Source:Annals of Allergy, Asthma & Immunology
Author(s): Wiparat Manuyakorn, Buntita Bamrungchaowkasem, Nichanan Ruangwattanapaisarn, Wasu Kamchaisatian, Suwat Benjaponpitak
http://ift.tt/2pwI9oY
Σάββατο 29 Απριλίου 2017
Optimal needle length for epinephrine prefilled syringe in children
Source:Annals of Allergy, Asthma & Immunology
Author(s): Wiparat Manuyakorn, Buntita Bamrungchaowkasem, Nichanan Ruangwattanapaisarn, Wasu Kamchaisatian, Suwat Benjaponpitak
http://ift.tt/2pwI9oY
Successful management of hereditary angioedema during pregnancy in a patient with heterozygous MTHFR mutation
Source:Annals of Allergy, Asthma & Immunology
Author(s): Inmaculada Martinez Saguer, Carmen Escuriola Ettingshausen
http://ift.tt/2oUjbMi
The Effect of Ventilating Tubes in Young Children with Recurrent Acute Otitis Media: an Update of the Literature
Abstract
Purpose of Review
Ventilating tube treatment (VT) is a common surgical procedure in preschool children. Twenty to fifty percent of children treated with VT suffer from recurrent acute otitis media (RAOM). The aim of this review is to update current knowledge on the topic.
Recent Findings
There is still controversy regarding the use of VT for children with RAOM. So far, only six randomized trials have been published. From the limited data pool, it seems that children with RAOM treated with VT experienced less time with acute otitis media and experienced less recurrence compared to controls. However, no difference in quality of life was found between subgroups in one trial.
Summary
Children with RAOM seem to benefit from VT on objective parameters, especially if middle ear effusion is present in between acute episodes. There is a need for more high quality evidence on the subjective domains such as disease severity and quality of life.
http://ift.tt/2qrjyPB
Guidelines for the Treatment of Acute Otitis Media: Why Are There Worldwide Differences?
Abstract
Purpose of Review
This study aims to review differences between acute otitis media (AOM) diagnosis and treatment guidelines from different countries, with regards to the aspects of diagnostic criteria and methods, supplementary tests, treatment options, recommended first-, second-, and third-line antibiotics, non-antibiotic treatment options, and preventive means and measures.
Recent Findings
Tympanic membrane (TM) bulging, opacity, and presence of middle ear fluid are the pillars for diagnosis, as marginal/uncertain cases are not accepted anymore. Guidelines from developed countries offer the use of pneumatic otoscopy and tympanometry to aid diagnosis. Withholding antibiotic therapy and a "watchful waiting" in mild-moderate cases are preferred in settings where follow-up visits are both possible and attainable, mostly in developed countries. While amoxicillin is mostly accepted as the first-line antibiotic therapy, options for second- and third-line antibiotics vary, according to local bacteriology and antimicrobial susceptibility data and costs. Other treatments, such as complementary and alternative medicine, steroids, or anti-histamines, are either rejected or ignored. Reduction of known risk factors and call for vaccinations (influenza, pneumococcal conjugate vaccine) are encouraged mostly in developed countries, where such immunizations have been implemented in National Immunization Programs.
Summary
Despite regional differences, AOM guidelines worldwide share common grounds on various matters concerning diagnosis and management: diagnosis based on TM findings observed on otoscopy and/or pneumatic otoscopy or tympanometry, "watchful waiting" approach in appropriate cases, oral analgesic treatment using ibuprofen/paracetamol, reduction of risk factors, and preventive measures to reduce AOM.
http://ift.tt/2oKL51Z
Development of a financially viable model for the management of mandibular fractures as day cases in a level 1 major trauma centre
There is a subgroup of patients with mandibular fractures who could safely and effectively be managed in an outpatient day-care unit. Suitability depends on medical, social, and operative factors, and identification of the correct criteria will govern management after that in the emergency department. Reduced use of beds would lead to less money being spent on emergency treatment, and increased capacity for elective surgery. The aims of this study were to identify a group of patients with mandibular fractures whose duration of operation and period of recovery would be suitable for treatment in the day-care unit, and to evaluate the potential financial benefits.
http://ift.tt/2qjCyA7
Use of couplers for vascular anastomoses in 601 free flaps for reconstruction of defects of the head and neck: technique and two-year retrospective clinical study
We describe our experience with the use of 854 couplers for venous or arterial anastomoses, or both, in 601 free flaps for reconstruction of defects of the head and neck. We reviewed 601 patients who had had free flaps (with the microvascular anastomoses being made with couplers in 519) between July 2013 and December 2015. Personal details, and clinical data including the site of the defect, the tumour excised, the types of flaps, the size of the couplers, the method of anastomosis (venous or arterial) in which the coupler was used, and postoperative complications were recorded.
