Head and Neck Medicine by Alexandros G.Sfakianakis: 04/21/17

Παρασκευή 21 Απριλίου 2017

Efficacy of fractionated microneedle radiofrequency with and without adding subcision for the treatment of atrophic facial acne scars: A randomized split-face clinical study

Summary

Background

There is no gold standard treatment for facial acne scars, and overall, little literature exists about the combination therapy for treatment of acne scar.

Aims

The aim of this study was to evaluate the efficacy of fractionated microneedle radiofrequency (FMR) vs FMR combined with subcision for the treatment of atrophic acne scars.

Patients/Methods

This was a randomized, split-face clinical study of 25 patients with II-IV Fitzpatrick skin types with moderate to severe facial atrophic acne scars. Initially, standard subcision by Nokor needle was performed on one side. Two weeks after subcision, FMR treatment was performed on both cheeks of each participant. Second and third FMR treatment sessions were performed within 4-week intervals. Two-blinded dermatologists performed clinical assessments using a quartile grading scale, and patients were also asked to judge their satisfaction using a visual analog scale (VAS) scoring system.

Results

The age of the patients varied from 24 to 40 years (mean: 30.08±4.94 years). Only nine patients (36%) were males. Clinical assessment by two-blinded dermatologists showed statistically significant improvement in the combination (FMR+subcision) group (P=.009). Patient satisfaction was statistically significantly better in the combination group (P=.001). A darkening of skin phototype was associated with a decrease in patient's satisfaction VAS score (P=.07).

Conclusion

The combination of subcision and FMR is a safe and effective modality for mixed type acne scars. Additional randomized clinical study with long-term follow-up is necessary for further evaluation of FMR in combination with other procedures.

The full trial protocol can be accessed in: http://ift.tt/2q1emS9.

The clinical trial registration number is IRCT2016103130597N1.

http://ift.tt/2pnBLkv

Effect of Ficus carica leaf extract on the gene expression of selected factors in HaCaT cells

Summary

Background

Ficus carica Linn. (Fc), common fig, has been traditionally used for many metabolic, cardiovasculary, respiratory, gastrointestinal, and skin disorders. Several studies were performed showing its anti-inflammatory, anti-angiogenic, anticancerogenic, and tissue-protective effects. In all of those studies, the positive effects of Fc were concluded as the result of its antioxidant and anti-inflammatory features due to the polyphenols it contains.

Aims

To study the phenolic compounds of Fc extract and to investigate the molecular basis of anti-inflammatory, anti-angiogenic, antimitotic, and anti-androgenic effects of Fc leaf extract in vitro.

Materials and Methods

The gene expression levels of vascular endothelial growth factor (VEGF), tumor necrosis factor-alpha (TNF-a), interleukin 1-alpha (IL-1a), and 5 alpha-reductase type II (SRD5A2) were tested in human keratinocyte cells (HaCaT) by RT-qPCR.

Results

The gene expression analysis showed that the plant extract caused statistically significant downregulation of VEGF, TNF-a, IL-1a, and SRD5A2 compared to the untreated cells.

Discussion

These preliminary results of this in vitro study may partially explain the clinical success of Fc in the traditional medicine.

Conclusion

Topical Fc leaf extract may be beneficial for some inflammatory disorders and androgen-dependent disorders of the skin such as androgenetic alopecia.

http://ift.tt/2pnDvdH

Clinical predictors of remission and persistence of adult-onset asthma

Publication date: Available online 22 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Guus A. Westerhof, Hanneke Coumou, Selma B. de Nijs, ElsJ. Weersink, Elizabeth H. Bel
BackgroundAdult-onset asthma is an important but relatively understudied asthma phenotype and little is known about its natural course and prognosis. The remission rate is believed to be low, and it is still obscure which factors predict remission or persistence of the disease.ObjectiveTo determine the remission rate, and identify predictors of persistence and remission of adult-onset asthma.MethodsTwo hundred adult patients with recently diagnosed (<1 year) asthma were recruited from secondary and tertiary pulmonary clinics and prospectively followed for 5 years. Clinical, functional and inflammatory parameters were assessed at baseline and at yearly visits. Asthma remission was defined as absence of asthma symptoms for ≥1 year and no asthma medication use for ≥1 year. Descriptive statistics and logistic regression analysis were performed.ResultsFive-year follow-up data of 170 patients (85%) was available. Of these, 27 patients (15.9%) experienced asthma remission. Patients with asthma persistence were older, had worse asthma control, required higher doses of inhaled corticosteroids, had more severe airway hyperresponsiveness, more often nasal polyps and higher levels of blood neutrophils as compared to patients who experienced clinical remission.In a multivariable logistic regression analysis, only moderate-severe bronchial hyperresponsiveness and nasal polyps were independent predictors of asthma persistence. Patients with these two characteristics had less than 1% chance of asthma remission.ConclusionOne in six patients with adult-onset asthma experiences remission within the first 5 years of the disease. In patients with moderate to severe bronchial hyperresponsiveness and nasal polyposis the chance of remission is close to zero.

Teaser

Adult-onset asthma remission occurs in 16% of the patients within 5 years after diagnosis. Nasal polyposis and moderate to severe bronchial hyperresponsiveness at the time of asthma diagnosis reduces the chance of remission to <1%.

http://ift.tt/2q0TbQ7

Monoclonal Antibody AbCR1 Against Guinea Pig CXCR1 and Monoclonal Antibody AbCR2 Against Guinea Pig CXCR2

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy Apr 2017, Vol. 36, No. 2: 82-82.

http://ift.tt/2pNWpXV

Monoclonal Antibody: 5C9H2 Against Human Ghrelin Receptor

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy Apr 2017, Vol. 36, No. 2: 80-81.

http://ift.tt/2p5JOBD

Bypass of an anesthesiologist-directed preoperative evaluation clinic results in greater first-case tardiness and turnover times

We evaluated 4 hypotheses related to bypass of an anesthesiologist-directed preoperative evaluation clinics (APEC): 1) first-case tardiness and turnover times increased; 2) turnover times increased more than first-case tardiness; and higher American Society of Anesthesiologists Physical Status (ASA PS) resulted in both an ordered increase among ASA PS and within ASA PS in 3) first-case tardiness; and 4) turnover times.

http://ift.tt/2pONM29

A novel treatment for chronic opioid use after surgery

In a recent article from the Center for Disease Control, the authors addressed the current opioid epidemic in America and emphasized the importance of utilizing non-opioid analgesic alternatives to opioid medication for treating chronic pain. In cases where non-opioid analgesic drugs alone have failed to produce adequate pain relief, these authors suggested that non-pharmacologic therapies should also be considered. This Case Series describes a pilot study designed to evaluate a novel non-pharmacologic approach to treating long-standing (>1year) opioid dependency.

http://ift.tt/2q0EjkM

Ultrasound-guided “lateral” thoracolumbar interfascial plane (TLIP) block: A cadaveric study of the spread of injectate

To the Editor:

http://ift.tt/2pOZGsI

Molecular Profiling of Papillary Thyroid Carcinoma in Korea with a High Prevalence of BRAFV600E Mutation

Thyroid , Vol. 0, No. 0.

http://ift.tt/2pNIrp9

Trends of Second Primary Malignancy in Patients with Thyroid Cancer: A Population-Based Cohort Study in Israel

Thyroid , Vol. 0, No. 0.

http://ift.tt/2png1Fx

Cone beam computed tomography assessment of the pterygomaxillary region and palatine canal for Le Fort I osteotomy

The aim of this study was to evaluate the anatomical linear measurements of the descending palatine canal and the pterygomaxillary fissure for Le Fort I preoperative planning. Seventy-five patients, comprising 46 females (61.3%) and 29 males (39.7%), underwent multi-slice computed tomography examinations performed for preoperative orthognathic surgical planning. The images were categorized according to sex, craniofacial side, and skeletal and craniofacial patterns. The anterior length between the descending palatine canal and the lateral wall of the piriform rim showed a higher mean value for males compared to females (P=0.0121).

http://ift.tt/2oyMhjW

Effects of different radiation doses on the microhardness, superficial morphology, and mineral components of human enamel

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Sandra Ribeiro de Barros da Cunha, Felipe Paiva Fonseca, Pedro Augusto Minorin Mendes Ramos, Cecília Maria Kalil Haddad, Eduardo Rodrigues Fregnani, Ana Cecília Corrêa Aranha
ObjectiveTo evaluate the effects of three different radiotherapy doses (20, 40, and 70Gy) on the microhardness, superficial morphology, and mineral content (based on Ca and P values) of three different depths of human enamel (cervical, middle, and occlusal).DesignThirty-four third molars were cut, separated, and prepared. Microhardness samples (n=30) were embedded in acrylic resin and then polished, and depths were delimited. Microhardness tests were performed on cervical, middle, and occlusal enamel pre- and post-radiotherapy with a load of 50g for 30s. For the scanning electron microscopy (SEM) analysis (n=4) and energy dispersive X-ray spectroscopy (EDS) (n=12), samples were fixed in a 3% glutaraldehyde solution, washed in 0.1M cacodylate solution, and dehydrated in crescent concentrations of ethanol. Microhardness data were tested for significant differences using a two-way analysis of variance (ANOVA) and Tukey's test (p<0.05), while SEM and EDS were evaluated qualitatively.ResultsThe results showed a decrease in microhardness values only in the cervical enamel, regardless of the radiation dose used; no morphological or mineral change was observed.ConclusionRadiotherapy can affect the microhardness values of only cervical enamel without compromising the morphological or mineral (Ca and P) content at any depth.

