Plated-rich plasma for androgenetic alopecia: Does it work? Evidence from meta analysis

Summary

Introduction

The use of plated-rich plasma (PRP) has increased among different surgical specialities for the treatment of various conditions. Androgenetic alopecia is a common condition, with severe attendant psychosocial implications. PRP injections for hair restoration have become a popular practice among plastic surgeons. We performed a meta-analysis comparing local injection of plated-rich plasma versus control to evaluate this issue in order to investigate the effectiveness of PRP local injections for androgenetic alopecia.

Methods

A systematic literature search was performed. Primary outcome was the increase in number of hairs. Secondary outcomes were the increase in hair thickness and the percentage increase in hair number and thickness. We performed random-effect analysis.

Results

Six studies involving 177 patients were retrieved and included in the present analysis. A significantly locally increased hair number per cm² was observed after PRP injections versus control (mean difference (MD) 17.90, 95%CI 5.84-29.95, P=.004). Similarly, a significantly increased hair thickness cross section per 10⁻⁴ mm² (MD 0.22, 95%CI 0.07-0.38, P=.005) favoring PRP group. The pooled results did not show statistically significant differences in percentage increase in hair number (MD 24.12%, 95%CI −12.76-60.99, P=.20) and hair thickness (MD 32.63%, 95%CI −16.23-81.48, P=0.19) among patients treated with PRP.

Conclusions

Local injection of PRP for androgenic alopecia might be associated with an increased number of hairs and some hair thickness improvement in the treated areas with minimal morbidity. The results of this meta-analysis should be interpreted with caution as it consists of pooling many small studies. Larger randomized studies can verify this perception.

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Simvastatin-associated dermatomyositis

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Adverse effects of isotretinoin: A large, retrospective review

Abstract

Acne is a very common and disfiguring disease that affects mostly adolescents and, to some extent, adults. The objective of our study was to estimate the adverse effects after isotretinoin by treatment of 3,525 patients due to acne vulgaris in a 5-year observation. Retrospective, comparative study was carried out in Poland and Romania from January 2012 to August 2016. Inclusion criteria into this study were moderate, severe, and nodulocystic inflammatory acne vulgaris. Exclusion criteria were mild acne, pregnant, and lactating women. Statistical analysis was carried out using T test and Chi square. All patients were treated with oral isotretinoin. Patient age ranged from 13-35 years. Dry lips was the most commonly reported adverse effect, affecting 100% of users, followed by xerosis (94.97%) and facial erythema (66.21%). Of all adverse effects, psychiatric symptoms accounted for 25.16%; eye lesions accounted for 8.96%. In lab investigations an increase in the level of total cholesterol and serum triglycerides was observed. This study documents the adverse effect profile of isotretinoin in a large number of patients collected over a period of 4 years. Side effects were mild and well tolerated and did not necessitate stopping the treatment. However, it is important to educate patients about this potential consequence.

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Successful treatment to a tretinoin/clindamycin gel in a late onset of nevus comedonicus

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Successful use of Bruton's kinase inhibitor, ibrutinib, to control paraneoplastic pemphigus in a patient with paraneoplastic autoimmune multiorgan syndrome and chronic lymphocytic leukaemia

Abstract

We present the case of a 51-year-old man who developed paraneoplastic pemphigus (PNP) in the context of chronic lymphocytic leukemia (CLL). His CLL was successfully controlled with ibrutinib. Concurrently, there was significant improvement of his PNP, suggesting that ibrutinib may be a very useful addition to the treatment options in this potentially life-threatening autoimmune disorder.

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The PD-L1/PD-1 pathway promotes dysfunction, but not “exhaustion”, in tumor-responding T cells from pleural effusions in lung cancer patients

Abstract

Malignant pleural effusions are frequent in patients with advanced stages of lung cancer and are commonly infiltrated by lymphocytes and tumor cells. CD8+ T cells from these effusions have reduced effector functions. The programmed death receptor 1(PD-1)/programmed death ligand 1 (PD-L1) pathway is involved in T-cell exhaustion, and it might be responsible for T-cell dysfunction in lung cancer patients. Here, we show that PD-L1 is expressed on tumor cell samples from malignant effusions, on lung cancer cell lines, and, interestingly, on MRC-5 lung fibroblasts. PD-L1 was up-regulated in lung cancer cell lines upon treatment with IFN-gamma, but not under hypoxic conditions, as detected by RT-qPCR and flow cytometry. Blockade of PD-L1 on tumor cells restored granzyme-B expression in allogenic CD8+ T cells in vitro. Remarkably, pleural effusion CD8+ T cells that responded to the tumor antigens MAGE-3A and WT-1 (identified as CD137+ cells) were lower in frequency than CMV pp65-responding CD8+ T cells and did not have an exhausted phenotype (PD-1+ TIM-3+). Nonetheless, tumor-responding CD8+ T cells had a memory phenotype and expressed higher levels of PD-1. A PD-L1 blocking antibody increased the expression of granzyme-B and perforin on polyclonal- and tumor-stimulated CD8+ T cells. Taken together, our data show that rather than being exhausted, tumor-responding CD8+ T cells are not completely differentiated into effector cells and are prone to negative regulation by PD-L1. Hence, our study provides evidence that lung cancer patients respond to immunotherapy due to blockade of the PD-L1/PD-1 pathway.

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Expression patterns of programmed death-ligand 1 in esophageal adenocarcinomas: comparison between primary tumors and metastases

Abstract

Expression analysis of programmed death-ligand 1 (PD-L1) may be helpful in guiding clinical decisions for immune checkpoint inhibition therapy, but testing by immunohistochemistry may be hampered by heterogeneous staining patterns within tumors and expression changes during metastatic course. PD-L1 expression (clone SP142) was investigated in esophageal adenocarcinomas using tissue microarrays (TMA) from 112 primary resected tumors, preoperative biopsies and full slide sections from a subset of these cases (n = 24), corresponding lymph node (n = 55) and distant metastases (n = 17). PD-L1 expression was scored as 0.1–1, >1, >5, >50% positive membranous staining of tumor cells and any positive staining of tumor-associated inflammatory infiltrates and/or stroma cells. There was a significant correlation with overall PD-L1 expression between the full slide sections and the TMA (p = 0.001), but not with the corresponding biopsies. PD-L1 expression in tumor cells >1% was detected in 8.0% of cases (9/112) and 51.8% of cases (58/112) in tumor-associated inflammatory infiltrates and/or stroma cells of primary tumors. Epithelial expression in metastases was found in 5.6% of cases (4/72) and immune cell expression in 18.1% of cases (13/72), but did not correlate with the expression pattern in the primary tumor. Overall PD-L1 expression in the primary tumor did not influence survival. However, PD-L1 expression was correlated with the number of CD3⁺ tumor-infiltrating lymphocytes in the tumor center, and a combinational score of PD-L1 status/CD3⁺ tumor-infiltrating lymphocytes was correlated with patients' overall survival.

