Τετάρτη 15 Μαρτίου 2017
A Study of Trastuzumab Emtansine in Participants With Human Epidermal Growth Factor Receptor 2 (HER2) Positive Breast Cancer Who Have Received Prior Anti-HER2 And Chemotherapy-based Treatment
Condition: Breast Cancer
Intervention: Drug: Trastuzumab Emtansine
Sponsor: Hoffmann-La Roche
Recruiting - verified March 2017
http://ift.tt/2npWTpa
Intervention: Drug: Trastuzumab Emtansine
Sponsor: Hoffmann-La Roche
Recruiting - verified March 2017
http://ift.tt/2npWTpa
Molecular effects of fractional ablative erbium:YAG laser treatment with multiple stacked pulses on standardized human three-dimensional organotypic skin models
Abstract
The molecular changes in gene expression following ablative laser treatment of skin lesions, such as atrophic scars and UV-damaged skin, are not completely understood. A standardized in vitro model of human skin, to study the effects of laser treatment on human skin, has been recently developed. Therefore, the aim of the investigation was to examine morphological and molecular changes caused by fractional ablative erbium:YAG laser treatment on an in vitro full-thickness 3D standardized organotypic model of human skin. A fractional ablative erbium:YAG laser was used to irradiate organotypic human 3D models. Laser treatments were performed at four different settings using a variety of stacked pulses with similar cumulative total energy fluence (60 J/cm2). Specimens were harvested at specified time points and real-time PCR (qRT-PCR) and microarray studies were performed. Frozen sections were examined histologically. Three days after erbium:YAG laser treatment, a significantly increased mRNA expression of matrix metalloproteinases and their inhibitors (MMP1, MMP2, MMP3, TIMP1, and TIMP2), chemokines (CXCL1, CXCL2, CXCL5, and CXCL6), and cytokines such as IL6, IL8, and IL24 could be detected. qRT-PCR studies confirmed the enhanced mRNA expression of IL6, IL8, IL24, CXCLs, and MMPs. In contrast, the mRNA expression of epidermal differentiation markers, such as keratin-associated protein 4, filaggrin, filaggrin 2, and loricrin, and antimicrobial peptides (S100A7A, S100A9, and S100A12) as well as CASP14, DSG2, IL18, and IL36β was reduced. Four different settings with similar cumulative doses have been tested (N10%, C10%, E10%, and W25%). These laser treatments resulted in different morphological changes and effects on gene regulations. Longer pulse durations (1000 μs) especially had the strongest impact on gene expression and resulted in an upregulation of genes, such as collagen-1A2, collagen-5A2, and collagen-6A2, as well as FGF2. Histologically, all treatment settings resulted in a complete regeneration of the epidermis 3 days after irradiation. Fractional ablative erbium:YAG laser treatment with a pulse stacking technique resulted in histological alterations and shifts in the expression of various genes related to epidermal differentiation, inflammation, and dermal remodeling depending on the treatment setting applied. A standardized in vitro 3D model of human skin proved to be a useful tool for exploring the effects of various laser settings both on skin morphology and gene expression during wound healing. It provides novel data on the gene expression and microscopic architecture of the exposed skin. This may enhance our understanding of laser treatment at a molecular level.
http://ift.tt/2mvgqAl
A split-face comparison of Q-switched Nd:YAG 1064-nm laser for facial rejuvenation in Nevus of Ota patients
Abstract
We aimed to investigate the efficacy and safety of using the 1064-nm Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser (QSNYL) for skin rejuvenation in patients with Nevus of Ota. A retrospective, randomized, split-faced, clinical study was conducted. Twenty-nine patients with unilateral moderate to severe Nevus of Ota were enrolled. The participants completed 3–13 sessions of QSNYL treatments 3–6 months apart. Two independent physicians compared the treated and untreated sides of the face to evaluate the clearance of Nevus of Ota, the wrinkle severity rating scale (WSRS), the global aesthetic improvement scale (GAIS), and adverse event reporting. Patients' satisfaction levels were also considered. Of the 29 patients, 28 (96.6%) achieved nearly complete pigmentation clearance. After an average of 7.76 ± 2.99 sessions, statistically significant improvement in wrinkles and skin texture were observed, compared with the untreated side. The degree of skin rejuvenation was positively correlated with the number of treatment sessions. No clinically adverse effects were observed. Repeated QSNYL treatments not only remove the pigment in Nevus of Ota effectively and safely but also improve facial rejuvenation.
http://ift.tt/2mQFGUk
Development of oral cancer vaccine using recombinant Bifidobacterium displaying Wilms’ tumor 1 protein
Abstract
Several types of vaccine-delivering tumor-associated antigens (TAAs) have been developed in basic and clinical research. Wilms' tumor 1 (WT1), identified as a gene responsible for pediatric renal neoplasm, is one of the most promising TAA for cancer immunotherapy. Peptide and dendritic cell-based WT1 cancer vaccines showed some therapeutic efficacy in clinical and pre-clinical studies but as yet no oral WT1 vaccine can be administrated in a simple and easy way. In the present study, we constructed a novel oral cancer vaccine using a recombinant Bifidobacterium longum displaying WT1 protein. B. longum 420 was orally administered into mice inoculated with WT1-expressing tumor cells for 4 weeks to examine anti-tumor effects. To analyze the WT1-specific cellular immune responses to oral B. longum 420, mice splenocytes were isolated and cytokine production and cytotoxic activities were determined. Oral administrations of B. longum 420 significantly inhibited WT1-expressing tumor growth and prolonged survival in mice. Immunohistochemical study and immunological assays revealed that B. longum 420 substantially induced tumor infiltration of CD4+T and CD8+T cells, systemic WT1-specific cytokine production, and cytotoxic activity mediated by WT1-epitope specific cytotoxic T lymphocytes, with no apparent adverse effects. Our novel oral cancer vaccine safely induced WT1-specific cellular immunity via activation of the gut mucosal immune system and achieved therapeutic efficacy with several practical advantages over existing non-oral vaccines.
http://ift.tt/2m1WM31
Associations of FoxP3 gene polymorphisms with severe recurrent respiratory papillomatosis in Korean patients
Abstract
Background
FoxP3 is the most dependable marker for regulatory T cells which play a major role in immune tolerance. Foxp3 gene polymorphisms were associated with various autoimmune diseases and clearance of viral infections. We studied the association of Foxp3 polymorphisms in severe RRP patients.
Methods
A total of 30 Korean severe RRP patients and 195 healthy controls were enrolled. Foxp3 polymorphisms (rs5902434 del/ATT, rs3761548 C/A, rs3761549 C/T, and rs2232365 G/A) were determined by PCR and sequencing.
