Head and Neck Medicine by Alexandros G.Sfakianakis: 05/02/17

Τρίτη 2 Μαΐου 2017

Development of a scoring system to predict massive postpartum transfusion in placenta previa totalis

Abstract

Purpose

It is important to predict massive postpartum hemorrhage in patients with placenta previa totalis (PPT) and a method that accurately predicts this event is needed. The present study developed a scoring system that predicts massive transfusion in patients with PPT.

Methods

This single-center retrospective cohort study comprised 238 patients with PPT who underwent caesarean section between January 2004 and December 2010. Massive transfusion was defined as the transfusion of ≥8 units of packed red blood cells within 24 h after delivery. Multivariate regression analysis was used to estimate the risks of massive transfusion. A probability score model was then constructed and tested for performance. Subsequently, the model was validated in other patients with PPT (n = 117).

Results

Thirty-one patients (13.0%) underwent massive transfusion. Ultrasound suspicion of placental adhesion, previous caesarean section, gestational age <37 weeks, sponge-like appearance of the cervix, and anterior placenta were all independent predictors of massive transfusion. The performance for the score model revealed good calibration (Hosmer–Lemeshow chi-squared 1.64; P = 0.44), and its discrimination (the area under the receiver operating characteristic for this model was 0.84) was better than when suspicion of placental adhesion was used alone (0.67; P < 0.001). In the validation set, the performance was 0.88.

Conclusion

The scoring system developed using the five independent risk factors had better performance to predict massive transfusion in patients with PPT than when suspicion of placental adhesion was used alone. However, further large-scale studies are warranted to clarify the usefulness and accuracy of this model.

http://ift.tt/2qCOkFl

Sedative effects of oral pregabalin premedication on intravenous sedation using propofol target-controlled infusion

Abstract

Purpose

The sedative effects of pregabalin during perioperative period have not been sufficiently characterized. The aim of this study was to verify the sedative effects of premedication with pregabalin on intravenous sedation (IVS) using propofol and also to assess the influences of this agent on circulation, respiration, and postanesthetic complications.

Methods

Ten healthy young volunteers underwent 1 h of IVS using propofol, three times per subject, on separate days (first time, no pregabalin; second time, pregabalin 100 mg; third time, pregabalin 200 mg). The target blood concentration (C _T) of propofol was increased in a stepwise fashion based on the bispectral index (BIS) value. Ramsay's sedation score (RSS) was determined at each propofol C _T. Propofol C _T was analyzed at each sedation level. Circulation and respiration during IVS and complications were also verified.

Results

Propofol C _T was reduced at BIS values of 60 and 70 in both premedicated groups (100 mg: p = 0.043 and 0.041; 200 mg: p = 0.004 and 0.016, respectively) and at a BIS value of 80 in the pregabalin 200 mg group (p < 0.001). Propofol C _T was decreased at RSS 4–6 in the pregabalin 100 mg group (RSS 4: p = 0.047; RSS 5: p = 0.007; RSS 6: p = 0.014), and at RSS 3–6 in the pregabalin 200 mg group (RSS 3–5: p < 0.001; RSS 6: p = 0.002).

Conclusion

We conclude that oral premedication with pregabalin reduces the amount of propofol required to obtain an acceptable and adequate sedation level.

http://ift.tt/2pX2HIj

MEP monitoring during aortic surgery: what we truly know

http://ift.tt/2qCYLZs

Liquid biopsy: unlocking the potentials of cell-free DNA

Abstract

Circulating tumor DNA (ctDNA) has garnered much excitement over the past few years for its potential clinical utility as a surrogate for tumor biopsies in early cancer detection and prognosis. Numerous studies have demonstrated that ctDNA is shed into the circulation and is elevated in disease states such as cancer. Despite the low levels of ctDNA in the "sea" of normal DNA, advances in next generation sequencing (NGS) and digital polymerase chain reaction (PCR) technologies have led to dramatic improvements in variant detection sensitivity and specificity. These technologies allow the quantification of ctDNA, providing both prognostic and predictive information. Here, we review the history of cell-free DNA and different technologies for the detection of ctDNA in cancer and describe the different modalities for using ctDNA in clinical oncology.

http://ift.tt/2qwPin7

The Greek Version of the Ohkuma Questionnaire for Dysphagia Screening

http://otorhinolaryngology-crete.blogspot.gr/2017/05/the-greek-version-of-ohkuma.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Trunk rotation,Cervical induced horizontal nystagmus,“neck torsion test” (NTT),There is a “cervicotonic provocation nystagmus” in response to objective reaction to cervical straining with a static trunk excursion.

