Purpose of review: The purpose of this review is to summarize the most recent up to date research data and recommendations regarding anaesthetic management of patients with liver disease undergoing surgery. The incidence of chronic liver disease (CLD) continues to rise and perioperative mortality and morbidity remains unacceptably high in this group. Meticulous preoperative assessment and carefully planned anaesthetic management are vital in improving outcomes in patients with liver disease undergoing surgery. Recent findings: The presence of cirrhosis is associated with a significantly increased risk of postoperative morbidity and mortality in patients undergoing elective surgery. The Child--Pugh--Turcotte scale and model for end-stage liver disease (MELD) score remain the most commonly applied scoring systems in preoperative risk assessment, but new MELD-based indices and novel scoring systems might offer better prognostic value. Propofol and new inhalational agents (sevoflurane, desflurane) are recommended hypnotic agents. The titration of opiates in the perioperative period is recommended because of their altered metabolism in patients with liver disease. Perioperative management should include close haemodynamic monitoring and admission to a critical care area should be considered. Summary: Patients with liver disease undergoing anaesthesia pose significant challenges and advanced planning and preparation are required in order to improve perioperative outcomes in this group. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
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Παρασκευή 17 Μαρτίου 2017
Anesthesia in adults with congenital heart disease.
http://ift.tt/2nxGAXH
Training future anesthesiologists in obstetric care.
http://ift.tt/2mCoxKS
The American College of Surgeons Children's Surgery Verification and Quality Improvement Program: implications for anesthesiologists.
http://ift.tt/2mCm8Qr
Ventilation with high versus low peep levels during general anaesthesia for open abdominal surgery does not affect postoperative spirometry: A randomised clinical trial.
BACKGROUND: Invasive mechanical ventilation during general anaesthesia for surgery typically causes atelectasis and impairs postoperative lung function. OBJECTIVE: We investigated the effect of intraoperative ventilation with high positive end-expiratory pressure (PEEP) and recruitment manoeuvres (RMs) on postoperative spirometry. DESIGN: This was a preplanned, single-centre substudy of an international multicentre randomised controlled trial, the PROVHILO trial. SETTING: University hospital from November 2011 to January 2013. PATIENTS: Nonobese patients scheduled for major abdominal surgery at a high risk of postoperative pulmonary complications (PPCs). INTERVENTION: Intraoperative low tidal volume ventilation with PEEP levels of 12 cmH2O and RM (the high PEEP group) or with PEEP levels of 2 cmH2O or less without RM (the low PEEP group). MAIN OUTCOME MEASURES: Time-weighted averages (TWAs) of the forced expiratory volume in 1 s (FEV1) and the forced vital capacity (FVC) up to postoperative day five. RESULTS: Thirty-one patients were allocated to the high PEEP group and 32 to the low PEEP group. No postoperative spirometry test results were available for 6 patients. In both groups, TWA of FEV1 and FVC until postoperative day five were lower than preoperative values. Postoperative spirometry test results were not different between the high and low PEEP group; Data are median [interquartile range], TWA FVC 1.8 [1.6 to 2.4] versus 1.7 [1.2 to 2.4] l (P = NS) and TWA FEV1 1.2 [1.1 to 2.5] versus 1.2 [0.9 to 1.9] l (P = NS). Patients who developed PPCs had lower FEV1 and FVC on postoperative day five; 1.1 [0.9 to 1.6] versus 1.6 [1.4 to 1.9] l (P = 0.001) and 1.6 [1.2 to 2.6] versus 2.3 [1.7 to 2.6] l (P = 0.036), respectively. CONCLUSION: Postoperative spirometry is not affected by PEEP and RM during intraoperative ventilation for open abdominal surgery in nonobese patients at a high risk of PPCs, but rather is associated with the development of PPCs. TRIAL REGISTRATION: ClinicalTrials.gov NCT01441791. (C) 2017 European Society of Anaesthesiology
http://ift.tt/2mSVqom
http://ift.tt/2mSVqom
The use of dipyrone in the ICU is associated with acute kidney injury: A retrospective cohort analysis.
BACKGROUND: Use of dipyrone (metamizole) in perioperative and ICU pain therapy remains controversial due to a lack of solid evidence weighing dipyrone benefit against its potential life-threatening complications. Although dipyrone has known analgesic and antipyretic properties, its mechanisms of actions are incompletely understood. Although dipyrone effects on renal vasodilator prostaglandin synthesis are documented, little is known about its potential renal side effects, especially in the critical care environment. OBJECTIVE: Investigation of the perioperative nephrotoxic potential of dipyrone in patients prone to acute kidney injury (AKI). DESIGN: Retrospective cohort study. SETTING: Single centre study in a tertiary referral hospital from January 2013 until June 2013. PATIENTS: A total of 500 consecutive patients aged 18 years and older referred to the anaesthesia ICU. Patients were excluded if admitted from or discharged to other ICUs, if referred for post resuscitation care, or if repeatedly admitted to the ICU. MAIN OUTCOME MEASURES: Incidence of AKI, as defined by the Kidney Disease: Improving Global Outcomes Acute Kidney Injury Work Group criteria, and duration of vasopressor therapy. RESULTS: Use of dipyrone was associated with an increased incidence of AKI in a dose-dependent manner with a 1.6-fold increase in the incidence of AKI with each additional gram of intravenous dipyrone per day. Dipyrone dose of more than 2.5 g day-1 was the best risk predictive cut-off for AKI. Patients receiving dipyrone on the ICU presented with a prolonged duration of vasopressor therapy. CONCLUSION: Increasing dipyrone dosage is a potential independent risk factor for AKI in adult ICU patients and may prolong vasopressor therapy. Clinical evidence for a benefit of dipyrone therapy in the ICU is insufficient and needs further critical evaluation. (C) 2017 European Society of Anaesthesiology
http://ift.tt/2mSXay5
http://ift.tt/2mSXay5
Perinatal probiotics decreased eczema up to 10 years of age but at 5–10 years allergic rhino-conjunctivitis was increased
Abstract
Perinatal use of Lactobacillus GG (LGG) has been associated with fewer allergic diseases, mainly eczema in high-risk children at the age of two years [1,2], a phenomenon still seen at 6–9 years [2-5]. We reported earlier that in high-risk children pre- and postnatal use of a mixture of probiotics reduced the incidence of atopic eczema at two years of age, and during the first five years atopic eczema reduction was seen in Caesarean-delivered children but not in the whole cohort [1,6]. Mothers were recruited during pregnancy and randomized at 35 weeks of gestation to the probiotic or placebo group. Prematurity (less than 37 weeks of gestation), infants having major malformations or infants born as B-twins were excluded.
This article is protected by copyright. All rights reserved.
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Hypersensitivity Pneumonitis in an 11-Year-Old Boy—A Case Report
Pediatric Allergy, Immunology, and Pulmonology Mar 2017, Vol. 30, No. 1: 60-63.
http://ift.tt/2nO02v5
Decreased Expression of B cell Maturation Antigen in Patients with Common Variable Immunodeficiency
Pediatric Allergy, Immunology, and Pulmonology Mar 2017, Vol. 30, No. 1: 7-13.
http://ift.tt/2niBkqc
Pediatric Allergy, Immunology and Pulmonology Celebrates Its 30th Year
Pediatric Allergy, Immunology, and Pulmonology Mar 2017, Vol. 30, No. 1: 1-1.
http://ift.tt/2nOhjo4
Smoking Patterns and Perspectives of Families of Infants with Bronchopulmonary Dysplasia
Pediatric Allergy, Immunology, and Pulmonology Mar 2017, Vol. 30, No. 1: 26-30.
http://ift.tt/2niIP08
Hypersensitivity Pneumonitis in an 11-Year-Old Boy—A Case Report
Pediatric Allergy, Immunology, and Pulmonology Mar 2017, Vol. 30, No. 1: 60-63.
http://ift.tt/2mc4k32
Decreased Expression of B cell Maturation Antigen in Patients with Common Variable Immunodeficiency
Pediatric Allergy, Immunology, and Pulmonology Mar 2017, Vol. 30, No. 1: 7-13.
http://ift.tt/2mS20eB
Pediatric Allergy, Immunology and Pulmonology Celebrates Its 30th Year
Pediatric Allergy, Immunology, and Pulmonology Mar 2017, Vol. 30, No. 1: 1-1.
http://ift.tt/2mbSbLG
Smoking Patterns and Perspectives of Families of Infants with Bronchopulmonary Dysplasia
Pediatric Allergy, Immunology, and Pulmonology Mar 2017, Vol. 30, No. 1: 26-30.
http://ift.tt/2mRW9X1
Voice outcomes post total laryngectomy.
http://ift.tt/2nO4me3
Behaviour change technique taxonomy: a method of describing head and neck cancer dysphagia intervention delivery.
http://ift.tt/2niwTvI
A cross-sectional survey of the nature and correlates of sleep disturbance in people with psoriasis
Abstract
Background
Research suggests that sleep disturbance is common in psoriasis. Despite 32 studies conducted in sleep, many demonstrate methodological flaws, often using unvalidated measurement, with no study examining multiple dimensions of sleep-wake functioning. Moreover, research has yet to comprehensively examine the range of physical and psychological factors that may affect sleep in people with psoriasis.