http://ift.tt/2phvlC6
Successful management of hereditary angioedema during pregnancy in a patient with heterozygous MTHFR mutation
Hereditary angioedema (HAE) caused by C1-esterase inhibitor (C1-INH) deficiency is a rare, autosomal dominant disorder. Type 1 HAE makes up 85% of cases and is caused by reduced circulating levels of C1-INH, whereas type 2 HAE is caused by dysfunctional circulating C1-INH despite normal levels.1 Symptoms of type 1 and 2 HAE may include abdominal symptoms and episodes of swelling of the face, genitalia, extremities, urinary tract, and upper airways. Angioedema of the upper airways is life-threatening and can lead to death by asphyxiation.
http://ift.tt/2oKjZIs
Optimal needle length for epinephrine prefilled syringe in children
Patients with a history of anaphylaxis have a strong indication for the use of epinephrine auto-injectors (EAIs).1 However, EAIs are available in only 59.1% of countries according to a recent report from the World Allergy Organization.2 Appropriate EAI needle length for delivering epinephrine into intramuscular tissues has been studied in adults3–5 and children.6–8 EAIs also require a pressure trigger for delivery of epinephrine, which compresses the subcutaneous tissues and thus shortens the skin-to-muscle depth (STMD).
http://ift.tt/2oWKiXP
Haplotypes of the RANK and OPG genes are associated with chronic arthralgia in individuals with and without temporomandibular disorders
The aim of this study was to evaluate the association between genetic polymorphisms and the comorbid presence of chronic systemic arthralgia in patients with articular temporomandibular disorders (TMD). Subjects were evaluated for the presence of TMD and asked about the presence of chronic joint pain. Four groups were included in the study: articular TMD and systemic arthralgia (n=85), no articular TMD and systemic arthralgia (n=82), articular TMD and no systemic arthralgia (n=21), no articular TMD and no systemic arthralgia (control, n=72).
http://ift.tt/2psGKOb
Long-term therapeutic effects of dextrose prolotherapy in patients with hypermobility of the temporomandibular joint: a single-arm study with 1-4 years’ follow up
Publication date: Available online 29 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): H. Refai
The aim was to analyse the short-term and long-term therapeutic efficacy of dextrose prolotherapy for dislocation or subluxation (hypermobility) of the temporomandibular joint (TMJ). Sixty-one patients with symptomatic hypermobility of the TMJ were included in this single-arm prospective study, in which they were each given four sessions of intra-articular and pericapsular injections six weeks apart. Each injection comprised 10% dextrose/mepivacaine solution 3ml. Clinical outcomes including severity of pain on movement according to the numerical rating scale (NRS), maximal interincisal opening, clicking, and frequency of locking were measured before treatment (T1), during treatment (T2) (just before the third session of injections), at the short-term follow-up (T3) (three months after treatment), and at the long-term follow-up (T4) (1-4 years after treatment). Condylar translation and osseous changes of each joint were evaluated at T1 and T4 using tomography. There was significant reduction in all variables by T2 (p<0.001, p<0.001, p=0.006, and p<0.001). The pain scores (p<0.001) and clicking (p<0.001) had decreased significantly by T3. linear tomograms of each joint at T1 and T4 showed no alteration in the morphology of the bony components of the joint, and at T4, tomographic open views of all joints showed condylar hypertranslation. Dextrose prolotherapy provided significant and sustained reduction of pain and recovery of constitutional symptoms associated with symptomatic hypermobility of the TMJ without changing either the position of the condyle or the morphology of the bony components of the joint.
http://ift.tt/2oJqV8l
Fixation of fractures of the condylar head of the mandible with a new magnesium-alloy biodegradable cannulated headless bone screw
Publication date: Available online 29 April 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): H. Leonhardt, A. Franke, N.M.H. McLeod, G. Lauer, A. Nowak
It is difficult to fix fractures of the condylar head of the mandible. Several techniques have been described which show satisfactory outcomes, but stability can be questionable, and some can cause irritation of the soft tissues. We describe a technique and first results of treating such fractures with resorbable magnesium-based headless bone screws (Magnezix® 2.7mm CS; Syntellix AG, Hanover, Germany).
http://ift.tt/2oVWBne
A rare complication of tonsillitis: septic arthritis of the temporomandibular joint
Publication date: Available online 29 April 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): E. Araz Server, O. Onerci Celebi, B. Hamit, O. Yigit
Septic arthritis of the temporomandibular joint (TMJ) is a rarely seen clinical condition. Such an infection may be encountered following infections in the head and neck region, with direct or haematogenous spread to the joint. This article presents the case of a patient with tonsillitis leading to septic arthritis of the TMJ and reports the results of a review of the literature.
http://ift.tt/2oJl1nN
Routine usage of sentinel node biopsy in melanoma management must cease: reply from authors
We thank Mr. Saleh for his comments and are pleased he agrees that acceptance into melanoma therapeutic trials should not be contingent on undergoing sentinel node biopsy (SNB). We disagree with his assertion that SNB still has a viable role in melanoma management. Suppose SNB followed by completion lymphadenectomy (CL) was a drug therapy for melanoma, subjected to a ten-year randomized controlled trial involving 2000 patients where a survival benefit was not found.