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Radial/Circumferential Surgical Margin in Laryngectomy Specimens

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Long-Term Control of Hypercortisolism by Vandetanib in a Case of Medullary Thyroid Carcinoma with a Somatic RET Mutation

Thyroid , Vol. 0, No. 0.


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Postoperative brachial artery entrapment associated with pediatric supracondylar fracture of the humerus: a case report

Severely displaced supracondylar fractures of the humerus in children are frequently associated with complications including neurovascular injuries, non-union, or compartment syndrome. In the current literatur...

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Overexpression of Rsf-1 correlates with poor survival and promotes invasion in non-small cell lung cancer

Abstract

Rsf-1 (HBXAP) was recently reported to play roles in tumorigenesis and tumor progression. There have been many reports referred to Rsf-1 overexpression in various cancers and associated with the malignant behavior of cancer cells. However, the molecular mechanism of Rsf-1 in non-small cell lung cancer aggressiveness remains ambiguous. In the present study, we found that there was a significant association between Rsf-1 overexpression and poor overall survival (p = 0.028) in lung cancer. Furthermore, knockdown of Rsf-1 expression in H1299 and H460 cells with high endogenous Rsf-1 expression inhibited cell migration and invasion and downregulated MMP2 expression and nuclear levels of NF-κB. NF-κB inhibitor could also block the effect of Rsf-1 in regulation of MMP2 expression. Further experiments demonstrated that Rsf-1 depletion restrained NF-κB reporter luciferase activity and downregulated bcl-2 and p-IκB protein level. In conclusion, we demonstrated that Rsf-1 was overexpressed in lung cancer and associated with poor survival. Rsf-1 regulated cell invasion through MMP2 and NF-κB pathway.

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Helicobacter Pylori infection in Omani children

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Issue Information

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Analysis of Disease Activity Categories in Chronic Spontaneous/Idiopathic Urticaria

Abstract

Background

Measurement of disease activity guides treatment of chronic spontaneous urticaria (CSU). A weekly Urticaria Activity Score―here, the average of twice-daily patient assessment of itch and hives scores summed over 1 week (UAS7_TD)―measures severity from 0 to 42. Insufficient evidence exists whether disease activity states, defined by categorical UAS7_TD scores, correlate with other patient-reported outcomes and treatment response.

Objective

To evaluate and compare categorical UAS7_TD scores with selected measures of disease-related quality of life and impact.

Methods

Data from three randomised clinical trials of omalizumab in CSU were pooled. Continuous UAS7_TD scores were categorised into five disease activity states: urticaria-free, well-controlled, mild, moderate, and severe urticaria. Total scores from the Dermatology Life Quality Index (DLQI); the Chronic Urticaria Quality of Life questionnaire (CU-Q₂oL); and questions on sleep and daily activity interference, presence of angioedema, and diphenhydramine use were compared within categorised UAS7_TD disease-state scores, using one-way analyses of variance for analysis at different time points and mixed-effects regressions for analysis of all data pooled.

Results

Pooled analyses showed that categorical UAS7_TD disease states accurately predicted differences among treated CSU patients with different levels of disease activity. A consistent pattern existed between categories, with higher-activity disease states associated with significantly higher impact and an increase in angioedema frequency. Results at different treatment time points were consistent.

Conclusion

Categorical UAS7_TD disease states can discriminate between measures when considering the impact of urticaria activity. Using five categorical disease states could simplify clinical assessment and monitoring of treatment efficacy.

This article is protected by copyright. All rights reserved.

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Search strategies for finding systematic reviews

Abstract

I have read with interest the 2017 article by F Gómez-García and colleagues called "Systematic reviews and meta-analyses on psoriasis: role of funding sources, conflict of interest, and bibliometric indices as predictors of methodological quality" published in the BJD.

This study makes a very important point about the influence of funding sources and conflicts of interests on the methodological quality of systematic reviews.

However, I have some concerns about the search strategy used to find systematic reviews for this analysis.

This article is protected by copyright. All rights reserved.

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(A) Hematoxylin-eosin (×400). Lung parenchyma with metastasis from the primary parathyroid carcinoma. (B) Immunohistochemical analysis of PTH expression (×400). Diffuse intensive expression of PTH by the lung metastasis from the primary parathyroid carcinoma.

Figure 2: (A) Hematoxylin-eosin (×400). Lung parenchyma with metastasis from the primary parathyroid carcinoma. (B) Immunohistochemical analysis of PTH expression (×400). Diffuse intensive expression of PTH by the lung metastasis from the primary parathyroid carcinoma.

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Radial/Circumferential Surgical Margin in Laryngectomy Specimens

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Thomas Earl Starzl, MD, PhD Transplant Pioneer, Polymath, Mentor March 11th, 1926-March 4th, 2017.

No abstract available

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Locoregional Therapy with Curative Intent versus Primary Liver Transplant for Hepatocellular Carcinoma: Systematic Review and Meta-analysis.

Background: Loco-regional therapy with curative intent (CLRT) followed by salvage liver transplant (SLT) in case of HCC recurrence is an alternative to primary liver transplant (LT) in selected patients with HCC. Methods: We performed a systematic review and meta-analysis of studies comparing the survival of patients treated with CLRT versus LT, stratified by the stage of liver disease, extent of cancer, and whether SLT was offered or not. Results: We included 48 studies involving 9835 patients (5736 patients with CLRT and 4119 patients with primary LT). Five-year overall survival (OS) and disease-free survival (DFS) was worse for all categories of CLRT combined, than for primary LT (odds ratio (OR) for OS: 0.59 (0.48-0.71), p

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The Times, They are a-Changing: HOPE for HIV-to-HIV Organ Transplantation.