Objective
To characterise sleep disturbance using validated measures and identify physical and psychological predictors of sleep quality in people with psoriasis.
Methods
An online survey was conducted (n=186;Mage=39.2) comprising validated measures assessing sleep (Pittsburgh Sleep Quality Index [PSQI], Berlin Questionnaire, Pre-Sleep Arousal Scale), chronotype (Morningness-Eveningness Questionnaire), mood (Hospital Anxiety and Depression Scale), itch (5-D Itch Scale) and psoriasis severity (Simplified Psoriasis Index). Group comparisons and regression analyses were used to examine predictors of poor sleep.
Results
Mean PSQI score was 9.24 (SD=4.32), with 76.3% scoring above the threshold for poor sleep (≥ 6 on the PSQI) and 32.5% scoring 'positive' for probable obstructive sleep apnoea. Poor sleep and high likelihood of OSA was associated with more severe psoriasis (p<.05; η2=.07; η2=.005). Cognitive arousal (β=.264, p=.001), itch (β=.260, p<.001) and depression (β=.236, p=.001) were the most robust predictors of poor sleep quality which, together with somatic arousal (β=.168, p=.022), accounted for 43% of variance in PSQI scores.
Conclusions
Poor sleep is common in psoriasis and associated with psychological and physical factors. Rates of probable obstructive sleep apnoea are also high. Given the importance of restorative sleep for health, sleep complaints should receive greater clinical attention in the management of psoriasis.
This article is protected by copyright. All rights reserved.
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A chronic recurrent disease course of dermatomyositis is associated with autoantibodies against TIF1γ
Abstract
Dermatomyositis (DM) is a rare autoimmune disease with high clinical variability in terms of cutaneous and muscle involvement as well as disease duration. DM severely impacts the quality of life of the patients and may be life threatening. This is primarily due to lung involvement and the 3.0 to 7.7 fold increased relative risk for cancer compared to the general adult population1;2.
This article is protected by copyright. All rights reserved.
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Bilateral adrenal hemorrhage in the background of Escherichia coli sepsis: a case report
Sepsis is a syndrome of life-threatening organ dysfunction caused by a dysregulated host response to infection. It can have devastating consequences, including bilateral adrenal hemorrhage, particularly in pat...
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Immune cells and mediators involved in the inflammatory responses induced by a P-I metalloprotease and a phospholipase A2 from Bothrops atrox venom
Source:Molecular Immunology, Volume 85
Author(s): Danilo L. Menaldo, Carolina P. Bernardes, Karina F. Zoccal, Anna L. Jacob-Ferreira, Tássia R. Costa, Maria P.F.M. Del Lama, Rose M.Z.G. Naal, Fabiani G. Frantz, Lúcia H. Faccioli, Suely V. Sampaio
Bothrops envenomations can promote severe inflammatory responses by inducing edema, pain, leukocyte recruitment and release of chemical mediators by local cells. In the present study, two toxins from Bothrops atrox venom (the P-I metalloprotease Batroxase and the acidic phospholipase A2 BatroxPLA2) were evaluated in relation to their inflammatory effects induced in vivo and in vitro, mainly focusing on the participation of different immune cells and inflammatory mediators. Both toxins mainly promoted acute inflammatory responses with significant recruitment of neutrophils in the early hours (1–4h) after administration into the peritoneal cavity of C57BL/6 mice, and increased infiltration of mononuclear cells especially after 24h. Among the mediators induced by both toxins are IL-6, IL-10 and PGE2, with Batroxase also inducing the release of L-1β, and BatroxPLA2 of LTB4 and CysLTs. These responses pointed to possible involvement of immune cells such as macrophages and mast cells, which were then evaluated in vitro. Mice peritoneal macrophages stimulated with Batroxase produced significant levels of IL-6, IL-1β, PGE2 and LTB4, whereas stimulus with BatroxPLA2 induced increases of IL-6, PGE2 and LTB4. Furthermore, both toxins were able to stimulate degranulation of RBL-2H3 mast cells, but with distinct concentration-dependent effects. Altogether, these results indicated that Batroxase and BatroxPLA2 promoted local and acute inflammatory responses related to macrophages and mast cells and to the production of several mediators. Our findings should contribute for better understanding the different mechanisms of toxicity induced by P-I metalloproteases and phospholipases A2 after snakebite envenomations.
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Paramedics perform lifesaving thoracostomy on crushed patient
By Audrey Fraizer CONROE, Texas — Walking with the assistance of leg braces shows remarkable progress in recovery for 20-year-old Jonathan Arteaga, considering the trauma he experienced one year earlier. The then 19-year-old Arteaga was prepping for the move of a mobile home, which is a routine operation for Arteaga's Mobile Home Service, in Conroe, Texas. Sometimes unexpected things happen ...
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Chirurgische Behandlung von Verbrennungen
Zusammenfassung
Hintergrund
Die Behandlung von Kindern mit Verbrennungsverletzungen ist aufgrund der Häufigkeit und der möglichen langfristigen Nachwirkungen von großer Bedeutung. Schwerstverbrennungen bei Kindern werden in Verbrennungszentren behandelt und bedürfen einer speziellen Betreuung.
Ziel der Arbeit
Ziel dieser Arbeit ist es, die aktuellen Therapiestandards sowie wesentliche Neuerungen in der Behandlung von verbrannten Kindern darzustellen, um die auch im dermatologischen Alltag häufig zu beurteilenden typischen, insbesondere auch die flächenmäßig kleineren kindlichen Verbrennungen und Verbrühungen einer adäquaten Behandlung zuzuführen.
Material und Methoden
Es erfolgten eine Analyse der aktuellen Literatur sowie Diskussion von Übersichtsarbeiten unter Berücksichtigung der aktuellen Leitlinien
Ergebnisse
Verbrennungen sind im Kindesalter besonders gehäuft. Eine Verbesserung der Überlebenswahrscheinlichkeit ist durch Behandlung in speziellen Zentren möglich. Die Einschätzung des Verletzungsausmaßes durch den Erstversorger ist ein wichtiger Faktor. Es wurde eine Übersicht zur ambulanten Versorgung leichter Verbrennungen erstellt. Neue Methoden bieten die Chance auf bessere Langzeitergebnisse.
Schlussfolgerung
Adäquate Versorgung unter Berücksichtigung der aktuellen Literatur und der Leitlinien verbessert das Outcome. Die Implementierung neuer Methoden im gesetzten Rahmen ist sinnvoll und empfehlenswert.
http://ift.tt/2mRm5lq
Reply
Source:Journal of Allergy and Clinical Immunology
Author(s): Kusumam Joseph, Rosemeire N. Constantino-Silva, Anete S. Grumach, Anna Feldweg, Lakiea Wright, Natasha Frank, Dana Vuzman, Rohit Sharma, Chiara Suffritti, Marco Cicardi, Lilian Varga, Henriette Farkas, Konrad Bork, Allen P. Kaplan
http://ift.tt/2nNrlG6
C3 nephritic factors: a changing landscape
Source:Journal of Allergy and Clinical Immunology
Author(s): Daniella Levy Erez, Kevin E. Meyers, Kathleen E. Sullivan
http://ift.tt/2mXPHiz
Absence of functional fetal regulatory T cells in humans causes in utero organ-specific autoimmunity
Source:Journal of Allergy and Clinical Immunology
Author(s): Eric J. Allenspach, Laura S. Finn, Mara H. Rendi, Ahmet Eken, Akhilesh K. Singh, Mohamed Oukka, Sean D. Taylor, Matthew C. Altman, Corinne L. Fligner, Hans D. Ochs, David J. Rawlings, Troy R. Torgerson
Teaser
Regulatory T cells play a critical role in preventing fetal organ-specific autoimmunity in humans. Autopsies of neonatal IPEX patients shortly after birth demonstrate chronic exocrine-dominant pancreatitis with tertiary lymphoid structures containing expanded oligoclonal T/B lymphocytes.http://ift.tt/2nNutS6
Normal PAI-2 level in French FXII-HAE patients
Source:Journal of Allergy and Clinical Immunology
Author(s): Raphaël Marlu, Alban Deroux, Aurélie Du-Thanh, Isabelle Boccon-Gibod, David Launay, Laurence Bouillet
http://ift.tt/2mXMdg6
Positive pressure ventilation in a patient with a right upper lobar bronchocutaneous fistula: right upper bronchus occlusion using the cuff of a left-sided double lumen endobronchial tube
Abstract
In patients with a bronchocutaneous fistula, positive pressure ventilation leads to air leakage and potential hypoxemia. A male patient with a right upper bronchocutaneous fistula was scheduled for esophageal reconstruction. His preoperative chest computed tomography image revealed aeration in the right middle and lower lobe, a large bulla in the left upper lobe, and pleural effusion and pneumonia in the left lower lobe. Therefore, left one-lung ventilation was considered to result in hypoxemia. Before anesthesia induction, the bronchocutaneous fistula was covered with gauze and film to prevent air leakage. After anesthesia induction, mask ventilation was performed with a peak positive pressure of 10 cmH2O. A left-sided double lumen endobronchial tube (DLT) was then inserted into the right main bronchus for occluding only the right superior bronchus, and two-lung ventilation was performed to minimize airway pressure and maintain oxygenation, which did not cause air leakage through the fistula. During anesthesia, no ventilation-related difficulty was faced. The method of inserting a left-sided DLT into the right main bronchus and occluding the right upper bronchus selectively by bronchial cuff is considered to be an option for mechanical ventilation in patients with a right upper bronchial fistula, as demonstrated in the present case.