Results
Genotype frequencies (GF) of rs5902434 ATT/ATT and rs2232365 GG were significantly decreased in female RRP patients than controls (0.0% vs 23.0%, p = 0.039, OR = 9.4 for both).
Conclusions
We showed that Foxp3 polymorphism of rs5902434 and rs2232365 could be an important protective factor in the susceptibility of severe RRP in female Koreans. Further studies on larger number of patients and other ethnic groups are needed to clarify the association.
http://ift.tt/2npbrpk
Associations of FoxP3 gene polymorphisms with severe recurrent respiratory papillomatosis in Korean patients
FoxP3 is the most dependable marker for regulatory T cells which play a major role in immune tolerance. Foxp3 gene polymorphisms were associated with various autoimmune diseases and clearance of viral infectio...
http://ift.tt/2n1hBe4
Replacing a pediatric tracheostomy tube
Augusta University medical professional demonstrate how to replace a pediatric tracheostomy tube.
http://ift.tt/2mKhotO
Utility of Store and Forward Teledermatology for Skin Patch Test Readings
Background: Teledermatology (TD) is the use of imaging technology to provide dermatology services at a distance. To date, studies assessing its application for grading skin patch test reactions have been lacking. Objectives: The aim was to compare conventional, in-person (IP) grading of skin patch test reactions with store-forward TD. Methods: Patients undergoing patch testing to the North American Contact Dermatitis Group (NACDG) screening series were invited to participate in this repeated-measures study. Photographs of the NACDG screening series patch sites were obtained at 2 time points (48-hour and final readings). Teledermatology assessments were completed by the same staff dermatologist who performed the IP readings; 48-hour and final TD photographs were viewed at weeks 4 and 8 after the IP encounter, respectively, to prevent recall bias. Staff dermatologists were blinded to IP grading results. The main outcome was percent agreement. Eight categories of agreement were created according to possible pairings of TD and IP reading results. Three final outcome groups of "success," "indeterminate," and "failure" were defined based on clinical significance. Results: One hundred one participants completed the study. There were 7070 comparison points between IP and TD final readings. Excluding negative/negative agreement, there was "success" of TD in 54% of final readings. "Indeterminate" agreement with possible clinical significance was present in 40% of final readings. There was "failure" (definite clinical significance) in 6% of final readings. Conclusions: Teledermatology may be a viable option for grading skin patch test reactions, particularly for clinicians who perform limited patch testing. However, a clinically significant "failure" rate of 6% and practical barriers to TD implementation may preclude its widespread use for skin patch testing in tertiary referral centers where large numbers of patches are tested per patient.http://ift.tt/2mKEnVz
Contact Allergy to (Ingredients of) Toothpastes
The literature on contact allergy to (ingredients of) toothpastes is critically reviewed. We have found 47 case reports, small case series (n = 2-5) and citations published between 1900 and 2016 describing more than 60 patients allergic to toothpastes, and in addition 3 larger case series and many descriptions of toothpaste allergy among selected groups of patients. Allergic reactions usually manifest as cheilitis with or without dermatitis around the mouth, less frequently by oral symptoms. Formerly, many reactions were caused by cinnamon derivatives; more recently, reported allergens are diverse. A semiopen test or closed patch test with the toothpaste "as is" may be performed as an initial test, but a positive reaction should always be followed by confirmatory tests. The role of contact allergy to toothpastes in patients with oral symptoms (stomatitis, glossitis, gingivitis, buccal mucositis, burning, soreness, and possibly burning mouth syndrome and recurrent aphthous ulcers) is unclear and should be further investigated.http://ift.tt/2m1I3VP
Periorbital Allergic Contact Dermatitis Due to Ketotifen
No abstract availablehttp://ift.tt/2m1MBvk
Gallate Contact Dermatitis: Product Update and Systematic Review
Allergic contact dermatitis related to cosmetic use can result from allergens not routinely evaluated by standard patch test protocols. Propyl, octyl, and dodecyl gallates are commonly used antioxidant preservatives with reports of associated allergic contact dermatitis in the literature. The objectives of this review were to investigate the role of gallates in allergic contact dermatitis and to explore products containing these preservatives. A systematic review of the literature through April 2016 was performed to explore cases of reported gallate allergy. Food and cosmetic product databases were searched for products containing gallates. Seventy-four cases of gallate contact allergy have been reported. In addition, a variety of commercially available cosmetic products and foods contain gallate chemicals. Propyl gallate is the most commonly reported gallate contact allergen and often causes facial and/or hand dermatitis.http://ift.tt/2m1yp5n
Interleukin 4 –590C/T (rs2243250) Polymorphism Is Associated With Increased Risk of Atopic Dermatitis: Meta-Analysis of Case-Control Studies
Background: Interleukin 4 (IL-4) −590C/T polymorphism has been reported to influence atopic dermatitis (AD) susceptibility, but the results are controversial. Objective: This meta-analysis was performed to study the association between IL-4 −590C/T polymorphism and AD susceptibility. Methods: The PubMed, Embase, and China National Knowledge Infrastructure databases were searched. Odds ratios (ORs) with 95% confidence intervals (CIs) were performed to estimate the strength of the association. Results: Ten studies comprising 923 cases and 1215 controls were included. The overall population revealed significant associations between IL-4 −590C/T polymorphism and AD susceptibility under the allele (OR, 1.19; 95% CI, 1.03–1.38; I2 = 0.0%), recessive (OR, 1.27; 95% CI, 1.002–1.61; I2 = 0.0%), and dominant (OR, 1.33; 95% CI, 1.003–1.76; I2 = 0.0%) models; similar results were found under the allele (OR, 1.19; 95% CI, 1.01–1.39; I2 = 0.0%) and recessive (OR, 1.27; 95% CI, 1.001–1.62; I2 = 0.0%) models after excluding not-in–Hardy-Weinberg equilibrium studies. However, subgroup analyses by ethnicity showed no significant association in Asians or whites. Subgroup analyses by age indicated a significant association in children under the allele (OR, 1.30; 95% CI, 1.06–1.60; I2 = 0.0%) and dominant (OR, 1.42; 95% CI, 1.02–1.97; I2 = 0.0%) models, children in articles with Hardy-Weinberg equilibrium under the allele model (OR, 1.33; 95% CI, 1.05–1.69; I2 = 0.0%), and Asian children under the allele model (OR, 1.41; 95% CI, 1.02–1.95; I2 = 0.0%) but not in white children. Conclusions: The IL-4 −590C/T polymorphism may contribute to AD susceptibility in the overall population and children, especially for Asian children, but large well-designed studies are warranted to confirm this conclusion.http://ift.tt/2noMxps
Contact Allergy Cross-reactions: Retrospective Clinical Data and Review of the Literature
We discuss cross-reactions that can occur when a patient allergic to a specific allergen also reacts to a similar allergen. Currently, The American Contact Dermatitis Society Contact Allergy Management Program, which allows physicians to identify safe products for their patients, uses a 10% threshold to distinguish significant cross-reactors. New clinical data from a patch testing center along with previous data in the literature are analyzed to help determine whether current cross-reactor definitions are reasonable or should be altered.http://ift.tt/2noPqHa
American Contact Dermatitis Society Core Allergen Series: 2017 Update
The American Contact Dermatitis Society Core Allergen Series was introduced in 2012. After 4 years of use, changes in our recommended allergens are necessary. For the updated series, we have reordered the first 4 panels to approximately mirror the current TRUE Test and removed parthenolide, triclosan, glutaraldehyde, and jasmine. Polymyxin B, lavender, sodium benzoate, ethylhexylglycerin, and benzoic acid are new additions to the American Contact Dermatitis Society series.http://ift.tt/2noNbDL
Reporting of harm and safety results in randomized controlled trials published in 5 dermatology journals
Randomized controlled trials (RCTs) are considered the gold standard for assessing efficacy and short-term harm of medicines. However, several studies have come to the conclusion that harm is less well reported than efficacy outcomes.