This article is protected by copyright. All rights reserved.
http://ift.tt/2pfUIV9
Fueling the Mechanisms of Asthma: Increased Fatty Acid Oxidation in Inflammatory Immune Cells May Represent a Novel Therapeutic Target
Abstract
Background
Increasing evidence has shown the close link between energy metabolism and the differentiation, function, and longevity of immune cells. Chronic inflammatory conditions such as parasitic infections and cancer trigger a metabolic reprogramming from the preferential use of glucose to the up-regulation of fatty acid oxidation (FAO) in myeloid cells, including macrophages and granulocytic and monocytic myeloid-derived suppressor cells. Asthma is another chronic inflammatory condition where macrophages, eosinophils, and polymorphonuclear cells play an important role in its pathophysiology.
Objective
We tested whether FAO might play a role in the development of asthma-like traits and whether the inhibition of this metabolic pathway could represent a novel therapeutic approach.
Methods
OVA and house dust mite (HDM)-induced murine asthma models were used in this study.
Results
Key FAO enzymes were significantly increased in the bronchial epithelium and inflammatory immune cells infiltrating the respiratory epithelium of mice exposed to OVA or HDM. Pharmacologic inhibition of FAO significantly decreased allergen-induced airway hyperresponsiveness, decreased the number of inflammatory cells, and reduced the production of cytokines and chemokines associated with asthma.
Conclusions and clinical relevance
These novel observations suggest that allergic airway inflammation increases FAO in inflammatory cells to support the production of cytokines, chemokines, and other factors important in the development of asthma. Inhibition of FAO may therefore provide a novel therapeutic approach for the treatment of asthma by re-purposing existing drugs that block FAO and are approved for the treatment of heart disease.
This article is protected by copyright. All rights reserved.
http://ift.tt/2oIACnH
Tubotympanic system functioning
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): C. Martin, A. Karkas, J.-M. Prades
The Eustachian (auditory) tube and tympanomastoid cavities form an anatomic and functional whole that cannot easily be divided, and is therefore known as the "tubotympanic system". The system has been the focus of several studies, with complex and sometimes contradictory results, making an overview of its functioning difficult to obtain. The objective of the present article is to review the current state of knowledge, as an indispensable preliminary to understanding tubotympanic system dysfunction, and notably the development of chronic otitis. The system as a whole is covered by mucosa, which provides continuity, although with certain particularities from one area to another, and plays a primordial role. Thus, under physiological conditions, gas diffusion across the tympanomastoid mucosa largely ensures the equilibrium of pressure between the middle ear and outside environment, the tube orifice being very little involved. Under large rapid change in atmospheric pressure, the aeration function of the Eustachian tube comes into play, governed by a reflex mechanism. The system also has other functions that are essential to good middle-ear functioning: protection against nasopharyngeal secretions and pathogens and against certain physiological noises; middle-ear cavity clearance by mucociliary transport of pathogens, partly related to submucosal gland secretion; and immune defense.
http://ift.tt/2oIzSyU
Association of Japanese cedar pollinosis and sensitization with HLA-DPB1 in the Japanese adolescent
Publication date: Available online 29 April 2017
Source:Allergology International
Author(s): Wataru Morii, Aiko Sakai, Takahiro Ninomiya, Masanori Kidoguchi, Ryo Sumazaki, Shigeharu Fujieda, Emiko Noguchi
BackgroundAllergic rhinitis (AR) is a heterogeneous disorder that significantly affects daily activity, work productivity, sleep, learning, and quality of life in all generations. Japanese cedar (JC) pollen is the most common allergen responsible for the development of AR in Japan. AR caused by JC pollen is considered to be a multifactorial inheritance disease that is caused by both environmental and genetic factors. The aim of this study was to investigate whether Human Leukocyte Antigen-DPB1 (HLA-DPB1) is associated with JC sensitization/pollinosis.MethodsSubjects in the present study were 544 students at the University of Tsukuba from 2013 to 2015. PCR-SSOP was performed to determine each individual's HLA-DPB1 alleles. Logistic regression analysis was performed to examine relationships between JC-related phenotypes and alleles/amino acid polymorphisms of HLA-DPB1.ResultsHLA-DPB1*02 allele were significantly associated with both JC sensitization/pollinosis (q < 0.05). Furthermore, HLA-DPB1*02:01 and HLA-DPB1*02:02 had a protective tendency for JC sensitization/pollinosis, and HLA-DPB1*05:01 had a susceptible tendency for sensitization (P < 0.05). In amino acid polymorphism analyses, Glutamic acid in position 69, Glycine-Glycine-Proline-Methionine in positions 84–87, Threonine in position 170 and Methionine in position 205 were also observed to have a protective tendency for JC sensitization (P < 0.05). Amino acid positions 69 and 84–87 were located in binding pocket 5 and 1 of HLA-DPβ1, respectively.ConclusionsAmino acid changes in the allergen-binding pocket of HLA-DPβ1 are likely to influence pollinosis/sensitization to the allergenic peptide of JC pollen and determine the pollinosis risk for each individual exposed to JC pollen.