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Increased Spontaneous Programmed Cell Death Is Associated with Impaired Cytokine Secretion in Peripheral Blood Mononuclear Cells from Hepatitis C Virus-Positive Patients
Viral Immunology , Vol. 0, No. 0.
http://ift.tt/2nhYQnk
Effect of acidity of in-office bleaching gels on tooth sensitivity and whitening: a two-center double-blind randomized clinical trial
Abstract
Objectives
The study aimed to compare the tooth sensitivity (TS) and bleaching efficacy of two hydrogen peroxide gels with different pHs (acid pH [Pola Office, SDI] and the neutral pH [Pola Office+, SDI]) used for in-office bleaching.
Materials and methods
Fifty-four patients from Brazil and Chile, with right superior incisor darker than A2, were selected for this double-blind, split-mouth randomized trial. Teeth were bleached in two sessions, with 1-week interval. Each session had three applications of 8 min each, according to the manufacturer's instructions. The color changes were evaluated by subjective (Vita Classical and Vita Bleachedguide) and objective (Easy shade spectrophotometer) methods. Participants recorded TS with 0–10 visual analog scale. Color change in shade guide units (SGU) and ΔE was analyzed by Student's t test (α = 0.05). The absolute risk and intensity of TS were evaluated by McNemar's test and Wilcoxon-paired test, respectively (α = 0.05).
Results
All groups achieved the same level of whitening after 30 days of clinical evaluation. The use of a neutral in-office bleaching gel significantly decreases the absolute risk of TS (28%, 95% CI 18–41) and intensity of TS when compared to the acid bleaching gel (absolute risk of 50%, 95% CI 37–63).
Conclusion
The use of a neutral in-office bleaching agent gel produced the same whitening degree than an acid bleaching gel but with reduced risk and intensity of tooth sensitivity.
Clinical significance
Clinicians should opt to use in-office bleaching with a neutral gel than an acid product because the former causes a significant lower risk and intensity of tooth sensitivity.
http://ift.tt/2mDv3Sh
Evolution of MHC-based technologies used for detection of antigen-responsive T cells
Abstract
T cell-mediated recognition of peptide-major histocompatibility complex (pMHC) class I and II molecules is crucial for the control of intracellular pathogens and cancer, as well as for stimulation and maintenance of efficient cytotoxic responses. Such interactions may also play a role in the development of autoimmune diseases. Novel insights into this mechanism are crucial to understanding disease development and establishing new treatment strategies. MHC multimers have been used for detection of antigen-responsive T cells since the first report by Altman et al. showed that tetramerization of pMHC class I molecules provided sufficient stability to T cell receptor (TCR)-pMHC interactions, allowing detection of MHC multimer-binding T cells using flow cytometry. Since this breakthrough the scientific community has aimed for expanding the capacity of MHC multimer-based detection technologies to facilitate large-scale epitope discovery and immune monitoring in limited biological material. Screening of T cell specificity using large libraries of pMHC molecules is suitable for analyses of T cell recognition potentially at genome-wide levels rather than analyses restricted to a selection of model antigens. Such strategies provide novel insights into the immune specificities involved in disease development and response to immunotherapy, and extend fundamental knowledge related to T cell recognition patterns and cross-recognition by TCRs. MHC multimer-based technologies have now evolved from detection of 1–2 different T cell specificities per cell sample, to include more than 1000 evaluable pMHC molecules using novel technologies. Here, we provide an overview of MHC multimer-based detection technologies developed over two decades, focusing primarily on MHC class I interactions.
http://ift.tt/2mDhYIK
Lipoteichoic acids from Staphylococcus aureus stimulate proliferation of human non-small-cell lung cancer cells in vitro
Abstract
Pulmonary infections are frequent complications in lung cancer and may worsen its outcome and survival. Inflammatory mediators are suspected to promote tumor growth in non-small-cell lung cancer (NSCLC). Hence, bacterial pathogens may affect lung cancer growth by activation of inflammatory signalling. Against this background, we investigated the effect of purified lipoteichoic acids (LTA) of Staphylococcus aureus (S. aureus) on cellular proliferation and liberation of interleukin (IL)-8 in the NSCLC cell lines A549 and H226. A549 as well as H226 cells constitutively expressed TLR-2 mRNA. Even in low concentrations, LTA induced a prominent increase in cellular proliferation of A549 cells as quantified by automatic cell counting. In parallel, metabolic activity of A549 cells was enhanced. The increase in proliferation was accompanied by an increase in IL-8 mRNA expression and a dose- and time-dependent release of IL-8. Cellular proliferation as well as the release of IL-8 was dependent on specific ligation of TLR-2. Interestingly, targeting IL-8 by neutralizing antibodies completely abolished the LTA-induced proliferation of A549 cells. The pro-proliferative effect of LTA could also be reproduced in the squamous NSCLC cell line H226. In summary, LTA of S. aureus induced proliferation of NSCLC cell lines of adeno- and squamous cell carcinoma origin. Ligation of TLR-2 followed by auto- or paracrine signalling by endogenously synthesized IL-8 is centrally involved in LTA-induced tumor cell proliferation. Therefore, pulmonary infections may exert a direct pro-proliferative effect on lung cancer growth.
http://ift.tt/2maVxyg
Cross-sectional study about impact of parental smoking on rhinitis symptoms in children
Abstract
Objective
assess the prevalence of rhinitis and exposure to environmental tobacco smoke of children in our community and its relationship with symptoms of rhinitis
Methods (design, setting, participants, main outcome measures)
cross-sectional study using questionnaire on rhinitis of the International Study of Asthma and Allergies in Childhood, in children (6-7 years) and adolescents (13-14 years). Categories: "rhinitis ever", "recent rhinitis", "recent rhinoconjunctivitis", "severe rhinoconjunctivitis". Parental smoking: 1) neither parent smokes; 2) only the mother smokes; 3) only the father smokes; and 4) both parents smoke. Odds ratio of the prevalence of symptoms of rhinitis according to environmental tobacco smoke exposure was calculated using logistic regression.
Results
10,690 children and 10,730 adolescents. The prevalence of "rhinitis ever" in children: 29.4%, "recent rhinitis" 24%, "recent rhinoconjunctivitis" 11.5% and "severe rhinoconjunctivitis" 0.1%. In adolescents: 46.2%, 34.5%, 16.2% and 0.2% respectively. environmental tobacco smoke exposure in the home occurred in 51% of cases. Parental smoking was associated with a higher prevalence of forms of rhinitis in adolescents when only the mother was a smoker. In children when both parents were smokers.
Conclusion
Rhinitis is highly prevalent in our community. Environmental tobacco smoke exposure is still very common. The relationship between environmental tobacco smoke and rhinitis symptoms in children of this community is not as robust as that found for asthma.
This article is protected by copyright. All rights reserved.
http://ift.tt/2mQZMw0
A helpful technique for water precautions following ear surgery; Utilising the anaesthetic air cushion mask
Abstract
Water avoidance in the immediate post-operative period following ear surgery is vital to prevent infection, allow incisions to heal and so lead to an improvement in recovery rates. Advice regarding this is varied from 24 hours – several weeks depending on the surgical approach and surgeon preference. Advice is usually given to prevent water from entering the ear canal by barrier methods such as cotton wool covered in petroleum jelly, custom ear plugs, putty or bathing caps.
This article is protected by copyright. All rights reserved.
http://ift.tt/2n6u68q
Surgical management of extensive osteoradionecrosis in nasopharyngeal carcinoma patients with the maxillary swing approach and free muscular flaps
Abstract
Radiation therapy has been a standard treatment for nasopharyngeal carcinoma. However, it can cause extensive osteoradionecrosis which is associated with catastrophic complications including carotid artery rupture, cerebral infection, brain necrosis and cachexia.1,2,3,4 Most of the cases of limited osteoradionecrosis of the nasopharynx have been treated by endoscopic debridement with a favorable success rate.3.
