Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Σάββατο 22 Απριλίου 2017

Pathogenic CD4+ T cells in patients with asthma

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Publication date: Available online 22 April 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Lyndsey M. Muehling, Monica G. Lawrence, Judith A. Woodfolk
Asthma encompasses a variety of clinical phenotypes that involve distinct T cell–driven inflammatory processes. Improved understanding of human T-cell biology and the influence of innate cytokines on T-cell responses at the epithelial barrier has led to new asthma paradigms. This review captures recent knowledge on pathogenic CD4+ T cells in asthmatic patients by drawing on observations in mouse models and human disease. In patients with allergic asthma, TH2 cells promote IgE-mediated sensitization, airway hyperreactivity, and eosinophilia. Here we discuss recent discoveries in the myriad molecular pathways that govern the induction of TH2 differentiation and the critical role of GATA-3 in this process. We elaborate on how cross-talk between epithelial cells, dendritic cells, and innate lymphoid cells translates to T-cell outcomes, with an emphasis on the actions of thymic stromal lymphopoietin, IL-25, and IL-33 at the epithelial barrier. New concepts on how T-cell skewing and epitope specificity are shaped by multiple environmental cues integrated by dendritic cell "hubs" are discussed. We also describe advances in understanding the origins of atypical TH2 cells in asthmatic patients, the role of TH1 cells and other non-TH2 types in asthmatic patients, and the features of T-cell pathogenicity at the single-cell level. Progress in technologies that enable highly multiplexed profiling of markers within a single cell promise to overcome barriers to T-cell discovery in human asthmatic patients that could transform our understanding of disease. These developments, along with novel T cell–based therapies, position us to expand the assortment of molecular targets that could facilitate personalized treatments.



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Conversion Disorder, Functional Neurological Symptom Disorder, and Chronic Pain: Comorbidity, Assessment, and Treatment

Abstract

Purpose of Review

This paper examines the overlap of conversion disorder with chronic pain conditions, describes ways to assess for conversion disorder, and provides an overview of evidence-based treatments for conversion disorder and chronic pain, with a focus on conversion symptoms.

Recent Findings

Conversion disorder is a significant problem that warrants further study, given that there are not many well-established guidelines. Accurate and timely assessment should help move treatment in a more fruitful direction and avoid unnecessary medical interventions. Advances in neuroimaging may also help further our understanding of conversion disorder. Creating a supportive environment and a collaborative treatment relationship and improving understanding of conversion symptoms appear to help individuals diagnosed with conversion disorder engage in appropriate treatments. Novel uses of earlier treatments, such as hypnosis and psychodynamic approaches, could potentially be beneficial and require a more vigorous and systematic study.

Summary

There are treatments that produce significant improvements in functioning and reduction of physical symptoms from conversion disorder even for very severe cases. Hypnotherapy, cognitive behavioral therapy, and inpatient multidisciplinary treatment with intensive physiotherapy for severe cases have the most evidence to support reduction of symptoms. Components of treatment for conversion disorder overlap with treatments for chronic pain and can be used together to produce therapeutic effects for both conditions. Treatment needs to be tailored for each individual's specific symptoms.



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Positive airway pressure adherence and mask interface in the setting of sinonasal symptoms

Objectives/Hypothesis

Despite reports of lower positive pressure adherence rates with oronasal masks, patients with sinonasal problems are often prescribed this interface over a nasal interface. The aim of this study was to characterize the relationship between mask type and therapy adherence in the setting of sinonasal symptoms.

Study Design

Retrospective case series with chart review.

Methods

We reviewed 328 patients who underwent positive pressure titration between January 2012 and May 2015. Follow-up adherence data were available for 218 patients (66.5%). Multivariate analysis examined whether patients with sinonasal symptoms have improved adherence with oronasal masks compared to nasal or nasal pillow interfaces.

Results

At a median follow-up of 95 days, positive pressure adherence in patients with sinonasal symptoms was highest with the nasal pillow interface. When compared with oronasal interfaces, the odds of adequate therapy adherence were >5 times greater with nasal pillow interfaces (odds ratio [OR] = 5.20, 95% confidence interval [CI] = 1.61-16.80, P = .006) and >3 times greater with nasal interfaces (OR = 3.67, 95% CI = 1.20-11.26, P = .02) in these symptomatic patients.

Conclusions

The presence of nasal problems does not predict the need for an oronasal mask. Positive pressure adherence rates are higher with nasal and nasal pillow interfaces compared to oronasal masks, even in patients with sinonasal complaints.

Level of Evidence

4. Laryngoscope, 2016



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FKBP51s signature in peripheral blood mononuclear cells of melanoma patients as a possible predictive factor for immunotherapy

Abstract

The inhibitory immune checkpoint PD-L1/PD1 promotes the alternative splicing of the FKBP5 gene, resulting in increased expression of its variant 4 in the peripheral blood mononuclear cells of melanoma patients. The variant 4 transcript is translated into the truncated FKBP51s protein. Given the importance of co-inhibitory signalling in tumour immune escape, here we tested the potential for using FKBP51s expression to predict immunotherapy outcomes. To do this, we immunophenotyped PBMCs from 118 melanoma patients and 77 age- and sex-matched healthy controls. Blood samples were collected before patients underwent ipilimumab treatment. In 64 of the 118 patients, FKBP51s expression was also assessed in regulatory T cells (Tregs). We found that each PBMC subset analysed contained an FKBP51spos fraction, and that this fraction was greater in the melanoma patients than healthy controls. In CD4 T lymphocytes, the FKBP51sneg fraction was significantly impaired. Tregs count was increased in melanoma patients, which is in line with previous studies. Also, by analyses of FKBP51s in Tregs, we identified a subgroup of ipilimumab nonresponder patients (p = 0.002). In conclusion, FKBP51s-based immunophenotyping of melanoma patients revealed several profiles related to a negative immune regulatory control and identified an unknown Treg subset. These findings are likely to be useful in the selection of the patients that are candidate for immunotherapy.



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Comparative study of three kinds of fibula cutting guides in reshaping fibula for the reconstruction of mandible: An accuracy simulation study in vitro

In order to get predictable reassembling and higher accuracy in the reconstruction of the mandible, we designed three kinds of fibula cutting guides: (1) two-edge wide groove guide (WGG); (2) two-edge narrow groove guide (NGG); and (3) one-edge guide (OEG). The purpose of this study was to compare the accuracy of fibula remodelling using the three kinds of fibula cutting guides above in a simulation procedure in vitro.