http://ift.tt/2ntkX7r
Hereditary leiomyomatosis and renal cell cancer syndrome: An update and review
Hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome is a rare genetic disorder that predisposes individuals to multiple cutaneous leiomyomas, renal cell carcinomas, and in women, uterine leiomyomas. Also known as Reed syndrome, it is caused by a germline heterozygous mutation of the fumarate hydratase tumor suppressor gene. HLRCC is associated with significant morbidity because of pain from cutaneous and uterine leiomyomas, the cutaneous pain often of unique character. Although genetic testing is currently considered the criterion standard to diagnose HLRCC, newer immunohistochemistry markers may provide rapid and cost effective alternatives to genetic testing.
http://ift.tt/2n1jEyH
The adverse prognostic effect of tumor budding on the evolution of cutaneous head and neck squamous cell carcinoma
Tumor budding is a readily detectable histopathologic feature that has been recognized as an adverse prognostic factor in several human cancers.
http://ift.tt/2ntr4bR
Association of psoriasis and psoriatic arthritis with osteoporosis and pathological fractures
Previous studies examining the relationship between psoriasis (Pso), osteoporosis, and pathological fractures found conflicting results.
http://ift.tt/2n10xoB
Synovial chondromatosis of the temporomandibular joint with extension into the middle cranial fossa and internal carotid canal
This report presents the case of an extensive synovial chondromatosis of the temporomandibular joint (TMJ), with extension into the middle cranial fossa, middle ear, and carotid canal. Synovial chondromatosis of the TMJ is rare, particularly when associated with intracranial involvement. This case is unique owing to its size and the involvement with the internal carotid artery. The importance of a multidisciplinary approach in the surgical management of such a rare and complex form of this condition is highlighted.
http://ift.tt/2mtIt2m
The role of Kupffer cells in hepatic diseases
Source:Molecular Immunology, Volume 85
Author(s): Peizhi Li, Kun He, Jinzheng Li, Zuojin Liu, Jianping Gong
Kupffer cells (KCs) constitute 80–90% of the tissue macrophages present in the body. Essential to innate and adaptive immunity, KCs are responsible for the swift containment and clearance of exogenous particulates and immunoreactive materials which are perceived as foreign and harmful to the body. Similar to other macrophages, KCs also sense endogenous molecular signals that may result from perturbed homeostasis of the host. KCs have been implicated in host defense and the pathogenesis of various hepatic diseases, including endotoxin tolerance, liver transplantation, nonalcoholic fatty liver disease, and alcoholic liver disease. In this review, we summarized some novel findings associated with the role of KCs in hepatic diseases, such as the origin and mechanisms KCs polarization, molecular basis for caspase-1 activation called "non-canonical inflammasome pathway" involving the cleavage of Gsdmd by caspase-11, the important role of microRNA in liver transplantation, and so on. A better understanding of KCs biological characteristics and immunologic function in liver homeostasis and pathology may pave the way to investigate new diagnostic and therapeutic approaches for hepatic diseases.
http://ift.tt/2mtNb14
Gene delivery of TIPE2 inhibits breast cancer development and metastasis via CD8+ T and NK cell-mediated antitumor responses
Source:Molecular Immunology, Volume 85
Author(s): Zhenhua Zhang, Li Liu, Shousong Cao, Yizhun Zhu, Qibing Mei
Breast cancer is the second leading cause of cancer-related deaths in the female patients which was mainly caused by metastasis. Development of target gene therapy for breast cancer to suppress tumor progress and metastasis will improve the therapeutic options and be of great benefit to the patients. Tumor necrosis factor-alpha-induced protein 8-like 2 is a novel molecule for maintaining immune homeostasis and is involved in cancer development. In the present study, we overexpressed TIPE2 in breast cancer cells to investigate the role of TIPE2 in the development of breast cancer. Our results showed that overexpression of TIPE2 significantly inhibited the proliferation of 4T1 cells in vitro and in vivo. We constructed a non-viral targeted gene therapeutic system by using the minicircle plasmids expressing TIPE2. We found that the growth and metastasis of breast cancer was significantly inhibited by hydrodynamic gene delivery of TIPE2 plasmids in vivo. Mechanistically, TIPE2 increased T and NK cells, and decreased MDSCs. Gene delivery of TIPE2 up-regulated the production of IFN-γ and TNF-α by CD8+ T and NK cells in spleens and tumor microenvironment, and enhanced the cytotoxic activity of CD8+ T and NK cells. Taken together, TIPE2 inhibited breast cancer development and metastasis possibly via promoting CD8+ T and NK cell-mediated antitumor immune responses. Thus, the results indicate that TIPE2 may be a potential therapeutic target for breast cancer therapy.
http://ift.tt/2mPiHJx
The “GREAT” Score Predicts the Outcome of Antithyroid Drug Therapy of Graves’ Disease
Clinical Thyroidology Mar 2017, Vol. 29, No. 3: 110-113.