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Response of mandibular condyles of juvenile and adult rats to abnormal occlusion and subsequent exemption

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Guang Zeng, Bin Kuang, Wen-xing Xun, Gao-tong Ren, Ke-wen Wei
ObjectiveThe adaptation capacities of the mandibular condyle in response to mechanical stimuli might be different between juveniles and adults, but has not been compared. This study aimed to investigate whether abnormal molar occlusion and subsequent molar extraction could lead to different remodeling responses in the mandibular condyles of juvenile and adult rats.MethodsAbnormal molar occlusion (AMO) was established in the 5- and 16-wk old rats by moving their maxillary left and mandibular right third molars distally. AMO was removed in the molar extraction group at 4 weeks but remained in the AMO group. All rats were sacrificed at 8 weeks. Micro-computed tomography, histomorphology, immunohistochemistry and real-time PCR were adopted to evaluate the remodeling of condylar subchondral bone.ResultsCondylar subchondral bone loss and increased osteoclastic activities were observed in both juvenile and adult AMO groups, while increased osteoblastic activities were only seen in the juvenile AMO group. Decreased bone mineral density, bone volume fraction and trabecular thickness, but increased trabecular separation, number and surface of osteoclasts and mRNA levels of TRAP, cathepsin-K, RANKL in the juvenile AMO group were all reversed after molar extraction (all P<0.05). However, these parameters showed no difference between adult AMO and extraction groups (all P>0.05).ConclusionsAbnormal molar occlusion led to degenerative remodeling in the mandibular condyles of both juvenile and adult rats, while exemption of abnormal occlusion caused significant rescue of the degenerative changes only in the juvenile rats.

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The mucosal pellicle – An underestimated factor in oral physiology

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Christian Hannig, Matthias Hannig, Anna Kensche, Guy Carpenter
Bioadhesion and bio-adsorption of proteins, glycoproteins and other biomolecules are ubiquitous phenomena in the oral cavity. While the protective role of the adsorbed salivary biomolecules on teeth (the acquired enamel pellicle) is well established, it has yet to be defined whether comparable processes occur on the desquamating oral soft tissues. The general term for these layers is pellicle, but due to the different characteristics of the coated surfaces the enamel pellicle and mucosal pellicle are their own entities. There is considerable information on the enamel pellicle, whereas only limited data are available on the mucosal pellicle. This can be attributed to the difficult standardized preparation of this biological structure. Based on the present knowledge the abundant and characteristic components of the mucosal pellicle include secreted soluble mucins (MUC5B, MUC7), membrane-associated epithelial mucins (MUC1), and to a lesser degree CA VI, sIgA, and cystatin. However, it seems to be of completely different ultrastructure as compared with the enamel pellicle. Since it is comprised of larger glycoproteins retaining water, it might be considered as a hydrogel, and it appears to have a lower tenacity than the enamel pellicle. Maturation and turnover are influenced by the delivery of salivary proteins, by the flow of saliva and the underlying desquamating oral epithelium. Its probable functions include lubrication and moisture retention.In general, the mucosal pellicle can be regarded as an underestimated key player in oral physiology.

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Lysophosphatidic acid induces expression of genes in human oral keratinocytes involved in wound healing

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Hong Huynh Thorlakson, Stian Andre Engen, Olav Schreurs, Karl Schenck, Inger Johanne Schytte Blix
ObjectiveEpithelial cells participate in wound healing by covering wounds, but also as important mediators of wound healing processes. Topical application of the phospholipid growth factor lysophosphatidic acid (LPA) accelerates dermal wound healing and we hypothesized that LPA can play a role in human oral wound healing through its effects on human oral keratinocytes (HOK).DesignHOK were isolated from gingival biopsies and exposed to LPA. The LPA receptor profile, signal transduction pathways, gene expression and secretion of selected cytokines were analyzed.ResultsHOK expressed the receptors LPA1, LPA5 and LPA6 and LPA activated the ERK1/2, JNK and p38 intracellular pathways, substantiated by secretion of IL-6 and IL-8. The early (2h) and intermediate (6h) gene expression profiles of HOK after LPA treatment showed a wide array of regulated genes. The majority of the strongest upregulated genes were related to chemotaxis and inflammation, and became downregulated after 6h. At 6h, genes coding for factors involved in extracellular matrix remodeling and re-epithelialization became highly expressed. IL-36γ, not earlier known to be regulated by LPA, was strongly transcribed and translated but not secreted.ConclusionsAfter stimulation with LPA, HOK responded by regulating factors and genes that are essential in wound healing processes. As LPA is found in saliva and is released by activated cells after wounding, our results indicate that LPA has a favorable physiological role in oral wound healing. This may further point towards a beneficial role for application of LPA on oral surgical or chronic wounds.

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Lack of pathogenic mutations in SOS1 gene in phenytoin-induced gingival overgrowth patients

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Katia Margiotti, Giulia Pascolini, Federica Consoli, Valentina Guida, Carlo Di Bonaventura, Anna Teresa Giallonardo, Antonio Pizzuti, Alessandro De Luca
ObjectiveGingival overgrowth is a side effect associated with some distinct classes of drugs, such as anticonvulsants, immunosuppressants, and calcium channel blockers. One of the main drugs associated with gingival overgrowth is the antiepileptic phenytoin, which affects gingival tissues by altering extracellular matrix metabolism. It has been shown that mutation of human SOS1 gene is responsible for a rare hereditary gingival fibromatosis type 1, a benign gingival overgrowth. The aim of the present study is to evaluate the possible contribution of SOS1 mutation to gingival overgrowth-related phenotype.DesignWe selected and screened for mutations a group of 24 epileptic patients who experienced significant gingival overgrowth following phenytoin therapy. Mutation scanning was carried out by denaturing high-performance liquid chromatography analysis of the entire coding region of the SOS1 gene. Novel identified variants were analyzed in-silico by using Alamut Visual mutation interpretation software, and comparison with normal control group was done.ResultsMutation scanning of the entire coding sequence of SOS1 gene identified seven intronic variants and one new exonic substitution (c.138G>A). The seven common intronic variants were not considered to be of pathogenic importance. The exonic substitution c.138G>A was found to be absent in 100 ethnically matched normal control chromosomes, but was not expected to have functional significance based on prediction bioinformatics tools.ConclusionsThis study represents the first mutation analysis of the SOS1 gene in phenytoin-induced gingival overgrowth epileptic patients. Present results suggest that obvious pathogenic mutations in the SOS1 gene do not represent a common mechanism underlying phenytoin-induced gingival overgrowth in epileptic patients; other mechanisms are likely to be involved in the pathogenesis of this drug-induced phenotype.

http://ift.tt/2p1ldvw

Depressive behavior induced by unpredictable chronic mild stress increases dentin hypersensitivity in rats

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Fabiane Martins Barbosa, Danilo Cabral, Fernanda Kabadayan, Eduardo Fernandes Bondan, Maria de Fátima Monteiro Martins, Thiago Berti Kirsten, Leoni Villano Bonamin, Nicolle Queiroz-Hazarbassanov, Maria Martha Bernardi, Cintia Helena Coury Saraceni
ObjectiveThe present study evaluated the nociceptive response induced by dentin hypersensitivity after dental erosion in rats that were exhibited to unpredictable chronic mild stress (UCMS)-induced depressive-like behavior.DesignAdult male rats were subjected to UCMS (depression [D] group) or not (no depression [ND] group) for 30days and received either acidic solution to induce dental erosion (E) or water (W), thus forming the WND, END, WD, and ED groups. After the end of treatment, depressive-like parameters (i.e., sucrose preference and immobility in the forced swim test) and dentin hypersensitivity were evaluated. Plasma tumor necrosis factor α (TNF-α) and corticosterone levels were measured, and astrocytic glial fibrillary acidic protein (GFAP) expression was evaluated in the prefrontal cortex, hippocampus, amygdala, and hypothalamus.ResultsAdministration of the acidic solution potentiated dentin hypersensitivity and increased corticosterone levels in the ED group compared with the WD group. TNF-α levels only increased in the WD group. The ED group exhibited an increase in astrocytic GFAP expression in the hypothalamus and prefrontal cortex but decreases in the hippocampus.ConclusionsThese results suggest that UCMS exacerbated the nociceptive response associated with dentin hypersensitivity, concomitant with an increase in plasma corticosterone levels. Hypothalamic and prefrontal cortex astrogliosis in the ED group may be attributable to the increase in corticosterone associated to UCMS procedure. The reduction of astrocytic GFAP expression in the hippocampus in the ED group supports the association between dentin hypersensitivity and depression.

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CHMP Recommends Skilarence for Psoriasis

The Committee for Medicinal Products for Human Use of the European Medicines Agency recommended granting marketing approval for Skilarence for treatment of psoriasis.
International Approvals

http://ift.tt/2q0jK82

In-ear medical devices for acoustic therapies in tinnitus treatments, state of the art

Cochrane reviews indicate there is very limited support for all forms of sound therapy and cognitive behavioral therapy has the strongest support. American Academy of Otolaryngology (AAO) recently published some guidelines which recommends Cognitive Behavioral Therapy (CBT) for tinnitus intervention, and only indicates that sound therapy should be considered an "option" for intervention.Nevertheless, acoustic therapy could lead to cause changes in the tinnitus perception and has been appreciated by the affected people for years.

http://ift.tt/2oe0mb6

Effects of different radiation doses on the microhardness, superficial morphology, and mineral components of human enamel

Response of mandibular condyles of juvenile and adult rats to abnormal occlusion and subsequent exemption

The mucosal pellicle – An underestimated factor in oral physiology

Lysophosphatidic acid induces expression of genes in human oral keratinocytes involved in wound healing

Lack of pathogenic mutations in SOS1 gene in phenytoin-induced gingival overgrowth patients

Depressive behavior induced by unpredictable chronic mild stress increases dentin hypersensitivity in rats

Angiosarcoma of the tongue: A case series and literature review

Angiosarcoma of the tongue is an exceedingly rare malignancy of the head and neck. Such lesions can be primary in nature or occur in a previously irradiated field. We examine a series of cases with relation to clinical presentation, diagnosis, management, and outcomes.

http://ift.tt/2pNPoXg

Pleomorphic liposarcoma of the head and neck: Presentation of two cases and literature review

Pleomorphic liposarcoma (PL) is an exceedingly rare tumor of the head and neck. This aggressive liposarcoma variant portends a poorer prognosis compared to more typical sarcomatous tumors.

http://ift.tt/2odZVOo

Sphenopalatine Ganglion Block in the Management of Chronic Headaches

Abstract

Purpose of Review

Sphenopalatine ganglion (SPG) block has been used by clinicians in the treatment of a variety of headache disorders, facial pain syndromes, and other facial neuralgias. The sensory and autonomic fibers that travel through the SPG provided the scientific rationale for symptoms associated with these head and neck syndromes. Yet, despite the elucidation of this pathogenic target, the optimal method to block its pain-producing properties has not been determined. Clinicians have developed various invasive and non-invasive techniques, each of which has shown variable rates of success. We examined the available studies of sphenopalatine ganglion blockade and its efficacy in the treatment of cluster headaches, migraines, and other trigeminal autonomic cephalalgias.