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

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Publication date: Available online 21 April 2017
Source:Auris Nasus Larynx
Author(s): David Ibarra, Francisco Tavira-Sanchez, Manuel Recuero-Lopez, Brian W. Anthony
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. In the last decades, the use of sound or sound enrichment has become a central part of many tinnitus management programs used by audiologists, whether the intention was to mask tinnitus, suppress tinnitus, or interrupt the tinnitus generating neural activity.Several acoustic therapies have been developed and implemented in the last 40 years, but how can we determine which one is the most effective? We can determine the effects based on the results reported in many research studies, but in those studies are many factors that differ from one study to another, like in-ear medical devices used to apply acoustic therapy for tinnitus treatment.In this article, we review and analyze the different types of in-ear medical devices used in the most recently acoustic therapies in treatments against tinnitus, allowing us to identify the pros and cons. By our analysis, an optimal medical device could be characterized to enhance the application of acoustic therapies and in consequence the global results of the sound therapies that already exist. In this review, it was considered acoustic therapies, the technology implemented in medical devices and the clinical needs.



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The evaluation of pattern and quality of sleep in patients with chronic rhinosinusitis with nasal polyps

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Publication date: Available online 22 April 2017
Source:Auris Nasus Larynx
Author(s): Uzdan Uz, Kıvanç Günhan, Hikmet Yılmaz, Halis Ünlü
ObjectiveThe goal of this study is to evaluate the impact of chronic rhinosinusitis with nasal polyps (CRSwNP) on sleep pattern and sleep quality before and after functional endoscopic sinus surgery using subjective and objective parameters.MethodsTwenty-two patients with CRSwNP were evaluated. All subjects underwent assessment by nasal endoscopy, rhinomanometry and computed tomography. Sleep pattern and sleep quality were evaluated by Pittsburgh sleep quality index (PSQI) and polysomnography (PSG). All patients were reassessed 6 months after surgery.ResultsNasal resistance decreased after the surgery (p<0.001). Postoperative PSQI scores were significantly lower than preoperative scores (p<0.001). The preoperative mean values of total apnea index and apnea-hypopnea index were 25.4 and 13.3, respectively. After surgery, the total apnea and apnea-hypopnea index had decreased significantly to 7.8 and 11.2, respectively (p=0.009 and 0.019, respectively).ConclusionIn patients with CRSwNP, functional endoscopic sinus surgery significantly ameliorates sleep pattern and sleep quality. CRSwNP may be a predisposing factor for sleep related respiratory disorders.



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Cochlear implantation in children with anomalous cochleovestibular anatomy

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Publication date: Available online 22 April 2017
Source:Auris Nasus Larynx
Author(s): Ana Sofia Melo, Jorge Martins, João Silva, Jorge Quadros, António Paiva
ObjectiveThe aim of the study is to assess the audiological and surgical outcome after cochlear implantation in children with inner ear malformation and to compare them with a group of congenitally deaf children implantees without inner ear malformation.IntroductionChildren with profound sensorineural deafness with malformations of the inner ear represent a challenge, accounting to 5–15% of congenital sensorineural deafness. These cases were originally regarded as a contraindication for cochlear implant surgery.MethodsRetrospective study of 26 patients with congenital inner ear malformation, from a total population of 329 cochlear implant patients. Radiological evaluation with high resolution computed tomography and magnet resonance was performed to all patients in order to evaluate all the preoperative conditions. All patients were tested using European Portuguese word discrimination tests (monosyllabic test, number test and sentences test), capacity of auditory performance (CAP) and speech intelligibility rating (SIR).ResultsIn all 7.9% of deaf children in our center study have inner ear abnormalities. All children underwent successful implantation. CAP yielded an average 7.1 (+/−1.7), SIR 4.3 (+/−1.0). The children without inner ear abnormalities did not achieve statistically significant better scores. Two children had a perilymph gusher, and there were no other complications.ConclusionCochlear implantation can be successfully performed in children with inner ear malformation. Audiological performance after cochlear implantation in malformed inner ears is comparable to that found in other congenitally deaf patients. The risk of CSF leak is associated with inner ear abnormalities and should be anticipated during surgery.



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

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Publication date: Available online 22 April 2017
Source:American Journal of Otolaryngology
Author(s): Jay Agarwal, Sameep Kadakia, Abbas Agaimy, Anna Ogadzanov, Azita Khorsandi, Raymond L. Chai
BackgroundPleomorphic 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.MethodsMulti-institutional study including two cases of PL, the first case occurring in the post-auricular region and the second in the cheek with later recurrence within the parotid bed.ResultsBoth patients were treated surgically with wide local excision. One patient required reoperation to obtain negative margins. The other patient underwent a total parotidectomy with neck dissection for recurrent intraparotid nodal disease. Both patients underwent adjuvant radiotherapy. No patient had evidence of recurrent disease with minimum one year follow-up.ConclusionAlthough the literature is sparse on this disease, wide surgical extirpation with negative margins and adjuvant radiation is recommended. Increased reports of this pathology can be helpful in providing practitioners with experienced-based information that can aid in early detection and treatment. We present the first case series of PL of the head and neck in the literature.



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

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 ...

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Solvent-dependent transformation of aflatoxin B 1 in soil

Abstract

To date, all studies of aflatoxin B1 (AFB1) transformation in soil or in purified mineral systems have identified aflatoxins B2 (AFB2) and G2 (AFG2) as the primary transformation products. However, identification in these studies was made using thin layer chromatography which has relatively low resolution, and these studies did not identify a viable mechanism by which such transformations would occur. Further, the use of methanol as the solvent delivery vehicle in these studies may have contributed to formation of artifactual transformation products. In this study, we investigated the role of the solvent vehicle in the transformation of AFB1 in soil. To do this, we spiked soils with AFB1 dissolved in water (93:7, water/methanol) or methanol and used HPLC-UV and HPLC-MS to identify the transformation products. Contrasting previous published reports, we did not detect AFB2 or AFG2. In an aqueous-soil environment, we identified aflatoxin B2a (AFB2a) as the single major transformation product. We propose that AFB2a is formed from hydrolysis of AFB1 with the soil acting as an acid catalyst. Alternatively, when methanol was used, we identified methoxy aflatoxin species likely formed via acid-catalyzed addition of methanol to AFB1. These results suggest that where soil moisture is adequate, AFB1 is hydrolyzed to AFB2a and that reactive organic solvents should be avoided when replicating natural conditions to study the fate of AFB1 in soil.



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A rare case of three single rooted permanent second molars: A diagnosis with cone beam computed tomography (CBCT)

Publication date: Available online 22 April 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Monika koul, Mrinalini Shahi, Ahsan Abdullah, Vinod Upadhyay
The aim of this article is to present a case with an unusual morphology of maxillary second molars on both sides and a mandibular second molar on right side in the same patient which was observed during routine endodontic procedure. Three second permanent molars had single root, single canal and an accurate assessment of this unusual morphology was made with the help of radiographs and cone beam computed tomography (CBCT). This report extends the range of known possible anatomical variations to include teeth with lesser number of roots and canals.