http://ift.tt/2qhYNXb
The effect of blocking Notch signaling by γ-secretase inhibitor on allergic rhinitis
Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Le Shi, Yue Ma, Chunquan Zheng, Qingzhao Zhang
ObjectiveThis study aimed to investigate the effect of blocking Notch signaling by γ-secretase inhibitor (GSI) on allergic rhinitis.MethodGSI, N-[N-(3,5-difluorophenacetyl-L-alanyl)]-S-phenylglycine t-butylester (DAPT) was administered to ovalbumin-induced AR mice models intranasally. We observed symptoms of sneezing and nose rubbing. To detect the inflammatory state, the serum OVA-specific-IgE, IFN-γ, IL-4, and IL-5 were analyzed by ELISA, and Th cell cytokines in nasal mucosa were analyzed by RT-PCR, including T-bet, IFN-γ, GATA-3, IL-4, and IL-5. In addition, hematoxylin-eosin (HE) and periodic acid-Schiff (PAS) were applied for histopathological examination. As for the evaluation of Notch signaling, we analyzed the Notch-1, Notch signaling target Hes-1, and Hes-5 in mucosa by RT-PCR, besides, used western blotting and immunohistochemistry to assess NICD (Notch intracellular domain).ResultsThe results showed that the DAPT ameliorated the development of AR and suppressed Th2 cytokine levels significantly, alleviating eosinophils infiltration and goblet cells metaplasia, suggesting that the GSI can regulate Th2 response and weaken airway inflammation in AR.ConclusionOur findings provide evidence that blocking Notch signaling by GSI offers high value in treating AR.
http://ift.tt/2qgc6KE
Mutation analysis of common GJB2, SCL26A4 and 12S rRNA genes among 380 deafness patients in northern China
Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Jing Pan, Ping Xu, Weibo Tang, Zhongtao Cui, Miao Feng, Chunying Wang
ObjectivesThe molecular etiology of nonsyndromic deafness in Chinese population has not been investigated systematically, our study is aim to investigate the molecular etiology of nonsyndromic deafness patients from Northern China (Heilongjiang province), in order to provide genetic test and counseling to families.Methods380 unrelated patients with hearing loss who attended to the Department of Otolaryngology, The Fourth Affiliated Hospital of Harbin Medical University were enrolled to our study. All patients were diagnosed with nonsyndromic deafness by audiologic evaluation, 202 normal-hearing individuals were taken as controls. Mutations in three common deafness-causing genes (GJB2, SLC26A4 and 12S rRNA) were screened by direct sequencing.ResultsMutations (homozygote or compound heterozygote) in GJB2 accounted for 8.9% (34/380) of the patients, mutations in SLC26A4 accounted for 10.0% (38/380) of the patients screened. Only one case was found to carry 12S rRNA 1555A > G (1/380, 0.26%). Five types of mutations in GJB2 were identified, GJB2 235delC was the most prevalent mutation in our patient group (76/380, 20.0%), followed by 299-300delAT with a frequency of 7.4% (28/380). Two types of mutations in SLC26A4 were detected in our patient group (IVS7-2A > G and 2168A > G). IVS7-2A > G was identified in 27 patients (27/380, 7.1%) and 2168A > G was identified in 14 patients (14/380, 3.7%).ConclusionsOur results demonstrate that 19.2% patients with nonsyndromic deafness were caused by mutations in three common deafness genes (GJB2, SLC26A4 and 12S rRNA) in our northern China patient group. GJB2 235delC was the most prevalent mutation, same as in the most Asian populations. These data enrich the database of deafness mutations and provide the standard for clinical diagnose, treatment and genetic counseling in Northern China population.