Recent Findings

Studies have demonstrated that SPG blockade and neurostimulation can provide pain relief in patients with cluster headaches, migraines, and other trigeminal autonomic cephalalgias. Patients with these conditions showed varying levels and duration of pain relief from SPG blockade. The efficacy of SPG blockade could be related to the different techniques targeting the SPG and choice of therapeutic agents.

Summary

Based on current studies, SPG blockade is a safe and effective treatment for chronic headaches such as cluster headaches, migraines, and other trigeminal autonomic cephalalgias. Future studies are warranted to define the optimal image-guided technique and choice of pharmacologic agents for SPG blockade as an effective treatment for chronic headaches related to activation of the sphenopalatine ganglion.

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Neuropathic Pain: Central vs. Peripheral Mechanisms

Abstract

Purpose of Review

Our goal is to examine the processes—both central and peripheral—that underlie the development of peripherally-induced neuropathic pain (pNP) and to highlight recent evidence for mechanisms contributing to its maintenance. While many pNP conditions are initiated by damage to the peripheral nervous system (PNS), their persistence appears to rely on maladaptive processes within the central nervous system (CNS). The potential existence of an autonomous pain-generating mechanism in the CNS creates significant implications for the development of new neuropathic pain treatments; thus, work towards its resolution is crucial. Here, we seek to identify evidence for PNS and CNS independently generating neuropathic pain signals.

Recent Findings

Recent preclinical studies in pNP support and provide key details concerning the role of multiple mechanisms leading to fiber hyperexcitability and sustained electrical discharge to the CNS. In studies regarding central mechanisms, new preclinical evidence includes the mapping of novel inhibitory circuitry and identification of the molecular basis of microglia-neuron crosstalk. Recent clinical evidence demonstrates the essential role of peripheral mechanisms, mostly via studies that block the initially damaged peripheral circuitry. Clinical central mechanism studies use imaging to identify potentially self-sustaining infra-slow CNS oscillatory activity that may be unique to pNP patients.

Summary

While new preclinical evidence supports and expands upon the key role of central mechanisms in neuropathic pain, clinical evidence for an autonomous central mechanism remains relatively limited. Recent findings from both preclinical and clinical studies recapitulate the critical contribution of peripheral input to maintenance of neuropathic pain. Further clinical investigations on the possibility of standalone central contributions to pNP may be assisted by a reconsideration of the agreed terms or criteria for diagnosing the presence of central sensitization in humans.

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The importance of lymph node ratio for locoregional recurrence of squamous cell carcinoma of the tongue

There are no funding disclosures from any authors.

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Evaluation of tinnitus retraining therapy for patients with normal audiograms versus patients with hearing loss

Publication date: Available online 20 April 2017
Source:Auris Nasus Larynx
Author(s): Kana Lee, Kunihiko Makino, Kohei Yamahara
ObjectiveA few chronic tinnitus patients show normal hearing thresholds in the pure tone audiometry from 125Hz to 8000Hz (≤20dB). We report the characteristics of the course of those patients underwent tinnitus retraining therapy (TRT) compared with other patients suffering from chronic and severe tinnitus.MethodsWe identified 13 patients with normal hearing thresholds among 242 patients suffering over 3 months, Tinnitus Handicap Inventory (THI) ≥16/100, and follow up period is over 6 months. We divided into two groups – tinnitus with normal audiometry and with hearing loss – and contrasted these patients with age, gender, tinnitus duration, instruments for TRT, loudness and pitch of the tinnitus, THI and Visual Analogue Scale (VAS) scores.ResultsThe pitch-match of the tinnitus was higher and tinnitus duration was shorter in normal audiometry. The age is younger and the tinnitus loudness was smaller in normal hearing group significantly. THI of normal audiogram group showed significant improvement on 18 months treatment, though it once got worse on 12 months. THI of hearing loss group showed significant decreases in first 3 months and decreased slightly until 48 months treatment. The VAS scores of annoyance also showed a large decrease in first 3 months and decreased slightly until 24 months. Both THI after 48 months and VAS scores after 24 months treatment showed almost stable until 72 months in hearing loss group.ConclusionChronic tinnitus with normal audiometry and with hearing loss both showed adaptation with TRT. Normal audiometry group with chronic tinnitus may have damage in high frequency though there were not significant differences between two groups as to tinnitus pitch-match. They also need at least 18 months TRT to become adaptation, while 48 months treatment is enough and first 3 months treatment is very important for hearing loss with chronic tinnitus.

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Is OperaVOX a clinically useful tool for the assessment of voice in a general ENT clinic?

Abstract

Background

Objective acoustic analysis is a key component of multidimensional voice assessment. OperaVOX is an iOS app which has been shown to be comparable to Multi Dimensional Voice Program for most principal measures of vocal function. As a relatively cheap, portable and easily accessible form of acoustic analysis, OperaVOX may be more clinically useful than laboratory-based software in many situations. This study aims to determine whether correlation exists between acoustic measurements obtained using OperaVOX, and perceptual evaluation of voice.

Methods

Forty-four voices from the multidisciplinary voice clinic were examined. Each voice was assessed blindly by a single experienced voice therapist using the GRBAS scale, and analysed using OperaVOX. The Spearman rank correlation co-efficient was calculated between each element of the GRBAS scale and acoustic measurements obtained by OperaVOX.

Results

Significant correlations were identified between GRBAS scores and OperaVOX parameters. Grade correlated significantly with jitter (ρ = 0.495, p < 0.05), shimmer (ρ = 0.385, p < 0.05), noise-to-harmonic ratio (NHR; ρ = 0.526, p < 0.05) and maximum phonation time (MPT; ρ = −0.415, p < 0.05). Roughness did not correlate with any of the measured variables. Breathiness correlated significantly with jitter (ρ = 0.342, p < 0.05), NHR (ρ = 0.344, p < 0.05) and MPT (ρ = −0.336, p < 0.05). Aesthenia correlated with NHR (ρ = 0.413, p < 0.05) and MPT (ρ = −0.399, p < 0.05). Strain correlated with Jitter (ρ = 0.560, p < 0.05), NHR (ρ = 0.600, p < 0.05) and MPT (ρ = −0.356, p < 0.05).

Conclusions

OperaVOX provides objective acoustic analysis which has shown statistically significant correlation to perceptual evaluation using the GRBAS scale. The accessibility of the software package makes it possible for a wide range of health practitioners, e.g. general ENT surgeons, vascular surgeons, thyroid surgeons and cardiothoracic surgeons to objectively monitor outcomes and complications of surgical procedures that may affect vocal function. Given the increasing requirement for surgeons to monitor their outcomes as part of the move towards 'surgeon reported outcomes' this may become an invaluable tool towards that goal.

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Sir Charles Bell: Unheralded laryngologist

Publication date: Available online 21 April 2017
Source:American Journal of Otolaryngology
Author(s): Elliot Abemayor
IntroductionSir Charles Bell is renowned and revered as an outstanding surgeon, anatomist, clinician and teacher and his many contributions to various medical fields have been amply described. What are less well-known are his contributions to the field of laryngology.MethodsSelected clinical and physiological publications by Bell were examined that addressed issues related specifically to the airway or pharynx. These included both case reports and case series.ResultsBell was keenly interested in the physiology of voice production, disorders of the airways and deglutition. Despite a busy clinical and teaching practice, he took careful notice of individual cases that highlighted important generalizations regarding care for upper aerodigestive tract disorders that are relevant today. He was also the first to recognize the anatomy and physiology of pharyngoesophageal diverticula that Zenker later made more famous.ConclusionsIn addition to his many contributions to neurology, facial nerve anatomy and physiology, Sir Charles Bell was also a keen Laryngologist before the era of subspecialization. Rediscovery and study of his work should make us more appreciative of past clinician-investigators who cast a wide net to advance knowledge rather than burrow into a narrow tunnel of vision.

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Angiosarcoma of the tongue: A case series and literature review

Publication date: Available online 21 April 2017
Source:American Journal of Otolaryngology
Author(s): Pratik B. Patel, Edward C. Kuan, Kevin A. Peng, Frederick Yoo, Scott D. Nelson, Elliot Abemayor
PurposeAngiosarcoma of the tongue is an exceedingly rare malignancy of the head and neck. Such lesions can be primary in nature or occur in a previously irradiated field. We examine a series of cases with relation to clinical presentation, diagnosis, management, and outcomes.Materials and methodsRetrospective chart review of all patients with angiosarcoma of the tongue at a tertiary academic institution yielded a single case between 2005 and 2016. The MEDLINE database was additionally searched for all case series or reports of angiosarcoma arising in the tongue, and pertinent clinical data were extracted.ResultsThe clinical presentation, disease course, and management of a patient with angiosarcoma of the tongue are presented. Institutional and literature search yielded a total of eight patients with angiosarcoma of the tongue. The most common primary sites were dorsal and lateral oral tongue. Treatment consisted of surgical resection in 63% of cases with adjuvant therapy administered in 75% of cases. Follow-up times varied per patient, but 63% had persistent or recurrent disease and 67% died of or with disease within two years of index presentation.ConclusionAngiosarcoma of the tongue is a rare and highly aggressive tumor, accounting for fewer than 1% of all head and neck malignancies. The mainstay of treatment is surgical resection with negative margins followed by adjuvant chemoradiation for high-risk features. Due to rarity of the disease, consensus on optimal treatment approach is lacking, and multi-center prospective studies would be helpful to set clinical guidelines.