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Point-of-care ultrasound for oral and maxillofacial surgeons

Point-of-care ultrasound is an ultrasound examination that is made at the bedside by the examining clinician in the Accident and Emergency department, clinic, ward, or operating theatre, and it has been growing in popularity since it was first introduced in the 1990s. It is used as an adjunct to clinical examination to aid diagnosis or treatment. We have carried out a pilot survey to assess whether oral and maxillofacial surgeons in the United Kingdom either need or desire to make such an examination.

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The evaluation of pattern and quality of sleep in patients with chronic rhinosinusitis with nasal polyps

The goal of this study is to evaluate the impact of chronic rhinosinusitis with nasal polyps (CRSwNP) on sleep pattern and sleep quality before and after functional endoscopic sinus surgery using subjective and objective parameters.

http://ift.tt/2p3US07

Cochlear implantation in children with anomalous cochleovestibular anatomy

The aim of the study is to assess the audiological and surgical outcome after cochlear implantation in children with inner ear malformation and to compare them with a group of congenitally deaf children implantees without inner ear malformation.

http://ift.tt/2pRg2Bq

Parotid gland involvement as an initial presentation of papillary thyroid carcinoma

Papillary thyroid carcinoma (PTC) is the most differentiated malignant thyroid neoplasm. Local metastases of PTC commonly occur in the regional lymph nodes, while distant metastases are mainly to the lung and bone. The case of a patient with PTC who presented with swelling of the parotid gland and neck, mimicking a primary parotid neoplasm, is presented herein. This case is unique due to the unexpected initial presentation of PTC with no signs of disease in the thyroid gland.

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Ototoxicity of boric acid powder in a rat animal model

Publication date: Available online 22 April 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Murat Salihoglu, Salim Dogru, Enver Cesmeci, Halil Caliskan, Onuralp Kurt, Zafer Kuçukodaci, Atila Gungor
IntroductionBoric acid, which has antiseptic and acidic properties, is used to treat external and middle ear infections. However, we have not found any literature about the effect of boric acid powder on middle ear mucosa and inner ear.ObjectiveThe purpose of this study is to investigate possible ototoxic effects of boric acid powder (BAP) on cochlear outer hair cell function and histological changes in middle ear mucosa in a rat animal model.MethodsTwenty healthy, mature Wistar albino rats were used in this study. The rats were divided into two groups, Group A and Group B, each of which consisted of 10 rats. Initially, the animals in each group underwent distortion product otoacoustic emissions (DPOAE) testing of their right and left ears. After the first DPOAE test, a surgical microscope was used to make a small perforation in both ears of the rats in each group, and a second DPOAE test was used to measure both ears in all of the rats. BAP was applied to the right middle ear of the rats using tympanic membrane perforation, and the DPOAEs were measured immediately after the BAP application. The histological changes and DPOAEs were evaluated three days later in Group A and 40 days later in Group B.ResultsNo significant differences were found at all of the DPOAE frequencies. In Group A, mild inflammation of the middle ear mucosa was found on the third day after BAP application. In Group B, BAP caused mild inflammatory changes on the 40th day, which declined over time. Those changes did not lead to significant fibrosis within the mucosa.ConclusionIn rats, BAP causes mild inflammation in middle ear mucosa and it has no ototoxic effects on cochlear outer hair cell function in the inner ear of rats.



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Differentiating Middle Ear and Medial Olivocochlear Effects on Transient-Evoked Otoacoustic Emissions

Abstract

The response of the inner ear is modulated by the middle ear muscle (MEM) and olivocochlear (OC) efferent systems. Both systems can be activated reflexively by acoustic stimuli delivered to one or both ears. The acoustic middle ear muscle reflex (MEMR) controls the transmission of acoustic signals through the middle ear, while reflex activation of the medial component of the olivocochlear system (the MOCR) modulates cochlear mechanics. The relative prominence of the two efferent systems varies widely between species. Measuring the effect of either of these systems can be confounded by simultaneously activating the other. We describe a simple, sensitive online method that can identify the effects both systems have on otoacoustic emissions (OAEs) evoked by transient stimuli such as clicks or tone pips (TEOAEs). The method detects directly in the time domain the changes in the stimulus and/or emission pressures caused by contralateral noise. Measurements in human participants are consistent with other reports that the threshold for MOCR activation is consistently lower than for MEMR. The method appears to control for drift and subject-generated noise well enough to avoid the need for post hoc processing, making it promising for application in animal experiments (even if awake) and in the hearing clinic.



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Editorial Board

Publication date: May 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 5





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Announcements

Publication date: May 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 5





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EACMFS Prizes and Awards

Publication date: May 2017
Source:Journal of Cranio-Maxillofacial Surgery, Volume 45, Issue 5





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

Publication date: Available online 22 April 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Ali-Farid Safi, Andrea Grandoch, Hans-Joachim Nickenig, Joachim E. Zöller, Matthias Kreppel




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Airway spray efficacy of local anesthetic with fiberscope



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Pupilloplasty to prevent dexamethasone intravitreal implant migration to anterior chamber

Description

We present a case of a 84-year-old man, treated with dexamethasone intravitreal implant (Ozurdex®) for Irvine-Gass syndrome after complicated cataract surgery, with subsequent vitrectomy and retropupillar positioning of iris-fixated intraocular lens. Four weeks after the implantation, the patient presented with the implant in the anterior chamber. To prevent corneal oedema, the implant was removed the day after. After evaluating the anterior segment, the communication between the vitreal cavity and the anterior chamber, through which the implant has migrated, was found (figure 1A). The cystoid macular oedema (CME) reappeared (figure 2A), so, the patient was submitted to pupilloplasty and implantation of dexamethasone intravitreal implant in the same procedure (figure 1B). Two months after the implantation, the CME has significantly improved (figure 2B) and there was no new migration of the implant.

Figure 1

(A) Anterior segment photography after...



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Rugger-jersey spine in osteopetrosis

Description

A 30-year-old Japanese man presented to our hospital with a fall injury. He had no medication or family history. His height and weight were within the normal ranges, and physical and neurological examination results were non-specific. His calcium and phosphorus levels were within the standard limits. X-ray images showed calcification of the lumbar vertebrae, bilateral sacroiliac joint, acetabulum and caput femoris where gravity was applied (figures 1 and 2). The border of the lumbar vertebrae ossification was very clear and did not touch the endplate. In the pelvic frontal view, ossification was also located inside of the bone and it was consistent with the absence of symptoms such as joint pain. The imaging characteristics of osteopetrosis are 'sandwich vertebrae', 'rugger-jersey spine' and 'bone within a bone'. He was diagnosed with osteopetrosis. Although similar ossification is seen in hyperparathyroidism, the border of the ossification is...