This article is protected by copyright. All rights reserved.
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Goodpasture's disease with late presentation of renal abnormality and anti-GBM autoantibody
Goodpasture's disease without circulating autoantibodies is a rare presentation of a rare diagnosis. We present the case of a man aged 17 years who had 3 hospital admissions over a 2-month period with haemoptysis and shortness of breath. Throughout his first 2 admissions, his renal function was normal and anti-glomerular basement membrane (GBM) antibodies were negative. CT pulmonary angiogram during his second admission revealed florid and diffuse alveolar infiltrates. However, high-resolution CT chest performed 4 weeks later showed complete resolution of these changes. On his third admission, he developed acute kidney injury. A repeat CT chest revealed the reappearance of initial findings and anti-GBM antibodies were now positive. Goodpasture's disease was subsequently confirmed with renal biopsy. Our case, with delayed onset of renal impairment, initial seronegativity for anti-GBM antibodies and relapsing and remitting CT findings, emphasises the need to consider this diagnosis in the setting of otherwise unexplained pulmonary haemorrhage.
http://ift.tt/2n6vA2i
Fulminant tracheobronchial aspergillosis
Description
A man aged 56 years with a history of HIV and diffuse B-cell lymphoma (in remission) was referred to our institute for management of pancytopenia and acute kidney injury. Five days prior to the admission, the patient went to a dental clinic for tooth extraction; he was noted to have a rash on the lateral aspect of his tongue, extending through the oral cavity. On examination, he was alert, awake and oriented to time, place and person. Laboratory investigation revealed Hb: 8.3 mg/dL, WCC: 500 cells/mL and platelet: 70 000 cells/mL.
BUN/Cr was 47/3, CD4 count was 350 and HIV viral load was 10 K. Chest X-ray was unremarkable; CT scan chest revealed mediastinal lymphadenopathy. Bronchoscopy was scheduled for the evaluation of lymphoma reoccurrence. It revealed yellowish raised lesion throughout the distal trachea, right middle stream bronchus, left middle stream bronchus, right upper lobe bronchus and right lower lobe bronchus...
http://ift.tt/2mR4p9o
Cervical diffuse idiopathic skeletal hyperostosis (DISH) causing oropharyngeal dysphagia
Diffuse idiopathic skeletal hyperostosis (DISH) is a non-inflammatory condition characterised by calcification and ossification of the vertebral ligaments. It is most commonly seen to affect the thoracic and lumbar vertebrae and is usually seen among elderly men. The cause of this condition is unknown. Risk factors include male gender, obesity, diabetes and advancing age. The majority of these cases are found incidentally on imaging and patients are generally asymptomatic. Cervical DISH is less common than its thoracic and lumbar counterparts. When symptomatic, it can cause dysphagia or sometimes airway compromise. If this happens, surgical intervention should be performed. Although a rare cause of dysphagia, DISH is easily diagnosed with imaging. When identified, surgical decompression produces very good clinical outcomes.
http://ift.tt/2n6mq5R
Unusual case of venous thrombosis
A young woman developed a line-associated deep vein thrombosis (DVT), which was treated with low molecular weight heparin (dalteparin). 8 days later, the DVT had significantly extended—in spite of therapeutic heparin levels. A diagnosis of heparin-induced thrombocytopenia and thrombosis (HITT) was considered, but the platelet count had not dropped. Nevertheless, a HITT assay was carried out which came back positive, with a repeat assay confirming the result. Dalteparin was stopped and apixaban treatment started, with symptomatic recovery over the following days and weeks.
http://ift.tt/2mR8dHN
Improvement in arm and hand function after a stroke with task-oriented training
A man aged 77 years sustained a left-hemisphere stroke with right hemiparesis. After spending 10 days in the hospital, he was referred to an area rehabilitation centre. There he carried out daily physical, occupational and speech therapy, with an emphasis on task-oriented treatment. The patient's upper-extremity motor performance was evaluated at admission to the rehabilitation centre and before leaving the hospital by 3 different measurement tools: the upper-extremity motor part of the Fugl-Meyer assessment scale, electromyography in hand-reach and grasp and object manipulation and handwriting tasks. Significant improvement in hand function was observed in proximal as well as in distal skills. Significant improvement in handwriting skills and decreased impairment level of the upper extremity had considerable effects on the quality of life of the patient. The case report emphasises the importance of intensive task-oriented training during the first 3 months after stroke to support the natural recovery of the lesioned area.
http://ift.tt/2n6jKVS
Non-recurrent laryngeal nerve with a coexisting contralateral nerve demonstrating extralaryngeal branching
Non-recurrence and extralaryngeal branching are 2 of the more frequently encountered anomalies of the recurrent laryngeal nerve. If not anticipated intraoperatively, these abnormalities can put the nerve at risk, with subsequent vocal cord palsy. It is therefore important to report on and understand these abnormalities. We present a unique case of a non-recurrent laryngeal nerve with a coexisting contralateral nerve demonstrating extralaryngeal branching. This case allows us to demonstrate the importance of arteria lusoria in head and neck surgery, and to conclude that non-recurrence and extralaryngeal branching can occur separately within individual nerves in the same patient. The case also highlights the importance of a systematic intraoperative approach to the identification of every recurrent laryngeal nerve, especially in bilateral procedures having already exposed an anomalous nerve on one side.
http://ift.tt/2mR2ulm
The relationship between nasopharyngeal CCL5 and microbiota on disease severity among infants with bronchiolitis
Abstract
Emerging evidence suggests that the airway microbiota plays an important role in viral bronchiolitis pathobiology. However, little is known about the combined role of airway microbiota and CCL5 in infants with bronchiolitis. In this multicenter prospective cohort study of 1,005 infants (age <1 year) hospitalized for bronchiolitis during 2011-2014, we observed statistically-significant interactions between nasopharyngeal airway CCL5 levels and microbiota profiles with regard to the risk of both intensive care use (Pinteraction=0.02) and hospital length-of-stay ≥3 days (Pinteraction=0.03). Among infants with lower CCL5 levels, the Haemophilus-dominant microbiota profile was associated with a higher risk of intensive care use (OR, 3.20; 95%CI, 1.18-8.68; P=0.02) and hospital length-of-stay ≥3 days (OR, 4.14; 95%CI, 2.08-8.24; P<0.001) compared to the Moraxella-dominant profile. Conversely, among those with higher CCL5 levels, there were no significant associations between the microbiota profiles and these severity outcomes (all P≥0.10).
This article is protected by copyright. All rights reserved.
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New approach shows no association between maternal milk fatty acid composition and childhood wheeze or asthma
Abstract
Background
Previous observational studies have implied breast milk fatty acid composition may play a role in development of atopic eczema or atopic sensitization in breastfed infants and toddlers. However, studies investigating associations with wheeze and asthma in later childhood are scarce and did not account for inherent correlation of compositional data. Our aim was to explore the association of maternal milk fatty acid composition with childhood wheezing phenotypes and asthma up to age 13 years using a new statistical approach.
Methods
Breast milk was collected 6 weeks and 6 months post-delivery in the Ulm Birth Cohort Study (n=720 and n=454, respectively). Concentrations of 28 fatty acids were measured by high-resolution capillary gas-liquid chromatography. To control for constant sum constraint, concentration data were transformed using the centered log ratio method. Compositional biplots and correlation matrices were used to group centered log ratio transformed fatty acids. Adjusted risk ratios with parent-reported wheezing phenotypes and doctor-diagnosed asthma were computed using a modified Poisson regression.
Results
We observed no straightforward evidence of associations between overall breast milk fatty acid composition and specific wheeze phenotypes or doctor-diagnosed asthma.
Conclusion
Using appropriate statistical methodology, we report null associations. These findings may partly be attributable to several cohort-specific factors associated with breastfeeding and breast milk collection. Further studies could improve on ours by analyzing samples of breast milk and formula and by including all children for whom these are exclusively or together the major source of fatty acids in the first months of life.
This article is protected by copyright. All rights reserved.
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Positioning the Principles of Precision Medicine in Care Pathways for Allergic Rhinitis and Chronic Rhinosinusitis - an EUFOREA-ARIA-EPOS-AIRWAYS ICP statement
Abstract
Precision medicine (PM) is increasingly recognized as the way forward for optimizing patient care. Introduced in the field of oncology, it is now considered of major interest in other medical domains like allergy and chronic airway diseases, which face an urgent need to improve the level of disease control, enhance patient satisfaction and increase effectiveness of preventive interventions. The combination of personalized care, prediction of treatment success, prevention of disease and patient participation in the elaboration of the treatment plan is expected to substantially improve the therapeutic approach for individuals suffering from chronic disabling conditions. Given the emerging data on the impact of patient stratification on treatment outcomes, European and American regulatory bodies support the principles of PM and its potential advantage over current treatment strategies.
