden. Etwa 70 % der Ätiologien waren vaskulärer Genese; 30 % waren seltene Ursachen. Die Anzahl verschiedener Ätiologien zeigte erhebliche Unterschiede bezogen auf die Erstmanifestation und das Auftreten in einzelnen Lebensdekaden. Insbesondere nichtvaskuläre Ätiologien wie ein Pyoderma gangraenosum oder eine Necrobiosis lipoidica zeigen sich bei jüngeren Patienten relativ gesehen häufiger als im Alter.

Diskussion

Mit den Erkenntnissen unserer Studie ist es besser möglich, anhand des Erstmanifestationsalters die zugrunde liegende Ätiologie einzugrenzen, um eine weiterführende Diagnostik gezielter einzusetzen. Somit können diese Informationen dazu beitragen, die knappen zeitlichen Ressourcen in der Praxis zu optimieren, und eine Hilfe zu der Vorhersagewahrscheinlichkeit der Ätiologie darstellen.

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A Comparative Study of Pharyngeal Repair in Two Layers Versus Three Layers, Following Total Laryngectomy in Carcinoma of Larynx

Abstract

http://ift.tt/2niLgw9

Virulence factors of fluconazole-susceptible and fluconazole-resistant Candida albicans after antimicrobial photodynamic therapy

Abstract

This study evaluated the effects of antimicrobial photodynamic therapy (aPDT) mediated by Photodithazine® (PDZ) and LED light on the virulence factors of fluconazole-susceptible (CaS) and fluconazole-resistant (CaR) Candida albicans. Standardized suspensions of strains were prepared (10⁷), and after 48 h of biofilm formation, these strains were incubated with PDZ (100 mg/L) for 20 min and exposed to LED light (660 nm, 37.5 J/cm²). Additional samples were treated with PDZ or light only, and the control consisted of biofilms that received no treatment. After aPDT, the cells were recovered and the virulence factors were evaluated. To analyze the capacity of adhesion, cells were recovered after aPDT and submitted to the adhesion process in the bottom of a 96-well plate. After this, metabolic activity tests (XTT assay) and cell viability (colony forming units per milliliter, CFU/mL) were applied. To evaluate the biofilm-forming ability after aPDT, the cells recovered were submitted to biofilm formation procedures, and the biofilm formed was evaluated by XTT, CFU/mL, and total biomass (crystal violet) tests. Lastly, the capacity for synthesizing protease and phospholipase enzymes after aPDT was evaluated by fluorimetric tests. Data were analyzed by two- or three-way ANOVA tests (p ≤ 0.05). It was verified that aPDT reduced the viability of both strains, fluconazole-susceptible and fluconazole-resistant C. albicans. It was also observed that the CaR strain had lower susceptibility to the aPDT when compared with the CaS strain. However, regarding the virulence factors evaluated, it was demonstrated that aPDT did not alter the adherence and biofilm formation ability and enzymatic production.

http://ift.tt/2m6npzz

Shear bond, wettability and AFM evaluations on CO 2 laser-irradiated CAD/CAM ceramic surfaces

Abstract

The purpose of this study is to determine the CO₂ laser irradiation in comparison with sandblasting (Sb), hydrofluoric acid (Hf) and silane coupling agent (Si) on shear bond strength (SBS), roughness (Rg) and wettability (Wt) of resin cement to CAD/CAM ceramics. Sixty (CAD/CAM) ceramic discs were prepared and distributed into six different groups: group A, control lithium disilicate (Li); group B, control zirconia (Zr); group C, Li: CO₂/HF/Si; group D, Li: HF/Si; group E, Zr: CO₂/Sb/Si; group F, Zr: Sb/Si. Result showed significant difference between irradiated and non-irradiated in terms of shear bond strength for zirconia ceramics (p value = 0.014). Moreover, partial surface wettability for irradiated and non-irradiated ceramics. Irradiated surface demonstrated more rough surface in lithium disilicate than zirconia ceramics. CO₂ irradiation could increase shear bond strength, surface roughness and wettability for both CAD/CAM ceramics.

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Histomorphologic and ultrastructural recovery of myopathy in rats treated with low-level laser therapy

Abstract

The purpose of the present work was to study the effect of low-level laser therapy (LLLT): helium-neon (He-Ne) and gallium arsenide (Ga-As) laser on the histomorphology of muscle and mitochondria in experimental myopathy in rats. Thirty Suquía strain female rats were distributed in groups: (A) control (intact), (B) injured, (C) injured and treated with He-Ne laser, (D) injured and treated with Ga-As laser, (E) irradiated with He-Ne laser on the non-injured muscle, and (F) irradiated with Ga-As laser on the non-injured muscle. Myopathy was induced by injecting 0.05 mg/rat/day of adrenaline in the left gastrocnemius muscle at the same point on five consecutive days, in groups B, C, and D. LLLT was applied with 9.5 J cm⁻² daily for seven consecutive days in groups C, D, E, and F. The muscles were examined with optic and electronic microscopy. The inflammation was classified as absent, mild, and intense and the degree of mitochondrial alteration was graded I, II, III, and IV. Categorical data were statistically analyzed by Chi-square and the Fisher-Irwin Bilateral test, setting significant difference at p < 0.05. The damage found in muscle and mitochondria histomorphology in animals with induced myopathy (B) was intense or severe inflammation with grade III or IV of mitochondrial alteration. They underwent significant regression (p < 0.001) compared with the groups treated with He-Ne (C) and Ga-As (D) laser, in which mild or moderate inflammation was seen and mitochondrial alteration grades I and II, recovering normal myofibrillar architecture. No differences were found between the effects caused by the two lasers, or between groups A, E, and F. Group A was found to be different from B, C, and D (p < 0.001). LLLT in experimental myopathy caused significant muscular and mitochondrial morphologic recovery.

http://ift.tt/2m6nqU9

What does it mean to celebrate International Women’s Day in health and medicine?