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Isolated duodenal rupture: primary repair without diversion; is it safe? Review of literature

Isolated duodenal rupture is a rare injury encountered among children following blunt abdominal trauma. Early diagnosis and treatment are essential to decrease the associated morbidity and mortality. The debate is about the optimum operative management. We report a 6-year-old child who presented with acute abdominal pain due to isolated duodenal injury following blunt abdominal trauma. Emergency laparotomy revealed duodenal rupture at the junction of the first and second part of duodenum and absence of any other visceral injuries. The duodenal injury was defined as grade III, that is, involving 75% of the circumference. We opted to perform primary repair of the injured duodenum in two layers alone without diversion. The abdominal cavity was drained using an open system drain next to the repair. Nasogastric and jejunostomy tubes were used postoperatively for gastric decompression and enteral feeding, respectively. The child had an uneventful recovery, was discharged well on the 10th postoperative day and no stenosis was found on long-term follow-up. The debate was whether to repair the defect primarily or to combine the repair with diversion. Early diagnosis, the isolated nature of the duodenal injury and the possibility of minimal contamination favoured primary repair of the defect without diversion. The good outcome attributed to these factors were in agreement with most of the literature.



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A paediatric case of bilateral mandibular condyle fracture presenting with bloody otorrhoea following trauma

A 7-year-old boy presented to the emergency department with bilateral bloody otorrhoea after falling from his scooter. Skull base fracture was suspected. CT showed no evidence of skull base fracture but bilateral mandibular condyle and external acoustic canals fractures. We report this case to illustrate a rare possibility of bilateral external acoustic canal fracture associated with condylar fracture in trauma patients presented with bloody otorrhoea.



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Lethal high: acute disseminated encephalomyelitis (ADEM) triggered by toxic effect of synthetic cannabinoid black mamba

A previously well 25-year-old man presented with agitation, double incontinence and left-sided incoordination. His symptoms started after smoking a synthetic cannabinoid (black mamba) 5 days earlier. Over 48 hours, he developed aphasia, generalised hypertonia, hyper-reflexia and dense left hemiparesis. This progressed to profuse diaphoresis, fever, tachycardia, hypertension and a possible seizure necessitating admission to the intensive care unit. CT head and cerebrospinal fluid analysis were unremarkable. MRI brain demonstrated asymmetric multifocal hyperintense lesions in white and grey matter, which raised suspicions of acute disseminated encephalomyelitis (ADEM). An electroencephalogram showed widespread brain wave slowing, indicating diffuse cerebral dysfunction. Cerebral angiogram was normal. Toxicology analysis of the substance confirmed a potent synthetic cannabinoid NM2201, technically legal at the time. The patient made a slow but significant recovery after a course of intravenous methylprednisolone, intravenous immunoglobulins and oral steroids, and was later transferred to a rehabilitation bed.



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Physical urticaria

Description

A 23-year-old woman with medical history of allergic asthma, physical urticarias (cold-induced and dermatographism) and allergic rhinitis presented with pruritic hives and swelling on her hands 20 min after playing the cello (figure 1A,B). The angioedema lasted from 45 min to 1 hour. A vibratory challenge test using a vortex mixer was performed on her forearm (figure 1C). This resulted in urticarial/angioedema within 5 min (figure 1D). Her other physical urticarias responded well to high-dose antihistamines, leukotriene receptor blocker and omalizumab. She continued to have vibratory angioedema despite these medications.

Figure 1

(A,B) Pruritic hives and swelling on hands after playing the cello. (C,D) Positive challenge test before and after the application of vortex mixer, respectively.

Learning points

Physical urticarias are identified by history and physical factors and stimuli provoking cutaneous symptoms.

Diagnosis is confirmed...



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Differentiating Middle Ear and Medial Olivocochlear Effects on Transient-Evoked Otoacoustic Emissions

Abstract

The response of the inner ear is modulated by the middle ear muscle (MEM) and olivocochlear (OC) efferent systems. Both systems can be activated reflexively by acoustic stimuli delivered to one or both ears. The acoustic middle ear muscle reflex (MEMR) controls the transmission of acoustic signals through the middle ear, while reflex activation of the medial component of the olivocochlear system (the MOCR) modulates cochlear mechanics. The relative prominence of the two efferent systems varies widely between species. Measuring the effect of either of these systems can be confounded by simultaneously activating the other. We describe a simple, sensitive online method that can identify the effects both systems have on otoacoustic emissions (OAEs) evoked by transient stimuli such as clicks or tone pips (TEOAEs). The method detects directly in the time domain the changes in the stimulus and/or emission pressures caused by contralateral noise. Measurements in human participants are consistent with other reports that the threshold for MOCR activation is consistently lower than for MEMR. The method appears to control for drift and subject-generated noise well enough to avoid the need for post hoc processing, making it promising for application in animal experiments (even if awake) and in the hearing clinic.



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Chapter 4 Proteomics of Wheat Flour

Publication date: 2017
Source:Proteomics in Food Science
Author(s): Susan B. Altenbach
Wheat is a major food crop grown on more than 215million hectares of land throughout the world. Wheat flour provides an important source of protein for human nutrition and is used as a principal ingredient in a wide range of food products, largely because wheat flour, when mixed with water, has unique viscoelastic properties that make it possible to produce a cohesive dough. The viscoelastic properties are conferred by a complex group of proteins accumulated in the grain during development and form the basis of wheat flour quality. Certain proteins in wheat flour also are responsible for human health problems including allergies, food intolerances, and sensitivities. In recent years, proteomics methods have facilitated the detailed study of the wheat flour proteins and provided new insights into the molecular basis of flour quality and immunogenic potential.



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Simultaneous transient global amnesia and right MCA stroke after Valsalva manoeuvre

A 61-year-old man suffered an episode of transient confusion and anterograde amnesia after a Valsalva-related manoeuvre. The MRI diffusion weighted imaging (DWI) sequences showed a left hippocampal and two right parietal lesions that were deemed as acute. The MR angiography disclosed a high-grade stenosis in the right middle cerebral artery as was described by a transcranial colour-coded ultrasound as well. Ultrasound investigation of the jugular veins showed a right jugular venous reflux after a Valsalva manoeuvre. The patient was diagnosed with transient global amnesia based on clinical grounds and the right parietal lesions were considered as silent strokes. The Valsalva manoeuvre could have played as a common trigger for both diseases.