http://ift.tt/2qpi3RG
Type 1 Tympanoplasty by Cartilage Palisade and Temporalis Fascia Technique: A Comparison
Abstract
(1) To compare graft take up of type-1 tympanoplasty with cartilage palisade technique with those of type-1 tympanoplasty using autotemporalis fascia. (2) To compare hearing results of type 1 tympanoplasty with cartilage palisade technique with those of type-1 tympanoplasty using autotemporalis fascia. A prospective clinical study. It consisted of 60 patients divided into two groups of 30 patients each. After randomization 30 patients underwent type 1 tympanoplasty using cartilage palisade technique and 30 underwent type 1 tympanoplasty using autotemporalis fascia. In follow up, pure tone audiogram were carried out at 2nd, 4th and 6th month. Clinical assessment was done at 2nd 4th and 6th month. The graft uptake rate between the group 1 and group 2 are 93.33 and 90% respectively. As p value was greater than 0.05 so statistically there is no significant difference between the two group. The post operative air bone gap of the two groups were compared using student t test. The pre op mean of group 1 was 32.5 db and pre op mean of group 2 was 30.66 db. The post op mean of group 1 was 21.33, with standard deviation of 3.6984 and standard error of 0.67523. The post op mean of group 2 was 21.09 with standard deviation of 3.29 and standard error of 0.58261. t value was 0.1357. Analysis was done using student t test and p value was found to be greater than 0.05. p value is greater than 0.05 which shows that there is no statistical difference between the two groups. This study establishes the fact that hearing results after performing type 1 tympanoplasty by autotemporalis fascia when compared with type 1 tympanoplasty performed by cartilage palisade technique showed similar hearing gain and post operatively graft take up rate was also similar in two groups. The disadvantage of reducing the mechanical vibration of the tympanic membrane was overcome by the palisade reconstruction of the tympanic membrane. This study definitely emphasizes upon usage of new grafting materials in reconstruction of tympanic membrane, with similar, if not better functional results, without compromising the acoustic transfer characteristics.
http://ift.tt/2qg2YWj
Mature Nasopharyngeal Teratoma in a Neonate: Case Report and a Review of Literature
Abstract
Teratomas are true neoplasms that contain tissues foreign to the site in which they arise. They are derived from germ cells with components of the three embryonic layers (ectoderm, mesoderm and endoderm). The present report is about a 10 day old neonate with teratoma arising from the nasopharyngeal surface of the soft palate, which was successfully removed.
http://ift.tt/2prOsrM
n-Hexane intoxication in a Chinese medicine pharmaceutical plant: a case report
n-Hexane is a well-known neurotoxicant. Polyneuropathy due to occupational n-hexane exposure has been reported worldwide, however, our case is the first report in the Chinese herb indu...
http://ift.tt/2oIlAOK
Variants at the OCA2/HERC2 locus affect time to first cutaneous squamous cell carcinoma in solid organ transplant recipients collected using two different study designs
Abstract
Background
Variants at the Oculocutaneous albinism 2 (OCA2)/ HECT and RLD Domain Containing E3 Ubiquitin Protein Ligase 2 (HERC2) locus have been associated with pigmentation phenotypes as well as risk of developing multiple types of skin cancer.
Objectives
The goal of this study was to evaluate OCA2/HERC2 locus variants for impact on time to develop cutaneous squamous cell carcinoma (cSCC) in organ transplant recipients (OTRs) who are at elevated risk of developing cSCC.
Methods
Participants were solid organ transplant recipients ascertained from two centers (n=125 and 261) with an average of 13.1 years follow-up post-transplant. DNA was available for genotyping for all participants in addition to medical records and questionnaire data. The Ohio State University (OSU) study design was a case-control with prospective follow-up, and the University of California San Francisco (UCSF) study design was a national cross-sectional survey with retrospective chart review.
Results
OCA2 variants rs12913832 and rs916977 were significantly associated with time to first cSCC post-transplant. OTRs homozygous for the brown eye alleles of rs916977 (GG) and rs12913832 (AA) had significant delays of time to first cSCC post-transplant compared to individuals homozygous for the blue eye alleles [HR=0.34, p<0.001and HR=0.54, p=0.012, respectively]. Both variants were highly associated with eye color in combined studies (p<0.001).
Conclusions
This study is the first to show an association between OCA2/HERC2 variants and time to first cSCC post-transplant which may impact dermatologic screening recommendations for high-risk populations.
This article is protected by copyright. All rights reserved.
http://ift.tt/2pvb7p5
Reply to ‘Impact of biologic therapies on risk of major adverse cardiovascular events in patients with psoriasis: systematic review and meta-analysis of randomized controlled trials’
We read with interest the recent article by Rungapiromnan et al. that utilized a meta-analysis to compile data from 38 randomized controlled trials (RCTs) to determine if there is an association between biologic therapies and major adverse cardiovascular events (MACEs) in patients with plaque psoriasis. In the current study, only 10 MACEs were reported over nine of the RCTs examined. The reported absolute values of the Peto odds ratios are worthy of attention.