http://otorhinolaryngology-crete.blogspot.gr/2017/05/cervico-vestibular-muscle-afferents.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Prolonged endotracheal intubation is the main indication of tracheostomy, performed after two weeks of intubation. Although there were no major early complications, laryngotracheal stenosis is still a challenging sequel for tracheostomy that needs to be investigated to be prevented.

http://otorhinolaryngology-crete.blogspot.com/2017/05/prolonged-endotracheal-intubation-is.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Sialendoscopy Training

http://otorhinolaryngology-crete.blogspot.gr/2017/05/sialendoscopy.html

Introduction

Several surgical training simulators have been created for residents and young surgeons to gain experience with surgical procedures. Laboratory training is fundamental for acquiring familiarity with the techniques of surgery and skill in handing instruments.

Objective

The aim of this study is to present a novel simulator for training sialendoscopy.

Method

This realistic simulator was built with a synthetic thermo-retractile, thermosensible rubber which, when combined with different polymers, producesmore than 30 different formulas. These formulas present textures, consistencies, and mechanical resistance are similar to many human tissues.

Results

The authors present a training model to practice sialendoscopy. All aspects of the procedure are simulated: month opening, dilatation of papillae, insert of the scope, visualization of stones, extraction of these stones with grasping or baskets, and finally, stone fragmentation with holmium laser.

Conclusion

This anatomical model for sialendoscopy training should be considerably useful to abbreviate the learning curve during the qualification of young surgeons while minimizing the consequences of technical errors.

Keywords : salivary glands; learning; medical education.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

The angle of mandible was found to be the most accurate landmark for identifying the cervical level, which corresponded to C2 and C2–C3 disc space. The hyoid bone, thyroid cartilage, and cricoid cartilage were not reliable to predict the cervical levels : The lateral flexion and extension radiographs of cervical spine in standing position : Anterior Cervical Surgical Landmarks (the hyoid bone, thyroid cartilage, and cricoid cartilage).The main corresponding cervical levels for the mandibular angle were C2 on both of the flexion and extension films, for the hyoid bone were the C3–C4 interspace on flexion film and C3 on extension film, for the thyroid cartilage C5 on both of flexion and extension films, and for the cricoid cartilage C6 on flexion film and C5–C6 interspace on extension film, respectively.

http://otorhinolaryngology-crete.blogspot.com/2017/05/the-angle-of-mandible-was-found-to-be.html

Radiographic Evaluation of the Reliability of Neck Anatomic Structures as Anterior Cervical Surgical Landmarks

στο World Neurosurgery

Μετάφραση άρθρου

Publication date: July 2017

Source:World Neurosurgery, Volume 103

Author(s): Jia-Ming Liu, Liu-Xue Du, Xu Xiong, Xuan-Yin Chen, Yang Zhou, Xin-Hua Long, Shan-Hu Huang, Zhi-Li Liu

BackgroundAccurate location of the skin incision is helpful to decrease the technical difficulty and save the operative time in anterior cervical spine surgery. Spine surgeons usually use the traditional neck anatomic structures (the hyoid bone, thyroid cartilage, and cricoid cartilage) as landmarks during the surgery. However, the reliability of these landmarks has not been validated in actual practice.ObjectiveTo find out which landmark is the most accurate for identifying the cervical levels in anterior cervical spine surgery.MethodsThe lateral flexion and extension radiographs of cervical spine in standing position from 30 consecutive patients from January 2015 to February 2015 were obtained. The cervical vertebral bodies from C2 to C7 were divided equally into 2 segments. The cervical segments corresponding to each of the surface landmarks were recorded on the flexion and extension radiographs, respectively, and the displacement of corresponding cervical segments from the flexion to extension radiographs for each landmark was calculated.ResultsBased on the measurements, the main corresponding cervical levels for the mandibular angle were C2 on both of the flexion and extension films, for the hyoid bone were the C3–C4 interspace on flexion film and C3 on extension film, for the thyroid cartilage C5 on both of flexion and extension films, and for the cricoid cartilage C6 on flexion film and C5–C6 interspace on extension film, respectively. The ratios of displacement within 2 segments from flexion to extension were 83.3% (25/30) for mandibular angle, 56.7% (17/30) for hyoid bone, 66.7% (20/30) for thyroid cartilage, and 56.7% (17/30) for cricoid cartilage, respectively. The mean displacement from flexion to extension films were significantly less than 2 cervical segments for the mandibular angle but greater than 2 segments for the other landmarks. Significant differences were found between mandibular angle and the other 3 landmarks for the displacement from flexion to extension.ConclusionsThe angle of mandible was found to be the most accurate landmark for identifying the cervical level, which corresponded to C2 and C2–C3 disc space. The hyoid bone, thyroid cartilage, and cricoid cartilage were not reliable to predict the cervical levels.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Variable expressivity of TCTEX1D2 mutations and a possible pathogenic link of molar-incisor malformation to ciliary dysfunction