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The seatbelt sign: early recognition may be life-saving

Description

A 47-year-old woman with body mass index (BMI) of 27kg/m2 was involved in a high speed (60 mph) frontal car accident. She was the driver wearing seatbelts and the airbag deployed. There was a transient loss of consciousness before arrival to the emergency department. On presentation, the patient was breathing spontaneously and was haemodynamically stable: blood pressure was 125/80 mm Hg, heart rate 77 beats/min and the Glasgow Coma Scale (GCS) was 15. Physical examination of the abdomen revealed mild generalised tenderness. A linear ecchymosis (seatbelt sign) was present at the level of the left superior iliac spine extending across the right flank. Laboratory tests showed normal C reactive protein, increased creatine kinase (908 U/L) and white cell count (0.00001829x109/L). Echo-fast of the abdomen was negative. The chest film showed multiple rib fractures and a fracture of the left clavicle. Abdominal CT scan revealed extraluminal air adjacent to a thickened bowel loop,...



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Gastrocolic fistula in a child following corrosive acid ingestion

Gastrocolic fistulas in children are most commonly seen after placement of a percutaneous endoscopic gastrostomy. We present a 14-year-old girl who developed a gastrocolic fistula following accidental corrosive acid ingestion. On evaluation of her symptoms, a barium swallow identified the gastrocolic fistula. It healed spontaneously in 3 months. This was both unexpected and remarkable. To the best of our knowledge this is the first case of a gastrocolic fistula occurring following corrosive ingestion.



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

Publication date: Available online 21 April 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): G.Q.V. Oliveira, M.A. Rossi, T.V. Vasconcelos, F.S. Neves, I. Crusoé-Rebello
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). The posterior distance also showed a difference between the sexes and the highest mean was observed in females (P=0.0295). Comparing the posterior width for the skeletal patterns, a statistical difference was observed between classes I and III (P=0.0371), and classes II and III (P=0.0094). Regarding the craniofacial patterns, the brachycephalic (P=0.0078) and mesocephalic (P=0.0015) groups showed a greater posterior width in females. In conclusion, the patient's sex and aspects of the skeletal pattern and craniofacial pattern have an influence on the pterygomaxillary area and descending palatine canal anatomy. A preoperative computed tomography analysis involving this evaluation could reduce the risk of surgical complications.



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Editorial Board/Reviewing Committee

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Publication date: June 2017
Source:International Journal of Oral and Maxillofacial Surgery, Volume 46, Issue 6





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Cover 2 - Masthead (p/u from previous issue)

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Publication date: March 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 1





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Editorial Board (p/u from previous issue)

Publication date: March 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 1





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Contents

Publication date: March 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 1





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Future and recent issues (p/u from previous issue and update)

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Publication date: March 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 1





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Information for authors (p/u from previous issue)

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Publication date: March 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 1





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Allergic contact dermatitis caused by diethyl thiourea in a neoprene-containing wet suit



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Refractory acrodermatitis continua of Hallopeau successfully treated with oral alitretinoin



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Adult T-cell leukemia/lymphoma with subungual hematomas in all fingers and toes as the first manifestation



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Systematic review of self-management interventions for people with eczema

Abstract

Eczema is a common, long-term condition but inadequate support and information can lead to poor adherence and treatment failure. We have reviewed the international literature of interventions designed to promote self-management in adults and children with eczema. MEDLINE, MEDLINE in process, EMBASE, CINAHL and GREAT were searched from their inception to August 2016 for randomised controlled trials. Two authors independently applied eligibility criteria, assessed risk of bias for all included studies and extracted data. Twenty studies (3028 participants) conducted in 11 different countries were included. The majority (18) were based in secondary care and most (16) targeted children with eczema. Reporting of studies, including descriptions of the interventions and the outcomes themselves, was generally poor. Thirteen studies were face-to-face educational interventions, five delivered online and two were of written action plans. Follow-up in most studies (12) was short-term (up to 12 weeks). Only six trials specified a single primary outcome. There was limited evidence of effectiveness. Three studies collected and reported any outcomes related to cost and just one study undertook any formal cost-effectiveness analysis. In summary, we have identified a general absence of well conducted and reported RCTs with a strong theoretical basis. There is therefore still uncertainty about how best to support self-management of eczema in a clinically and cost effective way. Recommendations on design and conduct of future trials are presented.

This article is protected by copyright. All rights reserved.



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Prognostics factors and survival in acral lentiginous melanoma

Abstract

Background

Acral lentiginous melanoma is a rare melanoma subtype that disproportionately afflicts people of color. Acral lentiginous melanomas have a worse prognosis than other melanomas subtypes, which has been attributed to aggressive biological behavior, more advanced stage at presentation and possible disparities in access to healthcare.

Objectives

Using comprehensive patient data and long-term follow-up information in a well-characterized cohort, to examine how patient, tumor, and clinical management variables impact overall and melanoma-specific survival.

Methods

We characterized a consecutive cohort of 123 acral lentiginous melanomas diagnosed from 1987-2013 and analyzed predictors of overall and melanoma-specific survival for their association with survival.

Results

Univariate hazard ratios and 95% confidence intervals using Cox regression models showed that increased Breslow depth, presence of ulceration, receipt of radiation, chemo- and vaccine therapy were associated with worse melanoma-specific survival. Notably, non-white race-ethnicity was not associated with worse overall or melanoma-specific survival. Multivariate modeling adjusting for patient, tumor, and management variables revealed Breslow depth greater than 2 millimeters and disease extent as significantly associated with poor melanoma-specific survival.

Conclusions

Melanoma-specific mortality among acral lentiginous melanomas patients is associated with increased tumor thickness and more advanced stage at presentation, but not race-ethnicity. Advanced tumor features at presentation and access to care may account for less favorable survival outcomes reported among non-white patients.

This article is protected by copyright. All rights reserved.



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Emollients and moisturisers for eczema: abridged Cochrane systematic review including GRADE assessments

Summary

Eczema is a chronic inflammatory skin disorder with considerable impact on quality of life. Emollients or moisturisers are widely recommended, but are these effective and safe? We searched for randomised controlled trials (RCTs) in the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, Medline, Embase, LILACS, GREAT database and five trial registers to December 2015. We included 77 RCTs with 6603 participants. Seven studies (9.1%) were at low risk of bias, 34 (44.2%) at unclear and 36 (46.8%) at high risk. The quality of the evidence was mainly low or moderate for the prespecified outcomes. The most important comparison 'moisturiser versus no moisturiser' showed an improved SCORAD in the moisturiser group compared to no moisturiser (mean difference (MD) -2.42, 95% confidence interval (CI) -4.55 to -0.28), but did not meet the minimal important difference (MID) of 8.7. Fewer flares were seen (risk ratio (RR) 0.40, 95% CI 0.23 to 0.70) and rate of flare was reduced (hazard ratio (HR) 3.74, 95% CI 1.86 to 7.50). The groups applying moisturiser used less topical corticosteroids over six to eight weeks (MD -9.30 g, 95% CI 15.3 to -3.27). Glycyrrhetinic acid-containing cream, urea-containing and glycerol-containing creams worked better than their control (vehicle, placebo or no moisturiser) according to both participants and physicians. More flares were reported with moisturiser alone than when combined with twice weekly fluticasone propionate (RR 2.17, 95% CI 1.55 to 3.11). Adding moisturisers to topical anti-inflammatory treatment was more effective than anti-inflammatory treatment alone and with fewer flares.