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Primary mucosal melanoma of the palatine tonsil: Report of a case and review of the literature

Publication date: Available online 21 April 2017
Source:American Journal of Otolaryngology
Author(s): Marcela Osorio, Sami P. Moubayed, Juan Hernandez-Prera, John Scott, Mark L. Urken
BackgroundMucosal melanoma of the palatine tonsil is extremely rare. Due to its poor prognosis, primary tonsillar melanoma requires prompt recognition and treatment.MethodsA 62-year old female presented with a deeply pigmented and exophytic lesion in the left tonsillar fossa. The patient underwent a partial pharyngectomy through a midline labio-mandibulotomy approach along with a left level I–V neck dissection. Reconstruction with a left radial forearm free flap and a pharyngeal constrictor advancement pharyngoplasty was performed.ResultsThe patient remains free of disease at eight months after adjuvant proton therapy and eleven months after surgery. To our knowledge, less than thirty cases have been either reported or referenced in the literature since the early 1900′s. This report is the first in English literature to compile all reported cases of primary tonsillar melanoma.ConclusionCurrently, evidence suggests that mucosal melanoma in the palatine tonsil should be treated in the same fashion as other head and neck mucosal melanomas, mindful of the high rates at which locoregional and distant metastases occur.

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The effect of LED on blood microcirculation during chronic wound healing in diabetic and non-diabetic patients—a prospective, double-blind randomized study

Abstract

Chronic wounds, especially in diabetic patients, represent a challenging health issue. Since standard treatment protocols often do not provide satisfactory results, additional treatment methods—like phototherapy using low-level light therapy—are being investigated. The aim of our study was to evaluate the effect of phototherapy with light-emitting diodes on chronic wound treatment in diabetic and non-diabetic patients. Since a sufficient blood supply is mandatory for wound healing, the evaluation of microcirculation in the healthy skin at a wound's edge was the main outcome measure. Forty non-diabetic patients and 39 diabetics with lower limb chronic wounds who were referred to the University Medical Center Ljubljana between October 2012 and June 2014 were randomized to the treated and control groups. The treated group received phototherapy with LED 2.4 J/cm² (wavelengths 625, 660, 850 nm) three times a week for 8 weeks, and the control group received phototherapy with broadband 580–900 nm and power density 0.72 J/cm². Microcirculation was measured using laser Doppler. A significant increase in blood flow was noted in the treated group of diabetic and non-diabetic patients (p = 0.040 and p = 0.033), while there was no difference in the control groups. Additional Falanga wound bed score evaluation showed a significant improvement in both treated groups as compared to the control group. According to our results, phototherapy with LED was shown to be an effective additional treatment method for chronic wounds in diabetic and non-diabetic patients.

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Role of low-level laser therapy added to facial expression exercises in patients with idiopathic facial (Bell’s) palsy

Abstract

The aim of the present study was to investigate the efficacy of low-level laser therapy in conjunction with conventional facial exercise treatment on functional outcomes during the early recovery period in patients with facial paralysis. Forty-six patients (mean age 41 ± 9.7 years; 40 women and 6 men) were randomized into two groups. Patients in the first group received low-level laser treatment as well as facial exercise treatment, while patients in the second group participated in facial exercise intervention alone. Laser treatment was administered at a wavelength of 830 nm, output power of 100 Mw, and frequency of 1 KHz using a gallium-aluminum-arsenide (GaAIAs, infrared laser) diode laser. A mean energy density of 10 J/cm² was administered to eight points of the affected side of the face three times per week, for a total of 6 weeks. The rate of facial improvement was evaluated using the facial disability index (FDI) before, 3 weeks after, and 6 weeks after treatment. Friedman analysis of variance was performed to compare the data from the parameters repeatedly measured in the inner-group analysis. Bonferroni correction was performed to compare between groups as a post hoc test if the variance analysis test result was significant. To detect the group differences, the Bonferroni Student t test was used. The Mann-Whitney U test was used to compare numeric data between the groups. In the exercise group, although no significant difference in FDI scores was noted between the start of treatment and week 3 (p < 0.05), significant improvement was observed at week 6 (p < 0.001). In the laser group, significant improvement in FDI scores relative to baseline was observed at 3 and 6 weeks (p < 0.001). Improvements in FDI scores were significantly greater at weeks 3 and 6 in the laser group than those in the exercise group (p < 0.05). Our findings indicate that combined treatment with low-level laser therapy (LLLT) and exercise therapy is associated with significant improvements in FDI when compared with exercise therapy alone.

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Biostimulation with diode laser positively regulates cementoblast functions, in vitro

Abstract

The aim of this study was to evaluate the effects of diode laser biostimulation on cementoblasts (OCCM.30). A total of 40 root plates were obtained from healthy third molar teeth and assigned to the following two groups: (1) control group and (2) laser-treated group. Root plates were placed into the cell culture inserts, and OCCM.30 cells were seeded onto root plates. Cells were irradiated with a low level of diode laser (power: 0.3 W in continuous wave, 60 s/cm²). Proliferation and mineralized tissue-associated gene's and BMP's messenger RNA (mRNA) expressions of cementoblasts were evaluated. Total RNAs were isolated on day 3 and integrin-binding sialoprotein (Ibsp), bone gamma-carboxyglutamate protein (Bglap), Type I collagen (Col1a1), osteoblastic transcription factor, runt-related transcription factor (Runx2), and Bone Morphogenetic Protein (BMP)-2, 3, 4, 6, and 7 mRNA expressions were determined using quantitative RT-PCR. von Kossa staining was performed to evaluate biomineralization of OCCM.30 cells. In the proliferation experiment, while there was no significant difference until 96 h, laser irradiation retarded the decrease in cell proliferation trend after 96 h compared to the untreated control group. Statistically significant increase in Ibsp, Bglap, and BMP-2,3,6,7 mRNA expressions were noted in the laser groups when compared to the untreated control group (p < 0.05). Laser irradiation induced mineralized nodule formation of cementoblasts. The results of this study reveal that the biostimulation setting of diode laser modulates the behavior of cementoblasts inducing mineralized tissue-associated gene's mRNA expressions and mineralization. Therefore, biostimulation can be used during regenerative periodontal therapies to trigger cells with periodontal attachment apparatus.

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Downregulation of neuropilin-1 on macrophages modulates antibody-mediated tumoricidal activity

Abstract

Neuropilin-1 (NRP-1)-expressing macrophages are engaged in antitumor immune functions via various mechanisms. In this study, we investigated the role of NRP-1 on macrophages in antibody-mediated tumoricidal activity. Treatment of macrophages with NRP-1 knockdown or an anti-NRP-1-neutralizing antibody significantly suppressed antibody-dependent cellular cytotoxicity and modulated cytokine secretion from macrophages in vitro. Furthermore, in vivo studies using a humanized mouse model bearing human epidermal growth factor receptor-2 (HER2)-positive breast cancer xenografts showed that antibody-mediated antitumor activity and tumor infiltration of CD4⁺ T lymphocytes were significantly downregulated when peripheral blood mononuclear cells in which NRP-1 was knocked down were co-administered with an anti-HER2 antibody. These results revealed that NRP-1 expressed on macrophages plays an important role in antibody-mediated antitumor immunity. Taken together, the induction of NRP-1 on macrophages may be a therapeutic indicator for antibody treatments that exert antibody-dependent cellular cytotoxicity activity, although further studies are needed in order to support this hypothesis.

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FDA Clears Second Remicade Biosimilar (Renflexis)

The FDA approves infliximab-abda (Renflexis, Samsung Bioepis) for multiple indications.
FDA Approvals

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Comparison between clinical and audiological results of tympanoplasty with modified sandwich technique and underlay technique

Publication date: Available online 21 April 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Sanjana Vijay Nemade, Kiran Jaywant Shinde, Chetana Shivadas Naik, Haris Qadri
IntroductionSurgical repair of the tympanic membrane, termed a type one tympanoplasty is a tried and tested treatment modality. Overlay or underlay technique of tympanoplasty is common. Sandwich tympanoplasty is the combined overlay and underlay grafting of tympanic membrane.ObjectiveTo describe and evaluate the modified sandwich graft (mediolateral graft) tympanoplasty using temporalis fascia and areolar fascia. To compare the clinical and audiological outcome of modified sandwich tympanoplasty with underlay tympanoplasty.MethodsA total of 88 patients of chronic otitis media were studied. 48 patients (Group A) underwent type one tympanoplasty with modified sandwich graft. Temporalis fascia was underlaid and the areolar fascia was overlaid. 48 patients (Group B) underwent type one tympanoplasty with underlay technique. We assessed the healing and hearing results.ResultsSuccessful graft take up was accomplished in 47 patients (97.9%) in Group A and in 40 patients (83.3%) Group B. The average Air-Bone gap closure achieved in Group A was 24.4±1.7dB while in Group B; it was 22.5±3.5dB. Statistically significant difference was found in graft healing rate. Difference in hearing improvement was not statistically significant.ConclusionDouble layered graft with drum-malleus as a 'meat' of sandwich maintains a perfect balance between sufficient stability and adequate acoustic sensitivity.