Publication date: August 2017
Source:Archives of Oral Biology, Volume 80
Author(s): Johannes Zschocke, Anna Schossig, Dieter D. Bosshardt, Daniela Karall, Rudolf Glueckert, Ines Kapferer-Seebacher
ObjectiveClarification of the molecular basis of a ciliopathy associated with molar-incisor malformation in a consanguineous Turkish family.DesignFull dental and clinical examinations, histologic analysis, comprehensive genetic analyses including exome sequencing, ciliary function tests and transmission electron microscopy of ciliary biopsies in the surviving patient.ResultsTwo siblings had situs inversus and complex heart defects suggestive of ciliary dysfunction. The affected girl who died in utero showed severe chest abnormalities compatible with Jeune syndrome which were not present in the affected boy. Dental investigations in the boy showed typical signs of molar-incisor-malformation. Exome sequencing identified a homozygous intragenic deletion in TCTEX1D2 which is predicted to completely remove protein function. Ciliary function tests and electron microscopy showed mild irregularities of motile cilia such as compound cilia and loss of membranes.ConclusionsOur findings support the suggestion that TCTEX1D2 mutations have variable expressivity and may be associated with disturbances of embryonic development caused by both, ciliary signaling and motile dysfunction. The presence of molar-incisor-malformation in the living patient raises the possibility of a pathogenetic link of this rare dental anomaly to ciliary dysfunction during tooth development at least in some individuals.

http://ift.tt/2qCQkgr

Expression of cancer cell-derived IgG and extra domain A-containing fibronectin in salivary adenoid cystic carcinoma

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Wan-Qi Lv, Jing Peng, Hai-Cheng Wang, De-ping Chen, Yue Yang, Yang Zhao, Xiao-yan Qiu, Jiu-Hui Jiang, Cui-Ying Li
ObjectiveCancer-IgG is a newly-discovered molecule, mainly derived from epithelial carcinoma cells and is significantly correlated with differentiation, metastasis, local invasion, and poor prognosis of many cancers. In our previous study we detected IgG expression in oral epithelial carcinoma, including salivary adenoid cystic carcinoma (SACC), using an IgG-specific commercial antibody. Here, we explored the correlation between cancer-IgG and clinicopathological features of SACC.DesignA total of 68 human SACC tissue specimens and 2 siRNAs were used to analyze the correlation between cancer-IgG and extra domain A (EDA⁺)-containing fibronectin using the cancer-IgG-specific monoclonal antibody, RP215.ResultsWe found an unexpected correlation between cancer-IgG and EDA⁺ fibronectin, both of which showed aberrant expression in SACC tissue samples. Both were highly expressed in SACC with nerve invasion. In our previous study, EDA⁺ fibronectin overexpression in SACC cells decreased N-cadherin expression. In the present study, we used SACC-83 cells, wherein EDA⁺ fibronectin is overexpressed and cancer-IgG is knocked down. EDA⁺ fibronectin expression was reduced with cancer-IgG knockdown, while cancer-IgG expression did not affect EDA⁺ fibronectin overexpression. Furthermore, knockdown of non-B cell-derived IgG in SACC cells decreased cellular motility (P<0.05) as well as increased E-cadherin and alpha-smooth muscle actin levels.ConclusionThe results suggest that cancer IgG potentially regulates EDA⁺ fibronectin expression, thereby suggesting possible new therapeutic approaches for SACC.