http://ift.tt/2nFBEvI
Multimodality Treatment with Surgery, External-Beam Radiation, and Chemotherapy Improves Survival for Selected Patients with Anaplastic Thyroid Cancer
Clinical Thyroidology Mar 2017, Vol. 29, No. 3: 90-93.
http://ift.tt/2mtIOTI
Prostate-Specific Membrane Antigen Expression in Metastasized Iodine-Negative Thyroid Cancer May Provide a Novel Therapeutic Approach
Clinical Thyroidology Mar 2017, Vol. 29, No. 3: 94-96.
http://ift.tt/2mPm8jr
Treatment of Subclinical Hypothyroidism Has Diverse Effects on Obstetric Outcomes
Clinical Thyroidology Mar 2017, Vol. 29, No. 3: 116-118.
http://ift.tt/2nbacJI
Active Surveillance of Small, Low-Risk Papillary Thyroid Cancers Can Be a Safe Alternative to Surgery in Selected Patients
Clinical Thyroidology Mar 2017, Vol. 29, No. 3: 97-99.
http://ift.tt/2mtP1yR
Incidental Thyroid Nodules Detected on CT, MRI, or PET-CT Correlate Well with Subsequent Ultrasound Evaluation
Clinical Thyroidology Mar 2017, Vol. 29, No. 3: 107-109.
http://ift.tt/2mP6Mv7
Pregnancy Has Little Effect on the Progression of Differentiated Thyroid Cancer in Women with an Excellent, Indeterminate, or Biochemically Incomplete Risk Classification Status
Clinical Thyroidology Mar 2017, Vol. 29, No. 3: 100-103.
http://ift.tt/2mtG4pr
Among Myxedema Coma Patients, Older Age and Catecholamine Use Are Associated with Higher Risk for In-Hospital Mortality
Clinical Thyroidology Mar 2017, Vol. 29, No. 3: 114-115.
http://ift.tt/2nFCB7k
Large NIFTP Have a Very Low Risk of Recurrence
Clinical Thyroidology Mar 2017, Vol. 29, No. 3: 104-106.
http://ift.tt/2nbmlym
Are Changes in Cardiac Deiodinase Activities Involved in Certain Cardiac Disorders?
Clinical Thyroidology Mar 2017, Vol. 29, No. 3: 119-121.
http://ift.tt/2nFQzpH
Immunologische Mechanismen der allergenspezifischen Immuntherapie
Zusammenfassung
Die allergenspezifische Immuntherapie (SIT) geht sowohl auf zellulärer als auch auf humoraler Ebene mit einer Vielzahl an immunologischen Veränderungen einher. Im Wesentlichen kommt es zu einem Shift der Th2-Immunantwort in eine Immunantwort vom Th1-Typ, der mit einem Anstieg an regulatorischen T‑ und B‑Zellen sowie dem Zytokin IL-10 und einer Abnahme von Effektorzellen und Eosinophilen im Gewebe zusammen mit der Reduktion von IgE zugunsten der Zunahme von IgG4-Antikörpern im Blut der Patienten einhergeht. Ein besseres Verständnis der immunologischen Mechanismen, die der SIT zugrunde liegen, ist essenziell für die weitere Optimierung der Therapie sowie die Entwicklung von Biomarkern zum Monitoring des Therapieansprechens sowie der Patienten-Compliance.
http://ift.tt/2nbiuRX
Evaluation of Patients with Sinonasal and Ventral Skull Base Malignancies
A wide variety of tumors present in the sinonasal and ventral skull base. Patients often have nonspecific symptoms initially and present with advanced tumors, affecting the orbit and other adjacent structures. Evaluation of these malignancies with modern imaging techniques can define tumor invasion, but biopsy is often required to establish a diagnosis because most have a nonspecific appearance. A thorough understanding of the anatomy is the key to treatment planning, and a multidisciplinary approach determines the optimal strategy.
http://ift.tt/2nFw0ts
Population-Based Results in the Management of Sinonasal and Ventral Skull Base Malignancies
Population-based cancer registries allow for data collection on the scale of large populations, outside the limits of a single institution, and facilitate study of rare entities. The SEER database has been used to study more than 7000 cases encompassing a wide variety of relatively rare sinonasal malignant histologies. Clinically useful parameters have been gleaned from these analyses. Important limitations, such as omission of chemotherapy data, surgical approach used, type of radiation administered, and selection and confounding bias, should be considered. Nevertheless, population-based analyses yield readily generalizable and clinically relevant information regarding the management of sinonasal malignancies for the practicing clinician.
http://ift.tt/2naYXRk
Staging of Sinonasal and Ventral Skull Base Malignancies
Tremendous pathologic diversity among sinonasal and ventral skull base malignancies complicates development of a uniform and prognostically relevant staging system. Because of the comparatively low incidence of these tumors, comprehensive evaluation and comparison of specific staging systems is difficult. The current American Joint Committee on Cancer TNM staging system for sinonasal malignancies is the most common and widely used system in current clinical practice. Alternative systems have been proposed for use with individual histopathologic subtypes. Many of these staging systems are of great utility and accurately predict patient survival. Further research and adjustment of these current staging systems remains an important area of research.
http://ift.tt/2nFsL5d
Endoscopic Resection of Clival Malignancies
Surgical management of clival lesions presents numerous therapeutic challenges because of the close proximity of surrounding critical structures. With a detailed understanding of the endoscopic endonasal approach and relevant considerations, appropriate lesions can be removed in a safe and minimally invasive manner. Use of this technique as a primary approach represents the standard of care for many lesions at leading skull base centers, although adjunct techniques may be necessary in extensive lesions and those with significant lateral extension.
http://ift.tt/2nFGk4N
Anterior Skull Base Malignancies—The Otolaryngologist’s Contribution
The anterior skull base represents a challenging space necessitating surgical collaboration between Otolaryngology, Neurosurgery, and Ophthalmology. The input of those specialties as well as from Medical and Radiation Oncology, Radiology, Nuclear Medicine and Imaging, and affiliated Allied Healthcare Specialists is vital. It enables optimal patient outcome, from a tumor removal and disease-free survival perspective as well as in how it pertains to quality of life.
http://ift.tt/2naZ5k8
Combined Endoscopic and Open Approaches in the Management of Sinonasal and Ventral Skull Base Malignancies
Combined transcranial and endoscopic endonasal approaches remain useful in the treatment of ventral skull base malignancies. The extended bifrontal transbasal approach provides wide access to the anterior ventral skull base and paranasal sinuses without transfacial incisions. In more extensive lesions, the bifrontal transbasal approach can then be combined with an endoscopic endonasal approach (EEA) from below. This article reviews the indications, surgical technique, and operative nuances of combined transbasal and EEA (cranionasal) approaches for the surgical management of ventral skull base malignancies.