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Erratum to: Review Article: Retropharyngeal Abscess—Mimickers and Masqueraders

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Invited Commentary: In vivo cutaneous malignancy diagnosis using mitochondrial imaging

Abstract

A recent study by Pouli et al. (2016) published in Science Translational Medicine used an elegant set of experiments to demonstrate the ability of mitochondrial monitoring to distinguish skin cancer cells from healthy tissue in vivo. This study reveals important implications regarding the future of real-time malignancy detection (Pouli 2016).

Skin cancers represent the vast majority of human malignancy, with the current estimated incidence of 4.5 million cases per year in the United States alone (Centers for Disease Control 2017).

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Professor Crispian Scully

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Cover Image

The cover image, by AG Barbe et al., is based on the Original Article Hyposalivation and xerostomia among Parkinson's disease patients and its impact on quality of life, DOI 10.1111/odi.12622.

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Vitamin D und UV-Schutz

Zusammenfassung

Erniedrigte Vitamin-D₃-Spiegel finden sich bei einem großen Prozentsatz der Bevölkerung. Erniedrigte Vitamin-D₃-Spiegel sind auszugleichen. Orale Substitution ist einfach und nebenwirkungsarm durchführbar. Da Vitamin D₃ durch Ultraviolett-B (UVB)-Strahlung in der Haut erzeugt wird, besteht die Möglichkeit, erniedrigte Vitamin-D₃-Spiegel auch durch UVB-Exposition auszugleichen. UVB, ein totales Kanzerogen, induziert aber Hautkrebs, was die Option, die Vitamin-D₃-Synthese durch UVB-Exposition zu stimulieren, einschränkt. UV-Schutzmaßnahmen insbesondere das Meiden von Sonnenexposition, das Tragen von Kleidung und UV-Schutzpräparate, wenn richtig angewandt, korrelieren mit reduzierten Vitamin-D₃-Spiegeln. Im Sinne einer Risiko-Nutzen-Abwägung ist der oralen Substitution von Vitamin D₃ der Vorzug vor UVB-/Sonnenexposition zur Erhöhung des Serum-Vitamin-D₃-Spiegels zu geben.

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Core Topics in Obstetric Anesthesia.

No abstract available

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Flurbiprofen Axetil Provides Effective Analgesia Without Changing the Pregnancy Rate in Ultrasound-Guided Transvaginal Oocyte Retrieval: A Double-Blind Randomized Controlled Trial.

BACKGROUND: In this prospective double-blind randomized study, we evaluated the analgesic effect and potential effect on pregnancy rate of the nonsteroidal anti-inflammatory drug flurbiprofen axetil in patients undergoing ultrasound-guided transvaginal oocyte retrieval under propofol-remifentanil anesthesia. METHODS: A total of 200 patients scheduled to undergo ultrasound-guided transvaginal oocyte retrieval were randomly allocated to receive 1.5 mg/kg of flurbiprofen axetil (FA group) or placebo (control group) 30 minutes before the procedure. Postoperative pain scores, embryo implantation rate, and pregnancy rate were recorded. Neuroendocrine biomarkers and prostaglandin E2 levels in follicular fluid were tested after oocyte retrieval. RESULTS: Patients in the FA group awakened earlier after surgery than patients in the control group (3.3 +/- 2.6 vs 5.3 +/- 3.4 minutes, P

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Quality Management in Intensive Care: A Practical Guide.

No abstract available

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In Response.

No abstract available

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Brain Tissue Oximetry: What Are We Really Measuring?.

No abstract available

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Cricoid Pressure, Gender, and Black Cats.

No abstract available

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Perioperative Outcomes of Robotic-Assisted Hysterectomy Compared With Open Hysterectomy.

BACKGROUND: Increasing numbers of robotic hysterectomies (RH) are being performed. To provide ventilation (with pneumoperitoneum and steep Trendelenburg position) for these procedures, utilization of lung protective strategies with limiting airway pressures and tidal volumes is difficult. Little is known about the effects of intraoperative mechanical ventilation and high peak airway pressures on perioperative complications. We performed a retrospective review to determine whether patients undergoing RH had increased pulmonary complications compared to total abdominal hysterectomy (TAH). METHODS: We performed a single center retrospective review comparing the intraoperative, anesthetic, and immediate and 30-day postoperative course of patients undergoing RH to TAH, including intraoperative ventilatory parameters and respiratory complications. Patients undergoing TAH (201) from 2004 to 2006 were compared to RH (251) from 2009 to 2012. It was our hypothesis that patients undergoing RH would have increased incidence of postoperative pulmonary complications. A secondary hypothesis was that morbid obesity predicts pulmonary complications in patients undergoing RH. Complications were compared between groups using Fisher's exact test. To account for potential confounders, the primary analysis was performed for a subgroup of patients matched on the propensity for RH. RESULTS: A total of 351 RH and 201 TAH procedures are included. Higher inspiratory pressures were required in ventilation of the RH group (median [25th, 75th] 31 [26, 36] cm H2O) than the TAH group (23 [19, 27] cm H2O) (P

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Scale-Ampule Assembly to Assess Ramp Position for Airway Management.

No abstract available

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Continuous Peripheral Nerve Blocks and Alternative Regional Analgesic Modalities: Clarification Regarding Relative Superiority.

No abstract available

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Lack of Association Between the Use of Nerve Blockade and the Risk of Postoperative Chronic Opioid Use Among Patients Undergoing Total Knee Arthroplasty: Evidence from the Marketscan Database.

BACKGROUND: Total knee arthroplasty (TKA) is associated with high rates of prolonged opioid use after surgery (10%-34%). By decreasing opioid use in the immediate postoperative period, perioperative nerve blockade has been hypothesized to decrease the risk of persistent opioid use. METHODS: Using health care utilization data, we constructed a sample of 120,080 patients undergoing TKA between 2002 and 2012 and used billing data to identify the utilization of peripheral or neuraxial blockade. We then used a multivariable logistic regression to estimate the association between nerve blockade and the risk of chronic opioid use, defined as having filled >=10 prescriptions or >=120 days' supply for an opioid in the first postsurgical year. Our analyses were adjusted for an extensive set of potential confounding variables, including -medical comorbidities, previous opioid use, and previous use of other medications. RESULTS: We did not find an association between nerve blockade and the risk of postsurgical chronic opioid use across any of these 3 groups: adjusted relative risk (ARR) 0.984 for patients opioid-naive in the year before surgery (98.3% confidence interval [CI], 0.870-1.12, P = .794), ARR 1.02 for intermittent opioid users (98.3% CI, 0.948-1.09, P = .617), and ARR 0.986 (98.3% CI, 0.963-1.01, P = .257) for chronic opioid users. Similar results held for alternative measures of postsurgical opioid use. CONCLUSIONS: Although the use of perioperative nerve blockade for TKA may improve short-term outcomes, the analyzed types of blocks do not appear to decrease the risk of persistent opioid use in the longer term. (C) 2017 International Anesthesia Research Society

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In Response.

No abstract available

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Attempted Development of a Tool to Predict Anesthesia Preparation Time From Patient-Related and Procedure-Related Characteristics.

BACKGROUND: Operating room (OR) utilization generally ranges from 50% to 75%. Inefficiencies can arise from various factors, including prolonged anesthesia preparation time, defined as the period from induction of anesthesia until patients are considered ready for surgery. Our goal was to use patient-related and procedure-related factors to develop a model predicting anesthesia preparation time. METHODS: From the electronic medical records of adults who had noncardiac surgery at the Cleveland Clinic Main Campus, we developed a model that used a dozen preoperative factors to predict anesthesia preparation time. The model was based on multivariable regression with "Least Absolute Shrinkage and Selection Operator" and 10-fold cross-validation. The overall performance of the final model was measured by R2, which describes the proportion of the variance in anesthesia preparation time that is explained by the model. RESULTS: A total of 43,941 cases met inclusion and exclusion criteria. Our final model had only moderate discriminative ability. The estimated adjusted R2 for prediction model was 0.34 for the training data set and 0.27 for the testing data set. CONCLUSIONS: Using preoperative factors, we could explain only about a quarter of the variance in anesthesia preparation time-an amount that is probably of limited clinical value. (C) 2017 International Anesthesia Research Society

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Assessing the Role of Place and Timing Cues in Coding Frequency and Amplitude Modulation as a Function of Age

Abstract

Natural sounds can be characterized by their fluctuations in amplitude and frequency. Ageing may affect sensitivity to some forms of fluctuations more than others. The present study used individual differences across a wide age range (20–79 years) to test the hypothesis that slow-rate, low-carrier frequency modulation (FM) is coded by phase-locked auditory-nerve responses to temporal fine structure (TFS), whereas fast-rate FM is coded via rate-place (tonotopic) cues, based on amplitude modulation (AM) of the temporal envelope after cochlear filtering. Using a low (500 Hz) carrier frequency, diotic FM and AM detection thresholds were measured at slow (1 Hz) and fast (20 Hz) rates in 85 listeners. Frequency selectivity and TFS coding were assessed using forward masking patterns and interaural phase disparity tasks (slow dichotic FM), respectively. Comparable interaural level disparity tasks (slow and fast dichotic AM and fast dichotic FM) were measured to control for effects of binaural processing not specifically related to TFS coding. Thresholds in FM and AM tasks were correlated, even across tasks thought to use separate peripheral codes. Age was correlated with slow and fast FM thresholds in both diotic and dichotic conditions. The relationship between age and AM thresholds was generally not significant. Once accounting for AM sensitivity, only diotic slow-rate FM thresholds remained significantly correlated with age. Overall, results indicate stronger effects of age on FM than AM. However, because of similar effects for both slow and fast FM when not accounting for AM sensitivity, the effects cannot be unambiguously ascribed to TFS coding.

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Acute generalized exanthematous pustulosis associated with ipilimumab and nivolumab

Abstract

Acute generalized exanthematous pustulosis (AGEP) is a rare potentially severe adverse cutaneous eruption, that is usually induced by a variety of drugs, most commonly anti-bacterial drugs. AGEP is characterized by the acute development of extensive, non-follicular, sterile pustules on an erythematous background accompanied by systemic symptoms such as fever and leucocytosis.¹ The prognosis is usually favourable, but in elderly patients with comorbidities morbidity and mortality are increased.²

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Sunscreen or Sun Screen?