http://ift.tt/2pWqR5u

Effect of preparation method and storage period on the stability of saliva DNA

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Maribasappa Karched, Radhika G. Bhardwaj, Eunice M. Pauline, Swapna George, Sirkka Asikainen
Saliva is an attractive source for oral microbial detection and quantification since sampling is non-invasive and rapid.ObjectivesTo determine whether different saliva preparation methods or preservation time periods affect DNA stability.MethodsSaliva samples from 4 healthy adult volunteers were processed to obtain 3 different preparations: whole saliva, and after centrifugation pellet and supernatant. Purified DNA (MasterPure™) from each sample was divided into 4 aliquots, one for immediate analysis and 3 (stored at −80°C) for later analyses after 1 week and 2 and 6 months. DNA concentrations and qPCR based quantities of Porphyromonas gingivalis, Prevotella intermedia, Parvimonas micra, Fusobacterium nucleatum, Filifactor alocis and Streptococcus mutans were determined.ResultsDNA concentration did not decrease (P>0.05) during the 6-month period in any sample. Mean (SE) DNA concentrations (ng/μl) in whole saliva were 152.2 (51.2) and 147.8 (50) at day 0 and 6 months, respectively. Similarly, the values for pellet were 134.9 (42.5) and 133.6 (42.9), and for supernatant, 11 (1.9) and 8.9 (2.3), the difference being significant (P<0.001) between supernatant and whole saliva or pellet. The quantities of most bacterial species found at day 0 remained stable over the 6-month period in all saliva preparations. In supernatant, species quantities were lower (P<0.05) than in whole saliva or pellet.ConclusionsDNA concentrations were comparable between whole saliva and pellet, suggesting that either of them can be used for DNA-based analyses. Our results also demonstrated that DNA extracted from saliva can be preserved at −80°C for at least 6 months without decrease in DNA concentration.

http://ift.tt/2qCKiMS

Measurement of root surface area of permanent teeth in a Chinese population

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Y. Gu, Q. Zhu, Y. Tang, Y. Zhang, X. Feng
ObjectivesThe aim of this study was to investigate the relation between the remaining area of periodontal attachment and the attachment levels for each type of permanent teeth in a Chinese population by using micro-computed tomography (micro-CT) scans.DesignA total of 440 extracted permanent teeth (including each tooth type except for the third molars) were collected from a Chinese population and scanned using a micro-CT. The CT data were input into Mimics 15.01 to generate 3D tooth models. To simulate various attachment levels, the roots were virtually cut at 0, 2, 4, 6, 8, and 10mm from the cemonto-enamel junction (CEJ). The net and percent remaining root surface area (RSA) were measured and calculated, and the data corresponding to attachment level were fitted to a linear function.ResultsA Linear function can perfectly fit in relating the simulated attachment level to the net and percent remaining RSA (R²>0.99, and p<0.001 for each tooth type). For net remaining RSA, the slope of the linear function was steepest for maxillary first molars (b1=−39.32) and least steep for mandibular central incisor (b1=−13.08); whereas for the percentage of remaining RSA, the slopes (b1) were relatively within a narrow range, from −7.40 (maxillary canine) to −9.64 (maxillary first molars).ConclusionMicro-CT offers simple and precise technique for quantitative analysis of the RSA. The total amount and vertical distribution of the RSA varied by tooth type. Linear formulas can perfectly describe the relation between the attachment level and the net and percent remaining RSA.

http://ift.tt/2pWy1XD

Impact of wear and diet on molar row geometry and topography in the house mouse

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Sabrina Renaud, Ronan Ledevin
ObjectivesDental evolution affects the geometry of the tooth, but the adaptive relevance of these changes is related to tooth sharpness, complexity, and relief (topography). On a set of laboratory mice, we assessed how wear related to age and food consistency affected molar geometry and topography.DesignThree groups of laboratory inbred mice (C57BL/6J strain) were considered: Four week old mice close to weaning, six month old mice fed on regular rodent pellets, and six month old mice fed on rodent pellets that were powdered and served as jelly. Their upper and lower molar rows were imaged in 3D. The geometry of the surfaces was quantified using a template describing the whole surface of the rows. Topographic indices were estimated on the same surfaces.ResultsThe geometry of the molar rows was heavily affected by age-related wear. Food consistency affected mostly the upper molar row, which was more worn and less helical in soft food eaters. Tooth sharpness and relief decreased with age-related wear. Tooth relief was lower in soft food eaters, but only on the upper molar row. Tooth complexity was insensitive to wear.ConclusionThe primary factor affecting tooth geometry and topography is age-related wear, as wear erodes the molar surfaces. Tooth complexity, however, appears to be insensitive to wear, making this index relevant for comparison of tooth morphology among wild mice of unknown age. Soft food eaters displayed more worn teeth, with less helical molar row occlusal surface, possibly because behavior and jaw morphology were disturbed due to this unusual food resource.