The aim of the current document is to propose a consensus on the position and gradual implementation of the principles of PM within existing adult treatment algorithms for allergic rhinitis (AR) and chronic rhinosinusitis (CRS). At the time of diagnosis, prediction of success of the initiated treatment and patient participation in the decision of the treatment plan can be implemented. The second level approach ideally involves strategies to prevent progression of disease, in addition to prediction of success of therapy, and patient participation in the long-term therapeutic strategy. Endotype-driven treatment is part of a personalized approach and should be positioned at the tertiary level of care, given the efforts needed for its' implementation and the high cost of molecular diagnosis and biological treatment.
This article is protected by copyright. All rights reserved.
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Radiation Dose Escalation in Esophageal Cancer
Condition: Esophageal Cancer
Intervention: Radiation: radiotherapy plus chemotherapy
Sponsor: Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
Recruiting - verified March 2017
http://ift.tt/2mzZSqc
Intervention: Radiation: radiotherapy plus chemotherapy
Sponsor: Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
Recruiting - verified March 2017
http://ift.tt/2mzZSqc
Pembrolizumab Combined With Cetuximab for Treatment of Recurrent/Metastatic Head & Neck Squamous Cell Carcinoma
Conditions: HNSCC; Lip SCC; Oral Cavity Cancer; Oropharynx Cancer; Larynx Cancer; Hypopharynx Cancer; Nasopharynx Cancer; Sinonasal Carcinoma; Cutaneous Squamous Cell Carcinoma; Head and Neck Neoplasms; Head and Neck Cancer; Head and Neck Squamous Cell Carcinoma
Intervention: Drug: Pembrolizumab, Cetuximab
Sponsors: Assuntina G. Sacco; Merck Sharp & Dohme Corp.
Not yet recruiting - verified March 2017
http://ift.tt/2nvlatX
Intervention: Drug: Pembrolizumab, Cetuximab
Sponsors: Assuntina G. Sacco; Merck Sharp & Dohme Corp.
Not yet recruiting - verified March 2017
http://ift.tt/2nvlatX
Prediction Model of Response for CCRT in Esophageal Cancer
Condition: Esophageal Cancer
Intervention: Other: chemoradiotherapy
Sponsor: Kyungpook National University
Recruiting - verified March 2017
http://ift.tt/2mA0gVJ
Intervention: Other: chemoradiotherapy
Sponsor: Kyungpook National University
Recruiting - verified March 2017
http://ift.tt/2mA0gVJ
Longitudinal Evaluation of Hip Cartilage Degeneration: FAI
Condition: Femoroacetabular Impingement
Intervention: Other: dGEMERIC MRI technique
Sponsors: Hospital for Special Surgery, New York; National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Recruiting - verified March 2017
http://ift.tt/2mzTGi5
Intervention: Other: dGEMERIC MRI technique
Sponsors: Hospital for Special Surgery, New York; National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Recruiting - verified March 2017
http://ift.tt/2mzTGi5
Changes in health-related quality of life of oral cancer patients treated with curative intent: experience of a developing country
Publication date: Available online 16 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): J.G. Doss, W.M.N. Ghani, I.A. Razak, Y.H. Yang, S.N. Rogers, R.B. Zain
This study aimed to assess changes in oral cancer patients' health-related quality of life (HRQOL) and the impact of disease stage on HRQOL scores. HRQOL data were collected from seven hospital-based centres using the Functional Assessment of Cancer Therapy–Head and Neck (FACT-H&N) version 4.0 instrument. The independent samples t-test, χ2 test, and paired samples t-test were used to analyse the data. A total of 300 patients were recruited. The most common oral cancer sub-site was tongue and floor of mouth (42.6%). Surgical intervention (41.1%) was the most common treatment modality. Significant differences in ethnicity and treatment modality were observed between early and late stage patients. Pre-treatment HRQOL scores were significantly lower for late than early stage patients. At 1 month post-treatment, the functional and head and neck domains and the FACT-H&N (TOI) summary scores showed significant deterioration in both early and late stage patients. In contrast, the emotional domain showed a significant improvement for early and late stage patients at 1, 3, and 6 months post-treatment. Although HRQOL deterioration was still observed among early and late stage patients at 6 months post-treatment, this was not statistically significant. In conclusion, advanced disease is associated with poorer HRQOL. Although ethnic differences were observed across different disease stages, the influence of ethnicity on patient HRQOL was not evident in this study.
http://ift.tt/2mCoLT3
Dexamethasone injection into the pterygomandibular space in lower third molar surgery
Publication date: Available online 16 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): K. Boonsiriseth, M.M. Latt, S. Kiattavorncharoen, V. Pairuchvej, N. Wongsirichat
The objective of this study was to evaluate the effects of 8mg dexamethasone injection into the pterygomandibular space on the postoperative sequelae of lower third molar surgery. A prospective, randomized, controlled, split-mouth study was designed involving 62 lower third molar extractions (31 patients). Prior to surgery, the study group received 2ml of 4mg/ml (8mg) dexamethasone injection through the pterygomandibular space following local anaesthesia; the control group received 2ml normal saline injection. Facial swelling, mouth opening, pain on a visual analogue scale (VAS), and the number of analgesics consumed were assessed. Descriptive statistics and the independent-samples t-test were used to compare the two groups at P<0.05. There was a significant reduction in swelling on day 2 postoperative in the dexamethasone group. Mouth opening was also significantly greater on day 2 in the dexamethasone group. The VAS pain score was significantly lower on the day of the operation and first postoperative day in the dexamethasone group, but did not differ significantly between the groups on the other postoperative days. The injection of 8mg dexamethasone into the pterygomandibular space was effective in reducing postoperative swelling, limited mouth opening, and pain following impacted lower third molar extraction.
http://ift.tt/2m9BpNn
JAMA Otolaryngology-Head & Neck Surgery.
| Related Articles |
JAMA Otolaryngology-Head & Neck Surgery.
JAMA Otolaryngol Head Neck Surg. 2017 Mar 01;143(3):211
Authors:
PMID: 28301665 [PubMed - in process]
http://ift.tt/2mzCMQH
Incorrectly Reported Data.
| Related Articles |
Incorrectly Reported Data.
JAMA Otolaryngol Head Neck Surg. 2017 Mar 01;143(3):318
Authors:
PMID: 28301663 [PubMed - in process]
http://ift.tt/2mzFnKx
Traumatic Facial Injuries Among Elderly Nursing Home Residents: Never Event or Frequent Occurrence?
| Related Articles |
Traumatic Facial Injuries Among Elderly Nursing Home Residents: Never Event or Frequent Occurrence?
JAMA Otolaryngol Head Neck Surg. 2017 Mar 16;:
Authors: Bobian M, El-Kashlan N, Hanba CJ, Svider PF, Folbe AJ, Eloy JA, Zuliani GF, Carron M
Abstract
Importance: As the nursing home population continues to increase, an understanding of preventable injuries becomes exceedingly important. Although other fall-related injuries have been characterized, little attention has been dedicated to facial trauma.
Objectives: To estimate the incidence of facial trauma among nursing home residents and detail mechanisms of injury, injury characteristics, and patient demographic data.
Design, Setting, and Participants: The National Electronic Injury Surveillance System was used to calculate a weighted national incidence of facial trauma among individuals older than 60 years from a nationally representative collection of emergency departments from January 1, 2011, through December 31, 2015. Entries were screened for nursing home residents, and diagnosis, anatomical site, demographic data, and mechanism of injury were analyzed.
Results: There were 109 795 nursing home residents (median age, 84.1 years; interquartile range, 79-89 years; 71 466 women [65.1%]) who required emergency department care for facial trauma. Women sustained a greater proportion of injuries with increasing age. The most common injuries were lacerations (48 679 [44.3%]), other soft-tissue injuries (45 911 [41.8%]; avulsions, contusions, and hematomas), and fractures (13 814 [12.6%]). Nasal (9331 [67.5%]) and orbital (1144 [8.3%]) fractures were the most common sites. The most common injury causes were direct contact with structural housing elements or fixed items (62 604 [57.0%]) and transfer to and from bed (24 870 [22.6%]).
Conclusions and Relevance: Despite falls being considered a Centers for Medicare & Medicaid Services preventable never event in hospitals, our analysis in the nursing home setting found more than 100 000 facial injuries during 5 years, suggesting these underappreciated injuries contribute substantially to health care expenditures. Although structural elements facilitated the greatest number of falls, transfer to and from bed remains a significant mechanism, suggesting an area for intervention.
PMID: 28301646 [PubMed - as supplied by publisher]
http://ift.tt/2mWkPio
Association of Body Mass Index With Infectious Complications in Free Tissue Transfer for Head and Neck Reconstructive Surgery.
| Related Articles |
Association of Body Mass Index With Infectious Complications in Free Tissue Transfer for Head and Neck Reconstructive Surgery.