This article is protected by copyright. All rights reserved.
http://ift.tt/2oSbNAQ
RE: Routine usage of sentinel node biopsy in melanoma management must cease
I read with interest the communication by Dixon and colleagues. I share concern if patients are being told therapies are only available to them if they have a sentinel node biopsy (SNB). SNB does more than offer a subset of patients added prognostic information. What the MLST-1 trial emphatically demonstrated is that SNB is a useful staging tool to stratify patients. Those with a positive SNB do significantly worse than those with a negative result. Furthermore, micro-metastases in a lymph node left alone, is highly likely to become macroscopic, prompting a therapeutic lymph node dissection (TLND).
This article is protected by copyright. All rights reserved.
http://ift.tt/2pv2ue2
Microbes and the Role of Antibiotic Treatment for Wheezy Lower Respiratory Tract Illnesses in Preschool Children
Abstract
Purpose of Review
Antibiotics are commonly used to treat wheezy lower respiratory tract illnesses in preschoolers, although these infections have been traditionally thought to be predominantly of viral origin. Our purpose is to review recent research pertaining to the role of antibiotics in lower respiratory tract illnesses and on subsequent asthma development, as well as the possible mechanisms of their effects.
Recent Findings
Increasing evidence suggests that asthma pathogenesis is associated with events during infancy and early childhood, particularly respiratory tract infections. While viruses are frequently detected in children with lower respiratory tract infections, the presence of potentially pathogenic bacteria is also often detected and may play a role in asthma pathogenesis. Recent evidence suggests that use of macrolides, particularly azithromycin, may decrease the risk of and duration of lower respiratory tract illnesses and prevent future episodes in specific high-risk populations.
Summary
Infants and preschoolers who have wheezy lower respiratory tract illnesses have a higher risk of asthma development. Alterations in the microbiome are thought to be influential. While several recent studies identify azithromycin as a therapeutic option in these illnesses, additional research is needed.
http://ift.tt/2pg1sSP
Panniculus morbidus: obesity-related abdominal wall lymphoedema
A 52-year-old female patient presented with a massive abdominal wall swelling that adversely affected her lifestyle. Imaging revealed significant subcutaneous oedema and the presence of grossly distended veins. Subsequently, she underwent a 'toilet' panniculectomy and abdominoplasty. We describe the surgical technique used to retract the lymphoedematous tissue facilitating excisional surgery, and discuss the pathophysiology of this condition and the possible contribution of venous obstruction to the development of subcutaneous oedema.
http://ift.tt/2qhNdvg
A case of fulminant necrotising fasciitis
Description
A 57-year-old man presented to the emergency department with fever, chills and a wound on his left foot since 2 weeks. He had no previous medical history. Despite receiving flucloxacillin, the wound was neglected and became necrotic with skin discoloration and a purulent, foul-smelling discharge. The leg developed functional impairment with severe claudication pain. All digits were pale, cold and numb (figure 1A, B). Biochemistry showed high infection parameters and hyperlactaemia as a sign of hypoperfusion. Hyperglycaemia revealed de novo diabetes. X-rays of the left lower extremity showed subcutaneous air (figure 2A–C).
Figure 1
(A,B) The extension of necrotising fasciitis of the left lower extremity.
Figure 2
X-rays of the foot (A) and knee (B and C) showing subcutaneous air (arrows), which is typical of necrotising fasciitis.
Patient underwent immediate left transfemoral amputation. Postoperatively he was...
http://ift.tt/2pfHsj9
Scalp vein sign: a forgotten clinical clue?
Description
A 72-year-old man presented for general health check. He was asymptomatic except for hard of hearing and uses hearing aid for the last 4 years. Clinical examination revealed very prominent tortuous superficial temporal veins bilaterally, more on the left side (figure 1) with no bruit and a warm non-tender skull on palpation. Serum chemistries showed significantly elevated alkaline phosphatase 1520 U/L (normal, 45–140 U/L) with normal liver, kidney and haematological parameters. Serum calcium, phosphorus, 25-hydroxy vitamin D and parathyroid hormone levels were normal. Skull radiograph showed moth-eaten appearance suggestive of Pagetoid bone (figure 2). With this clinico-biochemical picture in an otherwise asymptomatic individual, Paget's disease of bone was strongly considered. It was confirmed by significant uptake of technetium-methylene diphosphonate (MDP) in skull and right hemipelvis. He was managed with intravenous zoledronic acid, calcium and vitamin D supplementation. Serum alkaline phosphatase normalised at 6 months follow-up, though hearing and scalp vein...