This article is protected by copyright. All rights reserved.



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Lingual hyperpigmentation after 5-fluorouracil chemotherapy

Description

A 76-year-old woman presented to our hospital with abdominal pain, diarrhoea and new-onset hyperpigmented spots on her tongue. Her medical history includes metastatic colon cancer, acute myeloid leukemia (AML) in remission after bone marrow transplant, hypertension, chronic kidney disease (CKD), osteoarthritis and prior internal jugular deep venous thrombosis (DVT). She had just received second cycle of 5-fluorouracil, bevacizumab and leucovorin 3 days prior to admission. Examination revealed hyperactive bowel sounds, diffuse abdominal tenderness and multiple hyperpigmented papules on her tongue (figure 1). Upright chest film did not show any gastrointestinal perforation. Abdominal CT scan was consistent with pancolitis. PCR for Clostridium difficile toxin was positive. She was started on a 14-day course of vancomycin and metronidazole and was discharged a few days later after her diarrhoea and abdominal pain improved. On follow-up 4 weeks later, the hyperpigmented papules on her tongue were noted to have improved...



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Pulmonary metastasis from renal epithelioid angiomyolipoma in the setting of breast cancer

A 68-year-old woman presented with visible haematuria. Ultrasonography and triphasic CT revealed a 2.6 cm mass in the lower pole of the left kidney. A biopsy suggested low-grade renal cell carcinoma. Radical nephrectomy was performed and revealed an epithelioid angiomyolipoma. At year 3, the patient developed ductal carcinoma of the right breast and underwent a wide local excision and sentinel lymph node biopsy followed by chemotherapy and radiotherapy. 4 months later, she was noted to have a 1.6 cm nodule in the middle lobe of her right lung. The primary differential diagnosis was a breast cancer metastasis. Biopsy revealed a metastatic renal epithelioid angiomyolipoma. The patient elected to have stereotactic radiotherapy over surgical excision. Renal angiomyolipomata are generally regarded as benign tumours. In the present report, we describe the first case of pulmonary metastasis from renal epithelioid angiomyolipoma in the setting of breast cancer.



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Haemophagocytic lymphohistiocytosis presenting as HELLP syndrome: a diagnostic and therapeutic challenge

Haemophagocytic lymphohistiocytosis (HLH) is a rare, potentially fatal, haematological disorder, which can be clinically challenging to diagnose and manage. We report a case of HLH in a previously healthy 33-year-old primigravida. The patient presented at 22 weeks gestation with dyspnoea, abdominal pain, anaemia, thrombocytopenia and elevated liver enzymes suggestive of HELLP syndrome.HELLP, a syndrome characterised by haemolysis, elevated liver enzymes and low platelets is considered a severe form of pre-eclampsia. Despite delivery of the fetus, her condition deteriorated over 3–4 days with high-grade fever, worsening thrombocytopenia and anaemia requiring transfusion support. A bone marrow biopsy showed haemophagocytosis and a diagnosis of HLH was made. Partial remission was achieved with etoposide-based chemotherapy and complete remission following bone marrow transplantation. Eleven months post-transplant, the disease aggressively recurred, and the patient died within 3 weeks of relapse.



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An unusual guest in a patient with Hodgkin's lymphoma

Description

A 42-year-old man with chronic intermittent low grade fever and rapidly progressive right cervical swelling was evaluated in the outpatient clinic. The swelling involved the right level III, IV and V cervical region measuring 10x6x3 cm. Fine needle aspiration from the mass revealed many Reed-Sternberg cells and monolobated Hodgkin's cells (figure 1) which were positive for CD15 and CD30 on immunocytochemical analysis of the cell block material; this was further confirmed on excision biopsy of the lymph nodal mass. Bone marrow (BM) aspiration and trephine biopsy were performed as a part of lymphoma staging. Many sheathed microfilariae of Wuchereria bancrofti with a tapering tail free of cell nuclei were seen in the BM aspiration smears; some of these microfilariae were observed to be in close contact with the BM particles (figure 2). Trilineage haematopoesis without eosinophilia or any evidence of infiltration by Hodgkin's lymphoma was...



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Oncological outcome following de-intensification of treatment for stage I and II HPV negative oropharyngeal cancers with transoral robotic surgery (TORS): A prospective trial

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Publication date: June 2017
Source:Oral Oncology, Volume 69
Author(s): Surender Dabas, Karan Gupta, Reetesh Ranjan, Ashwani K. Sharma, Himanshu Shukla, Anant Dinesh
ObjectiveThis prospective study aimed to see long-term oncological outcome of Transoral Robotic Surgery as single modality treatment for cT1-T2 N0 HPV negative oropharyngeal malignancies.MethodFrom March 2013 to October 2015, 57 patients with early stage oropharyngeal carcinoma underwent Transoral robotic surgery (TORS) with neck dissection using daVinci® Surgical system. Patients were evaluated for disease free survival, overall survival, locoregional and distant metastasis.Results57 patients (48 males and 9 females) underwent TORS for early stage oropharyngeal carcinoma. All patients underwent ipsilateral neck dissection and 12 patients underwent bilateral neck dissection. 49 patients with final histopathology suggestive of stage I and II disease did not received any adjuvant treatment. Mean age at presentation was 59.4years (37–88years). Most common site of involvement was the base of tongue (BOT) in 31 (54.8%) patients. Twenty-four (42.1%) patients were cT1 and 33 (57.9%) were cT2 at presentation. During follow-up, 2 (4.2%) patients recurred locoreginally and 1 (2.1%) patient had distant metastasis. Two patients expired due to causes other than malignancy. Forty-three (89.6%) patients were disease free on an average follow-up of 29months with an overall survival of 93.8% at mean follow-up of 29months.ConclusionTransoral Robotic Surgery as a single modality treatment is a good option for cure in HPV negative early resectable oropharyngeal malignancies which are relatively unresponsive to radiation. TORS can be used to de-intensify the treatment of early stage oropharyngeal carcinoma and thus avoid the early and late toxicities associated with Radiotherapy/Chemoradiotherapy.