HIV-infected persons who achieve undetectable viral loads on antiretroviral therapy currently have near-normal lifespans. Liver disease is a major cause of non-AIDS-related deaths, and as a result of longer survival, the prevalence of end-stage renal disease in HIV is increasing. HIV-infected persons undergoing organ transplantation generally achieve comparable patient and graft survival rates compared to their HIV-uninfected counterparts, despite a nearly threefold increased risk of acute rejection. However, the ongoing shortage of suitable organs can limit transplantation as an option, and patients with HIV have higher waitlist mortality than others. One way to solve this problem would be to expand the donor pool to include HIV-infected individuals. The results of a South Africa study involving 27 HIV-to-HIV kidney transplants showed promise, with 3 and 5-year patient and graft survival rates similar to those of those of their HIV-uninfected counterparts. Similarly, individual cases of HIV-to-HIV liver transplantation from the United Kingdom and Switzerland have also shown good results. In the United States, HIV-to-HIV kidney and liver transplants are currently permitted only under a research protocol. Nevertheless, areas of ambiguity exist, including streamlining organ allocation practices, optimizing HIV-infected donor and recipient selection, managing donor-derived transmission of a resistant HIV strain, determining optimal immunosuppressive and antiretroviral regimens, and elucidating the incidence of rejection in HIV-to-HIV solid organ transplant recipients. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Spurious Hypoxemia During Craniotomy.

No abstract available

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A Review of Electronic Devices to Assess Inhaler Technique

Abstract

Purpose of Review

Multiple electronic devices exist that provide feedback on the accuracy of patient inhaler technique. Our purpose is to describe the inhaler technique feedback provided by these devices, including specific technique steps measured, how feedback is displayed, target of feedback (patient, provider, researcher), and compatibility with inhaler type (metered-dose inhaler [MDI], diskus, etc.).

Recent Findings

We identified eight devices that provide feedback on inhaler technique. Only one device assessed all evidence-based MDI technique steps. Most devices provide limited real-time feedback to patients, if any feedback at all.

Summary

Technologies to assess inhaler technique are advancing and hold great potential for improving patient inhaler technique. Many devices are limited in their ability to detect all evidence-based technique steps and provide real-time user-friendly feedback to patients and providers. Usability tests with patients and providers could identify ways to improve these devices to improve their utility in clinical settings.

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Rare Melanomas Prove 'Hard to Get' Using Immunotherapy

Dr Jeffrey Weber assesses the benefit of immunotherapies in two rare subtypes of melanoma and finds that rates of survival and duration of response trail well behind those associated with cutaneous melanoma.
Medscape Oncology

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Clinical Trial Brings Hope for Prurigo Nodularis Patients

Serlopitant is the first treatment shown to be effective for patients with this uncommon disorder, which is characterized by crusty lesions and intense itch.
Medscape Medical News

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A Review of Electronic Devices to Assess Inhaler Technique

Abstract

Purpose of Review

Multiple electronic devices exist that provide feedback on the accuracy of patient inhaler technique. Our purpose is to describe the inhaler technique feedback provided by these devices, including specific technique steps measured, how feedback is displayed, target of feedback (patient, provider, researcher), and compatibility with inhaler type (metered-dose inhaler [MDI], diskus, etc.).

Recent Findings

We identified eight devices that provide feedback on inhaler technique. Only one device assessed all evidence-based MDI technique steps. Most devices provide limited real-time feedback to patients, if any feedback at all.

Summary

Technologies to assess inhaler technique are advancing and hold great potential for improving patient inhaler technique. Many devices are limited in their ability to detect all evidence-based technique steps and provide real-time user-friendly feedback to patients and providers. Usability tests with patients and providers could identify ways to improve these devices to improve their utility in clinical settings.

http://ift.tt/2nxrptx

Relationship Between Types of Exercise and Quality of Life in a Korean Metabolic Syndrome Population: A Cross-Sectional Study

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


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Increased Coagulation and Decreased Fibrinolysis as Measured with Overall Hemostatic Potential Are Dependent on BMI and Not Associated with PCOS

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.


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A Critical Review of Improvement Rates for Laser Therapy Used to Treat Toenail Onychomycosis

Abstract

Background

Onychomycosis is a nail infection that is primary caused by dermatophytes. Alternative treatments are needed as current therapies (oral and topical antifungals) have limited effectiveness. Lasers are currently approved by the FDA to temporarily increase the amount of clear nail in onychomycosis patients. Lasers can theoretically elicit fungicidal effects but in practice produce mixed results.

Objective

This review compares laser-induced improvement rates to FDA approved indications and traditional onychomycosis treatments.

Methods

A review of the literature (PubMed, Clinicaltrials. gov, Medline and Embase) was used to locate articles for this review. RCTs, non-randomized, uncontrolled and retrospective studies that included at least one of the following measures were eligible; complete cure, mycological cure, clinical improvement, and clinical cure.

Results

Mycological cure (negative culture and negative microscopy) was evaluated in two studies using patients as the unit of analysis with an average rate of 11% with the averaged rate increasing to 63% when nails were used as the unit of analysis (3 studies). Clinical cure (100% clear nail) was evaluated in 6 studies with a rate of 13% using nails as the unit of analysis and 13% when patients were used as the unit of analysis (2 studies). Clinical improvement (at any time point) was found in 36% of patients (5 studies) and 67% of nails (9 studies). Nail clarity as measured by clear nail growth and/or nail plate/bed clearance at 12 weeks was found to be 2.6 mm across onychomycotic nails.

Conclusions

Laser studies, to date, provide preliminary evidence of clinical improvement and clear nail growth in toenail onychomycosis, consistent with the FDA clearance for aesthetic endpoints. Laser studies however do not provide efficacy rates for medical endpoints that equate or exceed those found with traditional therapies (oral and topical treatments).

This article is protected by copyright. All rights reserved.

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Anterior condylar confluence dural arteriovenous fistula: a rare cause of hoarseness

Hoarseness secondary to an anterior condylar confluence (ACC) dural arteriovenous fistula (DAVF) has not been previously described. We present a 58-year-old patient with a 3-week history of progressive unilateral left-sided headaches and hoarseness. Nasolaryngoscopy and CT neck showed the presence of unilateral vocal cord palsy with no identifiable cause along the expected course of the recurrent laryngeal nerve. MRI revealed an incidental finding of abnormal serpiginous vessels in the left hypoglossal canal which led to a diagnostic cerebral angiogram, confirming the presence of an ACC DAVF. The patient underwent transvenous coil embolisation with subsequent resolution of arteriovenous shunting and symptoms. Follow-up MRI at 6 months showed no recurrence and there was complete resolution of clinical symptoms.