http://ift.tt/2nFqIhM
Management of Orbital Involvement in Sinonasal and Ventral Skull Base Malignancies
The orbit may be frequently involved by sinonasal or ventral skull base malignancy. This involvement bodes a poorer prognosis for survival. Multimodality therapy with surgery and radiation therapy is usually attempted to optimize local control and overall survival. Oncologic surgical resection with negative margins is critical to local control and survival. In the past, any involvement of the orbit was deemed to necessitate orbital sacrifice. However, contemporary studies show that in carefully selected cases, orbital preservation does not adversely impact survival. In addition, novel reconstructive techniques can help minimize complications and optimize functional and aesthetic outcomes.
http://ift.tt/2nFw5xr
Management of Cavernous Sinus Involvement in Sinonasal and Ventral Skull Base Malignancies
Cavernous sinus (CS) involvement by sinonasal and ventral skull base malignancies is infrequently encountered in neurosurgical practice. Despite advancements in skull base microneurosurgery and endoscopic techniques, detailed knowledge and experience of the surgical management of these lesions are limited. This article elaborates on surgical strategies and approaches for CS involvement of malignant ventral skull base tumors. The article discusses the indications, techniques, nuances, advantages, limitations, and complications of minimally invasive CS biopsy, transcranial microscopic, and transfacial endoscopic approaches to the CS using illustrative diagrams and operative videos. The principles and nuances of a high-flow cerebral revascularization procedure are mentioned.
http://ift.tt/2nFtJPc
The Role of Targeted Therapy in the Management of Sinonasal Malignancies
Cancers develop secondary to genetic and epigenetic changes that provide the cell with a survival advantage that promotes cellular immortality. Malignancy arises when tumors use mechanisms to evade detection and destruction by the immune system. Many malignancies seem to elicit an immune response, yet somehow manage to avoid destruction by the cells of the immune system. Cancers may evade this immune response by numerous mechanisms. Several targeted immune therapies are available that block some of these inhibitory signals and enhance the cell-mediated immune response. Many of these agents hold significant promise for future treatment of sinonasal and ventral skull base malignancies.
http://ift.tt/2nbeyAp
The Role of Robotic Surgery in Sinonasal and Ventral Skull Base Malignancy
Over the past decade, robotic surgery has gained wide popularity, making a significant impact on multiple surgical specialties. In the head and neck arena, transoral robotic surgery has proven to be safe and associated with acceptable oncological and superior functional outcomes for surgery of the oropharynx, hypopharynx, supraglottis, and glottis; thus, changing the paradigm for the management of tumors in these anatomic locations. Robotic surgery of the ventral skull base is at an early stage of development. In this article reviews the literature discussing the role of robotic surgery in managing sinonasal and ventral skull base malignant lesions.
http://ift.tt/2nFIUYp
Sinonasal and Ventral Skull Base Malignancies
OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA
http://ift.tt/2nb6wHZ
Management of Skull Base Defects After Surgical Resection of Sinonasal and Ventral Skull Base Malignancies
Over the past 2 decades, there has been a significant increase in the resection of larger and more complex ventral skull base malignancies. The resection of these lesions has resulted in the creation of larger and more difficult to repair skull base defects. There are many available options for ventral skull base reconstruction. Despite the variety of reconstructive options, the key objective is to eliminate any communication between the intracranial space and the sinonasal cavity. This article discusses some of the more common techniques currently used for repair of these skull base defects.
http://ift.tt/2nFJyW4
Sinonasal and Ventral Skull Base Malignancies
Over the last decades, management of sinonasal and ventral skull base malignancies has evolved significantly as a result of new advances in surgical instrumentations and optical devices, newer endoscopic and open techniques, better understanding of the sinonasal and ventral skull base anatomy, and improvement in radiotherapeutic, chemotherapeutic, and targeted treatment of these lesions. In addition, emphasis on multidisciplinary approach and closer collaborations between surgical teams has improved the ability to resect these lesions with less morbidity.
http://ift.tt/2nbbbcZ
Dermatology Consultations in Patients With Inflammatory Skin Diseases
This study investigates the association of dermatology consultations with outcomes of hospitalized patients with skin diseases.
http://ift.tt/2naNpOi
http://ift.tt/2naNpOi
Patients With Cellulitis Requiring Intensive Care
This cohort study describes the clinical presentation and outcomes of patients with intensive care unit–necessitating cellulitis and compares them with patients with necrotizing fasciitis.
http://ift.tt/2nFskb6
http://ift.tt/2nFskb6
An Asymptomatic Hyperpigmented Eruption on the Lower Extremities
A woman in her early 20s presented with 1 year of discrete asymptomatic brown lesions distributed over her lower extremities; she denied any history of trauma or prior lesions at these sites and denied fever, arthralgias, myalgias, or constitutional symptoms. What is your diagnosis?
http://ift.tt/2naVBhr
http://ift.tt/2naVBhr
Trends in Geographic Distribution of US Dermatology Workforce Density
This study examines the geographic distribution of the US dermatology workforce density using data from the American Academy of Dermatology and the Society for Dermatology Physician Assistants.
http://ift.tt/2nF8c9e
http://ift.tt/2nF8c9e
SJS/TEN Standard Reporting and Evaluation Guidelines
This Consensus Statement reports on efforts to establish a standardized case report form for Stevens-Johnson syndrome and toxic epidermal necrolysis to facilitate comparisons and maintain data quality based on an international panel experts who performed a Delphi consensus-building exercise.
http://ift.tt/2naDHv0
http://ift.tt/2naDHv0
Characteristics of the Infiltrating Cells in Histiocytoid Sweet Syndrome
This case series study characterizes the immunohistochemical phenotype of the infiltrate in histiocytoid Sweet syndrome and evaluates whether this variant of Sweet syndrome is more frequently associated with hematologic malignancies than classic Sweet syndrome.
http://ift.tt/2nF6F30
http://ift.tt/2nF6F30
Bradycardia in a Child After Using Brimonidine as Toothpaste
This case report describes the occurrence of bradycardia in a child after using brimonidine as toothpaste.