JAMA Otolaryngol Head Neck Surg. 2017 Mar 16;:
Authors: Khan MN, Russo J, Spivack J, Pool C, Likhterov I, Teng M, Genden EM, Miles BA
Abstract
Importance: Elevated body mass index (BMI) has been proposed as a risk factor for morbidity and mortality among patients undergoing surgery. Conversely, an elevated BMI may confer a protective effect on perioperative morbidity.
Objective: To examine whether an elevated BMI is an independent risk factor for perioperative and postoperative infectious complications after free tissue transfer in head and neck reconstructive surgery.
Design, Setting, and Participants: This cohort study included patients undergoing major head and neck surgery requiring free tissue transfer at a tertiary care center. Data were collected for 415 patients treated from January 1, 2007, through December 31, 2014.
Main Outcomes and Measures: The outcome of interest was postoperative infection and complications after head and neck surgery using free flaps. Covariates considered for adjustment in the statistical model included alcohol consumption (defined as >5 drinks per day [eg, 360 mL of beer, 150 mL of wine, or 45 mL of 80-proof spirits]), type 2 diabetes, prior radiotherapy, anesthesia time, hypothyroidism, smoking, American Society of Anesthesiologists classification, antibiotic regimen received (defined as a standard regimen of a first- or second-generation cephalosporin with or without metronidazole hydrochloride vs an alternative antibiotic regimen for patients allergic to penicillin), and primary surgeon. A multiple logistic regression model was developed for the incidence of the infection end point as a function of elevated BMI (>30.0).
Results: Among the 415 patients included in this study (277 men [66.7%] and 138 women [33.2%]; mean [SD] age, 61.5 [13.9] years), type 2 diabetes and use of an alternative antibiotic regimen were found to be independently associated with increased infectious complications after free flap surgery of the head and neck, with estimated odds ratios of 2.78 (95% CI, 1.27-6.09) and 2.67 (95% CI, 1.14-6.25), respectively, in the multiple logistic regression model. However, a high BMI was not found to be statistically significant as an independent risk factor for postoperative infectious complication (estimated odds ratio, 1.19; 95% CI, 0.48-2.92).
Conclusions and Relevance: Elevated BMI does not seem to play a role as an independent risk factor in postoperative complications in free tissue transfer in head and neck surgery.
PMID: 28301644 [PubMed - as supplied by publisher]
http://ift.tt/2mWmuom
Trismus and Swelling on the Side of the Face.
| Related Articles |
Trismus and Swelling on the Side of the Face.
JAMA Otolaryngol Head Neck Surg. 2017 Mar 16;:
Authors: Maeder ME, Hirsch DL, Shatzkes DR
PMID: 28301643 [PubMed - as supplied by publisher]
http://ift.tt/2mzC3Pe
Survival Outcomes in Oropharyngeal Small-Cell Carcinoma Compared With Squamous Cell Carcinoma: A Population-based Study.
| Related Articles |
Survival Outcomes in Oropharyngeal Small-Cell Carcinoma Compared With Squamous Cell Carcinoma: A Population-based Study.
JAMA Otolaryngol Head Neck Surg. 2017 Mar 16;:
Authors: Megwalu UC, Nuyen BA
PMID: 28301632 [PubMed - as supplied by publisher]
http://ift.tt/2nMoInE
Steroid intracochlear distribution differs by administration method: Systemic versus intratympanic injection
Objective
Steroids have been widely used to treat inner-ear diseases such as sudden sensorineural hearing loss, tinnitus, and Meniere's disease. They can be given via either systemic or intratympanic (IT) injection. The purpose of the present study was to explore differences in intracochlear steroid distribution by the administration method employed (systemic vs. IT injection).
Study Design
Animal study.
Methods
Twenty-three Sprague-Dawley rats were given fluorescein isothiocyanate-labeled dexamethasone (FITC-DEX) three times (on successive days) via intraperitoneal (IP) or IT injection. Cochlear uptake of FITC-DEX was evaluated via immunohistochemistry and flow cytometry at 6 hours, and 3 and 7 days after the final injection.
Results
FITC-DEX uptake was evident in spiral ganglion cells (SGs), the organ of Corti (OC), and the lateral walls (LWs), the basal turns of which were stained relatively prominently in both groups. Animals receiving IP injections exhibited higher FITC-DEX uptakes by the SGs and OC, whereas IT injection triggered higher-level FITC-DEX accumulation by the OC and LWs. Flow cytometry revealed that intracochlear FITC-DEX uptake by IT-injected animals was higher and more prolonged than in animals subjected to IP injections.
Conclusion
We thus describe differences in cochlear steroid distributions after systemic and IT injections. This finding could help our understanding of the pharmacokinetics of steroids in the cochlea.
Level of Evidence
NA. Laryngoscope, 2017
http://ift.tt/2mWi8gV
Sexual dimorphism in laryngeal muscle fibers and ultrasonic vocalizations in the adult rat
Objective
The human voice is sexually dimorphic in obvious ways, such as differences in fundamental frequency and gross laryngeal anatomy, but also in less apparent ways, such as in the prevalence and types of voice disorders and the manifestation of voice changes in advanced age. Differences between males and females are rarely explored, however, in mechanistic animal studies. The goal of this study was to explore sexual dimorphism in laryngeal function and structure in adult rats by examining ultrasonic vocalization acoustics and muscle fiber size and type in the thyroarytenoid muscle.
Study Design
Animal group comparison.
Methods
Spontaneous ultrasonic vocalizations from 10 male adult rats and 10 female adult rats were recorded, classified, and acoustically analyzed. Cross-sections of the thyroarytenoid muscle were stained and imaged for analysis of muscle fiber size and type. Acoustic and muscle parameters were statistically compared between sexes.
Results
Male rats had a lower mean frequency of short ultrasonic vocalizations. Male rats also had a larger mean fiber size in the external division of the thyroarytenoid and larger overall muscle area in both the vocalis and external divisions of the thyroarytenoid. However, muscle fiber type compositions were similar between sexes in both the vocalis and external division of the thyroarytenoid muscles.
Conclusion
Functional and structural laryngeal differences exist between adult male and female rats; therefore, the rat model can be used to further study sexual dimorphism of the voice.
Level of Evidence
NA. Laryngoscope, 2017
http://ift.tt/2ngtnSg
Endoscope or microscope-guided pediatric tympanoplasty? Comparison of grafting technique and outcome
Objectives/Hypothesis
To review experience from the introduction of totally endoscopic ear surgery (TEES) to a pediatric tympanoplasty practice to identify factors influencing technique selection and successful outcome.
Study Design
Prospective cohort study.
Methods
Analysis of prospectively acquired data from a consecutive series of 295 surgeries for tympanic membrane perforation over a 12-year period. Success of perforation closure was compared between microscope and TEES grafting techniques. Impact of the acquisition of endoscopic techniques and equipment were compared with annual proportion of cases completed by TEES.
Results
Of 267 tympanoplasties, 109 (41%) were completed with TEES and 158 by a postauricular approach. The proportion completed with TEES increased gradually to 97% of cases as equipment and expertise were acquired. Young age did not prevent TEES tympanoplasty. Two hundred nineteen of 250 (88%) perforations were closed successfully by tympanoplasty, with equivalent closure rates between TEES and postauricular approaches. Underlay of tragal perichondrium was less successful than lateral graft technique using TEES (P = .04, Fisher exact test). "Push-through" myringoplasty using a microscope or endoscope was least successful (19 of 28 (68%), P = .005). The median length of stay was 13 hours shorter for TEES than postauricular tympanoplasty (P = .04, Mann-Whitney rank sum test). Wound complications occurred in five (3%) postauricular cases and one TEES case.
Conclusions
TEES tympanoplasty is feasible in a large majority of children given appropriate equipment and surgical experience. Nonautogenous graft material is ideal for this minimally invasive approach. TEES is recommended as providing equivalent likelihood of perforation closure to the post-auricular approach but with less postoperative morbidity.
Level of Evidence
2b. Laryngoscope, 2017
http://ift.tt/2nMc3kF
Influence of human papillomavirus on the clinical presentation of oropharyngeal carcinoma in the United States
Objective
Much of what is known about the significance of human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma is derived from single-institution retrospective studies, post hoc analyses of tissue specimens from clinical trials, and tissue bank studies with a small sample size. The objective of this study is to investigate the impact of HPV on the frequency and clinical presentation of oropharyngeal carcinoma in a large, national sample with information from patients who underwent HPV testing.
Study Design
Retrospective, cross-sectional study.
Methods
We identified a comprehensive national sample of 8,359 patients with oropharyngeal carcinoma and known HPV status diagnosed between 2010 and 2011 within the National Cancer Database. Multivariable logistic regression was used to assess correlates of patient and tumor characteristics on HPV status.