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Carotid artery dissection: a rare complication of Eagle syndrome

Carotid artery dissection is a significant cause of ischaemic stroke in all age groups and accounts for a large percentage of strokes in young patients. Carotid dissection can be caused by trauma, underlying connective tissue disease, hypertension, mechanical injury or can be spontaneous. We present an exceedingly rare case of carotid dissection caused by an elongated styloid process, causing direct mechanical damage to the carotid artery.

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Cannabis arteritis: ever more important to consider

Cannabis arteritis (CA) is a major and underdiagnosed cause of peripheral arterial disease in young patients. A 34-year-old man, daily smoker of 20 cigarettes and two cannabis cigarettes for 14 years, presented with a necrotic plaque of left hallux for 3 weeks. The Doppler ultrasound and angiography were compatible with severe Buerger's disease. Submitted to a revascularisation procedure and hypocoagulation with rivaroxaban. He had ceased smoking but maintained consumption of cannabis. Owing to the persistence of distal necrosis, amputation of the hallux was performed with good evolution. CA is a subtype of Buerger's disease. It is poorly known but increasingly prevalent and manifests in cannabis users regardless of tobacco use. The drug is considered at least a cofactor of the arteriopathy. The most effective treatment is cessation of consumption. Being cannabis one of the most consumed drugs, its mandatory to ask about its use in all young patients with arteriopathy.

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Severe hypophosphataemia after intravenous iron administration

Iron deficiency is common and can be effectively treated with parenteral iron infusion. We report a case of an iron-deficient and vitamin D-deficient woman who developed severe symptomatic hypophosphataemia following intravenous ferric carboxymaltose administration. We stress the need of increased awareness of this potential complication among physicians. Patients should be informed of this complication and instructed to report for follow-up if they experience new musculoskeletal symptoms or worsening of tiredness. As severe hypophosphataemia is usually symptomatic, we recommend screening symptomatic patients for this complication. Recognising and treating the possible exacerbating factors, especially vitamin D deficiency, might be a simple measure to mitigate this complication.

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Presentation of calcinosis cutis universalis in mixed connective tissue disorder: an encounter during hip arthroplasty

A woman aged 23 years with a diagnosis of mixed connective tissue disorder presented with left groin pain extending over 6 months. Workup revealed avascular necrosis of the femoral head (Grade 3) secondary to systemic lupus erythematosus and chronic steroid intake. An uncemented total hip arthroplasty was considered as the patient was only in the third decade of life. During the preop workup, careful clinical assessment had revealed multiple subcutaneous nodules affecting the extensor musculature limited to the gluteal region, anterior and posterior aspects of the thigh. The diagnosis of calcinosis cutis universalis was made after a CT revealed calcified nodules in the subcutaneous, subfascial and muscular planes. A total hip arthroplasty using the posterior approach was performed with minimal trauma to the calcified nodules and thereby preventing a source of persistent drainage and reducing morbidity due to infection.

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Unusual cause of renal stone following robotic pyeloplasty

Non-absorbable Hem-o-Lok clips are commonly used for vascular pedicle control or suture stabilisation during laparoscopic or robotic reconstructive procedures. As they are placed close to suture line and with tension, these clips have a propensity to migrate. We report a case of a 22-year-old man with history of bilateral robotic pyeloplasty presenting with left inferior calyceal stone. He underwent left mini percutaneous nephrolithotomy which revealed an encrusted migrated Hem-o-Lok clip that was used to close the mesenteric window formed during transmesocolic pyeloplasty. Thus, these clips should be used sparingly and only at places where other effective alternatives are unavailable.

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Mycobacterium szulgai infection in the flexor sheath of the right index finger in an immunocompetent patient

A 53-year-old woman was identified with Mycobacterium szulgai infection in the flexor sheath of the right index finger. Tissue was debrided at operation, and the patient was successfully treated with appropriate antimicrobials. M. szulgai is a rare cause of non-tubercular mycobacterium infection worldwide, and there are currently no clear guidelines on diagnosis and management. This is the first case reporting M. szulgai infection in the flexor sheath of the right index finger of a non-immunocompromised patient in the UK.

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Fhit down-regulation is an early event in pancreatic carcinogenesis

Abstract

Aberrant Fhit expression characterizes a large proportion of primary pancreatic ductal adenocarcinomas (PDACs), but fragmentary information is available on Fhit expression during the phenotypic changes of pancreatic ductal epithelium during multistep transformation. We assessed Fhit expression by immunohistochemistry in two different multistep pancreatic carcinogenic processes: pancreatic intraepithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasia (IPMN). We considered 105 surgically treated PDACs/IPMNs and selected 30 samples of non-neoplastic pancreatic parenchyma, 50 PanIN lesions, 30 IPMNs, 15 IPMNs with associated invasive carcinoma, and 60 adenocarcinomas. Normal pancreatic ducts and surrounding acinar cells consistently showed moderate to strong Fhit immunoreactivity. Significant down-regulation of Fhit expression was observed in association with increasing severity of dysplastia/neoplastia in both carcinogenic processes. This was further confirmed by studying multiple lesions obtained from the same surgical specimen. Of 60 PDACs, only 14 showed Fhit expression comparable to normal pancreatic ductal epithelium, while the remainder (77%) showed clearly negative or reduced Fhit expression. This study demonstrates that Fhit down-regulation is an early event in both multistep carcinogenic processes leading to PDAC.

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Schmerzhafte Schwellung und Einblutung beider Beine

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Pembrolizumab and Combination Chemotherapy in Treating Patients With Relapsed or Refractory Hodgkin Lymphoma

Conditions:   Lymphocyte-Rich Classical Hodgkin Lymphoma;   Recurrent Lymphocyte-Depleted Classical Hodgkin Lymphoma;   Recurrent Mixed Cellularity Classical Hodgkin Lymphoma;   Recurrent Nodular Sclerosis Classical Hodgkin Lymphoma;   Refractory Lymphocyte-Depleted Classical Hodgkin Lymphoma;   Refractory Mixed Cellularity Classical Hodgkin Lymphoma;   Refractory Nodular Sclerosis Classical Hodgkin Lymphoma
Interventions:   Drug: Carboplatin;   Drug: Etoposide;   Drug: Ifosfamide;   Other: Laboratory Biomarker Analysis;   Biological: Pembrolizumab
Sponsors:   Northwestern University;   Merck Sharp & Dohme Corp.;   National Cancer Institute (NCI)
Not yet recruiting - verified March 2017

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Isocapnic Hyperventilation - an Alternative Method

Condition:   Oropharyngeal Neoplasms
Intervention:   Device: Isocapnic hyperventilation
Sponsor:   Sahlgrenska University Hospital, Sweden
Recruiting - verified March 2017

http://ift.tt/2miWzoe

Mutational signatures in oral cancer indicate a complex role for tobacco smoke carcinogens

Abstract

A recent publication by Alexandrov et al in Science (Alexandrov et al, 2016) presents a new approach to study the genomic changes in cancers associated with tobacco smoking. The genomic analyses, undertaken with a background of epidemiologic and clinical studies, indicate that tobacco smoking causes distinct mutations across the genome that are recognizable collectively as mutational signatures. By studying a range of cancer types that vary in the strength of association with tobacco smoking, including oral cavity cancer, the authors demonstrate the complex roles of tobacco smoke carcinogens in the mutational processes that lead to cancer.

