A peel-off facial mask comprising myoinositol and trehalose-loaded liposomes improves adult female acne by reducing local hyperandrogenism and activating autophagy

Summary

Background

Hyperandrogenism and reduced skin autophagy have been implicated in the pathogenesis of adult female acne (AFA). Here, we tested whether a ready-to-use peel-off facial mask containing myoinositol (an androgen inhibitor) and trehalose-loaded liposomes (as activators of cutaneous autophagy) applied overnight every other day for 60 days can improve AFA. We also sought to investigate the molecular mechanisms underlying the clinical effects.

Objectives

We conducted an uncontrolled, open-label clinical study in 40 cases of AFA to investigate the effect of the facial mask on lesion count, sebum production (measured with the Sebutape® technique), and Global Acne Grading System (GAGS) scale. We also investigated the changes from baseline to the end of treatment in androgen and beclin-1 levels (as a marker of authophagy) in skin biopsy supernatants.

Methods

Forty Caucasian patients with AFA were enrolled. Changes in clinical and molecular endpoints before and after treatment were investigated.

Results

The mean counts of comedones, papules, pustules, and nodular lesions decreased significantly (all P<.001). The mean Sebutape® score was reduced from 3.4±0.6 to 1.8±0.2 (P<.001), whereas the mean GAGS scale score decreased from 16.8±5.3 at baseline to 9.8±4.6 after treatment (P<.001). A significant decrease in testosterone and dehydroepiandrosterone sulfate in skin biopsy supernatants was observed, whereas beclin-1 levels increased significantly (P<.001).

Conclusion

A ready-to-use peel-off facial mask containing myoinositol and trehalose-loaded liposomes improved the cosmetic appearance of AFA by reducing cutaneous androgen content and promoting skin autophagy.

http://ift.tt/2nSd0Mq

Overexpression of Drosha, DiGeorge syndrome critical region gene 8 (DGCR8), and Dicer mRNAs in the pathogenesis of psoriasis

Summary

Introduction

Psoriasis is a complex autoimmune inflammatory disease that occurs in genetically susceptible individuals and presents with the development of inflammatory plaques on the skin. Recent studies have indicated that microRNAs (miRNAs) play important roles in psoriasis.

Objective

To investigate whether expression of Drosha, DGCR8, and Dicer mRNAs is involved in the pathogenesis of psoriasis.

Methods

Biopsies were obtained from involved psoriatic skin (PP), noninvolved psoriatic skin (PN), and healthy skin (NN). Expression of Drosha, Dicer, and DGCR8 was assessed with real-time quantitative real-time PCR in 25 patients with psoriasis and 25 healthy volunteers.

Results

We observed that expression levels of Drosha, Dicer, and DGCR8 were upregulated in patients with psoriasis compared to the control group. However, the Drosha and Dicer expression levels were higher in PP tissues and PN tissues compared to NN tissues, but they were more upregulated in PP tissues compared to PN tissues (P<.001). Although the DGCR8 expression was higher in PP tissues and PN tissues compared to NN tissues, it was more upregulated in PN tissues compared to PP tissues (P<.001).

Conclusion

Our data demonstrate that upregulated expression of Drosha, DGCR8, and Dicer mRNAs may be involved in the pathogenesis of psoriasis.

http://ift.tt/2o1IOvm

Case of lupus miliaris disseminatus faciei associated with marked formation of cysts, successfully treated with intralesional injections of triamcinolone acetonide

http://ift.tt/2mB5hCi

Acral lentiginous melanoma versus other melanoma: A single-center analysis in Japan

Abstract

We summarize herein our 14-year experience of conventional treatment outcomes before the era of molecular-targeted therapy and immunotherapy. Specifically, we conducted a retrospective review of our 252 patients with primary cutaneous melanoma (acral lentiginous melanoma [ALM], n = 121; non-acral lentiginous melanoma [non-ALM], n = 131), and compared the prognostic factors between ALM and non-ALM. Melanoma-specific survival and disease-free survival were estimated using the Kaplan–Meier method. Regarding the results, all patients were Japanese (106 male and 146 female), with a mean age of 60.1 years. Among ALM patients, age was elder and primary tumor size was larger than non-ALM. As for tumor thickness, in situ lesions were more frequently observed in ALM. There was no significant difference in the distribution of tumor thickness between the two groups when excluding the in situ lesions. For treatment of the primary melanoma, 248 patients (98.4%) had undergone curative surgical excision and 120 patients with more than 1 mm or ulcerated melanoma had undergone sentinel lymph node biopsy. Patients with systemic metastasis primarily underwent dacarbazine-based chemotherapy. The Kaplan–Meier survival curves revealed no significant difference in melanoma-specific survival and disease-free survival between those with ALM and non-ALM. The results also showed that both ALM and non-ALM, when they initially metastasize, first affect the regional lymph nodes. Incisional biopsy was not an adverse prognostic factor. These results suggest that ALM does not differ in its biological behavior from non-ALM, so we can consider ALM as being equivalent to non-ALM. The initial treatment for ALM and non-ALM can involve the same strategy.

http://ift.tt/2n3wpGe

Cutaneous spindle cell adenolipoma on the nose: A rare variant of lipoma

http://ift.tt/2mB38Xm

AMIStem Primary Hip System Prospective Post-marketing Multi-centre Surveillance Study

Conditions:   Osteoarthritis;   Arthritis;   Avascular Necrosis;   Fracture of the Femoral Neck or Head;   Congenital Hip Dysplasia
Intervention:   Device: AMIStem Hip System
Sponsor:   Medacta International SA
Recruiting - verified April 2016

http://ift.tt/2nP0soV

Endothelial Progenitor Cells in Cervical Cancer Patients Receiving Chemoradiation

Condition:   Cervical Cancer
Intervention:  
Sponsors:   Mackay Memorial Hospital;   National Science Council, Taiwan
Recruiting - verified March 2017

http://ift.tt/2n15hXO

Hypohidrosis and metal allergy: Trigger factors for unilateral lichen planus

Abstract

Unilateral lichen planus (LP) is a rare clinical variant of LP. The etiology of unilateral LP has not been clarified, although various causes have been reported because of the characteristic distribution. We focused on the contribution of metal allergy and sweating in the development of unilateral LP in this case. To confirm the presence of metal allergy, patch tests with metal allergens were performed. To investigate the cause of the unilateral distribution in unilateral LP, the function of sweating and sweat leaking in the dermis was assessed by a thermoregulatory sweat test and immunohistochemical staining of dermcidin. The patch tests with SnCl₂, H₂PtCl₆, ZnCl₂ and MnCl₂ were positive. The thermoregulatory sweat test using the starch–iodine method (Minor test) with sweating provoked by heat stimulation revealed hypohidrosis of the affected area, whereas no skin lesions were observed on the dorsal hand and wrist where sweating was normal. Histopathological examination showed keratin plugging of the acrosyringium and lymphocytic infiltrations in the papillary and subpapillary dermis around the intraepidermal and intradermal eccrine duct in the affected area. The immunohistochemical staining of dermcidin confirmed sweat leakage in the subpapillary dermis in the affected area. The symptoms refractory to the topical steroids were markedly improved after removal of the dental metals. The coexistence of metal allergy and sweat leakage in the hypohidrotic area may be involved in the development of unilateral LP.

http://ift.tt/2nxUTuz

Rheumatoid neutrophilic dermatitis in a patient taking tocilizumab for treatment of rheumatoid arthritis

http://ift.tt/2ofH40J

Japanese version of the Family Dermatology Life Quality Index: Translation and validation

Abstract

Skin conditions affect the quality of life (QoL) of patients and their family. To assess family members' QoL, a questionnaire uniquely designed for family members is necessary. We translated the Family Dermatology Life Quality Index (FDLQI), originally created and validated by Basra et al., into Japanese, and evaluated its reliability and validity. For psychometric evaluations, 150 dermatology patients and their family members were included. The Japanese version of the FDLQI showed high test–retest reliability (intraclass correlation coefficient = 0.95) and internal consistency reliability (Cronbach's alpha = 0.86). FDLQI scores significantly correlated with DLQI scores (r = 0.58, P < 0.01, Spearman's rho) and global question (GQ) which measured the patient's skin condition on a visual analog scale (r = 0.36, P < 0.01). Family members of patients with inflammatory skin diseases showed higher FDLQI scores than those with isolated lesions, but the difference was not statistically significant (P = 0.062, Mann–Whitney U-test). Responsiveness to change was demonstrated in a group in which the patient's skin condition was assessed as improved (n = 37, r = 0.46, P < 0.01) but not in that in which it became worse. The difference of the change between the two groups was statistically significant (P < 0.01). Additionally, the change in FDLQI scores and GQ were significantly correlated (r = 0.40, P < 0.01). Exploratory factor analysis suggested essential unidimensionality of the instrument. We showed acceptable validity and responsiveness of this Japanese version of FDLQI. Further clinical epidemiological studies are required to confirm this.

http://ift.tt/2nxYfxA

Increased number of mast cells in the dermis in actinic keratosis lesions effectively treated with imiquimod

Abstract

Actinic keratosis (AK) is a cutaneous cancer in situ which develops as a result of excessive exposure to ultraviolet (UV). Toll-like receptor (TLR)7 agonist imiquimod is a topical immune response modifier and is effective for the treatment of non-melanoma skin cancers. Recently, the diagnostic role of the dermatoscope has been reported in the course of treatment of AK. In addition, mast cells are now considered to contribute to both the innate and adaptive immune systems in topical imiquimod therapy. We assessed the effect of imiquimod treatment by dermatoscopic and immunohistochemical findings in 14 patients with a total of 21 AK lesions. With the dermatoscope, though the mean erythema score was not significantly different between the cured lesions and the unresponsive lesions, the erythema/red pseudo-network ("strawberry") pattern was decreased significantly in the cured lesions. By immunohistochemistry, the number of Ki-67-positive proliferative cells in the epidermis was decreased and that of CD117-positive mast cells in the dermis was increased in the responding lesions. To the best of our knowledge, this is the first study demonstrating that the number of mast cells in the dermis was increased in AK lesions effectively treated with imiquimod. Our present result suggests that mast cells may contribute an antitumor effect in human skin treated with topical imiquimod.