http://ift.tt/2qCyxGs

Exposure to Porphyromonas gingivalis LPS during macrophage polarisation leads to diminished inflammatory cytokine production

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Louise A. Belfield, Jon H. Bennett, Wondwossen Abate, Simon K. Jackson
ObjectiveThe objective of the present study was to determine the effects of concurrent LPS and cytokine priming, reflective of the in vivo milieu, on macrophage production of key periodontitis associated cytokines TNF, IL-1β and IL-6.DesignTHP-1 cells were pre-treated with combinations of Porphyromonas gingivalis and Escherichia coli lipopolysaccharide (LPS), concurrently with polarising cytokines IFNγ and IL-4, or PMA as a non-polarised control. Production of key periodontitis associated cytokines in response to subsequent LPS challenge were measured by enzyme − linked immunosorbent assay.ResultsCompared with cells incubated with IFNγ or IL-4 alone in the "polarisation" phase, macrophages that were incubated with LPS during the first 24h displayed a down-regulation of TNF and IL-1β production upon secondary LPS treatment in the "activation" phase. In all three macrophage populations (M0, M1 and M2), pre-treatment with P. gingivalis LPS during the polarisation process led to a significant decrease in TNF production in response to subsequent activation by LPS (p=0.007, p=0.002 and p=0.004, respectively). Pre-treatment with E. coli LPS also led to a significant down-regulation in TNF production in all three macrophage populations (p<0.001). Furthermore, the presence of E. coli LPS during polarisation also led to the down-regulation of IL-1β in the M1 population (p<0.001), whereas there was no measurable effect on IL-1β production in M0 or M2 macrophages. There was no significant effect on IL-6 production.ConclusionsMacrophages become refractory to further LPS challenge, whereby production of key periodontitis associated cytokines TNF and IL-1β is reduced after exposure to LPS during the polarisation phase, even in the presence of inflammatory polarising cytokines. This diminished cytokine response may lead to the reduced ability to clear infection and transition to chronic inflammation seen in periodontitis.

http://ift.tt/2pWrHz3

Epithelial to mesenchymal transition in Cyclosporine A-induced rat gingival overgrowth

Publication date: September 2017
Source:Archives of Oral Biology, Volume 81
Author(s): Fei Yang, Jing Lu, Youcheng Yu, Yiming Gong
Background and objectiveEpithelial-mesenchymal transition (EMT) has been proved to occur in drug-induced gingival overgrowth. However, the specific pathogenic mechanism remains uncertain. The aim of this study is to examine the expression of EMT markers in cyclosporine A (CsA)-induced gingival overgrowth in rat models.Material and methodsThirty-six rats were randomly divided into two groups. The experimental group received CsA therapy subcutaneously in a daily dose of 10mg/kg, and the other group was used as a control. Six rats per group were sacrificed at 20, 40 and 60days, and the gingivae were obtained. The expression of TGF-β1, E-Cadherin, ZEB1, ZEB2, and Snail1 were examined by quantitative real time PCR (qRT-PCR), western blotting, and immunohistochemistry. In addition, a group of microRNAs associated with EMT and fibrosis were also detected in gingival tissue by qRT-PCR.ResultsThe mRNA and protein levels of TGF-β1, ZEB1, and ZEB2 in gingivae were significantly upregulated after 40 and 60days of CsA administration. Conversely, the levels of E-cadherin were significantly downregulated in overgrowth sample at day 40 and 60. Intense immunohistochemmical staining for TGF-β1 were observed in the samples from CsA group at day 40 and 60. Concomitantly, the densities of E-cadherin were gradually decreased in the basal layers of epithelium with time. Three members of miR–200s (miR-200a, miR-200b and miR-200c) were significantly downregulated in CsA-treated rats at 40 and 60days, while miR-9, miR-23a and miR-155 were significantly upregulated when compared with those of the control group.ConclusionsThe process of EMT in CsA-induced rat gingival overgrowth is associated with increased expression of TGF-β1, ZEB1, and ZEB2, and decreased expression of E-cadherin.