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Editorial Board/Aims & Scope

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Publication date: May 2017
Source:Oral Oncology, Volume 68





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Paraneoplastic jaundice and prostate cancer

Cholestasis has numerous causes. We present the case of a 78-year-old man with a common diagnosis in this age group and gender but with an unusual presentation. There are only 11 articles published of patients with jaundice due to a paraneoplastic syndrome associated with prostate cancer. Interleukin 6 and other proinflammatory cytokines appear to contribute to the pathophysiology of this syndrome. Our patient remains symptom free 4 months after treatment initiation.



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In Response

No abstract available

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Personalized Intrathecal Drug Delivery: Models, Targets, and Approaches

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Computational and In Vitro Experimental Investigation of Intrathecal Drug Distribution: Parametric Study of the Effect of Injection Volume, Cerebrospinal Fluid Pulsatility, and Drug Uptake

imageBACKGROUND: Intrathecal drug delivery is an attractive option to circumvent the blood-brain barrier for pain management through its increased efficacy of pain relief, reduction in adverse side effects, and cost-effectiveness. Unfortunately, there are limited guidelines for physicians to choose infusion or drug pump settings to administer therapeutic doses to specific regions of the spine or the brain. Although empiric trialing of intrathecal drugs is critical to determine the sustained side effects, currently there is no inexpensive in vitro method to guide the selection of spinal drug delivery parameters. The goal of this study is to demonstrate current computational capabilities to predict drug biodistribution while varying 3 parameters: (1) infusion settings, (2) drug chemistry, and (3) subject-specific anatomy and cerebrospinal fluid dynamics. We will discuss strategies to systematically optimize these 3 parameters to administer drug molecules to targeted tissue locations in the central nervous system. METHODS: We acquired anatomical data from magnetic resonance imaging (MRI) and velocity measurements in the spinal cerebrospinal fluid with CINE-MRI for 2 subjects. A bench-top surrogate of the subject-specific central nervous system was constructed to match measured anatomical dimensions and volumes. We generated a computational mesh for the bench-top model. Idealized simulations of tracer distribution were compared with bench-top measurements for validation. Using reconstructions from MRI data, we also introduced a subject-specific computer model for predicting drug spread for the human volunteer. RESULTS: MRI velocity measurements at 3 spinal regions of interest reasonably matched the simulated flow fields in a subject-specific computer mesh. Comparison between the idealized spine computations and bench-top tracer distribution experiments demonstrate agreement of our drug transport predictions to this physical model. Simulated multibolus drug infusion theoretically localizes drug to the cervical and thoracic region. Continuous drug pump and single bolus injection were successful to target the lumbar spine in the simulations. The parenchyma might be targeted suitably by multiple boluses followed by a flush infusion. We present potential guidelines that take into account drug specific kinetics for tissue uptake, which influence the speed of drug dispersion in the model and potentially influence tissue targeting. CONCLUSIONS: We present potential guidelines considering drug-specific kinetics of tissue uptake, which determine the speed of drug dispersion and influence tissue targeting. However, there are limitations to this analysis in that the parameters were obtained from an idealized healthy patient in a supine position. The proposed methodology could assist physicians to select clinical infusion parameters for their patients and provide guidance to optimize treatment algorithms. In silico optimization of intrathecal drug delivery therapies presents the first steps toward a possible care paradigm in the future that is specific to personalized patient anatomy and diseases.

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Can the Perioperative Anesthesia Care of Patients With Cancer Affect Their Long-term Oncological Outcomes?

No abstract available

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Contrasting Effects of the γ-Aminobutyric Acid Type A Receptor β3 Subunit N265M Mutation on Loss of Righting Reflexes Induced by Etomidate and the Novel Anesthetic Barbiturate R–mTFD-MPAB: Erratum

No abstract available

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Plasma Transfusion as Bleeding Prophylaxis in the Critically Ill

No abstract available

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Atlas of Anatomy

No abstract available

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The PLAIN Truth: Caring for the Amish: What Every Anesthesiologist Should Know

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In Response

No abstract available

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Neuraxial Labor Analgesia: Does It Influence the Outcomes of Labor?

No abstract available

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Anesthesiologists and Disaster Medicine: A Needs Assessment for Education and Training and Reported Willingness to Respond

imageBACKGROUND: Anesthesiologists provide comprehensive health care across the emergency department, operating room, and intensive care unit. To date, anesthesiologists' perspectives regarding disaster medicine and public health preparedness have not been described. METHODS: Anesthesiologists' thoughts and attitudes were assessed via a Web-based survey at 3 major academic institutions. Frequencies, percentages, and odds ratios (ORs) were used to assess self-reported perceptions of knowledge and skills, as well as attitudes and beliefs regarding education and training, employee development, professional obligation, safety, psychological readiness, efficacy, personal preparedness, and willingness to respond (WTR). Three representative disaster scenarios (natural disaster [ND], radiological event [RE], and pandemic influenza [PI]) were investigated. Results are reported as percent or OR (95% confidence interval). RESULTS: Participants included 175 anesthesiology attendings (attendings) and 95 anesthesiology residents (residents) representing a 47% and 51% response rate, respectively. A minority of attendings indicated that their hospital provides adequate pre-event preparation and training (31% [23–38] ND, 14% [9–21] RE, and 40% [31–49] PI). Few residents felt that their residency program provided them with adequate preparation and training (22% [14–33] ND, 16% [8–27] RE, and 17% [9–29] PI). Greater than 85% of attendings (89% [84–94] ND, 88% [81–92] RE, and 87% [80–92] PI) and 70% of residents (81% [71–89] ND, 71% [58–81] RE, and 82% [70–90] PI) believe that their hospital or residency program, respectively, should provide them with preparation and training. Approximately one-half of attendings and residents are confident that they would be safe at work during response to a ND or PI (55% [47–64] and 58% [49–67] of attendings; 59% [48–70] and 48% [35–61] of residents, respectively), whereas approximately one-third responded the same regarding a RE (31% [24–40] of attendings and 28% [18–41] of residents). Fewer than 40% of attendings (34% [26–43]) and residents (38% [27–51]) designated who would take care of their family obligations in the event they were called into work during a disaster. Regardless of severity, 79% (71–85) of attendings and 73% (62–82) of residents indicated WTR to a ND, whereas 81% (73–87) of attendings and 70% (58–81) of residents indicated WTR to PI. Fewer were willing to respond to a RE (63% [55–71] of attendings and 52% [39–64] of residents). In adjusted logistic regression analyses, those anesthesiologists who reported knowing one's role in response to a ND (OR, 15.8 [4.5–55.3]) or feeling psychologically prepared to respond to a ND (OR, 6.9 [2.5–19.0]) were found to be more willing to respond. Similar results were found for RE and PI constructs. Both attendings and residents were willing to respond in whatever capacity needed, not specifically to provide anesthesia. CONCLUSIONS: Few anesthesiologists reported receiving sufficient education and training in disaster medicine and public health preparedness. Providing education and training and enhancing related employee services may further bolster WTR and help to build a more capable and effective medical workforce for disaster response.