In light of myths and concerns about sunscreen, Dr Lipper reviews whether natural alternatives are effective.
Medscape Dermatology

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Are We Overtreating Severely Dysplastic Nevi?

Even with negative margins, most severely dysplastic nevi are re-excised. Is this necessary or overtreatment?
Medscape Dermatology

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Dose Finding Study of TNO155 in Adult Patients With Advanced Solid Tumors

Conditions: Advanced EGFR-mutant Non-smallcell Lung Cancer; Head-and-Neck Squamous Cell Cancer; RAS/RAF Wild-type Other Solid Tumors
Intervention: Drug: TNO155
Sponsor: Novartis Pharmaceuticals
Not yet recruiting - verified April 2017

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Safety and Efficacy of CRS-207 With Pembrolizumab in Gastric, Gastroesophageal Junction or Esophageal Cancers

Conditions: Gastric Adenocarcinoma; Gastroesophageal Junction Adenocarcinoma; Esophageal Adenocarcinoma
Interventions: Biological: CRS-207; Biological: Pembrolizumab
Sponsors: Aduro Biotech, Inc.; Merck Sharp & Dohme Corp.
Not yet recruiting - verified April 2017

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The orbit first! A novel surgical treatment protocol for secondary orbitozygomatic reconstruction

Publication date: Available online 20 April 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Ruud Schreurs, Leander Dubois, Alfred G. Becking, Thomas J.J. Maal
A novel surgical treatment sequence for secondary orbitozygomatic complex (OZC) reconstruction is described. Orbital reconstruction is performed before OZC repositioning. A surgical plan is made: the affected OZC is virtually osteotomized and aligned with a mirrored model of the unaffected OZC. A patient-specific implant (PSI) is designed for orbital reconstruction. Screw holes from the primary reconstruction are used for fixation. Primary screw hole positions at the repositioned OZC are embedded in the design, to guide OZC repositioning. A second patient-specific design is made for guidance at the zygomaticomaxillary buttress.The workflow was utilized in two patients. The PSI was positioned using navigation feedback. After repositioning of the zygomatic complex, the screw hole positions at the infraorbital rim and zygomaticomaxillary buttress seemed to align perfectly: no screw hole adjustments were necessary. Minor deviations were seen between planned and acquired PSI position; the mean errors between planned and acquired OZC position were 1.5 and 1.2 mm.Orbital reconstruction with a PSI before OZC repositioning ensures true-to-original orbital reconstruction. The use of old screw hole positions enables the PSI to be used as a static guide for OZC repositioning. The combination of static and dynamic guidance increases predictability in secondary OZC reconstruction.

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Efficacy of proportional condylectomy in a treatment protocol for unilateral condylar hyperplasia: A review of 73 cases

Publication date: Available online 21 April 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Guillaume Mouallem, Zahia Vernex-Boukerma, Julie Longis, Jean-Philippe Perrin, Jean Delaire, Jacques-Marie Mercier, Pierre Corre
IntroductionUnilateral condylar hyperplasia (UCH) is characterized by an excessive growth of a mandibular condyle, resulting in facial, and occlusal deformities. Scintigraphic hyperactivity usually triggers the need of condylectomy. Delaire has presented a protocol for the treatment of active or non-active UCH using systematically a proportional condylectomy, which could solve both aetiology and adaptive deformities. The aim of this study was to evaluate this protocol by clinical and radiographical analysis.Materials and methodsSeventy-three patients with UCH were included in this retrospective study, and divided by clinical and cephalometric analysis in vertical, or transversal forms of UCH according to Delaire's classification. All patients were treated with 'proportional condylectomy', any indicated orthognathic procedures, along with maxilla-mandibular elastic therapy, and rehabilitation. Architectural, aesthetical, occlusal, and functional features were evaluated using clinical, cephalometric, and photographic measurements both preoperatively, and at the end of the follow-up.ResultsA female predominance was observed (65.8%). Vertical forms were more represented than transversal forms (61.6% vs 38.4%). There was a significant improvement of the occlusal plane, the posterior vertical excess, the chin deviation and the soft-tissue features (p<0.0001), regardless of the preoperative scintigraphic activity status (p<0.0001). The occlusion, and temporo-mandibular joint (TMJ) functions was considered as normal in respectively 72.7%, and 93% of the patients.ConclusionThe results of this study have demonstrated that a protocol using a 'proportional condylectomy', any indicated orthognathic techniques, maxilla-mandibular elastic therapy, and rehabilitation, is a reliable option for treating UCH, regardless the activity status of the pathology.

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Assessing the Role of Place and Timing Cues in Coding Frequency and Amplitude Modulation as a Function of Age

Abstract

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Hypoglycemia identified by a continuous glucose monitoring system in a second-trimester pregnant woman with insulinoma: a case report

Insulinoma associated with pregnancy is a very rare condition and can be difficult to diagnose. Here, we present an interesting case of insulinoma occurring during pregnancy with special attention paid to the ...

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Arterial spin-labelled perfusion MRI demonstrates early spontaneous recanalisation of clot after cardiogenic embolism

Description

A 71-year-old man with atrial fibrillation was presented to the emergency department 30 min after the sudden onset of disturbance of consciousness. On examination, he showed a disturbance of consciousness (Glasgow Coma Score: E4V2M5) and severe right hemiplegia, which subsequently improved, and he finally presented with moderate sensory aphasia alone. CT of the head showed no haemorrhage. Diffusion-weighted MRI (DW-MRI) of the brain showed a high-intensity spot lesion in the left insular cortex (figure 1A). Arterial spin-labelled (ASL) perfusion MRI showed hyperperfusion in the same area (figure 1B). Based on the dramatic improvement of symptoms and narrower infarction lesion on MRI than was initially anticipated, spontaneous recanalisation of a clot in the left middle cerebral artery was suspected, and oral rivaroxaban was initiated. On day 9, CT showed a mild haemorrhagic lesion on the left temporal lobe cortex (figure 2). On day...

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Ascites in a patient with episodic angio-oedema and eosinophilia: thinking outside the box

Episodic angio-oedema with eosinophilia (EAE) or Gleich's syndrome is a rare condition characterised by recurrent episodes of oedema and eosinophilia, accompanied by urticaria, fever and weight gain. The presence of ascites has not been reported so far. We report a 21-year-old Caucasian woman who presented with marked ocular oedema and ascites. Laboratory evaluation revealed marked eosinophilia. During the last 3 months, three episodes of facial and neck oedema were reported, which resolved spontaneously over a period of 3–5 days. The diagnosis of EAE was established after exclusion of secondary causes (infections, allergic reactions, collagen diseases, neoplasms) and clonal disorders associated with marked eosinophilia. Low-dose steroids resulted in eosinophil decrease and complete resolution of symptoms, including ascites. This case highlights that ascites can be a very rare manifestation of EAE particularly if other more frequent causes of ascites have been excluded and the clinical and laboratory findings are supportive of EAE.

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Conventional transanal excision for a very low gastrointestinal stromal tumour

Gastrointestinal stromal tumour (GIST) represents a rare tumour entity, which has been more intensively investigated during the last decade. The rectum as the primary site of GIST is even uncommon. The space constraints in the pelvis renders optimal oncological surgery demanding and proximity of these lesions to the anal sphincter enhances the potential morbidity of any radical surgery. We herein report on a young patient with a >5 cm rectal GIST localised at 1 cm from the anorectal junction.

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Primary malignant melanoma of the cervix: a rare disease

Malignant melanoma (MM) arising primarily in the cervix is exceedingly rare and has a poor prognosis. We report the case of a primary MM of the cervix in a 64-year-old woman with vaginal bleeding. She presented with a cervical amelanotic lesion which on biopsy rendered the diagnosis of MM. The patient was staged as International Federation of Gynecology and Obstetrics IIB and underwent Wertheim-Meigshysterectomy followed by brachytherapy. One year later, she was diagnosed with a large pelvic relapse for which surgery was performed. She then presented with a vaginal relapse and an isolated hepatic lesion, both of which were proposed for surgery. The diagnosis of MM of the cervix is a clinical and pathological challenge due to its rarity and overlapping features. Cytology cannot accurately diagnose it. Moreover, amelanotic MMs must be distinguished from other poorly differentiated carcinomas by diagnosis that ultimately relies on immunohistochemical staining. Radical surgery is the only treatment showing predictive benefit.

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An unusually large onychomatricoma

Onychomatricoma is a rare benign tumour of the nail matrix first described in 1992, and since then, no more than 80 cases have been reported. Despite distinct clinical characteristics, it is frequently misdiagnosed as onychomycosis partly due to remaining an unknown entity. The authors present the case of a patient with a 30-year history of nail abnormalities with more recent growth to alarming dimensions.

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Successful treatment of squamous cell carcinoma of the lip with electron beam therapy: a symphony of medicine and physics

Description

A female aged 57 years, a professional flautist by occupation presented with a history of non-healing 'pimple' on her left upper lip, which was gradually increasing in size over 6 months. There was history of occasional yellowish discharge and bleeding, provoked by her attempts to remove it. On examination, there was a firm non-tender swelling with fine, white crusting, measuring 5 mm at its widest along with surrounding induration of 1 cm (figure 1A), without involvement of the inner mucosa of lip.

Figure 1

Pretreatment and post-treatment images. (A) The visible lesion (black arrow) was surrounded by a 1 cm circumferential region of induration (white arrow) appreciated on palpation. These were marked on patients skin and a 2 cm margin (blue arrow) was also marked to serve as the planning target volume. Care was taken to exclude the nasal ala from this volume. To ensure reproducibility a custom...