This article is protected by copyright. All rights reserved.

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Mesenchymal stem cells may hold the secret to healing skin disease

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Announcement

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Issue Information

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DMARDs in psoriasis: a critical appraisal

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Announcement

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Forthcoming Events

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Diagnostic Bedside Vestibuloocular Reflex Evaluation in the Setting of a False Negative Fistula Test in Cholesteatoma of the Middle Ear

Background. False negative fistula testing in patients with chronic suppurative otitis media is a dilemma when proceeding to surgery. It is imperative to rule out a dead labyrinth or a mass effect secondary to the cholesteatoma in an otherwise normally functioning inner ear. We present a case series of three patients in whom a bedside vestibuloocular reflex (VOR) evaluation using a head impulse test was used successfully for further evaluation prior to surgery. Results. In all three cases with a false negative fistula test we were able to further evaluate at the bedside and were not only able to register the abnormal VOR but also localize its deterioration to a particular semicircular canal eroded by the fistula. Conclusion. Vestibuloocular reflex evaluation is mandatory in patients with suspected labyrinthine fistula due to cholesteatoma of the middle ear before proceeding to surgery. We demonstrate successful use of a bedside head impulse test for further evaluation prior to surgery in patients with false negative fistula test.

http://ift.tt/2mZM2lc

Seronegative Coeliac Disease in Children: A Case Report and Review of the Literature

Serology is frequently used for the diagnosis of coeliac disease in children; however, a small proportion of children are seronegative. We present a case of seronegative coeliac disease along with literature review to include diagnostic and management dilemmas.

http://ift.tt/2mCW6Q4

Ulcerated Lesion of the Tongue as Manifestation of Systemic Coccidioidomycosis

Systemic mycoses and their oral manifestations are very rare. We present a case of a 60-year-old man with an ulcerated lesion on the lateral border of the tongue. Histologic studies revealed a granulomatous fungal infection by Coccidioides immitis. After pharmacological treatment, the lesion resolved. Recently, northern Mexico has been reported to be an endemic zone of C. immitis infections; therefore it should be considered in the differential diagnosis of mouth lesions. A comprehensive clinical history, physical exploration, and complementary studies are essential for an accurate diagnosis.

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Cutaneous manifestations of subcutaneous and systemic fungal infections in tropical regions: a retrospective study from a referral center in southern Taiwan

Abstract

Background

Deep cutaneous fungal infections, including subcutaneous mycoses and systemic fungal infection with cutaneous involvement, cause significant morbidity and mortality in light of increasing immunocompromised patients and global warming. Although a few studies reviewed deep fungal infections in temperate regions, a relevant study in tropical regions is lacking. We evaluated features of deep cutaneous fungal infections in southern Taiwan among the tropical regions.

Methods

We retrospectively reviewed all histopathological specimens with deep cutaneous fungal infections in a single referral center from 2001 to 2014 and successfully identified 23 cases. Medical chart review revealed patient demographic data, clinical presentation, underlying disease, microbiological culture reports, and treatment outcomes.

Results

The average patient age was 52 years. Fourteen cases had primary subcutaneous mycoses, and nine had systemic mycoses. Fifteen patients were immunocompromised, including hematological malignancies. Acquired immune deficiency syndrome (AIDS) and long-term steroid use were most commonly associated with deep fungal infections. The positive culture growth rate was 63%. Fonsecaea sp. was most frequently identified by tissue culture. Aspergillosis, mucormycosis, and disseminated cryptococcosis were particularly fatal.

Conclusions

Diabetes and long-term steroid use appear as major risk factors for advanced mycoses in this region. Rapid diagnosis with skin biopsy and tissue culture along with appropriate treatment of deep cutaneous fungal infection are necessary.

http://ift.tt/2lSUxij

Effect of polymorphisms on TGFB1 on allergic asthma and helminth infection in an African admixed population

Publication date: Available online 9 March 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Ryan dos Santos Costa, Camila Alexandrina Figueiredo, Maurıcio Lima Barreto, Neuza Maria Alcantara-Neves, Laura Cunha Rodrigues, Alvaro A. Cruz, Candelaria Vergara, Nicholas Rafaels, Cassandra Foster, Joseph Potee, Monica Campbell, Rasika A. Mathias, Kathleen C. Barnes
BackgroundAllergic asthma is a complex disorder that results from a combination of genetic and environmental factors. Studies suggest that helminth infections can activate a regulatory network characterized by the production of regulatory cytokines, such as interleukin 10 and transforming growth factor β1 (TGF-β1) and subsequently protect against immune-mediated diseases, such as asthma. On the other hand, TGF-β1 is increased in the lungs of individuals with asthma and may modulate airway inflammation. The role of TGF- β 1 single-nucleotide polymorphisms (SNPs) in allergic disease remains inconclusive.ObjectiveTo evaluate the effects of genetic variations in the TGF-β1 on allergy and helminths infections in children.MethodsWe tested for association among 4 TGF-β1 SNPs and allergic asthma, specific IgE, skin prick test result, and IL-10 production in 1,335 Brazilians. In addition, we analyzed the association with markers of helminth infection (parasite burden, anti-Ascaris IgE, and worm specific IgG4). The polymorphisms were genotyped using Taq Man probes.ResultsWe found an association between rs1800470 (C allele) and atopic wheezing (odds ratio [OR], 0.60; 95% confidence interval [CI], 0.37–0.95) and markers of allergy (OR, 0.41; 95% CI, 0.22–0.79). In contrast, a positive association was observed between the haplotype ACCA and Trichuris trichiura infection (OR, 1.85; P = .003) and Ascaris lumbricoides infection (OR, 2.01; P < .001). This haplotype was also associated with increased IL-10 production (β = 50.7; P < .001).ConclusionIndividuals with TGF-β1 polymorphisms have an increased susceptibility to helminth infections and a lower risk of developing allergy. These studies suggest that immune modulation of allergic disease results not only from environmental factors but also from genetic susceptibility and IL-10 production.