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Anesthesiology and New Models of Perioperative Care: What Will Help Move the Needle?

No abstract available

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It Takes a Village to Deliver Effective and Efficient Care: Team-Based Performance

No abstract available

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Women, Minorities, and Leadership in Anesthesiology: Take the Pledge

imageNo abstract available

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Essential Echocardiography: Transesophageal Echocardiography for Non-cardiac Anesthesiologists

No abstract available

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The Law of Unintended Consequences Can Never Be Repealed: The Hazards of Random Urine Drug Screening of Anesthesia Providers

imageNo abstract available

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In Response

No abstract available

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Neuromuscular Monitoring as the Art of Probability

No abstract available

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Open Access, Crowd-Sourced Repository of Anesthesia Information (Wiki-Anesthesia) as Antidote to Inaccurate Internet-Based Resources

No abstract available

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Modeling Spinal Intrathecal Drug Distribution: The Challenge of Defining and Predicting Cerebrospinal Fluid Dynamics

No abstract available

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Prospective evaluation of the diagnostic value of sensitive KIT D816V mutation analysis of blood in adults with suspected systemic mastocytosis

Abstract

Background

Sensitive KIT D816V mutation analysis of blood has been proposed to guide bone marrow (BM) investigation in suspected systemic mastocytosis (SM). The aim of this prospective study was for the first time to compare the D816V-status of the "screening blood sample" used to guide BM biopsy in suspected SM to the outcome of the subsequent BM investigation.

Methods

58 adult patients with suspected SM were included. The outcome of sensitive KIT D816V-analysis of blood was compared to the result of the BM investigation.

Results

Screening blood samples from 44 of 58 patients tested D816V-positive. In 43 of these, SM was subsequently diagnosed in the BM investigation. One patient with a D816V-positive screening sample was diagnosed with monoclonal MC activation syndrome. Screening blood samples from 14 patients tested D816V-negative. SM was subsequently diagnosed in five of these, whereas nine patients did not fulfil any diagnostic SM criteria (excluding tryptase-criterion). Of the 48 SM patients, 90% tested D816V-positive. Thirteen SM patients presented with hymenoptera venom-induced anaphylaxis, no skin lesions and baseline serum-tryptase ≤20 ng/mL. Of these, 92% tested D816V-positive in the screening blood sample.

Conclusion

This prospective study demonstrates that a D816V-positive result in a screening blood sample identifies SM among patients with hymenoptera venom-induced anaphylaxis in whom the diagnosis would most probably have been missed, with potential severe implications. The observed false negative screening results also underline that BM investigation is mandatory in all adult patients with clear signs of, or highly suspected SM, regardless of the KIT mutation status.

This article is protected by copyright. All rights reserved.



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EACMFS Prizes and Awards

The Council of EACMFS wishes to ensure that all members of the Association are aware of the current awards and prizes that are available. These are designed to provide educational support and also to allow the opportunity for trainees and those who have recently achieved specialist status to visit units outside their own departments.

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Announcements

Dear Colleagues,

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Editorial Board



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Serum H-ficolin levels: Clinical association with interstitial lung disease in patients with systemic sclerosis

Abstract

Ficolins, a group of oligomeric lectins consisting of three isoforms (H-, L- and M-ficolin), contribute to innate immunity via activating the complement pathway and/or acting directly as opsonins against pathogens and apoptotic cells. Because apoptotic cells likely drive the development of systemic sclerosis (SSc) partly through innate immunity, we assessed the clinical association of serum H-ficolin levels in SSc patients. Despite no difference in serum H-ficolin levels between SSc and control subjects, SSc patients with decreased serum H-ficolin levels tended to have a higher prevalence of interstitial lung disease (ILD). More importantly, serum H-ficolin levels inversely correlated with ground-glass opacity score on chest computed tomography in SSc-ILD patients. Therefore, H-ficolin-related innate immunity may be involved in SSc-ILD development.



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High rate of systemic corticosteroid prescription among outpatient visits for psoriasis: A population-based epidemiological study using the Korean National Health Insurance database

Abstract

The use of systemic corticosteroids (SC) for the treatment of psoriasis is not recommended according to textbooks and guidelines. In clinical practise, however, many physicians frequently prescribe SC for patients with psoriasis. To determine the magnitude of SC prescription for outpatients with psoriasis in Korea and identify factors associated with the use of SC, we used the 2010–2014 nationwide claims data of the Health Insurance Review and Assessment Service of Korea. In frequency analysis for the full scale of prescribed SC, oral methylprednisolone was the most frequently prescribed SC, followed by dexamethasone and betamethasone injections. The prescription rate of SC was 26.4% in outpatient visit episodes for psoriasis. The prescription rate of SC was higher in older patients, Medical Aid recipients, patients who visited office-based physician practices and hospitals, and patients living in non-metropolitan areas. In multiple logistic regression analyses, the older age group and smaller health-care institutions were more associated with the SC prescription. In conclusion, SC were widely prescribed for patients with psoriasis in Korea despite the current guidelines. Both patients' individual and institutional characteristics were associated with the SC prescription.



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Case of recurrent severe cellulitis and cutaneous candidiasis during psoriasis treatment with ustekinumab



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Editorial Board/Reviewing Committee



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Kleinzelliges Lungenkarzinom – eine vernachlässigte Erkrankung



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Prävention in der Onkologie



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Aktinische Keratosen

Zusammenfassung

Aktinische Keratosen werden zunehmend häufiger diagnostiziert. Betroffen sind aufgrund ihrer langjährigen Exposition gegenüber UV(ultraviolett)-Licht v. a. ältere Patienten. Die Diagnose wird anhand des klinischen Befunds gestellt und bedarf selten einer histopathologischen Untersuchung. Hauptproblem ist, dass jede aktinische Keratose das Risiko birgt, in ein Plattenepithelkarzinom überzugehen, weshalb eine frühzeitige Therapie empfohlen wird. Hierzu stehen zahlreiche Konzepte zur Verfügung, die grundsätzlich in läsionsgerichtete Maßnahmen für isolierte aktinische Keratosen und feldgerichtete Verfahren bei einer Feldkanzerisierung unterteilt werden müssen.



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