http://ift.tt/2ofzwLB

Case of bullous pemphigoid coexisting with anti-desmoglein autoantibodies

Abstract

A 79-year-old Japanese woman had clinical and histopathological features of bullous pemphigoid, while direct immunofluorescence test revealed C3 and immunoglobulin G depositions in the lower cell surfaces of the epidermis in addition to those in the dermoepidermal junction. Chemiluminescent enzyme immunoassays were positive for desmoglein-1 and -3 antibodies in addition to anti-BP180 antibodies. In an immunoblotting study, antibodies against both 180-kDa bullous pemphigoid antigen and 130-kDa pemphigus vulgaris antigen were detected. Based on these results, bullous pemphigoid coexisting with anti-desmoglein autoantibodies was diagnosed in this case.

http://ift.tt/2ny4pxv

Critical contribution of the interleukin-6/signal transducer and activator of transcription 3 axis to vasculopathy associated with systemic sclerosis

Abstract

Reflecting the critical role of interleukin (IL)-6 in systemic sclerosis (SSc), tocilizumab, an anti-IL-6 receptor antibody, is currently under a global phase III trial against skin sclerosis of this disease. We here demonstrate that the IL-6/signal transducer and activator of transcription 3 axis is broadly activated in various cell types in the lesional skin of SSc patients irrespective of disease subtypes, especially in endothelial cells. Importantly, 12 monthly infusions of tocilizumab improved nailfold capillary changes as well as skin sclerosis in a patient with diffuse cutaneous SSc. The present findings suggest a potential disease-modifying effect of tocilizumab on SSc vasculopathy.

http://ift.tt/2ofI1Gw

Inflammatory Bowel Disease: Joint Management in Gastroenterology and Dermatology [Free article]

M.A. Sánchez-Martínez, E. Garcia-Planella, A. Laiz, L. Puig
Actas Dermosifiliogr.2017;108:184-91

Abstract - Full text - PDF

http://ift.tt/2nmb1P6

Clinicopathologic Variants of Mycosis Fungoides [Free article]

H. Muñoz-González, A.M. Molina-Ruiz, L. Requena
Actas Dermosifiliogr.2017;108:192-208

Abstract - Full text - PDF

http://ift.tt/2ngzmUS

Inflammatory Skin Conditions Associated With Radiotherapy [Free article]

I. Hernández Aragüés, A. Pulido Pérez, R. Suárez Fernández
Actas Dermosifiliogr.2017;108:209-20

Abstract - Full text - PDF

http://ift.tt/2nmeDAI

New Treatments for Hair Loss [Free article]

S. Vañó-Galván, F. Camacho
Actas Dermosifiliogr.2017;108:221-8

Abstract - Full text - PDF

http://ift.tt/2ngylw0

Cost of Cutaneous Melanoma by Tumor Stage: A descriptive analysis [Free article]

P. Serra-Arbeloa, Á.O. Rabines-Juárez, M.S. Álvarez-Ruiz, F. Guillén-Grima
Actas Dermosifiliogr.2017;108:229-36

Abstract - Full text - PDF

http://ift.tt/2nmeDkc

Objective Structured Clinical Examination as an Assessment Tool for Clinical Skills in Dermatology [Free article]

D. Saceda-Corralo, P. Fonda-Pascual, â.M. Moreno-Arrones, A. Alegre-Sánchez, Á. Hermosa-Gelbard, N. Jimèc)nez-Gómez, S. Vañó-Galván, P. Jaèc)n-Olasolo
Actas Dermosifiliogr.2017;108:237-43

Abstract - Full text - PDF

http://ift.tt/2ngxmfe

The impact of skin diseases on quality of life: A multicenter study [Free article]

G. Sanclemente, C. Burgos, J. Nova, F. Hernández, C. González, M.I. Reyes, N. Córdoba, Á. Arèc)valo, E. Melèc)ndez, J. Colmenares, S. Ariza, G. Hernández
Actas Dermosifiliogr.2017;108:244-52

Abstract - Full text - PDF

http://ift.tt/2nmcKnn

Extensive Acquired Telangiectasias: Comparison of Generalized Essential Telangiectasia and Cutaneous Collagenous Vasculopathy [Free article]

N. Knöpfel, A. Martín-Santiago, C. Saus, M.M. Escudero-Góngora, L.J. del Pozo, C. Gómez
Actas Dermosifiliogr.2017;108:e21-6

Abstract - Full text - PDF

http://ift.tt/2ngjAcx

Subcutaneous Tumor Deep to the Lateral Right Eyebrow [Free article]

P.P. García-Montero, A. Hernández-Nuñez, J.C. Tardío
Actas Dermosifiliogr.2017;108:253-4

Abstract - Full text - PDF

http://ift.tt/2nmfBNh

Rapidly Progressive Infiltrated Plaques in a Transplant Recipient [Free article]

I. Salgüero Fernández, F. Alfageme Roldán, D. Suarez Massa, G. Roustan Gullón
Actas Dermosifiliogr.2017;108:255-6

Abstract - Full text - PDF

http://ift.tt/2ngsd6P

RF- Insufficient Exposure to Sunlight and Global Mortality: Should We Advise Against or Recommend Sun Exposure? [Free article]

M.T. Monserrat-García, A. Ortíz-Prieto, P. Martín-Carrasco, J. Conejo-Mir-Sánchez
Actas Dermosifiliogr.2017;108:257-8

Abstract - Full text - PDF

http://ift.tt/2nm5bgB

Ulcerated Indurated Necrotic Plaque on the Chest Wall [Free article]

M.A. Flores-Terry, G. Romero-Aguilera, M. García-Arpa
Actas Dermosifiliogr.2017;108:259

Abstract - Full text - PDF

http://ift.tt/2nm3IHg

Bullous Pemphigoid on the Areola of Breast [Free article]

P. López Jiménez, Á. Vargas Nevado, E. Herrera Ceballos
Actas Dermosifiliogr.2017;108:260

Abstract - Full text - PDF

http://ift.tt/2ngws2t

Paraffin Wax Baths for the Treatment of Chronic Hand Eczema [Free article]

J.F. Mir-Bonafé, E. Serra-Baldrich, E. Rozas-Muñoz, L. Puig
Actas Dermosifiliogr.2017;108:261-4

Abstract - Full text - PDF

http://ift.tt/2nmefSD

Trichomycosis Axillaris: Clinical, Wood Lamp, and Dermoscopic Diagnostic Images [Free article]

E. Rojas Mora, A. Freites Martínez, A. Hernández-Núñez, J. Borbujo Martínez
Actas Dermosifiliogr.2017;108:264-5

Abstract - Full text - PDF

http://ift.tt/2ngp1Iu

Idiopathic Facial Aseptic Granuloma: Usefulness of Cutaneous Ultrasound [Free article]

I. Vázquez-Osorio, C.C. Álvarez-Cuesta, L. Rodríguez-González, E. Rodríguez-Díaz
Actas Dermosifiliogr.2017;108:266-8

Abstract - Full text - PDF

http://ift.tt/2nmeehx

Lymphangioma-like Kaposi sarcoma [Free article]

F. Martínez-Ortiz, M.P. Gómez Avivar
Actas Dermosifiliogr.2017;108:268-71

Abstract - Full text - PDF

http://ift.tt/2ngzjIG

Nodular Mucinosis Associated With Light-Chain Monoclonal Gammopathy of Uncertain Significance [Free article]

P. Rodríguez-Jiménez, P. Chicharro, A. Ascensión, D. de Argila, E. Daudén
Actas Dermosifiliogr.2017;108:272-3

Abstract - Full text - PDF

http://ift.tt/2nm7gZS

Initial Evaluation of the Adult Patient with Condylomata Acuminata [Free article]

A. Imbernón-Moya, J. Ballesteros
Actas Dermosifiliogr.2017;108:273-5

Abstract - Full text - PDF

http://ift.tt/2ngp0Eq

Did King Philip II of Ancient Macedonia Suffer a Zygomatico-Orbital Fracture? A Maxillofacial Surgeon's Approach

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1601431

Philip II, father of Alexander the Great, succeeded his brother, Perdiccas III, to the throne of Macedonia in 360 BC. He has been described by historians as a generous king and military genius who managed to achieve his ambitious plans by expanding the Macedonian city-state over the whole Greek territory and the greater part of the Balkan Peninsula. The aim of our study was to present the evidence with regard to the facial injury of King Philip II of Macedonia and discuss the treatment of the wound by his famous physician, Critobulos. We reviewed the literature for historical, archaeological, and paleopathological evidence of King Philip's facial injury. We include a modern reconstruction of Philip's face based on the evidence of his injury by a team of anatomists and archaeologists from the Universities of Bristol and Manchester. In the light of the archaeological findings by Professor Andronikos and the paleopathological evidence by Musgrave, it can be claimed with confidence that King Philip II suffered a significant injury of his zygomaticomaxillary complex and supraorbital rim caused by an arrow as can be confirmed in many historical sources. To the best of our knowledge, this is the first attempt to present the trauma of King Philip II from a maxillofacial surgeon's point of view.
[...]