http://ift.tt/2nF9BN8
http://ift.tt/2nF9BN8
Oral Sweet's syndrome occurring in ulcerative colitis
A man aged 78 years presented with a 3-week history of tender mouth ulceration associated with arthralgia and weight loss. He had ulcerative colitis that was diagnosed 10 years previously which was well controlled on adalimumab 40 mg fortnightly. Biochemical and haematological investigations showed raised inflammatory markers (CRP 105) and a marked neutrophilia (10). On examination, the patient had severe oral ulceration involving the anterior tongue and lips. In addition, on cutaneous examination had tender erythematous nodules involving the forehead. Histology from a diagnostic punch biopsy showed marked dermal oedema with an inflammatory infiltrate consisting of neutrophils. Our working diagnosis was therefore oral Sweet's syndrome. The patient was then started on oral prednisolone and later received colchicine which led to a complete resolution of symptoms.
http://ift.tt/2nETrmz
Antepartum uterine rupture at 29 weeks gestation following unilateral salpingectomy and review of literature
Antepartum uterine rupture following salpingectomy is a rare condition and is associated with high fetal and maternal mortality and morbidity. We illustrate a 33-year-old primigravida who presented with abdominal pain at 29 weeks of gestation. Her previous obstetric history included a ruptured right ectopic pregnancy for which she underwent laparoscopic salpingectomy with no breach of uterine cavity. Her antenatal care had otherwise been unremarkable. Following admission for undetectable fetal heart, ultrasound and CT demonstrated an extrauterine fetus at the right adnexal region with free fluid consistent with intra-abdominal haemorrhage. An exploratory laparotomy was performed which revealed a uterine rupture at the right cornua with the extruded fetus en caul. The fetus was delivered and the uterus repaired in three layers. The patient made an uneventful postoperative recovery and was discharged 5 days following surgery. We review the current literature including the evaluation and management of this rare condition.
http://ift.tt/2naqfHN
Forensic investigation into a death: post-traumatic amnesia in a worker with a work-related head injury sustained in a coal-fired thermal power plant in India
This is the first reported case of a work-related head injury in a coal-fired thermal power plant in India. This case highlights the trend of not reporting work injuries due to fears of reprisal from the management team that may include the termination of employment. Post-traumatic amnesia in a worker presenting with head trauma must be recognised by coworkers, so the cause of injury can be elicited early and the victim gets timely medical help. There are few published studies on work-related traumatic brain injury, and they provide no information on either anatomical localisation or signs and symptoms. It is imperative that this under-researched area is studied, so detailed epidemiology and accurate national and global statistics are made available to address this dangerous yet preventable condition.
http://ift.tt/2nEVpnh
Purulent pericarditis as a complication of bacteraemic Enterococcus faecalis urinary tract infection
Purulent pericarditis is a rare clinical entity in the modern antibiotic era. The most common portal of entry is thought to be direct extension from a primary lung source and is usually caused by Staphylococcus aureus, Streptococcus pneumoniae or Haemophilus influenzae. We report the case of a man aged 69 years who presented with purulent pericarditis due to Enterococcus faecalis likely caused by haematogenous spread from a urinary tract source. Urgent pericardiocentesis was vital and restored his haemodynamic stability. He was treated for a total duration of 4 weeks with susceptible antibiotics. Echocardiography 3 weeks later showed persistent resolution of the pericardial effusion. This case shows that prompt diagnosis and drainage of the pericardial effusion are vital to achieve a positive outcome in purulent pericarditis. To the best of our knowledge, this is the first reported case of purulent pericarditis caused by E. faecalis from a urinary tract source.
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Diffuse idiopathic skeletal hyperostosis (DISH): an unusual cause of airway obstruction
Description
Acute airway obstruction is a common ENT emergency with a wide range of aetiologies. The most common causes are infection, malignancy and foreign bodies, but more unusual causes should be considered.1
A 77-year old gentleman presented to the emergency department with worsening difficulty in breathing for 3 months since undergoing spinal surgery for multilevel cervical myelopathy. He of stertor, cough, dysphagia and intermittent apnoea. He was otherwise systemically well with no clinical signs of sepsis. Flexible nasendoscopy revealed a large posterior pharyngeal wall mass obscuring the glottis (figure 1).
Figure 1
Flexible nasendoscopy demonstrating a large posterior pharyngeal mass protruding into the airway resulting in narrowing of the glottic inlet as well as supraglottic oedema (Os, osteophyte compressing the posterior pharyngeal wall; Ep, epiglottis; *vocal fold demonstrating glottic oedema).
CT of the neck revealed a large confluence of osteophyte...
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Ergonomic analysis of the surgical position in functional endoscopic sinus surgery
Background
Ergonomics is the methodologic study of people's efficiency in their work environment and is based on anatomy, physiology, psychology, and engineering. Although highly studied in other work environments, little attention has been paid to surgeons until the landmark survey by Park et al in 2010. Many unique aspects of endoscopic surgery amplify task-related physical discomfort, and, because of these issues, we aimed to study the physical fatigue effects of functional endoscopic sinus surgery (FESS) performed in the standing and sitting positions.
Methods
Bilateral FESS was performed in 8 cadaver heads (4 in the standing position, 4 in the sitting position), following established ergonomic principles. Physical fatigue was assessed using a 27-point physical discomfort questionnaire, surface electromyography (EMG), and the NASA Task Load Index Survey. Paired and unpaired t tests were used for statistical analysis.
Results
Physical fatigue was noted after FESS performed in both positions. An overall similar task burden was seen when comparing the 2 positions, although the sitting position was more "frustrating" (p < 0.05). Discomfort after FESS in the standing position was worse in the legs and low back, whereas, in the sitting position, it was seen predominantly in the upper back and arms (p < 0.05). Mean power frequency EMG measurements demonstrated fatigue of major muscle groups in both positions.
Conclusion
Significant physical fatigue is reported after a single FESS operation, with measurable EMG changes. Surgeons should be aware of the short- and long-term physical implications of their daily tasks, and should use this information to be proactive in decision-making for their longevity.
http://ift.tt/2mNAxN4
Pyoderma gangrenosum: clinical characteristics, associated diseases, and responses to treatment in a retrospective cohort study of 31 patients
Abstract
Objective
The aim of this study was to describe the clinical characteristics of patients with pyoderma gangrenosum (PG) and to evaluate the association between these characteristics, the treatment followed, and the patient responses, relapses, and mortality rates.
Material and methods
This retrospective cohort study identified adults diagnosed with pyoderma gangrenosum over the duration of 10 years.
Results
Thirty-one patients were evaluated; 58% were women and 55% were older than 65 years, 87% presented with the ulcerative type, and 77% showed lower limb compromise. Approximately 74% of the cases were associated with systemic disease. The most frequent were inflammatory bowel disease (32%) and hematologic malignancies (22%). Pyoderma gangrenosum preceded the associated disease in 26% of the patients, all of them were younger than 50 years old (P = 0.059). In 83% of the latter, the diagnosis of associated disease followed the cutaneous lesions within 24 months. Among the 10 patients with inflammatory bowel disease, six required biologic agents to control the pyoderma gangrenosum (P = 0.002).