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Use of gabapentin in the treatment of chronic pain in an adolescent with sickle cell disease

Vaso-occlusive crises are the most common manifestation of sickle cell disease (SCD) and the main cause of hospital admission in these patients. There is emerging evidence that vaso-occlusive pain has both nociceptive and neuropathic components. However, the treatment of SCD-related pain with neuropathic drugs has not yet been systematically studied, particularly in children. We describe a 14-year-old girl with SCD and multiple hospital admissions for pain management for severe acute vaso-occlusive pain episodes. The patient was evaluated by a multidisciplinary team of specialists which considered that the chronic, refractory pain she was experiencing for years was probably neuropathic in origin and it was decided to start oral gabapentin (300 mg/day). At 10 months follow-up, the patient reported remarkable improvement in her quality of life with a significant decrease in the number of hospital admissions (three admissions for acute vaso-occlusive pain episodes in 10 months versus the previously monthly recurrences).

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Ultrasound-B scan: an indispensable tool for diagnosing ocular cysticercosis

Description

Ocular cysticercosis is still an important parasitic infection in low/middle-income countries, as its diagnosis requires meticulous ocular examination followed by skilful usage of point-focused ultrasound imaging for confirmation of the diagnosis. A 26-year-old woman presented with a history of recurrent redness in the left eye, which was not responsive to topical medications. Clinical examination showed congestion in the inferior conjunctiva with the rest of the anterior and posterior segments being within normal limits. Subsequent ultrasound examination of the extraocular muscle showed a large cyst inferior to the rectus muscle with a high amplitude localised spike corresponding to scolex (figure 1A). In a second scenario, a middle-aged female patient presented with painless diminution of vision in the left eye; because of the hazy media, a posterior segment ultrasonography was performed which showed a well-defined cystic cavity in the mid-vitreous with a high amplitude echo suggesting a cysticercosis. (figure 1B)...

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Intravitreal cysticercosis with full thickness macular hole: management outcome and intraoperative optical coherence tomography features

Ocular cysticercosis is a serious condition with a potential for complete vision loss if left untreated. Intravitreal cysticercosis is the most common ocular form of cysticercosis and is associated with retinal detachment, retinal traction, subretinal scarring and vitritis. To the best of our knowledge, there is no report of the occurrence of a live intravitreal cysticercosis with a full thickness macular hole (FTMH) in the literature. We here report a case of live intravitreal cysticercosis with a FTMH along with its management and intraoperative optical coherence tomography features of the live cysticercus.

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Calcified cauliflower ear in relapsing polychondritis

Description

A 59-year-old man with chronic obstructive pulmonary disease (COPD) presented with dyspnoea for 3 days. Physical examination revealed diffuse rhonchi over chest, and very hard, thick, deformed auricles except for the ear lobules, which were soft (figure 1A). Patient reported remote history of episodic pain and redness of his ears and nose, which improved with over-the-counter pain medicines. A radiograph of the ears showed calcification of the auricular cartilages (figure 1B, white arrow). A complete blood count showed neutrophilic leucocytosis of 13.1x10³/µL and chronic normocytic anaemia of 12.3 g/dL. Inflammatory markers including erythrocyte sedimentation rate and C reactive protein, and renal and liver function tests were normal. Prior work-up was negative for antinuclear and antineutrophil cytoplasmic antibodies. A clinical diagnosis of relapsing polychondritis (RP) was made based on the reported history and the Michet criteria.1 Review of a prior lung function test ruled out any...

http://ift.tt/2pLMZ29

The Lazarus phenomenon: spontaneous cardioversion after termination of resuscitation in a Scottish hospital

A 66-year-old man suffered a ventricular fibrillation cardiac arrest after an episode of chest pain. Despite advanced life support, his condition deteriorated; the situation was considered irrecoverable and resuscitation was discontinued. The patient was observed for about 5 min with irregular agonal gasping respirations evident but no palpable pulse. A gradual increase in the regularity of breathing pattern heralded the return of spontaneous circulation. An inferior myocardial infarction was diagnosed. Primary percutaneous coronary intervention was performed. The patient was discharged from hospital after 9 days with no neurological sequelae. There are several possible mechanisms to explain the Lazarus phenomenon including auto-positive end expiratory pressure and delayed drug actions, but cases are rarely reported in the medical literature. After discontinued resuscitation, we suggest consideration should be given to a period of continued monitoring. However, evidence is limited and prospective studies would be welcome to allow firmer recommendations.

http://ift.tt/2p2QaBt

Aggregatibacter actinomycetemcomitans pneumonia with chest and abdominal wall involvement

A 54-year-old man presented with a productive cough, chest pain, fever and weight loss. Initial analysis revealed a palpable chest wall mass and consolidation in the left lower lobe and pleural abnormalities on imaging. At that point no infectious cause or malignancy was identified. Microbiological analysis of a needle biopsy from a newly developed abdominal wall mass revealed growth of Aggregatibacter actinomycetemcomitans. The patient was successfully treated with antibiotic therapy for 1 year. Aggregatibacter actinomycetemcomitans is a Gram-negative coccobacillus and is part of the normal oral flora. It is capable of causing infections in humans including periodontitis, soft tissue abscesses and systemic invasive infections, most commonly endocarditis.

http://ift.tt/2pKP4bC

A tale of two vasculitides: biopsy-proven giant cell arteritis followed by the independent development of renal-limited microscopic polyangiitis

We describe an 80-year-old woman who presented with headaches, bilateral jaw claudication and visual symptoms. She was diagnosed with giant cell arteritis, which was confirmed by temporal artery biopsy. She was treated with high-dose prednisone followed by a slow taper, with complete resolution of symptoms. Approximately 4 years later, she developed progressively worsening renal function associated with haematuria. Serological workup revealed a high-titre perinuclear antinuclear cytoplasmic antibody and antibodies to myeloperoxidase. Renal biopsy demonstrated a pauci-immune focal crescentic glomerulonephritis. Extensive review of systems, physical exam and diagnostic studies demonstrated no evidence of extra-renal disease, and she was diagnosed with renal-limited microscopic polyangiitis. High-dose prednisone was resumed, but she refused treatment with either cyclophosphamide or rituximab due to concern for toxicity. Her prednisone dose was tapered and renal function stabilised. Our case highlights the need to recognise the successive occurrence of two distinct vasculitides in a single patient and monitor accordingly.

http://ift.tt/2oYpU9l

Postintervention acute opsoclonus myoclonus syndrome

Opsoclonus myoclonus syndrome (OMS) is a rare, neurological condition affecting 1 in 10 000 000 people annually. Opsoclonus, defined as involuntary rapid, multivectorial oscillations of the eyes, together with ataxia and myoclonus are usually present. OMS may be paraneoplastic: often associated with occult neuroblastoma in childhood and with breast carcinoma or small cell lung carcinoma in adults. Other aetiologies include viral or toxic agents. The pathogenesis is thought to be immune mediated. A 37-year-old woman with previous inflammatory cranial mononeuropathies was admitted for elective dilatation and curettage (D&C). Immediately after she complained of left-sided paraesthesia and later became disoriented, with incoherent speech, inability to obey commands, opsoclonus of the eyes and myoclonic jerks. Investigations including onconeuronal antibodies, cerebrospinal fluid analysis, and imaging were normal. She was treated with intravenous methylprednisolone with rapid improvement. Previous surgeries with anaesthesia were uncomplicated. The anaesthetic agents used for the D&C were fentanyl and propofol.

http://ift.tt/2pLE5Sa

Why tuberculosis control programmes fail? Role of microlevel and macrolevel factors: an analysis from India.

India accounts for one-fourth of the global tuberculosis (TB) burden. The National TB Program was started in 1962. Over a period of time, some lacunae such as poor case detection rate and incomplete treatment were observed. Later, the government formulated the Revised National Tuberculosis Control Program (RNTCP), which achieved a case detection rate of 70% and a cure rate of 85%. Still, the problem of relapse and defaulter cases persists. In 2014, 6% defaulter cases were reported from India. RNTCP has also focused on microlevel aspects, that is, newer diagnostics such as GenXpert, line probe assay and medicines such as bedaquiline for drug-resistant TB. Action on the macrolevel aspects, for example, social determinants, is ignored. This is natural because these are out of the purview of the health sector. This case study reflects how a resident doctor in a rural clinic of North India tried to resolve the macrolevel and microlevel issues pertaining to defaulter TB cases.

http://ift.tt/2oYiHX5

Population pharmacokinetics of intravenous acetaminophen in Japanese patients undergoing elective surgery

Abstract

Introduction

Intravenous (i.v.) acetaminophen is administered during surgery for postoperative analgesia. However, little information is available on the pharmacokinetics of i.v. acetaminophen in Japanese patients undergoing surgery under general anesthesia.

Methods

The study was approved by the Institutional Review Board and registered at UMIN-CTR (UMIN000013418). Patients scheduled to undergo elective surgery under general anesthesia were enrolled after obtaining written informed consent. During surgery, 1 g of i.v. acetaminophen was administered over 15, 60, or 120 min. Acetaminophen concentrations (15 or 16 samples per case) were measured at time points from 0−480 min after the start of administration (liquid chromatography−mass spectrometry/tandem mass spectrometry; limit of quantitation 0.1 μg/mL). The predictive performance of three published pharmacokinetic models was evaluated. Population pharmacokinetics were also analyzed using a nonlinear mixed-effect model based on the NONMEM program.

Results

Data from 12 patients who underwent endoscopic or lower limb procedures were analyzed (male/female = 7/5, median age 55 years, weight 63 kg). Anesthesia was maintained with remifentanil and propofol or sevoflurane. The pharmacokinetic model of i.v. acetaminophen reported by Würthwein et al. worked well. Using 185 datapoints, the pharmacokinetics of i.v. acetaminophen were described by a two-compartment model with weight as a covariate but not age, sex, or creatinine clearance. The median prediction error and median absolute prediction error of the final model were −1 and 10%, respectively.