Thieme Medical Publishers, Inc. 333 Seventh Avenue, New York, NY 10001, USA

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

http://ift.tt/2ofiIEs

Herpetiforme Pemphigus: Report of a Pediatric Case [Free article]

V.L. Taliercio, B. Ferrari, M.E. Abad, M. Larralde
Actas Dermosifiliogr.2017;108:276-7

Abstract - Full text - PDF

http://ift.tt/2nmjbH7

Correlation between single photon emission computed tomography and histopathologic findings in condylar hyperplasia of the temporomandibular joint

To analyse the correlation between the level of activity measured in the single photon emission computed tomography (SPECT) and the pathological findings in patients with condylar hyperplasia (CH).

http://ift.tt/2o1eiBA

Blunt cardiac injury due to trauma associated with snowboarding: a case report

Cardiac trauma is associated with a much higher mortality rate than injuries to other organ systems, even though cardiac trauma is identified in less than 10% of all trauma admissions. Here we report blunt tra...

http://ift.tt/2nxQurd

Long-term response in patient with recurrent oropharyngeal carcinoma treated with cetuximab, docetaxel and cisplatin (TPEx) as first-line treatment followed by cetuximab maintenance

Cetuximab, an anti-EGFR monoclonal antibody in combination with platinum and 5FU is the standard of care in first-line treatment of patients with recurrent head and neck squamous cell carcinoma (HNSCC), with an expected median outcome of 10months. For this population, development of efficacious and safer therapies is still needed.

http://ift.tt/2nRAwcB

Prognostic significance of extracapsular spread of lymph node metastasis from oral squamous cell carcinoma in the clinically negative neck

The presence of extracapsular spread (ECS) in patients with oral squamous cell carcinoma (OSCC) indicates a poor prognosis and is associated with a higher risk of regional recurrence and distant metastasis. The aim of this study was to analyse this important feature of cervical lymph nodes in the clinically node-negative setting. The study included 61 patients with clinically T1–T3N0 OSCC who underwent primary surgical treatment; 52 were male and nine were female, and their median age was 57 years.

http://ift.tt/2n3i6BF

Robotics in Sinus and Skull Base Surgery

Transoral robotic surgery (TORS) has been proven to be safe and to yield acceptable oncological and functional outcomes for surgery of the oropharynx, hypopharynx, supraglottis, and glottis. TORS has been successful at reducing morbidity, improving quality of life, and providing access to areas that previously required mandibulotomy or other more radical approaches in the past. This has changed the paradigm of management of tumors in these anatomic locations. In this article, the authors review the recent literature discussing the role of robotic surgery in managing sinonasal and skull base pathology and discuss its current advantages and limitations.

http://ift.tt/2nOm5FG

Asthma prevalence and severity in low-resource communities.

Purpose of review: The prevalence of asthma was thought to be low in most low-income countries, but several reports have indicated this is not always true. This is a narrative review of recent publications on the burden of asthma in low and middle-income countries (LMIC) and underprivileged communities from developed countries. Recent findings: Several studies have reported a low prevalence of asthma is LMIC, but indicate it is increasing. In the last few years, however, many surveys demonstrated this may not always be true. An analysis of the International Study for Asthma and Allergy in Childhood phase III database indicated although the prevalence of asthma among children and adolescents is higher in the developed countries, symptoms of asthma are often more severe in less affluent nations. The rate of uncontrolled asthma is also higher among underprivileged communities of developed countries. Secondary analysis of data generated by the WHO's world health survey performed among adults of 70 countries indicate symptoms of asthma are less frequent in middle-income countries and more frequent in the extremes, low income and high income. This sort of U shaped distribution suggests the disease (or syndrome) comprise more than one major phenotype related to diverse underlying mechanisms. In fact, recent reports show symptoms of asthma among the poor are associated with unhygienic living conditions, which may reduce the risk of atopy but increase the risk of nonatopic wheezing. Urbanization and exposure to air pollution also seem to contribute to an increasing prevalence severity of asthma in LMIC. Access to proper diagnosis and treatment with controller medications for asthma, specially with inhaled corticosteroids is feasible and cost-effective, reduce symptoms, health resource utilization, improves quality of life, and reduce mortality in low-resource settings. Summary: Prevalence of asthma was thought to be low in low-income countries, but several reports have indicated this is not always true. Under diagnosis, under treatment, exposure to air pollution, and unhygienic living conditions may contribute to a higher frequency and severity of symptoms of asthma among the poor. Proper diagnosis and treatment with controller medications for asthma is feasible and cost-effective in low-resource settings. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2nRnLPm

Asthma prevalence and severity in low-resource communities.

Purpose of review: The prevalence of asthma was thought to be low in most low-income countries, but several reports have indicated this is not always true. This is a narrative review of recent publications on the burden of asthma in low and middle-income countries (LMIC) and underprivileged communities from developed countries. Recent findings: Several studies have reported a low prevalence of asthma is LMIC, but indicate it is increasing. In the last few years, however, many surveys demonstrated this may not always be true. An analysis of the International Study for Asthma and Allergy in Childhood phase III database indicated although the prevalence of asthma among children and adolescents is higher in the developed countries, symptoms of asthma are often more severe in less affluent nations. The rate of uncontrolled asthma is also higher among underprivileged communities of developed countries. Secondary analysis of data generated by the WHO's world health survey performed among adults of 70 countries indicate symptoms of asthma are less frequent in middle-income countries and more frequent in the extremes, low income and high income. This sort of U shaped distribution suggests the disease (or syndrome) comprise more than one major phenotype related to diverse underlying mechanisms. In fact, recent reports show symptoms of asthma among the poor are associated with unhygienic living conditions, which may reduce the risk of atopy but increase the risk of nonatopic wheezing. Urbanization and exposure to air pollution also seem to contribute to an increasing prevalence severity of asthma in LMIC. Access to proper diagnosis and treatment with controller medications for asthma, specially with inhaled corticosteroids is feasible and cost-effective, reduce symptoms, health resource utilization, improves quality of life, and reduce mortality in low-resource settings. Summary: Prevalence of asthma was thought to be low in low-income countries, but several reports have indicated this is not always true. Under diagnosis, under treatment, exposure to air pollution, and unhygienic living conditions may contribute to a higher frequency and severity of symptoms of asthma among the poor. Proper diagnosis and treatment with controller medications for asthma is feasible and cost-effective in low-resource settings. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2nRnLPm

Newly developed method for mouse olfactory behavior tests using an automatic video tracking system

Publication date: Available online 24 March 2017
Source:Auris Nasus Larynx
Author(s): Hyung-Ju Cho, Yong Hyuk Lee, Bo Ra Kim, Hong-Kyung Kim, Hyo Jin Chung, Sang Chul Park, Je Kyung Seong, Joo-Heon Yoon, Chang-Hoon Kim
ObjectiveThe mouse is the most popular animal model in olfactory research. Behavior tests with odorants are essential for determining olfactory phenotype. To the best of our knowledge, the mouse olfactory behavior test has not been standardized, making the results vulnerable to inter-observer variation. We sought to develop a new mouse olfactory behavior test assessed by an automatic video tracking system with minimal inter-observer variation.MethodsA video-tracking system was used to automatically track mouse behavior in standard breeding cages with C57BL/6N mice. We tested two odorants (peanut butter for the preference test, 2MB acid for the avoidance test) and distilled water (for a control). Mouse behavior was recorded for 3min and analyzed. For the preference test, investigation time was measured. For the avoidance test, time spent in sectors away from the odorant zone was measured. To confirm our experimental settings, we also evaluated an anosmia mouse model prepared with intranasal administration of ZnSO4.ResultsAll strains of mice showed reproducible behavior patterns of preference or avoidance for the odorants. The anosmia mouse model, as expected, failed to show an olfactory ability for preference or avoidance, and this was well-matched by histologic changes caused by the ZnSO4 treatment. The automatic video tracking system successfully tracked and automatically calculated mouse behavior with good reproducibility.ConclusionOur olfactory behavior test offers a simple and accurate method to evaluate olfactory function in mice. This test can be utilized as a possible standard method to search for features of olfactory phenotypes in mice.



http://ift.tt/2ngc1Tk

Development of RAP Tag, a Novel Tagging System for Protein Detection and Purification

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.


http://ift.tt/2oepQRv

Nutzen der Zoster-Vakzinierung bei älteren Patienten

http://ift.tt/2nZXgUA

Paranasal sinus lymphoma: Retrospective review with focus on clinical features, histopathology, prognosis, and relationship to systemic lymphoma

ABSTRACT

Background

Paranasal sinus lymphoma is a rare clinical entity.

Methods

We conducted a retrospective case series of 68 patients with biopsy-confirmed paranasal sinus lymphoma with attention on systemic disease association.

Results

Of 63 patients with paranasal sinus lymphoma, 35 (56%) had systemic involvement. Four patient groups were identified: (1) primary paranasal sinus lymphoma (44%); (2) systemic disease occurring concurrently with paranasal sinus lymphoma (25%); (3) paranasal sinus lymphoma with relapse of preexisting systemic lymphoma (22%); and (4) progression to systemic disease after primary paranasal sinus lymphoma (8%). Most of the patients with systemic disease were diagnosed at 50 + years and had positive smoking histories. There was a trend toward disease activity in the neighboring ocular location. For patients with preexisting systemic lymphoma, the mean time to paranasal sinus lymphoma was 65 months. When systemic lymphoma developed after localized paranasal sinus lymphoma, mean time to progression was 23 months. Diffuse large B cell lymphoma was the most common paranasal sinus lymphoma.

Conclusion

There is a risk of systemic involvement during the disease course of paranasal sinus lymphoma. Biopsy is the preferred first management step and should precede debulking or mass resection in nonemergent cases. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

http://ift.tt/2nZqXoU

Isolated Sphenoid Sinusitis

Abstract

Isolated disease of sphenoid sinus is rare, representing 2-3% of all paranasal sinus lesions. Usually it is inflammatory in origin; very rarely it is due to neoplasm. Isolated sphenoid sinus diseases are difficult to diagnose and to treat because either the symptoms are very vague or they present to us very late as a result of disease complications. Here we are presenting a case of isolated sphenoid fungal sinusitis. A 40 year female came to our ENT outpatient department with complaints of intermittent headache for past 3 months. She was treated for similar complaints by a general practitioner with antibiotics and analgesics before three months. She was referred to an ophthalmologist and neurologist as the headache did not subside. Since there was no abnormality in ophthalmological examination, the neurologist suggested a MRI which showed opacification of the sphenoid sinus. Hence she was referred to an ENT specialist. ENT Clinical examination was normal. Urgent CT scan along with MRI was ordered which revealed complete opacification of the sphenoid sinus. There was no air fluid level, no hyper dense foci suggestive of fungal elements. There was no bony erosion. A provisional diagnosis of Chronic Sphenoid sinusitis was made and planned for endoscopic sphenoidotomy under general anesthesia. Sphenoid sinus was opened and fungal debri was seen inside, which was sent for culture. Sphenoid ostium was widened. Post operatively patient was completely relieved of headache. Patient was started on Tab.Itraconazole 200mg/day for 6 weeks, since the culture was suggestive of aspergillosis. Owing to the non specific presentation and the vague symptomology of the disease there may be considerable delay in diagnosing and treating the patient. Hence imaging studies like CT and MRI is necessary when the disease is suspected for prompt diagnosis.

http://ift.tt/2odOLof

A Randomised Controlled Trial of Sodium Citrate Spray for Non-Conductive Olfactory Disorders

Abstract

Background

Previous research has suggested that sodium citrate improves hyposmia by decreasing mucus calcium levels in the nose. This study aimed to confirm or refute this effect in a single application and assess potential side effects.