http://ift.tt/2qhXPKB
Granzyme B producing B-cells in renal transplant patients
Source:Clinical Immunology
Author(s): Jiqiao Zhu, Ye Zeng, Sebastian Dolff, Anja Bienholz, Monika Lindemann, Alexandra Brinkhoff, Manfred Schedlowski, Shilei Xu, Ming Sun, Hana Guberina, Julia Kirchhof, Andreas Kribben, Oliver Witzke, Benjamin Wilde
ObjectivesA separate subset of Granzyme B (GrB) producing B-cells regulating T-cell mediated immunity has been identified. In the present study, we investigated the role of GrB+ B-cells in renal transplant patients (RTX).Methods12 healthy controls (HC) and 26 RTX patients were enrolled. In addition, 19 healthy volunteers treated with cyclosporine A (CsA) were enrolled. GrB+ B-cells were determined via flow cytometry.ResultsRTX Patients showed a diminished fraction of GrB+ B-cells as compared to HC. CsA treatment of healthy volunteers had no impact on the development of GrB+ B-cells. RTX patients with a history of allograft rejection showed an increased frequency of GrB+ B-cells. RTX patients with at least one episode of CMV viremia tended to have lower GrB+ B-cells as compared to patients without viremic episodes.ConclusionWe demonstrate that treatment with CsA does not impair the development of GrB+ B-cells. GrB+ B-cells may have a dual role in renal transplantation as regulatory cells to maintain allospecific tolerance and as effector cells enhancing viral control.
http://ift.tt/2pIasSf
BREG cells in Hashimoto's thyroiditis isolated or associated to further organ-specific autoimmune diseases
Source:Clinical Immunology
Author(s): Maria Giulia Santaguida, Ilenia Gatto, Giorgio Mangino, Camilla Virili, Ilaria Stramazzo, Poupak Fallahi, Alessandro Antonelli, Maria Segni, Giovanna Romeo, Marco Centanni
Hashimoto thyroiditis (HT) may occur isolated or associated with other non-endocrine autoimmune disorders (NEAD). No data are available about Breg cells in these disorders and this represented the aim of the study. Th17 and Breg cells subset were characterized on peripheral blood mononuclear cells isolated from 18 healthy donors (HD), 19 patients with isolated HT and 26 patients with HT+NEAD. Th17 were higher in patients with isolated HT than in HD but no further changes were seen in patients with HT+NEAD. CD24hiCD38hi unstimulated Breg cells were similar in HT patients and in HD, but significantly higher in patients with HT+NEAD than in both HT and in HD. CD19+CD24hiCD27+ Breg memory phenotype was similar in HD and in HT patients, but decreased in patients with HT+NEAD (23.4%vs38.5%). Upon CpG-stimulation, CD24hiCD38hi IL-10+ Breg cells were higher in HT patients than in HD (3.9%vs1.8%) but similar in patients with HT+NEAD (2.4%).
http://ift.tt/2prB2vC
Tofacitinib attenuates arthritis manifestations and reduces the pathogenic CD4 T cells in adjuvant arthritis rats
Source:Clinical Immunology
Author(s): Smadar Gertel, Hussein Mahagna, Gidi Karmon, Abdulla Watad, Howard Amital
Rheumatoid arthritis (RA) is an autoimmune disease characterized by pronounced inflammation and leukocyte infiltration in affected joints.Tofacitinib is new agent, a selective inhibitor of Janus kinase (JAK) signaling pathways mediated by JAK1 and JAK3 and inhibits the key transcription factors STAT1 and STAT3.We investigated the action mechanisms of tofacitinib in rats with adjuvant-induced-arthritis (AIA). AIA-rats were treated orally with tofacitinib or with methotrexate. Arthritis severity and serum C-reactive protein (CRP) levels were evaluated, splenic cells were examined by flow cytometry and cytokines were analyzed by real-time PCR.Tofacitinib markedly reduced the clinical status of treated rats in comparison to control group. Reduced joints inflammation and down-regulated serum CRP levels reflected the clinical manifestations of the treated rats. Tofacitinib down-regulated significantly the frequency of CD4+IFN-γ+ T cells and reduced IL-1β mRNA expression levels in the spleen of the treated rats.These results show that tofacitinib attenuated arthritis severity, modified splenic populations and cytokine imbalance.
http://ift.tt/2pIaqd5
Influence of drug molecules on regulatory B cells
Source:Clinical Immunology
Author(s): Kahina Amrouche, Christophe Jamin
By their suppressive functions, regulatory B (Breg) cells are considered as key elements in the control and development of various disease states. Many signals can induce Bregs in vivo and in vitro and often from heterogeneous populations. Several specific signals delivered in a timely immunological context contribute to the establishment of Bregs. These are endogenous and physiological signals or stimuli, widely discussed in the literature participating in the establishment of an effective immune response. However, exogenous signals, much less clearly identified can also be considered as Bregs inducers. These extrinsic signals are capable of directly or indirectly influencing the suppressive capacity of Bregs, but also their expansion and functional restoration in its absence. Faced with the excitement generated by the development of processes favoring the expansion of Bregs in mice for therapeutic purposes, the challenge today is to extrapolate such approaches in humans. This perspective may already be in effect.