http://ift.tt/2qCZb1K

Variable expressivity of TCTEX1D2 mutations and a possible pathogenic link of molar-incisor malformation to ciliary dysfunction

Expression of cancer cell-derived IgG and extra domain A-containing fibronectin in salivary adenoid cystic carcinoma

Effect of preparation method and storage period on the stability of saliva DNA

Measurement of root surface area of permanent teeth in a Chinese population

Impact of wear and diet on molar row geometry and topography in the house mouse

Exposure to Porphyromonas gingivalis LPS during macrophage polarisation leads to diminished inflammatory cytokine production

Epithelial to mesenchymal transition in Cyclosporine A-induced rat gingival overgrowth

Molecular Pathology of Anaplastic Thyroid Carcinomas: A Retrospective Study of 144 Cases

Thyroid May 2017, Vol. 27, No. 5: 682-692.

http://ift.tt/2qqDllV

Glycyrrhizin, a Direct HMGB1 Antagonist, Ameliorates Inflammatory Infiltration in a Model of Autoimmune Thyroiditis via Inhibition of TLR2-HMGB1 Signaling

Thyroid May 2017, Vol. 27, No. 5: 722-731.

http://ift.tt/2qqydxQ

International Archives of Otorhinolaryngology: 20 Years of Excellence!

http://ift.tt/2pE65EH

Efficacy of Carbon Microcoils in Relieving Cervicogenic Dizziness

Abstract Introduction Cervical pain contributes to postural deviations and imbalance. Nanotechnology may be used for the treatment of neck pain by fixing to the skin small rounds silicone patches containing double spiral carbon nanotubes arranged in the form of a coil (Helical), which would then relieve dizziness caused by muscular contraction. Objective The objective of this study is to Evaluate pain and dizziness scores before and after Helical patches effect on cervicogenic dizziness treatment. Methods The selected patients should have neck pain arising from muscle contraction with loss of balance or instability lasting more than 90 days and normal electrooculography. Treatment consisted of placing 10 Helical patches distributed as follows: two in the upper cervical area, two in the lower cervical area (near the 5th and 6th vertebrae), two in the upper trapezius muscle area (between neck and shoulder), and four in the tender point area (as reported by the patient). Using a Visual Analogue Scale (VAS), we matched pain and dizziness scores from Day 1 to those from Day 15 and Day 30 using Mann-Whitney test. Results There was a significant difference between pain score reported on Day 1 and Day 15 (Z = 2.43, U = 5, p = 0.01). We also found significant differences between dizziness scores reportedondays1 and15 (Z = 2.62, U = 3.5, p = 0.01) and days 1 and 30 (Z = 2.36, U = 5.5, p = 0.01). Conclusion The Helical patches seem to be an effective treatment for cervicogenic dizziness.

http://ift.tt/2qqDgyp

Neck Dissection Technique Commonality and Variance: A Survey on Neck Dissection Technique Preferences among Head and Neck Oncologic Surgeons in the American Head and Neck Society

Abstract Introduction Neck dissection (ND) technique preferences are not well reported. Objective The objective of this study is to educate practitioners and trainees about surgical technique commonality and variance used by head and neck oncologic surgeons when performing a ND. Methods Online survey of surgeon members of the American Head and Neck Society (AHNS). Survey investigated respondents' demographic information, degree of surgical experience, ND technique preferences. Results In our study, 283 out of 1,010 (28%) AHNS surgeon members with a mean age of 50.3 years (range 32-77 years) completed surveys from 41 states and 24 countries. We found that 205 (72.4%) had completed a fellowship in head and neck surgical oncology. Also, 225 (79.5%) respondents reported completing more than 25 NDs per year. ND technique commonalities (>66% respondents) included: preserving level 5 (unless with suspicious lymph nodes (LN)), only excising the portion of sternocleidomastoid muscle involved with tumor, resecting lymphatic tissue en bloc, preservation of cervical sensory rootlets, not performing submandibular gland (SMG) transfer, placing one drain for unilateral selective NDs, and performing a ND after parotidectomy and thyroidectomy and before transcervical approaches to upper aerodigestive tract primary site. Variability existed in the sequence of LN levels excised, instrument preferences, criteria for drain removal, the timing of a ND with transoral upper aerodigestive tract primary site resections, and submandibular gland preservation. Results showed that 122 (43.1%) surgeons reported that they preserve the submandibular gland during the level 1b portion of a ND. Conclusions The commonalities and variances reported for the ND technique may help put individual preferences into context.