Conclusion
Despite the advances that have been made in the treatment of patients with pyoderma gangrenosum, we are still unclear as to the optimal way in which patients should be followed up once the diagnosis is made. The results of our study underline the importance of doing screening tests to detect potential disease, emphasizing patients younger than 50 years old, for a minimum time lapse of 24 months. It is essential to design randomized-controlled trials to understand the most appropriate and effective ways of following up patients with pyoderma gangrenosum.
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Cutaneous phaeohyphomycosis
Abstract
Background
Phaeohyphomycosis is an infrequent infection in human beings. However, in recent years, its prevalence has augmented in immunosuppressed patients (mostly in solid organ transplanted patients). Infection can be mucocutaneous or disseminated. In the former, the fungus inoculation occurs mainly through traumatism. Lesions may be polymorphic and asymptomatic, isolated or multiple, and are usually localized in exposed areas of the limbs and head. Treatment is not standardized. When possible, surgical resection of the lesion is combined with systemic antifungals.
Methods
We communicate three phaeohyphomycosis cases with cutaneous compromise.
Results
The cases we present show diverse clinical characteristics and varied severity and evolution.
Conclusion
It is important for dermatologists to recognize this cutaneous fungus infection because the diagnosis using microscopic examination and mycological culture depends on the clinical suspicion.
http://ift.tt/2nscamj
Phase 1-2 Study of ASTX660 in Subjects With Advanced Solid Tumors and Lymphomas
Conditions: Solid Tumors; Lymphoma
Intervention: Drug: ASTX660
Sponsor: Astex Pharmaceuticals
Recruiting - verified March 2017
http://ift.tt/2ms1X7y
Intervention: Drug: ASTX660
Sponsor: Astex Pharmaceuticals
Recruiting - verified March 2017
http://ift.tt/2ms1X7y
Successful medical treatment of a hepatic pregnancy: a case report
Hepatic pregnancy is a rare form of abdominal pregnancy, often documented only as case reports.
http://ift.tt/2mNbqK2
Emergent Awake Intubation
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Synovial chondromatosis of the temporomandibular joint with extension into the middle cranial fossa and internal carotid canal
Publication date: Available online 15 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): C. McCaffery, M. Dodd, F. Bekiroglu, E. Twohig
This report presents the case of an extensive synovial chondromatosis of the temporomandibular joint (TMJ), with extension into the middle cranial fossa, middle ear, and carotid canal. Synovial chondromatosis of the TMJ is rare, particularly when associated with intracranial involvement. This case is unique owing to its size and the involvement with the internal carotid artery. The importance of a multidisciplinary approach in the surgical management of such a rare and complex form of this condition is highlighted.
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The dynamics of HCV-specific antibody responses in HIV/HCV patients on long-term antiretroviral therapy
Source:Clinical Immunology
Author(s): Silvia Lee, Alfred Laiman, Martyn A French, James Flexman, Mark W Watson, Patricia Price
Antibody responses have not been fully characterised in chronically HIV/HCV patients receiving antiretroviral therapy (ART). Seventeen HIV/HCV patients receiving ART were followed for a median (range) interval of 597 (186–766) weeks. Prior to ART, HIV/HCV patients had lower levels of antibodies reactive with HCV core and JFH-1, and lower genotype cross-reactive neutralising antibodies (nAb) titres, than HCV patients. Levels of JFH-1 reactive antibody increased on ART, irrespective of CD4+ T-cell counts or changes in serum ALT levels. The appearance of nAb coincided with control of HCV viral replication in five HIV/HCV patients. In other patients, HCV viral loads remained elevated despite nAb responses. Sustained virological responses following HCV therapy were associated with reduced antibody responses to JFH-1 and core but elevated responses to non-structural proteins. We conclude that nAb responses alone may fail to clear HCV, but contribute to control of viral replication in some HIV/HCV patients responding to ART.
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Phenotypical analysis of ectoenzymes CD39/CD73 and adenosine receptor 2A in CD4+CD25highFoxp3+ regulatory T-cells in psoriasis
Abstract
Background
CD39 and CD73 are two novel cell surface markers of CD25highFoxp3+ regulatory T-cells (Tregs). Concordant expression of these two ectoenzymes not only discriminate Tregs from other cell populations, but also generates pericellular adenosine, which has been reported to suppress proliferation of activated T effector (Teff) cells. Because it is currently unclear whether human ectoenzymes (CD39/CD73) are involved in the impaired suppressive activity of Tregs in psoriasis, we examined the frequencies and phenotypes of CD39/CD73-expressing Tregs and related receptor adenosine receptor 2A (A2AR) in peripheral blood of patients with different types of psoriasis.
Methods
Peripheral blood mononuclear cells (PMBC) were prepared from patients with three different types of psoriasis (psoriasis vulgaris, pustular psoriasis and erythrodermic psoriasis). CD4+ cells were separated from PBMC by negative selection on midiMACS columns, and the frequencies and phenotypes of CD39 and CD73 expressing Tregs, and A2AR expressing Teff were all determined by flow cytometry analysis. Blood from healthy volunteers served as controls.
Results
The expression of single CD73+ Tregs was markedly reduced (approximately 50%) in psoriasis vulgaris, compared to normal controls. In pustular psoriasis, the mean numbers of CD39+ Tregs and A2AR+ Teff was significantly lower than in normal controls. Among three different types of psoriasis, CD39 expression was strikingly reduced in the blood Treg population of pustular psoriasis patients. Decreased CD73+ Tregs levels were observed in psoriasis vulgaris compared to pustular psoriasis and erythrodermic psoriasis.
Conclusions
The differences in the expression of CD39− and CD73− Tregs may be a factor in the pathogenesis of psoriasis.
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Characteristic features of cutaneous melanoma in a dermatology referral centre in Tehran, Iran
Abstract
Background/Objectives
The characteristics of cutaneous melanoma in the Middle-Eastern countries is poorly described. Therefore we conducted this study to determine the characteristics of melanoma in Iran.
Methods
A retrospective, cross sectional study of melanoma patients seen at a tertiary referral centre, Iran, from May 2004 to October 2014. Clinical data included age and gender of the patients at the time of diagnosis, tumour location and tumour size. Histological characteristics included Breslow thickness, Clark level and subtype of tumour.