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Sustained response of recombinant human C1 esterase inhibitor for acute treatment of hereditary angioedema attacks

Publication date: Available online 9 March 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Jonathan A. Bernstein, Anurag Relan, Joseph R. Harper, Marc Riedl
BackgroundSymptoms of hereditary angioedema (HAE) attacks can recur soon after initial treatment; the durability of response for recombinant human C1 esterase inhibitor (rhC1INH) treatment is unknown.ObjectiveTo examine the efficacy and durability of rhC1INH for acute HAE attacks.MethodsIn this pooled post hoc analysis of 2 trials, patients with type I or II HAE (functional C1INH levels <50% of normal) and a baseline visual analog scale score of at least 50 mm were included if they had received at least 1 intravenous dose of 50 U/kg of rhC1INH. Response was defined as symptom relief within 4 hours after treatment with persistence (≥20-mm decrease in visual analog scale scores [0 mm {"no symptoms at all"} to 100 mm {"extremely disabling"}] at 2 consecutive time points) during the 4 hours. Durability was the response without an increase of at least 20 mm in the minimum post-treatment visual analog scale score up to 24 hours. Recurrence and new attack symptoms were determined for patients with 72-hour post-treatment data.ResultsData were analyzed for 127 patients treated with 50 U/kg of rhC1INH in 2 studies. Most attacks (90.7%) responded within 4 hours, with differences in response rates among attack locations (61.5%–94.4%). The median time to the beginning of symptom relief was 75.0 minutes (95% confidence interval 65.0–80.0). No relapse occurred during 24 hours for attacks that initially responded. Only 7.1% of attacks were associated with symptom recurrence within 72 hours of initial rhC1INH treatment.ConclusionThis integrated analysis supports the efficacy of rhC1INH for treatment of acute HAE across multiple attacks, with a sustained response for at least 3 days.Trial RegistrationClinicalTrials.gov Identifiers: NCT00225147 and NCT00262301.



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Specificity and reproducibility of nasal biomarkers in patients with allergic rhinitis after allergen challenge chamber exposure

Publication date: March 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 3
Author(s): Philipp Badorrek, Meike Müller, Wolfgang Koch, Jens M. Hohlfeld, Norbert Krug
BackgroundAllergic rhinitis is an inflammatory disease that causes cellular influx and mediator release in the nose. These inflammatory changes might be used as nasal biomarkers to assess the efficacy of novel anti-allergic treatments.ObjectiveTo assess the specificity and reproducibility of nasal biomarkers in patients with allergic rhinitis after grass pollen exposure in an allergen challenge chamber.MethodsIn a monocenter pilot study, 15 patients with allergic rhinitis and 19 healthy individuals underwent two 4-hour Dactylis glomerate pollen challenges in the challenge chamber with an interval of 21 days. Before challenge, on exit, and after 2 and 22 hours, a nasal lavage was performed and nasal secretions were collected on filter paper to determine a wide panel of cells and mediators. Furthermore, total nasal symptom score, nasal flow, and nasal nitric oxide were measured.ResultsPollen exposure significantly increased eosinophil, interleukin (IL) 5, IL-6, IL-13, and macrophage inflammatory protein 1β levels in allergic patients but not in healthy individuals. The effect could be reproduced for eosinophils, IL-5, IL-6, and macrophage inflammatory protein 1β after the second allergen challenge. By contrast, the IL-13 levels were higher and eotaxin levels first increased after repetitive allergen challenge. There was no correlation between total nasal symptom score and elevated cell or cytokine levels. Nasal nitric oxide levels were nonspecifically elevated in both patients with allergy and healthy controls.ConclusionA subset of cellular and soluble biomarkers in nasal lavage and secretion reveals specificity and reproducibility in patients with allergic rhinitis. These can be used to measure the immunologic efficacy of antiallergic treatments in an allergen challenge chamber. Carryover effects attributable to priming must be considered when designing cross-over studies.Trial Registrationclinicaltrials.gov Identifier: NCT00297843.



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The Kingston Allergy Birth Cohort

Publication date: Available online 8 March 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Michelle L. North, Jeffrey R. Brook, Elizabeth Y. Lee, Vanessa Omana, Nadia M. Daniel, Lisa M. Steacy, Greg J. Evans, Miriam L. Diamond, Anne K. Ellis
BackgroundThe Kingston Allergy Birth Cohort (KABC) is a prenatally recruited cohort initiated to study the developmental origins of allergic disease. Kingston General Hospital was chosen for recruitment because it serves a population with notable diversity in environmental exposures relevant to the emerging concept of the exposome.ObjectivesTo establish a profile of the KABC using the exposome framework and examine parentally reported respiratory symptoms to 2 years of age.MethodsData on phase 1 of the cohort (n = 560 deliveries) were compiled, and multivariate Cox proportional hazards regression models were used to determine associations with respiratory symptoms.ResultsThe KABC exhibits diversity within the 3 exposome domains of general external (socioeconomic status, rural or urban residence), specific external (cigarette smoke, breastfeeding, mold or dampness), and internal (respiratory health, gestational age), as well as significant associations between exposures from different domains. Significant associations emerged between parental reports of wheeze or cough without a cold and prenatal cigarette smoke exposure, mold or dampness in the home, and the use of air fresheners in the early-life home environment. Breastfeeding, older siblings, and increased gestational age were associated with decreased respiratory symptoms.ConclusionThe KABC is a unique cohort with diversity that can be leveraged for exposomics-based studies. This study found that all 3 domains of the exposome had effects on the respiratory health of KABC children. Ongoing studies using phase 1 of the KABC continue to explore the internal exposome through allergy skin testing and epigenetic analyses and the specific external domain through in-home environmental analyses, air pollution modeling, and ultimately potential convergences within and among domains.