http://ift.tt/2prvOjy
IL-10 producing Bregs are impaired in psoriatic arthritis and psoriasis and inversely correlate with IL-17- and IFNγ-producing T cells
Source:Clinical Immunology
Author(s): Athanasios Mavropoulos, Areti Varna, Efterpi Zafiriou, Christos Liaskos, Ioannis Alexiou, Aggeliki Roussaki-Schulze, Marianna Vlychou, Christina Katsiari, Dimitrios P. Bogdanos, Lazaros I. Sakkas
Our aim was to study CD19(+)CD27(+)CD24(high) memory and CD19(+)CD24(high)CD38(high) transitional and IL-10+Breg cells, known to inhibit Th1 and Th17 cells in experimental arthritis, in psoriatic arthritis (PsA) and psoriasis (Ps). Peripheral blood Breg cells from 60 patients with PsA, 50 patients with Ps and 23 healthy controls were analyzed by flow cytometry. IL-17A-producing CD3(+) T cells and IFNγ-producing CD3(+) T cells and activation of p38 MAPK and STAT3 were also studied. CD19(+)CD27(+)CD24(high) and CD19(+)CD24(high)CD38(high) Breg cells were decreased in PsA and Ps. In Ps patients, CD19(+)CD27(+)CD24(high) Breg cells inversely correlated with PASI score. IL-10+Bcells were also decreased and inversely correlated with IL-17A+CD3+ and IFN-γ+CD3+ T cells. B cells from patients exhibited impaired activation of p38 MAPK and STAT3. In conclusion, IL-10+Breg cells are decreased PsA and Ps and inversely correlated with the severity of psoriasis and IL-17A+ and IFNγ+ T cells.
http://ift.tt/2pI8yRE
Effector and regulatory B cells in Multiple Sclerosis
Source:Clinical Immunology
Author(s): Elsebeth Staun-Ram, Ariel Miller
The role of B cells in the pathogenesis of Multiple Sclerosis (MS), an autoimmune neurodegenerative disease, is becoming eminent in recent years, but the specific contribution of the distinct B cell subsets remains to be elucidated. Several B cell subsets have shown regulatory, anti-inflammatory capacities in response to stimuli in vitro, as well as in the animal model of MS: Experimental Autoimmune Encephalomyelitis (EAE). However, the functional role of the B regulatory cells (Bregs) in vivo and specifically in the human disease is yet to be clarified. In the present review, we have summarized the updated information of the roles of effector and regulatory B cells in MS and the immune-modulatory effects of MS therapeutic agents on their phenotype and function.
http://ift.tt/2prtf0T
IL-18 binding protein reverses the life-threatening hyperinflammation of a baby with the NLRC4 mutation
Source:Journal of Allergy and Clinical Immunology
Author(s): Daniela Novick, Charles A. Dinarello
http://ift.tt/2oI2QyU
Reply
Source:Journal of Allergy and Clinical Immunology
Author(s): Scott W. Canna, Charlotte Girard, Louise Malle, Adriana de Jesus, Neil Romberg, Judith Kelsen, Lea F. Surrey, Pierre Russo, Andrew Sleight, Eduardo Schiffrin, Cem Gabay, Raphaela Goldbach-Mansky, Edward M. Behrens
http://ift.tt/2oVpJe6
Do traumatic events have more impact on the development of dental anxiety than negative, non-traumatic events?
The importance of exposure to traumatic events for the development of dental anxiety has not been investigated. The aim of the present study was to test the hypotheses that individuals who reported having been exposed to a traumatic event [that is, fulfilling Criterion A of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), for post-traumatic stress disorder (PTSD)] as the cause of their dental anxiety would report significantly higher levels of dental anxiety, typical trauma-related (PTSD) symptoms, and greater disturbance of memories involving these events than those who reported being exposed to non-traumatic events. Patients of a specialized dental fear clinic (n = 90) were divided into those who reported a traumatic event that initiated their dental trait anxiety and those who did not. The two groups did not differ in their severity of dental anxiety and number of PTSD symptoms, but the memories of those who had been exposed to traumatic events were significantly more vivid than the memories of those in the reference group. Length of time since the event took place did not play a role. Hence, traumatic events are remembered more vividly, but do not seem to initiate more severe forms of dental anxiety than other events.
http://ift.tt/2oHT0Nj
Εγγραφή σε:
Αναρτήσεις (Atom)