Results
A total of 450 cases of melanoma with a male/female ratio of 1.1:1 were reviewed. The mean age of patients was 57.5 years. The most frequent histological subtypes were acral lentiginous melanoma (30%) and lentigo maligna melanoma (29%). In 215 cases (49%) the tumour was located on the extremities. The second most common site was the face. Tumour invasion was mainly at Clark level III and IV. The mean Breslow thickness was 2.8 mm; 143 (38%) melanomas had a Breslow thickness less than 1 mm (T1) and 86 (23%) were more than 4 mm (T4).
Conclusion
This study indicates that clinical and histological features of melanoma in Iranians (who are mainly of skin phototypes 3–4) are different from those observed in Western countries. Further cohort studies are required to evaluate the role of ethnic and environmental risk factors for melanoma in different populations.
http://ift.tt/2mMQVx6
Strategies to reduce blood product utilization in obstetric practice.
Purpose of review: Patient blood management (PBM) aims to improve patient outcome and safety by reducing the number of unnecessary RBC transfusions and vitalizing patient-specific anemia reserves. Although PBM is increasingly recognized as best clinical practice in elective surgery, implementation of PBM is restrained in the setting of obstetrics. This review summarizes recent findings to reduce blood product utilization in obstetric practice. Recent findings: PBM-related evidence-based benefits should be urgently adopted in the field of obstetric medicine. Intravenous iron can be considered a safe, effective strategy to replenish iron stores and to correct both pregnancy-related and hemorrhage-related iron deficiency anemia. In addition to surgical techniques and the use of uterotonics, recent findings support early administration of tranexamic acid, fibrinogen and a coagulation factor concentrate-based, viscoelastically guided practice in case of peripartum hemorrhage to manage coagulopathy. In patients with cesarean section, autologous red cell blood salvage may reduce blood product utilization, although its use in this setting is controversial. Summary: Implementation of PBM in obstetric practice offers large potential to reduce blood loss and transfusion requirements of allogeneic blood products, even though large clinical trials are lacking in this specific field. Intravenous iron supplementation may be suggested to increase peripartum hemoglobin levels. Additionally, tranexamic acid and point-of-care-guided supplementation of coagulation factors are potent methods to reduce unnecessary blood loss and blood transfusions in obstetrics. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2mr9vY7
http://ift.tt/2mr9vY7
An update on the perioperative management of children with upper respiratory tract infections.
Purpose of review: This review summarizes the current evidence for the management of children with recent upper respiratory tract infections (URTIs). Furthermore, the review includes management guidelines for children with URTIs. Recent findings: Good history and clinical examination is sufficient in most children presenting with URTI. Testing for immune markers or preoperative nitric oxide measurement does not add any additional value. Preoperative bronchodilator administration, intravenous induction with propofol, and noninvasive airway management all reduce the occurrence of respiratory adverse events. Summary: Most children can be safely anaesthetized even in the presence of an URTIs if the perioperative anaesthesia management is optimized. In this review article, we have included a management algorithm for children with URTI presenting for elective surgery. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2nmivms
http://ift.tt/2nmivms
The use of ultrasound in obstetric anesthesia.
Purpose of review: The current review considers an array of recent applications for point-of-care ultrasound in clinical practice including diagnostic and therapeutic procedures that may be relevant for the obstetric anesthesiologist. The rapid advancement of technology and clinical applications for bedside ultrasound in obstetric anesthesiology requires an appraisal of the limitations and uses. Recent findings: The review presents the most recent literature describing ultrasound-guided airway assessments, airway management, cricothyroidotomy, transthoracic echocardiography, gastric volume assessments, point-of-care lung ultrasound diagnoses, intracranial pressure assessments, vascular access, neuraxial blocks, and transversus abdominis plane blocks. Each ultrasound technique is presented along with the most recent advances in knowledge and some limitations to integration of these ultrasound skills in clinical practice. Summary: Anesthesiologists have clearly embraced this facile versatile tool for bedside diagnostics and procedures. One limitation to widespread adoption is availability of suitable ultrasound skills and technology. Many of these ultrasound techniques have not yet established clear patient benefit, yet the sheer breadth of ultrasound techniques reported in the past few years demonstrate that our colleagues are becoming more proficient. It is important to follow the development of this emerging field to be aware of limitations to learning these skills and their potential clinical benefit. Proficiency in some of these point-of-care ultrasound techniques may become prerequisite for obstetric anesthesiologists to provide the best care. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2mr0pL5
http://ift.tt/2mr0pL5
Frailty and anesthesia.
Purpose of review: This review will deliberate on contemporary concepts regarding the frailty syndrome and its association with the perioperative period. Frailty syndrome and its relevance to organ systems, scoring tools and intervention measures will be discussed in detail. Recent findings: Frail patients have a reduced ability to respond to physical stress, similar to a decreased physiological reserve in the perioperative period. Frailty assessment is gaining popularity as a tool to guide medical interventions in the elderly population. Various measurement tools for preoperative frailty assessment were developed and show promising ability to predict perioperative morbidity, mortality and possibly to guide patient selection and intervention. Preoperative optimization for the frail patient shows mixed results. Summary: Preoperative frailty is associated with significant morbidity and mortality. Recently, frailty assessment tools have been developed and show good ability to predict postoperative adverse events. These tools might become a preoperative routine, as they set the ground for patient's selection, guide perioperative interventions for the frail elderly population and thus may influence patient's outcome. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2mr8yiN
http://ift.tt/2mr8yiN
Making the pediatric perioperative surgical home come to life by leveraging existing health information technology.
Purpose of review: To design a patient data dashboard for the Department of Anesthesiology, Perioperative and Pain Medicine at Boston Children's Hospital that supports care integration across the healthcare system as described by the pediatric perioperative surgical home (PPSH) initiative. Recent findings: By using 360 Technology, patient data was automatically pulled from all available Electronic Health Record sources from 2005 to the present. The PPSH dashboard described in this report provides a guide for implementation of PPSH Clinical Care Pathways. The dashboard integrates several databases to allow for visual longitudinal tracking of patient care, outcomes, and cost. The integration of electronic information provided the ability to display, compare, and analyze selected PPSH metrics in real time. By utilizing the PPSH dashboard format the use of an automated, integrated clinical, and financial health data profile for a specific patient population may improve clinicians' ability to have a comprehensive assessment of all care elements. This more global clinical thinking has the potential to produce bottom-up, evidence-based healthcare reform. Summary: The experience with the PPSH dashboard provides solid evidence for the use of integrated Electronic Health Record to improve patient outcomes and decrease cost. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2nmkaZf
http://ift.tt/2nmkaZf
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