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

Publication date: Available online 7 March 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Daniel J. Scherzer, Nnenna O. Chime, Nancy M. Tofil, Melinda Fiedor Hamilton, Karambir Singh, Rachel M. Stanley, Jennifer Kline, LeAnn M. McNamara, Michael A. Rosen, Elizabeth A. Hunt




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

Publication date: Available online 7 March 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Caroline Gouder, Rachelle Asciak, Stephen Montefort




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Mesalamine desensitization in a patient with treatment refractory ulcerative colitis and aspirin and nonsteroidal anti-inflammatory drug hypersensitivity

Publication date: Available online 9 March 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Jordan L. Heath, Ryan D. Heath, Cyrus Tamboli, Larry Johnson, Ashley S. Wilson, Sheva Chervinskiy, Matthew C. Bell, Joshua L. Kennedy




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Anabolic androgen use in the management of hereditary angioedema

Publication date: Available online 7 March 2017
Source:Annals of Allergy, Asthma & Immunology
Author(s): Kevin Y. Tse, Bruce L. Zuraw, Qiaoling Chen, Sandra C. Christiansen
BackgroundHereditary angioedema due to C1 inhibitor deficiency (HAE) is a rare, life-threatening disease that imposes a significant burden on affected patients. 17α-alkylated androgens (anabolic androgens) decrease attack frequency and severity but carry the risk of potentially serious dose-related adverse effects. Despite the emergence of targeted therapies for HAE, continued anabolic androgen use has been driven in part by their low cost.ObjectiveTo examine the hidden cost of anabolic androgen use related to the risk of developing non-HAE comorbidities.MethodsPatients with HAE were identified in the Southern California Kaiser Permanente database using clinical and laboratory findings compatible with HAE. These patients were stratified into anabolic androgen exposed and nonexposed groups. Matched controls were selected from the Kaiser database who did not have HAE or anabolic androgen exposure. Using multivariate analysis, we determined the number of non-HAE comorbidities linked to anabolic androgen use. We next determined the association between dosing and increasing exposure to anabolic androgens and the likelihood of having various comorbidities.ResultsPatients with HAE exposed to anabolic androgens had a 28% increase (P = .04) in non-HAE comorbidities when compared with their matched (nonexposed) controls. With each gram per month increase in exposure, a 12% increase in non-HAE comorbidities is observed (P < .01). The most commonly occurring non-HAE comorbidities were psychiatric, muscle cramps, obesity, and hyperlipidemia.ConclusionOur data suggest that long-term anabolic androgen use enhances the risk of developing comorbid health conditions, thus amplifying the cost of care. Our report provides additional support for the preferred use of newer, targeted therapies for the management of HAE.



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Information for Readers

Publication date: March 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 3





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Depression symptoms and lost productivity in chronic rhinosinusitis

Publication date: March 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 3
Author(s): Adam P. Campbell, Katie M. Phillips, Lloyd P. Hoehle, Allen L. Feng, Regan W. Bergmark, David S. Caradonna, Stacey T. Gray, Ahmad R. Sedaghat
BackgroundChronic rhinosinusitis (CRS) is associated with significant losses of patient productivity that cost billions of dollars every year. The causative factors for decreases in productivity in patients with CRS have yet to be determined.ObjectiveTo determine which patterns of CRS symptoms drive lost productivity.MethodsProspective, cross-sectional cohort study of 107 patients with CRS. Sinonasal symptom severity was measured using the 22-item Sinonasal Outcomes Test, from which sleep, nasal, otologic or facial pain, and emotional function subdomain scores were calculated using principal component analysis. Depression risk was assessed with the 2-item Patient Health Questionnaire (PHQ-2), whereas nasal obstruction was assessed with the Nasal Obstruction Symptom Evaluation (NOSE) instrument. Lost productivity was assessed by asking participants how many days of work and/or school they missed in the last 3 months because of CRS. Associations were sought between lost productivity and CRS symptoms.ResultsA total of 107 patients were recruited. Patients missed a mean (SD) of 3.1 (12.9) days of work or school because of CRS. Lost productivity was most strongly associated with the emotional function subdomain (β = 7.48; 95% confidence interval [CI], 5.71–9.25; P < .001). Reinforcing this finding, lost productivity was associated with PHQ-2 score (β = 4.72; 95% CI, 2.62–6.83; P < .001). Lost productivity was less strongly associated with the nasal symptom subdomain score (β = 2.65; 95% CI, 0.77–4.52; P = .007), and there was no association between lost productivity and NOSE score (β = 0.01; 95% CI, −0.12 to 0.13; P = .91).ConclusionSymptoms associated with depression are most strongly associated with missed days of work or school because of CRS. Further treatment focusing on depression-associated symptoms in patients with CRS may reduce losses in productivity.



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Table of Contents

Publication date: March 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 3





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Instructions for Authors

Publication date: March 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 3





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Editorial Board

Publication date: March 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 3





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Is it time for asthma action plan apps?

Publication date: March 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 3
Author(s): Jay M. Portnoy, Helen Murphy




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Asthma–chronic obstructive pulmonary disease overlap syndrome

Publication date: March 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 3
Author(s): Mauli Desai, John Oppenheimer, Donald P. Tashkin




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Mechanisms of anaphylaxis beyond classically mediated antigen- and IgE-induced events

Publication date: March 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 3
Author(s): Phil Lieberman




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Mite allergen extracts and clinical practice

Publication date: March 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 3
Author(s): Jerónimo Carnés, Víctor Iraola, Seong H. Cho, Robert E. Esch
ObjectiveTo provide physicians, researchers, and other interested health care professionals with information about how mite source materials and allergen extracts are manufactured, including the critical process parameters that can affect the final composition of allergenic extracts available for clinical use.Data SourcesA PubMed search was performed using focused keywords combined with relevant regulatory documents and industry guidelines.Study SelectionsThe information obtained through literature and specialized books was evaluated and combined with the personal expertise and experience of the authors.ResultsDermatophagoides farinae and Dermatophagoides pteronyssinus are the primary species responsible for allergen sensitizations and allergy symptoms in genetically predisposed individuals. Storage mites belonging to the families Glycyphagidae, Echimyopodidae, and Acaridae can also be relevant sources of indoor mite allergens. The cultivation and purification processes used to produce mite raw materials play a critical role in the final composition of mite allergen extracts. Mite extract standardization in the United States is based on total allergenic activity with respect to a single national standard, whereas in Europe consistency is ensured by in-house standards and international references. Because of the limitation of allergen avoidance and pharmacotherapy for patients with severe allergic rhinitis and asthma, house dust mite subcutaneous immunotherapy or sublingual immunotherapy can be an invaluable treatment option for them.ConclusionDifferences in manufacturing processes and extract standardization approaches may lead to differences in extract quality and potency. Physicians should be aware of these potential sources of mite extract variability. Use of well-standardized house dust mite extracts would be critical for success in the diagnosis and treatment of house dust mite allergy.