Results
Among patients with oropharyngeal carcinoma, the frequency of HPV-related squamous cell carcinoma in the United States was 65.4%. HPV-related oropharyngeal carcinoma was associated with younger age, male sex, and white race (P < 0.001). Advanced primary tumor stage was associated with HPV-negative disease (P < 0.001), whereas increasing nodal burden was associated with HPV-positive disease (P < 0.001). Despite less-advanced nodal disease, HPV-negative tumors were associated with a higher likelihood of metastasis at presentation (P < 0.001).
Conclusion
HPV now accounts for the majority of newly diagnosed oropharyngeal carcinoma in the United States and is associated with a distinct clinical profile, supporting efforts to re-evaluate the staging and treatment paradigm for HPV-associated oropharyngeal cancer.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2mPJqUr
Feasibility of endoscopic submandibular ganglion neurectomy for drooling
We performed endoscopic transoral neurectomy of the submandibular and sublingual glands to treat drooling. We bilaterally operated two adult cases with treatment-resistant drooling. In these patients, conventional treatment had failed. Repeated botilinum toxin type A (BOTOX®, Abdi Ibrahim Pharmaceutical Company, Istanbul, Turkey) injections had been effective but were becoming less so. The patients benefited from surgery in that their saliva scores decreased. No issue emerged over 6 months of follow-up. Endoscopic transoral neurectomy of the submandibular and sublingual glands reduces saliva production and allows management of drooling in treatment-resistant patients. Laryngoscope, 00:000–000, 2017
http://ift.tt/2ngFcrT
Phosphorylated FADD is not prognostic for local control in T1-T2 supraglottic laryngeal carcinoma treated with radiotherapy
Objective
The Fas-Associated Death Domain (FADD) gene is located in the chromosome 11q13-region and frequently is amplified in head and neck squamous cell carcinoma. Expression of FADD and its phosphorylated isoform (pFADD) have been associated with aggressive tumor growth, lymph node metastasis, and overall survival. Previously, we demonstrated that pFADD expression was related to a significantly improved local control in early stage (tumor [T]1 to T2) glottic laryngeal squamous cell carcinoma (LSCC). The aim of this study was to examine the prognostic value of pFADD and FADD in T1 to T2 supraglottic LSCC treated with primarily radiotherapy.
Methods
Tumor tissue sections of 60 patients with T1 to T2 supraglottic LSCC treated with primarily radiotherapy were assessed immunohistochemically for expression of pFADD and FADD. Expression percentages and clinical parameters and their associations with clinical outcome were studied using Cox regression and Kaplan-Meier survival analyses. Expression percentages in supraglottic and glottic LSCC were compared using the Mann-Whitney U test.
Results
Expression of pFADD and FADD in supraglottic and glottic LSCC did not significantly differ. In supraglottic LSCC, both pFADD and FADD did not show prognostic value for local control (hazard ratio [HR] 1.00, 95% confidence interval [CI] 0.98–1.03; HR 1.03, 95% CI 0.60–1.78, respectively) and overall survival (HR 0.99, 95% CI 0.98–1.01; HR 1.19, 95% CI 0.83–1.71 respectively). In this cohort, lymph node status was the best predictor for local control (HR 3.73, 95% CI 1.30–10.67).
Conclusion
In this homogeneous cohort of T1 to T2 supraglottic LSCC primarily treated with radiotherapy, lymph node status was associated with local recurrence, whereas the expression of pFADD was not.
Level of Evidence
NA. Laryngoscope, 2017
http://ift.tt/2mPXw8n
Insertion depth impacts speech perception and hearing preservation for lateral wall electrodes
Objectives
1) Examine angular insertion depths (AID) and scalar location of Med-El (GmbH Innsbruck, Austria) electrodes; and 2) determine the relationship between AID and audiologic outcomes controlling for scalar position.
Study Design
Retrospective review.
Methods
Postlingually deafened adults undergoing cochlear implantation with Flex 24, Flex 28, and Standard electrode arrays (Med-El) were identified. Patients with preoperative and postoperative computed tomography scans were included so that electrode location and AID could be determined. Outcome measures were 1) speech perception in the cochlear implant (CI)-only condition, and 2) short-term hearing preservation.
Results
Forty-eight implants were included; all electrodes (48 of 48) were positioned entirely within the scala tympani. The median AID was 408° (interquartile [IQ] range 373°–449°) for Flex 24, 575° (IQ range 465°–584°) for Flex 28, and 584° (IQ range 368°–643°) for Standard electrodes (Med-El). The mean postoperative CNC score was 43.7% ± 21.9. A positive correlation was observed between greater AID and better CNC performance (r = 0.48, P < 0.001). Excluding patients with postoperative residual hearing, a strong correlation between AID and CNC persisted (r = 0.57, P < 0.001). In patients with preoperative residual hearing, mean low-frequency pure-tone average (PTA) shift was 27 dB ± 14. A correlation between AID and low-frequency PTA shift at activation was noted (r = 0.41, P = 0.04).
Conclusion
Favorable rates of scala tympani insertion (100%) were observed. In the CI-only condition, a direct correlation between greater AID and CNC score was noted regardless of postoperative hearing status. Deeper insertions were, however, associated with worse short-term hearing preservation. When patients without postoperative residual hearing were analyzed independently, the relationship between greater insertion depth and better performance was strengthened.
Level of Evidence
4. Laryngoscope, 2016
http://ift.tt/2ngKHXe
Postoperative complications of total laryngectomy in diabetic patients
Objectives/Hypothesis
Analyze postoperative complications of total laryngectomies (TL) in patients with diabetes mellitus and apply these data toward preoperative management of diabetic patients undergoing TL.
Study Design
Retrospective analysis of surgical outcomes database
Methods
The American College of Surgeons National Surgical Quality Improvement Program database was queried for TL performed between 2005 and 2013. Comparison of demographics, preoperative comorbidities, and postoperative outcomes in a diabetic versus a nondiabetic cohort was conducted using SPSS software. Equal distribution of demographics and preoperative comorbidities was ensured between the diabetic and nondiabetic cohorts using a propensity-matching algorithm.
Results
Following propensity matching there were 495 TL patients included in this study. Among these, 110 (22.2%) were diabetic and 385 (77.8%) were nondiabetic. The only comorbidities associated with the diabetic cohort after matching were obesity, previous percutaneous coronary intervention, and hypertension. The rates of superficial surgical site infections were higher in the diabetic patient cohort (10.9% vs. 4.7%, P = .022). There were no significant differences in unplanned readmission (12.7% vs. 9.1%, P = .260), reoperation (14.3% vs. 15.1%, P = .864), and mortality (1.8% vs. 2.6%, P = 1.000) between the diabetic and the nondiabetic groups. Multivariate regression utilizing preoperative variables not accounted for by propensity matching showed that superficial surgical site infections were still higher in the diabetes cohort (odds ratio: 3.371, P = .021).
Conclusions
Diabetic patients undergoing TL showed an increased incidence of superficial surgical site infections postoperatively. There were no other significant differences in readmission, reoperation, and mortality.
Level of Evidence
4 Laryngoscope, 2016
http://ift.tt/2ngM8oR
Airway inflammation phenotype prediction in asthma patients using lung sound analysis with fractional exhaled nitric oxide
Publication date: Available online 17 March 2017
Source:Allergology International
Author(s): Terufumi Shimoda, Yasushi Obase, Yukio Nagasaka, Hiroshi Nakano, Reiko Kishikawa, Tomoaki Iwanaga
BackgroundWe previously reported the results of lung sound analysis in patients with bronchial asthma and demonstrated that the exhalation-to-inhalation sound pressure ratio in the low frequency range between 100 and 200 Hz (E/I LF) was correlated with the presence of airway inflammation and airway obstruction. We classified asthma patients by airway inflammation phenotype using the induced sputum eosinophil and neutrophil ratio and determined whether this phenotype could be predicted using E/I LF and fractional exhaled nitric oxide values.MethodsSteroid-naive bronchial asthma patients were classified into four phenotypes, including "Low inflammation" (35 patients), "Eosinophilic type" (58 patients), "Neutrophilic type" (15 patients), and "Mixed type" (15 patients) based on the results of induced sputum examinations. The E/I LF data and FeNO levels were then evaluated for the four phenotype groups; the prediction powers of these two indices were then analyzed for each phenotype.ResultsThe median E/I LF value was highest in the "Mixed type" and lowest in the "Low inflammation" group. FeNO differentiated between the "Low inflammation" and "Eosinophilic type" groups, "Low inflammation" and "Neutrophilic type" groups, and "Neutrophilic type" and "Mixed type" (p < 0.0001, p = 0.007, and p = 0.04, respectively). E/I LF differentiated between the "Low inflammation" and "Eosinophilic type" groups (p = 0.006). E/I LF could distinguish the "Mixed type" group from the "Low inflammation" and "Eosinophilic type" groups (p = 0.002).ConclusionsA combination of the E/I LF value and FeNO may be useful for the classification of the airway inflammation phenotype in patients with bronchial asthma.