Methodology

Study design was a randomised double-blind controlled trial of sodium citrate nasal spray (intervention) versus sterile water (control) in a tertiary care clinic. Fifty-five patients with non-conductive olfactory loss were randomised to receive the intervention or placebo. The primary outcome measure was improvement in measured olfactory thresholds for phenyl ethyl alcohol (PEA) over 2 hours. Other outcome measures assessed were Improvement in olfactory thresholds in 1-butanol, eucalyptol and acetic acid; number of responders with a clinically relevant response in each arm; adverse effects.

Results

A significant effect was seen in the intervention arm for PEA and for 1-butanol and eucalyptol when compared to the control arm (P<0.05); 32% of the intervention arm responded in terms of improved sensitivity towards some of the odours. Minor adverse effects noted included sore throat, nasal paraesthesia, slight rhinorrhoea and itching. The duration of effect of the citrate is transient, peaking at 30-60 minutes after application.

Conclusions

Sodium citrate yields some potential as a treatment for non-conductive olfactory loss, however these findings require corroboration in further clinical trials looking at longer-term regular use of the spray as a viable therapeutic option for patients where it would be applied at frequent intervals such as before meal times.

This article is protected by copyright. All rights reserved

http://ift.tt/2odWDG8

Intraoperative hydroxyethyl starch 70/0.5 administration may increase postoperative bleeding: a retrospective cohort study

Abstract

Purpose

Studies evaluating the safety of hydroxyethyl starch with a molecular weight of 70 kDa and a molar substitution ratio of 0.5 (HES 70/0.5) are scarce in the literature. In this study, we investigated the relationship between intraoperative HES 70/0.5 administration and postoperative bleeding.

Methods

This is a single-center, retrospective cohort study. Subjects were postoperative adult patients who stayed in the intensive care unit (ICU) for more than 24 h during the period from January 1, 2010 to December 31, 2012. We compared postoperative adult patients with and without intraoperative HES 70/0.5 administration. The primary outcome was the drainage volume from surgical sites during the first 24 h after ICU admission. We conducted propensity score matching between the control group and the HES group.

Results

We analyzed data for 769 patients who met our inclusion criteria. Using propensity score matching, we successfully created 119 matched pairs from the HES group and control group, with no significant differences in patient characteristics. The drainage volume during the first 24 h after ICU admission was greater in the HES group than in the control group (400 ± 479 vs. 260 ± 357 mL, p < 0.003).

Conclusion

Our retrospective cohort study suggests that intraoperative HES 70/0.5 administration is associated with increased postoperative bleeding.

http://ift.tt/2nf2FqH

Isolated Sphenoid Sinusitis

Abstract

Isolated disease of sphenoid sinus is rare, representing 2-3% of all paranasal sinus lesions. Usually it is inflammatory in origin; very rarely it is due to neoplasm. Isolated sphenoid sinus diseases are difficult to diagnose and to treat because either the symptoms are very vague or they present to us very late as a result of disease complications. Here we are presenting a case of isolated sphenoid fungal sinusitis. A 40 year female came to our ENT outpatient department with complaints of intermittent headache for past 3 months. She was treated for similar complaints by a general practitioner with antibiotics and analgesics before three months. She was referred to an ophthalmologist and neurologist as the headache did not subside. Since there was no abnormality in ophthalmological examination, the neurologist suggested a MRI which showed opacification of the sphenoid sinus. Hence she was referred to an ENT specialist. ENT Clinical examination was normal. Urgent CT scan along with MRI was ordered which revealed complete opacification of the sphenoid sinus. There was no air fluid level, no hyper dense foci suggestive of fungal elements. There was no bony erosion. A provisional diagnosis of Chronic Sphenoid sinusitis was made and planned for endoscopic sphenoidotomy under general anesthesia. Sphenoid sinus was opened and fungal debri was seen inside, which was sent for culture. Sphenoid ostium was widened. Post operatively patient was completely relieved of headache. Patient was started on Tab.Itraconazole 200mg/day for 6 weeks, since the culture was suggestive of aspergillosis. Owing to the non specific presentation and the vague symptomology of the disease there may be considerable delay in diagnosing and treating the patient. Hence imaging studies like CT and MRI is necessary when the disease is suspected for prompt diagnosis.

http://ift.tt/2odOLof

Search strategies for finding systematic reviews: reply from authors

Abstract

Dr. Grindlay provided a critique of systematic search strategies reported in our article by Gómez-García et al. titled "Systematic reviews and meta-analyses on psoriasis: role of funding sources, conflict of interest, and bibliometric indices as predictors of methodological quality," which was recently published in your journal ¹. Specifically, he explained his concern about the search strategy used to obtain the maximum number of systematic reviews published. He suggested that the problem probably arises because of the diversity in the nomenclature used to denominate this type of review and the low compliance with the PRISMA recommendations.

This article is protected by copyright. All rights reserved.

http://ift.tt/2mzzIZH

Dental Traits of Congenital Syphilis Revisited in Dental Outpatient Department (OPD)

http://ift.tt/2nZjsOM

Glycogen-Rich Clear Cell Squamous Cell Carcinoma Originating in the Oral Cavity

Abstract

Clear cell squamous cell carcinoma (CCSCC) is a rare histological subtype of squamous cell carcinoma (SCC) that was originally described in the skin. Here, we report a case of a 66-year-old female patient who presented with a fungating ulcerative mass of the left lateral tongue extending anteriorly to the floor of the mouth, and posteriorly to the left retromolar fossa and the oropharynx. The patient had a history of SCC of the left posterior tongue that was treated with partial glossectomy and adjuvant radiotherapy. Representative biopsies were obtained from the floor of the mouth, tongue and retromolar fossa. The examined biopsies showed various degrees of dysplastic surface epithelium with transition into infiltrating epithelial tumor nests and cords with clear cytoplasm and malignant cellular features. Pancytokeratin, CK5/6, and p63 were all diffusely positive. S-100, Calponin, and smooth muscle actin (SMA) were negative. PAS stain was diffusely positive and diastase labile in the tumor clear cells. Sparse areas of mucicarmine positivity were noted. Based on these findings a final diagnosis of a glycogen-rich CCSCC was given. This case represents a very rare histological variant of oral SCC, which is significant for the histological differential diagnosis of clear cell tumors of the oral cavity.

http://ift.tt/2nQ202c

Dental Traits of Congenital Syphilis Revisited in Dental Outpatient Department (OPD)

http://ift.tt/2nZjsOM

Glycogen-Rich Clear Cell Squamous Cell Carcinoma Originating in the Oral Cavity

Abstract

Clear cell squamous cell carcinoma (CCSCC) is a rare histological subtype of squamous cell carcinoma (SCC) that was originally described in the skin. Here, we report a case of a 66-year-old female patient who presented with a fungating ulcerative mass of the left lateral tongue extending anteriorly to the floor of the mouth, and posteriorly to the left retromolar fossa and the oropharynx. The patient had a history of SCC of the left posterior tongue that was treated with partial glossectomy and adjuvant radiotherapy. Representative biopsies were obtained from the floor of the mouth, tongue and retromolar fossa. The examined biopsies showed various degrees of dysplastic surface epithelium with transition into infiltrating epithelial tumor nests and cords with clear cytoplasm and malignant cellular features. Pancytokeratin, CK5/6, and p63 were all diffusely positive. S-100, Calponin, and smooth muscle actin (SMA) were negative. PAS stain was diffusely positive and diastase labile in the tumor clear cells. Sparse areas of mucicarmine positivity were noted. Based on these findings a final diagnosis of a glycogen-rich CCSCC was given. This case represents a very rare histological variant of oral SCC, which is significant for the histological differential diagnosis of clear cell tumors of the oral cavity.

http://ift.tt/2nQ202c

Rhabdomyosarcoma of the maxillofacial region in children and adolescents: Report of 9 cases and literature review

Publication date: Available online 23 March 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Ioannis Iatrou, Nadia Theologie-Lygidakis, Ourania Schoinohoriti, Fotis Tzermpos, Anna-Maria Vessala
ObjectiveTo review clinical presentation, histology, treatment and survival for pediatric maxillofacial rhabdomyosarcoma (RMS) and evaluate the role of surgical treatment.Study designRetrospective analysis of medical charts.MethodsFiles of patients, treated for primary maxillofacial RMS from 1997 to 2016, were examined for clinical presentation, staging, histology, treatment protocol and complications, recurrence and final outcome.ResultsOur cohort included 4 male and 5 female patients (mean age 8.47 years). One tumor, occupying the infratemporal space, was parameningeal; the other 8, located at the mandible (4) or the maxilla/zygomatic bone (4) were non-parameningeal. All patients received chemotherapy preoperatively. Surgery was performed in 7 patients, of whom 4 received postoperative radiotherapy. The histological type was alveolar (5) or embryonal (4). Overall survival hitherto was 66,6%, depending on histology (40% and 100% for the alveolar and embryonal type respectively).ConclusionsPediatric maxillofacial RMS originated mostly from the facial skeleton and most tumors were non-parameningeal. The alveolar type was slightly more common. An individualized multidisciplinary approach combining chemotherapy and local control mostly with surgery and selectively with radiotherapy has proven successful for the treatment of non-orbital, non-parameningeal maxillofacial RMS. Histology was a major treatment determinant and the most important prognostic factor.