By Manasi Jiwrajka

We look back at some of our case reports:

Gender remains an important determinant of health. For example, in HIV in India: the Jogini culture , we read that female gender ensured a lifestyle that exposed the patient to HIV.¹

"The patient never attended school. At menstruation, she awoke to a startling reality as she had her first sexual encounter in her parent's home."

Another case from India reports that more women and girls are illiterate compared to men (41.2% and 21.4% respectively).² Karande states that "maternal illiteracy directly affect[s] health-seeking behaviours," and in this case, maternal illiteracy as well as maternal undernutrition results in infantile iatrogenic Cushing syndrome.

In this case from the USA, a patient without prenatal care has devastating consequences by attempting to deliver at home. ³

Sometimes, being a female is uncertain in and of itself as in intersex individuals or rare conditions such as female hypospadias, which may be recognised early in the patient's life or much later.^4,5 Some females have had gender reassignment surgery, and were previously males. The surgical intervention to become a female may lead to complications.

"Vaginal reconstruction does come with a myriad of complications including rectovaginal fistula, urethral fistula, vaginal stenosis, with loss of either depth or width, urethral stenosis, hair growth in the vaginal canal if scrotal skin is used for construction"⁶

Women's health is often equated to maternal health or gynaecological health but women's global health includes cases such as the following:

Mental health in a Dominican, HIV+ woman who was scared of being considered "loca" and promiscuous. The authors write:

"Although the patient voiced suicidal intent, she was reluctant to see the psychologist for fear of being labelled as a 'loca' (crazy person). Locas are rejected in Dominican society for being perceived as being out-of-control, unpredictable and unable to fulfil expected gender roles…HIV-positive women are often negatively perceived as sexually promiscuous, which can be considered an insult to their partners' 'machismo' (sense of manliness), and women who disclose their serostatus are at a greater risk of abandonment and abuse by their partners." ⁷

Multiple Sclerosis in an anaesthesiologist from Trinidad and Tobago: MS incidence is higher among females, and the burden of the disease is high for any patient especially for someone working in "a medical specialty with a high level of stress and long hours of exposure and night shifts." The patient, and the doctor, in this case writes:

"For those who read this article, just be part of those who are disclosing this global health problem for the well-being of many."⁸

Women around the world are facing significant health issues both as patients and doctors. Some emerging priorities for women's health globally are well outlined in this paper by Temmerman et al.⁹

Restricted physical activity among women due to social norms
Tobacco use, maternal smoking and COPD
Women's cancers such as breast cancer, and cervical cancer
Conditions of older age without adequate treatment
Structural determinants of women's health

Women in health are also celebrating today that we have come a long way to become anaesthesiologists, surgeons, gynaecologists and urologists.

References:

Borick J. HIV in India: the Jogini culture. BMJ Case Reports. 2014;2014.
Karande S. Consequences of low birth weight, maternal illiteracy and poor access to medical care in rural India: infantile iatrogenic Cushing syndrome. BMJ Case Reports. 2015;2015.
Kumar N, Gilbert L, Ellis T, Krishnan S. Consequences of delivery at home in a woman without prenatal care. BMJ Case Reports. 2017;2017.
Prakash G, Singh M, Goel A, Jhanwar A. Female hypospadias presenting with urinary retention and renal failure in an adolescent: uncommon and late presentation with significant hidden morbidity. BMJ Case Reports. 2016;2016.
D'Cunha AR, Kurian JJ, Jacob TJK. Idiopathic female pseudohermaphroditism with urethral duplication and female hypospadias. BMJ Case Reports. 2016;2016.
Rezwan N, Basit AA, Andrews H. Bilateral ureteric obstruction: an unusual complication of male-to-female gender reassignment surgery. BMJ Case Reports. 2014;2014.
Santoso LF, Erkkinen EE, Deb A, Adon C. HIV-associated dementia in the Dominican Republic: a consequence of stigma, domestic abuse and limited health literacy. BMJ Case Reports. 2016;2016.
Reyes AJ, Ramcharan K, Sharma S. Multiple sclerosis in a postgraduate student of anaesthesia: illness in doctors and fitness to practice. BMJ Case Reports. 2016;2016.
Temmerman M, Khosla R, Laski L, Mathews Z, Say L. Women's health priorities and interventions. BMJ : British Medical Journal. 2015;351.

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Analysis of Clinical and Immunologic Phenotype in a Large Cohort of Children and Adults with Cartilage-hair Hypoplasia

Publication date: Available online 9 March 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Svetlana Kostjukovits, Paula Klemetti, Helena Valta, Timi Martelius, Luigi D. Notarangelo, Mikko Seppänen, Mervi Taskinen, Outi Mäkitie

Teaser

In our cohort of individuals with cartilage-hair hypoplasia 1) over 25% of patients manifest clinical combined immunodeficiency and they have lower CD3+, CD8+ and recent thymic emigrant counts; 2) specific antibody deficiency may exist; 3) low IgG2 levels associate with severe varicella.

http://ift.tt/2mmLnI1

Αρχειοθήκη ιστολογίου

Πέμπτη 9 Μαρτίου 2017

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