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An obstructive sleep apnea primer

Publication date: March 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 3
Author(s): Sara Pasha, Sandhya Kumar, Arjun B. Chatterjee, Guha Krishnaswamy




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Sublingual immunotherapy

Publication date: March 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 3
Author(s): Matthew Greenhawt, John Oppenheimer, Michael Nelson, Hal Nelson, Richard Lockey, Phil Lieberman, Anna Nowak-Wegrzyn, Anju Peters, Charlotte Collins, David I. Bernstein, Joann Blessing-Moore, David Khan, David Lang, Richard A. Nicklas, Jay M. Portnoy, Christopher R. Randolph, Diane E. Schuller, Sheldon L. Spector, Stephen A. Tilles, Dana Wallace




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AAAAI/ACAAI Joint Venom Extract Shortage Task Force Report

Publication date: March 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 118, Issue 3
Author(s): David B.K. Golden, David I. Bernstein, Theodore M. Freeman, James M. Tracy, David M. Lang, Richard A. Nicklas




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A small intestine volvulus caused by strangulation of a mesenteric lipoma: a case report

An emergency department encounters a variety of cases, including rare cases of the strangulation of a mesenteric lipoma by the greater omentum band.

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Stylistic features of case reports as a genre of medical discourse

The present paper discusses the lexical and grammatical peculiarities of English language medical case reports, taking into account their communicative purposes and intentions.

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Phenotypic analysis of asthma in Japanese athletes

Publication date: Available online 12 March 2017
Source:Allergology International
Author(s): Keisuke Tsukioka, Toshiyuki Koya, Hiroshi Ueno, Masachika Hayashi, Takuro Sakagami, Takashi Hasegawa, Masaaki Arakawa, Eiichi Suzuki, Toshiaki Kikuchi
BackgroundAsthma in athlete populations such as Olympic athletes has various pathogeneses. However, few reports are available on the features of asthma in the athlete population in clinical practice. In this study, we focused on classifying asthma in Japanese athlete population.MethodsWe performed a cluster analysis of data from pulmonary function tests and clinical biomarkers before administering inhaled corticosteroids (ICS) therapy in athlete population of individuals diagnosed with asthma (n = 104; male, 76.9%; median age, 16.0 years), based on respiratory symptoms and positive data on methacholine provocation tests. We also compared backgrounds, sports types, and treatments between clusters.ResultsThree clusters were identified. Cluster 1 (32%) comprised athletes with a less atopic phenotype and normal pulmonary function. Cluster 2 (44%) comprised athletes with a less atopic phenotype and lower percent predicted forced expiratory volume in 1 s (%FEV1) values, despite less symptomatic state. Cluster 3 (24%) comprised athletes with a strong atopic phenotype such as high eosinophil count in the blood and total serum immunoglobulin E level. After treatment with ICS or ICS plus long-acting β-adrenergic receptor agonist for 6–12 months, %FEV1 values were significantly improved in Cluster 2 athletes, whereas Cluster 3 athletes had a significant decrease in the fraction of exhaled nitric oxide compared to pretreatment values.ConclusionsThese data suggest three clusters exist in Japanese athlete population with asthma. Between the clusters, the characteristics differed with regard to symptoms, atopic features, and lower %FEV1 values. The pathogeneses between clusters may vary depending on the inflammation type and airway hyperresponsiveness.



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CD8+ T-cell activation by methazolamide causes methazolamide-induced Stevens–Johnson syndrome and toxic epidermal necrolysis

Abstract

Background

Methazolamide (MZ), a carbonic anhydrase inhibitor, occasionally causes Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Susceptibility to MZ-induced SJS/TEN is strongly associated with HLA-B*59:01.

Objective

To characterize the T-cell response against MZ in patients with MZ-induced SJS/TEN.

Methods

We enrolled four patients with MZ-induced SJS/TEN, performed lymphocyte transformation tests, generated MZ-specific T-cell clones, and evaluated the cytotoxic activities of these clones. Subsequently, we analyzed the human leukocyte antigen (HLA)-restricted T-cell response.

Results

Strong proliferative response to MZ was evident, whereas mild proliferative response to acetazolamide was also apparent. MZ-specific T-cell clones (CD8⁺ T-cells) were generated from the patient. These clones proliferated and secreted granzyme B upon MZ stimulation; MZ also increased the expression level of CD107a and granzyme B. Cell proliferation and granzyme B secretion stimulated by MZ were blocked by anti-HLA class I antibodies.

Conclusions

This is the first demonstration of the immunologic mechanism by which MZ -induces SJS/TEN.

This article is protected by copyright. All rights reserved.

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Coarctation of the Aorta as a Complication of Surgical Ligation of Patent Ductus Arteriosus in a Premature Infant

Surgical ligation of a patent ductus arteriosus (PDA) is a commonly performed procedure. Complications are infrequent and most commonly include recurrent laryngeal nerve injury and rarely ligation of left pulmonary artery. We report a case of accidental ligation of the descending thoracic aorta leading to a clinically significant coarctation.

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Infectious Complications of Pediatric Cochlear Implants are Highly Influenced by Otitis Media

Publication date: Available online 12 March 2017
Source:International Journal of Pediatric Otorhinolaryngology
Author(s): Peter M. Vila, Nsangou T. Ghogomu, Audrey R. Odom-John, Timothy E. Hullar, Keiko Hirose
ObjectiveDetermine the incidence of ear infections in cochlear implant patients, evaluate the contribution of otitis media to complications, describe the bacteriology of otitis media in the cochlear implant population, the treatment provided at our center, and the long term outcome.MethodsData collected included age at implantation, history of otitis media or ear tubes, etiology of hearing loss, inner ear anatomy, postoperative infections, time to infection, route of antibiotic administration, and interventions for infections. Categories of infection were acute otitis media, otitis media with effusion, tube otorrhea, meningitis, scalp cellulitis, and infection at the implant site.ResultsMiddle ear infections were diagnosed in 37% of implanted ears. Extension of middle ear infections into the implant site occurred in 2.8% of all implants (n = 16). Of the 16 infected devices, 10 were successfully treated with antibiotic therapy and did not require explantation. The retained implant group and explanted group both included some middle ear microbes such as Haemophilus influenzae and Streptococcus pneumoniae, as well as skin flora such as Staphylococcus aureus.ConclusionOtitis media in pediatric cochlear implant patients is a common event and usually does not lead to complications of the cochlear implant. However, when the ear infection spreads to the scalp and the implant site, it is still possible to eliminate the infection using antibiotic therapy, particularly when treatment is directed to the specific organism that is recovered from the infected space and the duration and route of antibiotic treatment is carefully considered.



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