http://ift.tt/2nvoZi2

Correlation between single photon emission computed tomography and histopathologic findings in condylar hyperplasia of the temporomandibular joint

Publication date: Available online 24 March 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Rafael Martin-Granizo, José M Garcia-Rielo, Oscar De la Sen, Lourdes Maniegas, Alberto Berguer, Manuel De Pedro
PurposeTo analyse the correlation between the level of activity measured in the single photon emission computed tomography (SPECT) and the pathological findings in patients with condylar hyperplasia (CH).Materials and MethodsAll patients evaluated in our department between 2007 and 2014 with a diagnosis of condylar hyperplasia who had undergone SPECT, evidenced signs of activity, and had undergone surgery were included. We included 28 patients, of whom 20 were women and 8 men.ResultsThe male:female ratio was 2,5:1. The mean age of the subjects was 24.4 years at the time of diagnosis (with a range between 14 and 42 years). In 19 cases the affected condyle was the right, and in the remaining 9 it was the left (ratio R:L 2,1:1). On the SPECT, in 16 patients a high level of activity was identified (57.1%) and in the remaining 12 a low level (42.9%). Only 13 patients (6 in the low-activity group and 7 in the high-activity group) presented with islands of cartilage. When comparing the results between the two groups, the main differences were observed in the parameters related to the islands of cartilage. These were more frequent in the group with high activity compared with low activity (5.5 versus 0 per mm² of median). Besides being more frequent, these islands were larger (more than double) in the high-activity group (385.1 μm versus 169.7 μm of median). This is the only statistically significant difference found, a fact that can be explained by the small sample size in the study.ConclusionRadioisotope tests are the best indicator of the level of activity in condylar hyperplasia, which seems to be directly related to the intensity signal collection.



http://ift.tt/2neMY37

Transpalatal wiring for the management of sagittal fracture of the maxilla/palate

Publication date: Available online 24 March 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): Sheetal Kapse, Sanidhya Surana, Ashwin Kumar Shastri




http://ift.tt/2njRajz

Human Orf complicated by Epidermolysis Bullosa Acquisita

Summary

Orf is a DNA parapoxvirus transmitted to humans by contact with infected goats and sheep. Many complications have been reported after Orf infection including erythema multiforme. A few cases of auto-immune bullous dermatosis complicating Orf disease have been reported to date, usually characterized by tense blisters eruptions with or without mucosal involvement, linear deposition of C3, IgG and/or IgA along the basement membrane and negativity of indirect immunofluorescence analysis and ELISA assays (performed in 4 of 11 reported cases) against target antigens of bullous pemphigoid, mucous membrane pemphigoid or epidermolysis bullosa acquisita, except one case of mucosal pemphigoid with antilaminin-332 antibodies. We describe the case of a patient who presented an ulceration on his finger ten days after a direct contact with a lamb during Eid al-Adha. Four weeks later, he developed a severe tense blistering eruption associated with mucous membrane erosions. Indirect immunofluorescence analysis using the patient's serum revealed circulating anti-basement membrane IgG that bound the dermal side of salt-split skin. Enzyme-linked immunosorbent assay (ELISA) was positive for recombinant immunodominant NC1 domain of type VII collagen. We finally diagnosed Epidermolysis Bullosa Acquisita complicating probable human Orf infection.

This article is protected by copyright. All rights reserved.

http://ift.tt/2n1dc8g

Silymarin for the treatment of obsessive-compulsive disorders in dermatology

http://ift.tt/2mY6ejn

Acupuncture plus moxibustion for herpes zoster: A systematic review and meta-analysis of randomized controlled trials

Abstract

Herpes zoster is an acute inflammatory condition which can have a significant impact on quality of life. Antiviral therapies are effective, but do not meet patients' expectations of symptomatic relief. Acupuncture and moxibustion have been used for herpes zoster; this systematic review evaluated their efficacy and safety. Nine English and Chinese databases were searched from their inceptions to March 2016. Randomized controlled trials evaluating the combination of acupuncture plus moxibustion in adult herpes zoster were included. Outcomes included pain intensity and duration, quality of life and adverse events. Meta-analysis was performed using RevMan software (version 5.3). Nine studies (945 participants) were included. Studies were of low to moderate methodological quality based on risk of bias assessment. Pain intensity (visual analogue scale) was lower among those who received acupuncture plus moxibustion compared with pharmacotherapy (one study; MD −8.25 mm, 95% CI −12.36 to −4.14). The clinical significance of this result is yet to be established. Some benefits were seen for other pain and cutaneous outcomes, and global improvement in symptoms. Mild adverse events were reported in the intervention groups. Acupuncture plus moxibustion may improve pain and cutaneous outcomes, although current evidence is limited by the number of studies and methodological shortcomings.

http://ift.tt/2nL6vKU

Extracorporeal photopheresis for the treatment of early-stage mycosis fungoides

Abstract

Extracorporeal photopheresis (ECP) has been used for nearly 30 years in the treatment of cutaneous T-cell lymphoma. However, current clinical practice largely reserves ECP for patients with late-stage mycosis fungoides (MF) or Sézary syndrome or for those who are refractory to other therapies. We briefly describe a 48-year-old male who experienced long-term complete remission of his patch MF disease with ECP, and we suggest a role for ECP in the treatment of early-stage MF given evidence of its efficacy, safety, and tolerability.

http://ift.tt/2mYhjRo

Contribution of Hyoid and Tonsillar Procedures to Outcome in Multilevel Surgery for Obstructive Sleep Apnea Syndrome

Background/Objective: In multilevel surgery for obstructive sleep apnea (OSA), the contribution of distinct operative steps is still unclear. The aim of the present study is to retrospectively compare different combinations of multilevel surgeries in order to estimate the contribution of hyoid and tonsillar procedures to the outcome. Methods: A total of 45 patients were selected in a retrospectively matched case-control study from a database of patients who underwent surgery for OSA at our institution: group A (n = 15) had hyoid suspension, tonsillectomy, and radiofrequency-assisted uvulopalatoplasty (RAUP); group B (n = 15) had hyoid pharyngoplasty with resection of the hyoid body and preepiglottic fat tissue, tonsillectomy, and RAUP; and group C (n = 15) had hyoid suspension and RAUP but no tonsillectomy, because the tonsils had already been removed. The apnea-hypopnea index (AHI) was defined as the primary outcome measure. Results: The postoperative AHI significantly improved in groups A and B, in which all patients had a tonsillectomy. However, the improvement in the patients of group C, who had no tonsillectomy, was not significant (p = 0.08). Conclusion: The patients having undergone multilevel surgery without tonsillectomy showed significantly poorer postoperative results, suggesting that the effectiveness of hyoid procedures at the level of the hypopharynx may be limited. However, removal of the tonsils is a major predictive factor for postoperative success.
ORL 2016;78:353-360

http://ift.tt/2n1cZSc

Adjuvant Human Papillomavirus Vaccination for Secondary Prevention: A Systematic Review.

Adjuvant Human Papillomavirus Vaccination for Secondary Prevention: A Systematic Review.

JAMA Otolaryngol Head Neck Surg. 2017 Mar 23;:

Authors: Dion GR, Teng S, Boyd LR, Northam A, Mason-Apps C, Vieira D, Amin MR, Branski RC

Abstract
Importance: Human papillomavirus (HPV) vaccination is recommended for children and younger adults but not older adults or those with prior HPV exposure, leaving a large portion of the population at risk for HPV-mediated disease. Emerging data suggest a possible role for vaccination as an adjuvant treatment for individuals with HPV-related clinical disease.
Objective: To systematically review the literature regarding HPV vaccination for secondary disease prevention after treatment of active clinical disease across disease sites to serve as a platform for the management of HPV-related disease of the head and neck.
Evidence Review: A systematic search from August 3 to 21, 2015, of the PubMed, MEDLINE, EMBASE, CINAHL, Cochrane Library, Web of Science, Biosis Citation Index, Current Contents Connect, Scientific Library Online, and Global Health databases used PRISMA guidelines to identify 326 relevant articles related to adjuvant use of HPV vaccination. Primary search terms were (HPV vaccine OR human papillomavirus vaccine OR papillomarvirus vaccines OR alphapapillomavirus vaccine) AND (HPV OR human papillomavirus OR alphapapillomavirus OR papillomaviridae OR virus warts OR wart virus) AND (recurrence OR relapse OR reoccurrence OR recurrences OR relapses OR relapsing). Forty-five full texts in English were reviewed, with 19 articles included in the final review. In some studies, subpopulations of individuals with HPV DNA positivity and/or seropositivity were extracted for inclusion. Included studies were assessed for bias and separated based on the presence of active clinical disease or HPV DNA positivity or seropositivity.
Findings: Nineteen studies with 22 474 unique patients were included in the review. When HPV vaccination was used as an adjuvant treatment for active clinical disease, 9 of 12 studies reported decreased disease recurrence, decreased disease burden, or increased intersurgical interval. In contrast, none of the 7 studies of vaccination in individuals with HPV DNA positivity and/or seropositivity without clinical disease reported improved outcomes.
Conclusions and Relevance: Differences between adjuvant vaccination in HPV-mediated clinical disease and vaccination in HPV DNA-positive and/or HPV-seropositive populations posit underlying differences in disease and immune processes. These data suggest that additional evaluation of adjuvant HPV vaccination in individuals with active clinical disease is warranted.

PMID: 28334393 [PubMed - as supplied by publisher]

http://ift.tt/2myO8sS

Vestibular Aqueduct Midpoint Width and Hearing Loss in Patients With an Enlarged Vestibular Aqueduct.