http://ift.tt/2m9nC9s
Predicting future risk of exacerbations in Japanese patients with adult asthma: A prospective 1-year follow up study
Publication date: Available online 17 March 2017
Source:Allergology International
Author(s): Akihiko Tanaka, Tomoki Uno, Haruna Sato, Megumi Jinno, Kuniaki Hirai, Yoshito Miyata, Munehiro Yamaguchi, Shin Ohta, Tetsuya Homma, Mayumi Yamamoto, Shintaro Suzuki, Takuya Yokoe, Hironori Sagara
BackgroundTo avoid future risk is a definitive goal of long-term asthma management. Exacerbations are considered to be the most relevant future risk in real life asthma management. Few comparative studies have evaluated the risk factors associated with exacerbations in Japanese patients with asthma.MethodsWe performed the prospective 1-year follow up study in Japanese patients with adult asthma. A total of 189 patients with asthma were enrolled and followed up for 1 year. Finally, 181 patients completed the study protocol.ResultsOf 181 patients, 43 patients (23.8%) had exacerbations during the follow-up period. Among the 45 patients who had exacerbations during the preceding year, 32 patients (71.1%) had exacerbations. Prevalence of patients with previous exacerbations and those with previous admissions were significantly higher in patients with exacerbations than those with no exacerbation. Logistic regression analysis also identified a significant association between exacerbations during the follow-up period and exacerbations during the preceding year, admissions during the preceding 3 years, ACT score below 20, low %FVC (<80%), or low FEV1 (<70%), respectively. Of the 55 patients with severe asthma, 29 patients (52.7%) had exacerbations. Among the 36 patients with severe asthma with previous exacerbations, 26 patients (72.2%) had exacerbations. The history of exacerbations during the preceding year was associated with a significantly increased risk of exacerbations both among the patients with severe asthma and those with non-severe asthma.ConclusionsThis study implicated that exacerbations during the preceding year reliably predict future risk of exacerbations in Japanese patients with asthma.
http://ift.tt/2mBPZJA
UDP/P2Y6 receptor signaling regulates IgE-dependent degranulation in human basophils
Publication date: Available online 17 March 2017
Source:Allergology International
Author(s): Manabu Nakano, Koichi Ito, Takeo Yuno, Nobuyuki Soma, Syun Aburakawa, Kosuke Kasai, Toshiya Nakamura, Hideki Takami
BackgroundP2Y purinergic receptors (P2YR) are G protein-coupled receptors that are stimulated by extracellular nucleotides. They mediate cellular effects by regulating cAMP production, protein kinase C activation, inositol trisphosphate generation, and Ca2+ release from intracellular stores. The P2Y6 receptor of this family is selectively stimulated by UDP, and selectively inhibited by MRS2578. In the present study, we examined the effect of UDP/P2Y6 receptor signaling on IgE-dependent degranulation in human basophils.MethodsBasophils were purified from human peripheral blood. The mRNA expression of genes encoding P2YR and ecto-nucleoside triphosphate diphosphohydrolase (ENTPDase) was measured by RT-PCR. Intracellular Ca2+ influx via UDP/P2Y6 receptor signaling in basophils was detected using a calcium probe. The effect of UDP/P2Y6 receptor signaling on IgE-dependent degranulation in basophils was confirmed by measuring CD63 expression by flow cytometry. Autocrine secretion of nucleotides was detected by HPLC analysis.ResultsWe showed that purified basophils express P2Y6 mRNA and that UDP increased intracellular Ca2+, which was reduced by MRS2578 treatment. UDP promoted IgE-dependent degranulation. Furthermore, MRS2578 inhibited IgE-dependent degranulation in basophils. HPLC analysis indicated that basophils spontaneously secrete UTP. In addition, basophils expressed the extracellular nucleotide hydrolases ENTPDase2, ENTPDase3, and ENTPDase8.ConclusionsThis study showed that UDP/P2Y6 receptor signaling is involved in the regulation of IgE-dependent degranulation in basophils, which might stimulate the P2Y6 receptor via the autocrine secretion of UTP. Thus, this receptor represents a potential target to regulate IgE-dependent degranulation in basophils during allergic diseases.
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Genetic association of the functional CDHR3 genotype with early-onset adult asthma in Japanese populations
Publication date: Available online 17 March 2017
Source:Allergology International
Author(s): Jun Kanazawa, Hironori Masuko, Yohei Yatagai, Tohru Sakamoto, Hideyasu Yamada, Yoshiko Kaneko, Haruna Kitazawa, Hiroaki Iijima, Takashi Naito, Takefumi Saito, Emiko Noguchi, Satoshi Konno, Masaharu Nishimura, Tomomitsu Hirota, Mayumi Tamari, Nobuyuki Hizawa
BackgroundRecent studies have demonstrated that a coding SNP (rs6967330, Cys529→Tyr) in cadherin-related family member 3 (CDHR3), which was previously associated with wheezing illness and hospitalizations in infancy, could support efficient human rhinovirus C (RV-C) entry and replication. Here, we sought to examine the genetic contribution of this variant to the development of adult asthma.MethodsWe performed a candidate gene case–control association study of 2 independent Japanese populations (a total of 3366 adults). The odds ratios (ORs) for association of the A allele at rs6967330 with adult asthma were calculated according to age at onset of asthma. In addition, the effect of the CDHR3 genotype on the development of specific asthma phenotypes was examined.ResultsThe A allele was associated with asthma (OR = 1.56; Mantel–Haenszel p = 0.0040) when the analysis was limited to patients with early-onset adult asthma. In addition, when the analysis was limited to atopic individuals, a stronger association of the CDHR3 variant with early-onset asthma was found, and interaction of the CDHR3 genotype with atopy was demonstrated. Finally, a significant association of this variant was specifically found with a phenotype of asthma characterized by atopy, early-onset, and lower lung function.ConclusionsOur study supports the concept that the CDHR3 variant is an important susceptibility factor for severe adult asthma in individuals who develop the disease in early life. The interaction between the CDHR3 variant and atopy indicates that genetic predisposition to early respiratory viral infection is combined with atopy in promoting asthma.
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Three-dimensional finite element analysis of zirconia all-ceramic cantilevered fixed partial dentures with different framework designs
The purpose of this study were: to perform stress analyses using three-dimensional finite element analysis methods; to analyze the mechanical stress of different framework designs; and to investigate framework designs that will provide for the long-term stability of both cantilevered fixed partial dentures (FPDs) and abutment teeth. An analysis model was prepared for three units of cantilevered FPDs that assume a missing mandibular first molar. Four types of framework design (Design 1, basic type; Design 2, framework width expanded buccolingually by 2 mm; Design 3, framework height expanded by 0.5 mm to the occlusal surface side from the end abutment to the connector area; and Design 4, a combination of Designs 2 and 3) were created. Two types of framework material (yttrium-oxide partially stabilized zirconia and a high precious noble metal gold alloy) and two types of abutment material (dentin and brass) were used. In the framework designs, Design 1 exhibited the highest maximum principal stress value for both zirconia and gold alloy. In the abutment tooth, Design 3 exhibited the highest maximum principal stress value for all abutment teeth. In the present study, Design 4 (the design with expanded framework height and framework width) could contribute to preventing the concentration of stress and protecting abutment teeth.
http://ift.tt/2mBDmOE
Sclerosing mucoepidermoid carcinoma of the sublingual gland
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): D.H. Lee, J.H. Kim, J.K. Lee, S.C. Lim
IntroductionSclerosing mucoepidermoid carcinoma of the salivary gland is a rare subtype of mucoepidermoid carcinoma. The most common site of sclerosing mucoepidermoid carcinoma of the salivary glands is the parotid gland, followed by the submandibular gland, and the minor salivary glands.ObservationHere we report the first case of sclerosing mucoepidermoid carcinoma of the sublingual gland.DiscussionClinicians should consider sclerosing mucoepidermoid carcinoma in the differential diagnosis of salivary gland neoplasm. Surgical excision with clear margins seems to be a sufficient initial treatment option for sclerosing mucoepidermoid carcinoma of the salivary gland.
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Electrophysiological exploration of hearing
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): D. Bakhos, M. Marx, A. Villeneuve, E. Lescanne, S. Kim, A. Robier
Electrophysiologic hearing tests have been developed since the 1960s to determine hearing thresholds objectively. They are now implemented in newborn hearing screening. While they determine thresholds, interpretation requires subjective pure-tone and speech audiometry to determine the type of hearing loss. Each examination tests a different anatomic region, enabling the auditory system to be explored from the organ of Corti to the auditory cortex. Thus, the various objective audiometric examinations are complementary.
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Authorship selection in industry sponsored publications of dermatology clinical trials
Abstract
The issue of conflict of interest management and authorship has been the subject of debates and recommendations over the past 15 years1–7. Some grey areas persist concerning the definition of authorship in industry-sponsored clinical trials (IRCT)8. The objective of the present study was to better understand this process.
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