Conclusion

A population pharmacokinetic model of i.v. acetaminophen in Japanese patients was constructed, with performance within acceptable ranges.

http://ift.tt/2otl1nC

Surgeon Volume in Parathyroid Surgery-Surgical Efficiency, Outcomes, and Utilization.

Surgeon Volume in Parathyroid Surgery-Surgical Efficiency, Outcomes, and Utilization.

JAMA Otolaryngol Head Neck Surg. 2017 Apr 20;:

Authors: Meltzer C, Klau M, Gurushanthaiah D, Tsai J, Meng D, Radler L, Sundang A

PMID: 28426880 [PubMed - as supplied by publisher]

http://ift.tt/2obiNgY

JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngol Head Neck Surg. 2017 Apr 01;143(4):332

Authors:

PMID: 28426863 [PubMed - in process]

http://ift.tt/2pKq3x6

Additional Data for Figures.

Additional Data for Figures.

JAMA Otolaryngol Head Neck Surg. 2017 Apr 01;143(4):430

Authors:

PMID: 28426861 [PubMed - in process]

http://ift.tt/2objMxi

Unilateral Hearing Loss and Otorrhea.

Unilateral Hearing Loss and Otorrhea.

JAMA Otolaryngol Head Neck Surg. 2017 Apr 20;:

Authors: Costello MS, Stevens S, Samy RN

PMID: 28426851 [PubMed - as supplied by publisher]

http://ift.tt/2oYbEh7

Differences in Survival With Surgery and Postoperative Radiotherapy Compared With Definitive Chemoradiotherapy for Oral Cavity Cancer: A National Cancer Database Analysis.

Differences in Survival With Surgery and Postoperative Radiotherapy Compared With Definitive Chemoradiotherapy for Oral Cavity Cancer: A National Cancer Database Analysis.

JAMA Otolaryngol Head Neck Surg. 2017 Apr 20;:

Authors: Spiotto MT, Jefferson G, Wenig B, Markiewicz M, Weichselbaum RR, Koshy M

Abstract
Importance: Because locally advanced oral cavity squamous cell carcinoma (OCSCC) is often treated with surgery followed by postoperative radiotherapy (S+PORT), the effectiveness of organ preservation with concurrent chemoradiotherapy (CRT) remains unclear.
Objective: To compare the differences in survival between patients with locally advanced OCSCC treated with S+PORT or CRT.
Design, Setting, and Participants: Using the National Cancer Database, this study compared 6900 patients with stage III to IVA OCSCC treated with S+PORT and CRT from 2004 through 2012 at academic and community-based cancer clinics. Comparisons were made using Kaplan-Meier methods and Cox proportional hazards regression models using the entire cohort and a propensity score-matched cohort of 2286 patients.
Main Outcomes and Measures: Overall survival (OS).
Results: Of the 6900 study patients, 4809 received S+PORT (3080 male [64.0%] and 1792 [36.0%] female) and 2091 received CRT (1453 male [69.5%] and 638 [30.5%] female). Median follow-up for the entire group was 23.0 months overall but was shorter for patients receiving CRT (17.3-month) vs S+PORT (25.6 months). Patients receiving CRT were more likely to be older than 60 years, treated before 2007, live within 10 miles of the treating facility, treated at nonacademic centers, have more comorbidities, have T3 to T4a tumors, and have N2a to N2c nodal disease. Propensity score matching identified cohorts of patients with similar clinical variables. S+PORT was associated with improved survival among all patients (3-year OS: 53.9% for S+PORT vs 37.8% for CRT; difference = 16.1%; 95% CI, 13.6%-18.6%) and in the propensity score-matched cohort (3-year OS: 51.8% for S+PORT vs 39.3% for CRT; difference = 11.9%; 95% CI, 7.8%-16.0%). S+PORT was associated with improved survival among patients with T3 to T4a tumors (3-year OS: 49.7% for S+PORT vs 36.0% for CRT; difference = 16.1%; 95% CI, 13.6%-18.6%) but was not associated with improved survival among patients with T1 to T2 tumors (3-year OS: 59.1% for S+PORT vs 53.5% for CRT; difference = 5.6%; 95% CI, -3.1% to 14.3%).
Conclusions and Relevance: Compared with CRT, S+PORT was associated with improved survival for locally advanced OCSCCs, especially in T3 to T4a disease. These data support the use of surgery as the initial treatment modality for operable OCSCCs.

PMID: 28426848 [PubMed - as supplied by publisher]

http://ift.tt/2pL6o3a

Understanding the Risks and Harms of Management of Incidental Thyroid Nodules: A Review.

Understanding the Risks and Harms of Management of Incidental Thyroid Nodules: A Review.

JAMA Otolaryngol Head Neck Surg. 2017 Apr 20;:

Authors: Hoang JK, Nguyen XV

Abstract
Importance: Incidental thyroid nodules are defined as nodules originally detected in a patient with no thyroid-related clinical symptoms, examination findings, or suspected thyroid disease. Medical imaging for diseases in the neck, chest, and spine is a common source of incidental thyroid nodules. They are easily detected but poorly characterized. The next step is to decide whether the incidental thyroid nodule should be further evaluated with ultrasonography.
Observations: Indiscriminate workup of incidental thyroid nodules with ultrasonography is not cost-effective and is potentially harmful. Although the concern for malignant neoplasms drives workup, the risk for poor outcomes without evaluation is minimal. The rate of malignant tumors in patients with 1 or more thyroid nodules larger than 5 mm is only 1.6%, and most small thyroid cancers are indolent. Substantial evidence suggests that a reservoir of thyroid cancers does not progress, and workup after detection with imaging leads to epidemiologic overdiagnosis. Finally, a significant proportion of patients with benign nodules have cytologic results that are not definitive and require lobectomy. Evidence-based recommendations for incidental thyroid nodules detected at computed tomography, magnetic resonance imaging, nuclear medicine studies, and extrathyroidal ultrasonography include selection criteria for nodule workup based on suspicious imaging findings, patient age, and nodule size. In the absence of clinical risk factors or suspicious imaging findings, workup with dedicated thyroid ultrasonography is only recommended for nodules at least 1.5 cm in patients 35 years or older and for nodules at least 1.0 cm in patients younger than 35 years.
Conclusions and Relevance: Only a few select incidental thyroid nodules require further evaluation with ultrasonography based on recommendations that aim to diagnose clinically significant thyroid cancers while reducing unnecessary workup and provide guidance for clinical practice.

PMID: 28426843 [PubMed - as supplied by publisher]

http://ift.tt/2ot3Frk

‘Extraction dermoscopy’ as a rapid and innovative diagnostic tool for eruptive vellus hair cyst

http://ift.tt/2owRWqY

The development, evidence, and current use of ATX-101 for the treatment of submental fat

Summary

ATX-101 (deoxycholic acid) is the first pharmaceutical therapy approved by the FDA for the reduction in submental fat. Deoxycholic acid is an endogenous secondary bile acid that normally solubilizes dietary fat, contributing to its breakdown and absorption within the gut. This article reviews the identification of deoxycholic acid as a lipolytic agent, and the mechanism of action, pharmacokinetics, and pharmacodynamics of ATX-101. In addition to phase I/II trials, four Phase III clinical trials have evaluated safety and efficacy of ATX-101. These studies helped establish the appropriate dosage, administration techniques, warnings, and side effects of ATX-101. ATX-101 is effective in treating submental fat. Adverse events, although common, are mild and transient.

http://ift.tt/2ob9kpS

Clinical bandings of Patient-Oriented Eczema Measure (POEM) scores among Japanese atopic eczema patients

Atopic eczema (AE) has a high prevalence worldwide, imposing a tremendous burden on patients in terms of the cost and time and the psychological trauma. The Harmonizing Outcome Measures for Eczema (HOME) members achieved a consensus that outcome domains for AE trials should include clinical signs, symptoms, long-term control of flares and quality of life. The Patient-Oriented Eczema Measure (POEM) is a self-assessed, repeatable measurement tool, so patients can monitor their own eczema severity without visiting a hospital.

http://ift.tt/2oXP7kh

Photobiomodulation therapy associated with treadmill training in the oxidative stress in a collagen-induced arthritis model

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by chronic and systemic inflammation, which leads to the destruction of the cartilage and bone and affects tissues in multiple joints. Oxidative stress has been implicated with regards to involvement in various disease conditions, such as diabetes mellitus and neurodegenerative, respiratory, cardiovascular, and RA diseases. In vivo experimental studies using photobiomodulation therapy (PBMT) have shown positive effects in reducing lipid peroxidation and in increasing antioxidant activity. The regular practice of physical exercise has also been reported to be a beneficial treatment capable of reducing oxidative damage. Thus, the aim of this study was to analyze the effects of photobiomodulation therapy at 2- and 4-J doses associated with physical exercise on oxidative stress in an experimental model of RA in protein expression involving superoxide dismutase (SOD), glutathione peroxidase (GPX), and/or catalase (CAT) on thiobarbituric acid reactive substances (TBARS). In this study, 24 male Wistar rats divided into four groups were submitted to an RA model (i.e., collagen-induced arthritis, CIA), with the first immunization performed at the base of the tail on days 0 and 7 were included. After 28 days, a third intraarticular dose was administered in both knees of the animals. After the last induction, PBMT was started immediately, transcutaneously at two points (i.e., the medial and lateral), with a total of 15 applications. Treadmill exercise was also started the day after the last induction, and lasted for 5 weeks. With respect to results, we obtained the decreases in the lipid peroxidation and the increases of the antioxidant activities of SOD, GPX and CAT, with physical exercise associated to PBMT in doses of 2 and 4 J. In conclusion, physical exercise associated with PBMT decreases lipid peroxidation and increases antioxidant activity.

http://ift.tt/2p28VFx

Αρχειοθήκη ιστολογίου

Παρασκευή 21 Απριλίου 2017

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