Vestibular Aqueduct Midpoint Width and Hearing Loss in Patients With an Enlarged Vestibular Aqueduct.

JAMA Otolaryngol Head Neck Surg. 2017 Mar 23;:

Authors: Ascha MS, Manzoor N, Gupta A, Semaan M, Megerian C, Otteson TD

Abstract
Importance: Elucidating the relationship between vestibular aqueduct size and hearing loss progression may inform the prognosis and counseling of patients who have an enlarged vestibular aqueduct (EVA).
Objectives: To examine the association between vestibular aqueduct size and repeated measures of hearing loss.
Design, Setting, and Participants: For this retrospective medical record review, 52 patients with a diagnosis of hearing loss and radiologic diagnosis of EVA according to the Valvassori criterion were included. All available speech reception threshold and word recognition score data was retrieved; mixed-effects models were constructed where vestibular aqueduct size, age at diagnosis of hearing loss, and time since diagnosis of hearing loss were used to predict repeated measures of hearing ability. This study was performed at an academic tertiary care center.
Exposures: Variable vestibular aqueduct size, age at first audiogram, length of time after first audiogram.
Main Outcomes and Measures: Speech reception threshold (dB) and word recognition score (%) during routine audiogram.
Results: Overall, 52 patients were identified (29 females [56%] and 23 males [44%]; median age at all recorded audiograms, 7.8 years) with a total of 74 ears affected by EVA. Median (range) vestibular aqueduct size was 2.15 (1.5-5.9) mm, and a median (range) of 5 (1-18) tests were available for each patient. Each millimeter increase in vestibular aqueduct size above 1.5 mm was associated with an increase of 17.5 dB in speech reception threshold (95% CI, 7.2 to 27.9 dB) and a decrease of 21% in word recognition score (95% CI, -33.3 to -8.0 dB). For each extra year after a patient's first audiogram, there was an increase of 1.5 dB in speech recognition threshold (95% CI, 0.22 to 3.0 dB) and a decrease of 1.7% in word recognition score (95% CI, -3.08 to -0.22 dB).
Conclusions and Relevance: Hearing loss in patients with an EVA is likely influenced by vestibular aqueduct midpoint width. When considering hearing loss prognosis, vestibular aqueduct midpoint width may be useful for the clinician who counsels patients affected by EVA.

PMID: 28334328 [PubMed - as supplied by publisher]

http://ift.tt/2nL5QJr

Long-term Surveillance Following Intralesional Steroid Injection for Benign Vocal Fold Lesions.

Long-term Surveillance Following Intralesional Steroid Injection for Benign Vocal Fold Lesions.

JAMA Otolaryngol Head Neck Surg. 2017 Mar 23;:

Authors: Wang CT, Lai MS, Cheng PW

Abstract
Importance: The short-term outcomes of vocal fold steroid injection (VFSI) are well documented. However, few studies have reported the long-term outcomes following VFSI.
Objective: To investigate the incidence rates of symptom recurrence and secondary interventions following VFSI for benign vocal fold lesions.
Design, Setting, and Participants: This prospective cohort study was conducted at a tertiary referral medical center in Taipei, Taiwan. The cohort included 189 patients with vocal fold lesions who had received VFSI as the primary treatment between August 2011 and September 2013.
Exposures: All participants underwent VFSI.
Main Outcomes and Measures: Long-term surveillance was conducted through structured telephonic interviews and by reviewing medical charts every 6 months over a 2-year period. We assessed the 10-item voice handicap index, dysphonic symptoms, and whether the patients had received any additional interventions after the initial VFSI.
Results: The 189 participants (32 men and 157 women; mean [SD] age, 39 [10] years [range, 20-74 years] included patients who had undergone VFSI for vocal fold nodules (n = 72), polyps (n = 72), or mucus-retention cysts (n = 45). Following VFSI, 141 patients (74.6%; 23 men and 118 women; mean age, 39 years [range, 20-70 years]) showed positive response (ie, clinically significant symptom resolution without the need for additional procedures) and received long-term surveillance. The median follow-up period was 19.4 months, and 2 patients were lost to follow-up postoperatively within 1 year. The cumulative failure rates (subjective symptom recurrence plus secondary treatments) at 6, 12, 18, and 24 months after VFSI were 12%, 17%, 24%, and 32%, respectively. When the initial response rate to VFSI (141 of 189, 74.6%) was considered altogether, VFSI remained effective after 2 years in 50% of the initially recruited 189 patients. The highest rate of long-term effectiveness of VFSI occurred in vocal polyps (54%), followed by nodules (49%) and cysts (43%).
Conclusions and Relevance: This study demonstrates that VFSI can be beneficial in managing benign vocal lesions, especially when first-line treatments are unsuitable. However, the long-term results of this study clarify that a substantial number of patients experience symptom recurrence or receive subsequent interventions within 2 years after VFSI; this should be considered in medical decision making.

PMID: 28334309 [PubMed - as supplied by publisher]

http://ift.tt/2ndQMBx

Current update on the diagnosis and management of head and neck hard tissue sarcomas

Abstract

Head and neck hard tissue sarcomas form a rare group of mesenchymal derived tumours that comprise less than 1% of all head and neck neoplasms. Hard tissue sarcomas account for 20% of head and neck sarcomas and they form a heterogeneous group with a diverse origin. Unlike head and neck soft tissue sarcomas, they have lower recurrence and mortality rates. In this article, we review the current management of head and neck hard tissue sarcomas.

This article is protected by copyright. All rights reserved.

http://ift.tt/2ne5JUl

Predictors of low quality of life in discoid lupus patients

Abstract

Discoid lupus erythematosus (DLE) is unique from other cutaneous lupus erythematosus (CLE) subtypes because of dyspigmentation and scarring, which are associated with quality of life (QoL) impairment in other skin disorders.^{1, 2} While previous QoL studies have included heterogeneous cohorts of patients with CLE, we focused on patients with DLE to identify clinical and demographic features that correlate with QoL impairment. We hypothesized that greater skin disease activity, skin disease damage, dark skin type, female gender, low socioeconomic status (defined by annual income), and current smoking status would be associated with poorer QoL in patients with DLE.

This article is protected by copyright. All rights reserved.

http://ift.tt/2ndYf3i

Referred by Google: mining Trends data to identify patterns in and correlates to searches for dermatologic concerns and providers

Abstract

Google Trends is a powerful tool that provides population-level insight into search volumes by time and geography. Since 2004, Google Trends has been profiled across studies of public interest, disease surveillance, prevention, and compliance.^1,2 Dermatologists have used Trends data to identify seasonal peaks in skin cancer and tanning searches^3,4 Other Google tools, including Health Cards⁵ and Reverse Image Searching⁶, have been explored by dermatologists for generating differential diagnoses.

This article is protected by copyright. All rights reserved.

http://ift.tt/2njzTXS

Smartphones in the dermatology department - acceptable to patients?

Abstract

Dermatology is a highly visual specialty and lends itself well to the use of MP for diagnosis, disease monitoring, and reducing the risk of wrong-site surgery.^1,2 Most patients and dermatologists own a smartphone with a camera function and there is already widespread use of smartphones in clinical practice.^1-4 Whilst the views of doctors on the use of smartphones are known, few studies have examined the views of patients. In this study, we investigated patients' views about photographing of their skin, and storing and transmitting of such images.

This article is protected by copyright. All rights reserved.

http://ift.tt/2ndTwyK

Light therapies for acne: abridged Cochrane systematic review including GRADE assessments

Abstract

We undertook a Cochrane review of randomized controlled trials (RCTs) evaluating the effects of light-based interventions for acne vulgaris. We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, LILACS, ISI Web of Science, and grey literature sources (September 2015). We used the Grading of Recommendations Assessment, Development and Evaluation Working Group approach to assess the quality of evidence (QE). We included 71 RCTs (4211 participants, median sample size 31). Results from a single study (n = 266, low QE) showed little or no difference in effectiveness on participants' assessment of improvement between 20% aminolevulinic acid (ALA) photodynamic therapy (PDT), activated by blue light, versus vehicle plus blue light, whereas another study (n = 180) of a comparison of ALA-PDT (red light) concentrations showed 20% ALA-PDT was no more effective than 15%, but better than 10% and 5% ALA-PDT. Pooled data from three studies, (n = 360, moderate QE) showed that methyl aminolevulinate (MAL)-PDT, activated by red light, had a similar effect on changes in lesion counts, compared with placebo cream with red light. Several studies compared yellow light to placebo or no treatment, infrared light to no treatment, gold-microparticle suspension to vehicle, and clindamycin/benzoyl peroxide (C/BPO) combined with pulsed dye laser to C/BPO alone. None of these showed any clinically significant effects. Most studies reported adverse effects, but inadequately, with scarring reported as absent, and blistering only in studies on intense pulsed light, infrared light and PDT (very low QE). Carefully planned studies, using standardised outcome measures, and common acne treatments as comparators are needed.

This article is protected by copyright. All rights reserved.

http://ift.tt/2njDpkY

Efficacy and Safety of Ustekinumab in Japanese Patients with Severe Atopic Dermatitis: A Randomised, Double-Blind, Placebo-Controlled, Phase 2 Study

Summary

Background

Ustekinumab, a fully human monoclonal antibody against interleukin-12/23, may be potentially effective for severe atopic dermatitis (AD) treatment.

Objectives

To evaluate efficacy and safety of ustekinumab 45 mg and 90 mg in severe AD patients.

Methods

In this placebo-controlled, randomised, phase 2 study, adult Japanese patients (aged 20–65 years) with severe or very severe AD entered a 12-week double-blind treatment period to receive (1:1:1) ustekinumab 45 mg, 90 mg or placebo subcutaneous injections at weeks 0 and 4; follow-up until week 24. Primary efficacy endpoint was percent change from baseline in Eczema Area and Severity Index (EASI) score at week 12. Major secondary efficacy endpoints: proportion of patients achieving EASI-50, EASI-75, Investigator's Global Assessment score 0-1, change from baseline Atopic Dermatitis Itch Scale and Dermatology Life Quality Index, all at week 12.

Results

79 patients were randomised (ustekinumab 45 mg: n=24, 90 mg: n=28, placebo: n=27). Ustekinumab treatment showed nonsignificant improvement in least-square mean change from baseline EASI score at week 12 (45 mg: –38.2%, 95% confidence interval [CI] –21.02; 19.51, p<0.94 and 90 mg: –39.8%, 95% CI, -21.84; 17.14, p<0.81) versus placebo (–37.5%). Nonsignificant improvement in major secondary efficacy endpoints was also observed in both ustekinumab groups versus placebo. The most common (>2 patients) treatment-emergent adverse events were nasopharyngitis (similar incidence among all groups); and worsened AD (higher in placebo vs ustekinumab groups).

Conclusion

Ustekinumab at 45 mg and 90 mg did not demonstrate meaningful efficacy in Japanese patients with severe AD. The treatment was generally well-tolerated.

This article is protected by copyright. All rights reserved.

http://ift.tt/2ndTeI5

Routine airway surveillance in pediatric tracheostomy patients

Publication date: June 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 97
Author(s): Ozgul Gergin, Eelam Adil, Kosuke Kawai, Karen Watters, Ethan Moritz, Reza Rahbar
ObjectivesThe aim of this study is to review airway findings in children with tracheostomies who underwent surveillance direct laryngoscopy and bronchoscopy (DLB) to determine the yield of routine airway evaluation in these patients.Study designRetrospective chart review at tertiary referral children's hospital.MethodsA retrospective chart review was conducted of all of the children with tracheostomies who underwent DLB after tracheostomy between 1984 and 2015.ResultsA total of 303 patients met inclusion criteria. The median time interval between tracheostomy and first follow-up DLB was 12.0 months (IQR 4.8–28.9 months). There was no significant difference in the incidence of airway lesions between patients who underwent endoscopy <6 months post tracheostomy versus those who had a longer time interval between tracheostomy and DLB (p = 0.16). One hundred sixty seven patients (55.1%) were diagnosed with lesions, with suprastomal granulation (39.9%) being the most common. Symptomatic patients were significantly more likely to have an airway lesion identified (69.9% versus 42.0%; p < 0.001). Ventilator dependent patients and those with either cardiopulmonary disease or traumatic injury as indications for tracheostomy were significantly more likely to have an airway lesion (p = 0.01).ConclusionsThe high incidence of airway lesions noted during surveillance DLB support the utility of routine airway endoscopy in pediatric tracheostomy patients. Symptomatic patients, those with ventilator dependence, or cardiopulmonary or trauma indications for tracheostomy are more likely to have airway lesions and should be monitored closely. The ideal time interval between surveillance endoscopies needs to be examined further.



http://ift.tt/2ndQHxH

Human leukocyte antigen class I deficiencies

Publication date: Available online 23 March 2017
Source:Clinical Immunology
Author(s): Tatiana Michel, Aurélie Poli, Jacques Zimmer




http://ift.tt/2njgdDa

Clinical Snippets

http://ift.tt/2njmrD5

Psoriasis – What′s Up ?

http://ift.tt/2ndDp4a

Issue Information

http://ift.tt/2njjyT6

Cardiovascular Parameters to 2 years After Kidney Transplantation Following Early Switch to Everolimus Without Calcineurin Inhibitor Therapy: An Analysis of the Randomized ELEVATE Study.

Background: Mammalian target of rapamycin (mTOR) inhibitors may confer cardioprotective advantages but clinical data are limited. Methods: In the open-label ELEVATE trial, kidney transplant patients were randomized at 10-14 weeks posttransplant to convert from calcineurin inhibitor (CNI) to everolimus or remain on standard CNI therapy. Prespecified endpoints included left ventricular mass index (LVMi) and, in a subpopulation of patients, arterial stiffness as measured by pulse wave velocity (PWV). Results: The mean change in LVMi from randomization was similar with everolimus versus CNI (month 24: -4.37 g/m2.7 versus -5.26 g/m2.7; mean difference 0.89 [p=0.392]). At month 24, LVH was present in 41.7% versus 37.7% of everolimus and CNI patients, respectively. Mean PWV remained stable with both everolimus (mean change from randomization to month 12: -0.24 m/s; month 24: -0.03 m/s) or CNI (month 12: 0.11 m/s; month 24: 0.16 m/s). The change in mean ambulatory night time blood pressure from randomization showed a benefit for diastolic pressure at month 12 (p=0.039) but not month 24. Major adverse cardiac events occurred in 1.1% and 4.2% of everolimus-treated and CNI-treated patients, respectively by month 12 (p=0.018) and 2.3% (8/353) and 4.5% by month 24 (p=0.145). Conclusions: Overall, these data do not suggest a clinically relevant effect on cardiac endpoints following early conversion from CNI to a CNI-free everolimus-based regimen. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2nXPLgZ

Vouchers for Future Kidney Transplants to Overcome 'Chronological Incompatibility' Between Living Donors and Recipients.

Background: The waiting list for kidney transplantation is long and growing. The creation of "vouchers" for future kidney transplants enables living donation to occur when optimal for the donor and transplantation to occur later, when and if needed by the recipient. Methods: The donation of a kidney at a time that is optimal for the donor generates a 'voucher' that only a specified recipient may redeem later when needed. The voucher provides the recipient with priority in being matched with a living donor from the end of a future transplantation chain. Besides its use in persons of advancing age with a limited window for donation, vouchers remove a disincentive to kidney donation, namely, a reluctance to donate now lest one's family member should need a transplant in the future. Results: We describe the first 3 voucher cases, in which advancing age might otherwise have deprived the donors the opportunity to provide a kidney to a family member. These 3 voucher donations functioned in a nondirected fashion and triggered 25 transplants through kidney paired donation across the United States. Conclusions: The provision of a voucher to potential recipients whose need for a transplant makes them "chronologically incompatible" with their donors may increase the number of living donor transplants. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2nORbgV

The Authors' Reply.

No abstract available

http://ift.tt/2nXOZAy

Intensive Care Solely to Facilitate Organ Donation - New Challenges.

No abstract available

http://ift.tt/2nOR58V

Vitamin D and Th17 Lymphocytes.

No abstract available

http://ift.tt/2nY6HEb

Multicenter Prospective Study for Laboratory Diagnosis of HHV8 Infection in Solid Organ Donors and Transplant Recipients and Evaluation of the Clinical Impact After Transplantation.

Background: We performed serological and molecular pretransplant screening in solid organ transplant (SOT) donors and recipients in north-central Italy and a surveillance program for human herpes virus 8 (HHV8) infection after transplant, aiming to establish an optimal management of HHV8 infection in SOT recipients. Methods: For pretransplant HHV8 screening in both donors and recipients, 6 serological (4 indirect immunofluorescent assays (IFA) and 2 enzyme-linked immunosorbent assays (ELISA) - both HHV8 lytic and latent antigen-based) and 2 molecular assays were used. A reference standard to identify HHV8-positive patients was defined by at least 2 positive assays. All transplant patients at risk to develop HHV8-related disease underwent virological posttransplant monitoring by quantitative real-time PCR assay. Results: HHV8 seroprevalence was 4% (10/249) in donors and 18% (93/517) in organ recipients. The best performance was obtained by 2 lytic antigen-based IFAs that showed almost perfect agreement to the reference standard (0.943 and 0.931 Cohen's kappa). HHV8-DNA was detected in 6.8% and 2.9% of HHV8-seropositive donor samples by in-house nested PCR and quantitative real-time PCR assays, respectively. After transplant, 3 out of 12 (25%) HHV8-mismatch patients (seropositive donor/seronegative recipient) developed a primary infection, 1 of whom developed a lethal nonmalignant illness. Two out of 93 HHV8-seropositive recipients (2.1%) had viral replication in posttransplant period, 1 of whom developed Kaposi's sarcoma. Conclusions: Serological assays, specifically lytic IFAs, were the best methodological approach to identify HHV8-infected SOT donors and recipients. A very low incidence (1.9%) of posttransplant HHV8-related disease was observed. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2nOV6dB

Laryngeal leishmaniasis, a rare manifestation of an emerging disease

Publication date: Available online 24 March 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): L. Silva, E. Damrose, A.-M.-F. Fernandes




http://ift.tt/2njhSst

Nasal foreign bodies in children in a pediatric hospital in Senegal: A three-year assessment

Publication date: Available online 23 March 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): P.-E.-J. Regonne, M. Ndiaye, A. Sy, Y. Diandy, A.-D. Diop, B.-K. Diallo
ObjectivesNasal foreign bodies (NFB) constitute a common domestic accident in children. The objectives of the present study were to report the particularities of NFBs in children presenting at a pediatric hospital in Senegal, and to describe our therapeutic attitude.Material and methodsA retrospective descriptive study included all under-15 year-olds presenting with NFB in the ENT department of the National Children's Hospital Center of Diamniadio, Senegal, between January 1, 2013 and December 31, 2015. Study variables comprised: age, gender, provenance, presenting symptoms, time to consultation, type of NFB, extraction method, and complications.Results58 NFB cases were retrieved. Mean age was 3years 4months; 93% of patients were under 5 years old. There was female predominance of 53.45%: i.e., sex-ratio, 0.87. Location was in the right cavity in 43 patients (74.1%). The presenting symptom was purulent rhinorrhea in 51.7% of cases. Time to consultation was within 24hours in 17.24% of cases. NFB type was firstly foam rubber (29.3%), followed by grain (20.7%). Extraction was performed in consultation in 84.5% of cases and in the operating room in 15.5%. Morbidity was 22.41%: 17.24% epistaxis and 5.17% nasal infection.ConclusionNFBs constitute a common domestic accident in under-5 year-olds. The rural Senegalese context shows delay in consultation.



http://ift.tt/2ndo1Vv

Erythematous plaques on the auditory canal

Publication date: Available online 23 March 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): G. Serarslan, C. Arlı, E. Atik




http://ift.tt/2njaSfi

Anesthesia Review: Blasting the Boards.

No abstract available

http://ift.tt/2ndmKOs

Higher Fresh Gas Flow Rates Decrease Tidal Volume During Pressure Control Ventilation.

BACKGROUND: We observed that increasing fresh gas flow (FGF) decreased exhaled tidal volume (VT) during pressure control ventilation (PCV). A literature search produced no such description whereby unintended VT changes occur with FGF changes during PCV. METHODS: To model an infant's lungs, 1 lung of a mechanical lung model (Dual Adult TTL 1600; Michigan Instruments, Inc, Grand Rapids, MI) was set at a compliance of 0.0068 L/cm H2O. An Rp50 resistor (27.2 cm H2O/L/s at 15 L/min) simulated normal bronchial resistance. The simulated lung was connected to a pediatric breathing circuit via a 3.5-mm cuffed endotracheal tube. A ventilator with PCV capability (Model 7900; Aestiva, GE Healthcare, Madison, WI) measured exhaled VT, and a flow monitor (NICO; Respironics, Murraysville, PA) measured peak inspiratory flow, positive end-expiratory pressure (PEEP), and peak inspiratory pressure. In PCV mode, exhaled VT displayed by the ventilator at FGF rates of 1, 6, 10, and 15 L/min was manually recorded across multiple ventilator settings. This protocol was repeated for the Avance CS2 anesthesia machine (GE Healthcare). RESULTS: For the Aestiva, higher FGF rates in PCV mode decreased exhaled VT. Exhaled VT for FGFs of 1, 6, 10, and 15 L/min were on average 48, 34.9, 16.5, and 10 mL, respectively, at ventilator settings of inspiratory pressure of 10 cm H2O, PEEP of 0 cm H2O, and respiratory rate of 20 breaths/min. This is a decrease by up to 27%, 65.6%, and 79.2% when FGFs of 6, 10, and 15 L/min are compared with a FGF of 1 L/min, respectively. In the GE Avance CS2 at the same ventilator settings, VT for FGF rates of 1, 6, 10, and 15 L/min were on average 46, 43, 40.4, and 39.7 mL, respectively. The FGF effect on VT was not as pronounced with the GE Avance CS2 as with the GE Aestiva. CONCLUSIONS: FGF has a significant effect on VT during PCV in the Aestiva bellows ventilator, suggesting caution when changing FGF during PCV in infants. Our hypothesis is that at higher FGF rates, an inadvertent PEEP is developed by the flow resistance of the ventilator relief valve that is not recognized by the ventilator. In turn, less change in pressure is needed to reach the set inspiratory pressure, resulting in lower VT delivery at higher FGF rates. This underappreciated FGF-VT interaction during PCV with a bellows ventilator may be clinically significant in pediatric patients; prospective data collection in patients is needed for further evaluation. (C) 2017 International Anesthesia Research Society

http://ift.tt/2njhWbH

Massive Transfusion in Cardiac Surgery: The Impact of Blood Component Ratios on Clinical Outcomes and Survival.

BACKGROUND: Cardiac surgery is the most common setting for massive transfusion in medically advanced countries. Studies of massive transfusion after injury suggest that the ratios of administered plasma and platelets (PLT) to red blood cells (RBCs) affect mortality. Data from the Red Cell Storage Duration Study (RECESS), a large randomized trial of the effect of RBC storage duration in patients undergoing complex cardiac, were analyzed retrospectively to investigate the association between blood component ratios used in massively transfused patients and subsequent clinical outcomes. METHODS: Massive transfusion was defined as those who had >=6 RBC units or >=8 total blood components. For plasma, high ratio was defined as >=1 plasma unit:1 RBC unit. For PLT transfusion, high ratio was defined as >=0.2 PLT doses:1 RBC unit; PLT dose was defined as 1 apheresis PLT or 5 whole blood PLT equivalents. The clinical outcomes analyzed were mortality and the change in the Multiple Organ Dysfunction Score ([DELTA]MODS) comparing the preoperative score with the highest composite score through the earliest of death, discharge, or day 7. Outcomes were compared between patients transfused with high and low ratios. Linear and Cox regression were used to explore relationships between predictors and continuous outcomes and time to event outcomes. RESULTS: A total of 324 subjects met the definition of massive transfusion. In those receiving high plasma:RBC ratio, the mean (SE) 7- and 28-day [DELTA]MODS was 1.24 (0.45) and 1.26 (0.56) points lower, (P = .007 and P = .024), respectively, than in patients receiving lower ratios. In patients receiving high PLT:RBC ratio, the mean (SE) 7- and 28-day [DELTA]MODS were 1.55 (0.53) and 1.49 (0.65) points lower (P = .004 and P = .022), respectively. Subjects who received low-ratio plasma:RBC transfusion had excess 7-day mortality compared with those who received high ratio (7.2% vs 1.7%, respectively, P = .0318), which remained significant at 28 days (P = .035). The ratio of PLT:RBCs was not associated with differences in mortality. CONCLUSIONS: This analysis found that in complex cardiac surgery patients who received massive transfusion, there was an association between the composition of blood products used and clinical outcomes. Specifically, there was less organ dysfunction in those who received high-ratio transfusions (plasma:RBCs and PLT:RBCs), and lower mortality in those who received high-ratio plasma:RBC transfusions. (C) 2017 International Anesthesia Research Society

http://ift.tt/2ndDUeG

Inhaled Remimazolam Potentiates Inhaled Remifentanil in Rodents.

BACKGROUND: Remimazolam is an ester-based short-acting benzodiazepine currently in clinical trials for IV administration. This study explored the feasibility of delivering remimazolam alone and as an adjunct to remifentanil via inhalation in rodent models. METHODS: Mice were exposed to remimazolam via inhalation; sedation was assessed using time to movement outside a set perimeter. Rats were also exposed to remimazolam aerosol alone and in combination with inhaled remifentanil, and analgesia was quantified by using a tail flick meter. Pulmonary injury was assessed in mice using mechanics measurements. RESULTS: Mice showed significantly increased time to movement outside a set perimeter after 5-minute exposure to increasing concentrations (10-25 mg/mL solutions) of inhaled remimazolam aerosols. Differences in mean (95% confidence interval) time to movement from pretest baseline group (0.05 [0.01-0.09] minutes) were 11 (4-18), 15 (5-26), 30 (19-41), and 109 (103-115) minutes after exposure to remimazolam aerosol of 10, 15, 20, and 25 mg/mL, respectively (P = .007 - P

http://ift.tt/2njdw4N

Video-Based Physiologic Monitoring During an Acute Hypoxic Challenge: Heart Rate, Respiratory Rate, and Oxygen Saturation.

BACKGROUND: The physiologic information contained in the video photoplethysmogram is well documented. However, extracting this information during challenging conditions requires new analysis techniques to capture and process the video image streams to extract clinically useful physiologic parameters. We hypothesized that heart rate, respiratory rate, and oxygen saturation trending can be evaluated accurately from video information during acute hypoxia. METHOD: Video footage was acquired from multiple desaturation episodes during a porcine model of acute hypoxia using a standard visible light camera. A novel in-house algorithm was used to extract photoplethysmographic cardiac pulse and respiratory information from the video image streams and process it to extract a continuously reported video-based heart rate (HRvid), respiratory rate (RRvid), and oxygen saturation (SvidO2). This information was then compared with HR and oxygen saturation references from commercial pulse oximetry and the known rate of respiration from the ventilator. RESULTS: Eighty-eight minutes of data were acquired during 16 hypoxic episodes in 8 animals. A linear mixed-effects regression showed excellent responses relative to a nonhypoxic reference signal with slopes of 0.976 (95% confidence interval [CI], 0.973-0.979) for HRvid; 1.135 (95% CI, 1.101-1.168) for RRvid, and 0.913 (95% CI, 0.905-0.920) for video-based oxygen saturation. These results were obtained while maintaining continuous uninterrupted vital sign monitoring for the entire study period. CONCLUSIONS: Video-based monitoring of HR, RR, and oxygen saturation may be performed with reasonable accuracy during acute hypoxic conditions in an anesthetized porcine hypoxia model using standard visible light camera equipment. However, the study was conducted during relatively low motion. A better understanding of the effect of motion and the effect of ambient light on the video photoplethysmogram may help refine this monitoring technology for use in the clinical environment. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (C) 2017 International Anesthesia Research Society

http://ift.tt/2ndtI5Q

The Effect of Sedation on Cortical Activation: A Randomized Study Comparing the Effects of Sedation With Midazolam, Propofol, and Dexmedetomidine on Auditory Processing.

BACKGROUND: Every day, millions of people undergo surgical procedures facilitated by anesthesia. Yet, there is no clinically accepted measure to predict the effects of sedation or anesthesia on the central nervous system. Auditory brain activation may provide an objective and quantifiable method to measure of the effects of sedation on neuronal processing. METHODS: This is a randomized clinical trial. Forty-eight healthy volunteers were randomly assigned to receive 1 of 3 sedative drugs (midazolam [n = 11], propofol [n = 12], or dexmedetomidine [n = 12]) at a concentration adjusted to achieve mild sedation by self-rating, or to a no-drug control group (n = 13). Participants underwent functional magnetic resonance imaging while listening to music in a 5-minute block design experiment. We tested the hypothesis that mild sedation changes the magnitude or extent of cortical activation of an auditory stimulus. RESULTS: We observed a significant reduction in auditory activation in both the dexmedetomidine (P = .001) and midazolam (P = .029) but not the propofol group (P = .619) when compared with saline control. CONCLUSIONS: Our findings indicate that, compared with saline control, there is a significant reduction of brain activation in the auditory cortex in response to midazolam and dexmedetomidine but not propofol when given at mildly sedative doses. This method serves as a novel approach to quantify the effects of sedative agents in an objective fashion. (C) 2017 International Anesthesia Research Society

http://ift.tt/2nj9VUi

Patient Blood Management.

No abstract available

http://ift.tt/2ndwFTU