http://ift.tt/2pDWwWu

Sialendoscopy Training: Presentation of a Realistic Model

Abstract Introduction Several surgical training simulators have been created for residents and young surgeons to gain experience with surgical procedures. Laboratory training is fundamental for acquiring familiarity with the techniques of surgery and skill in handing instruments. Objective The aim of this study is to present a novel simulator for training sialendoscopy. Method This realistic simulator was built with a synthetic thermo-retractile, thermosensible rubber which, when combined with different polymers, producesmore than 30 different formulas. These formulas present textures, consistencies, and mechanical resistance are similar to many human tissues. Results The authors present a training model to practice sialendoscopy. All aspects of the procedure are simulated: month opening, dilatation of papillae, insert of the scope, visualization of stones, extraction of these stones with grasping or baskets, and finally, stone fragmentation with holmium laser. Conclusion This anatomical model for sialendoscopy training should be considerably useful to abbreviate the learning curve during the qualification of young surgeons while minimizing the consequences of technical errors.

http://ift.tt/2qqReAr

Role of Monocyte Count and Neutrophil-to- Lymphocyte Ratio in Survival of Oral Cancer Patients

Abstract Introduction Inflammation seems to play a critical role in the development and progression of numerous cancers. Peripheral blood leukocyte count is an easily assessable parameter of systemic inflammatory response. Objective The aim of this study was to investigate whether the pretreatment leukocyte counts can predict the prognosis of patients with oral cavity cancer. Methods Medical records of 471 oral cavity cancer patients diagnosed between January 2007 and December 2008 were retrospectively analyzed. Receiver operating characteristic curve analysis and Cox proportional hazards analyses were applied to evaluate the associations of leukocyte counts with overall survival. Results The overall five year's survival of the cohort was found to be 49.4%. On univariate analysis, elevated monocyte count (≥500/mm3) and neutrophil-to-lymphocyte ratio (NLR) (>2.38) were associated with poor overall survival (OS) (p = 0.001 and 0.000, respectively). Multivariate Cox proportional hazard analysis showed that higher monocyte and NLR levels were significant independent predictors of worse OS (HR = 1.385, 95% CI = 1.049 - 1.829; p < 0.05 and HR = 1.392, 95% CI = 1.045 - 1.855; p < 0.05, respectively). The advanced overall stage and lymph nodal involvement were also independent indicators for poor OS. Conclusions Higher pretreatment monocyte and NLR levels are independent predictors of poor prognosis for patients with oral cavity cancer. Thus, these easily accessed variables can serve as a potent marker to predict the outcomes of oral cancer patients.

http://ift.tt/2pDABPi

Emotional Stress Evaluation of Patients with Moderate and Severe Sleep Apnea Syndrome

Abstract Introduction The scientific literature has shown that the damage caused by sleep fragmentation in people affected by Obstructive Sleep Apnea (OSA) can reflect emotionally, generating not only physical symptoms such as drowsiness and tiredness, but also psychical symptoms, such as stress. Objective This study aimed at comparing symptoms of stress in patients with moderate or severe OSA, before and after twomonths of treatment (clinical or surgical). Method This is an Individual, prospective, longitudinal, and interventional study. All patients underwent polysomnography before treatment.We collected data through the application of Stress Symptoms Inventory for Adults Lipp (ISSL) before and after two months of medical or surgical treatment for moderate or severe OSA. Results The sample consisted of 18 patients (72.2% male) with a mean age of 51.83 years. We found that 77.8% (n = 14) of patients had stress in the first evaluation. In the second evaluation (after treatment), this reduced to 16.7% (n = 3). The average stress symptoms decreased from the first to the second evaluation (M = 13.78 andM = 6.17, respectively), being statistically significant (z = -3.53; p < 0.000). Conclusions We found that moderate and severe apnea patients have significant stress index and that, after two months of medical or surgical treatment, there is a significant reduction of the symptom. In addition, the patients with severe OSA had a better outcome regarding the reduction of stress index than patients with moderate OSA.

http://ift.tt/2qqxDjE

Tracheostomy in the Intensive Care Unit: a University Hospital in a Developing Country Study

Abstract Introduction Tracheostomy is the commonest surgical procedure in intensive care units (ICUs). It not only provides stable airway and facilitates pulmonary toilet and ventilator weaning, but also decreases the direct laryngeal injury of endotracheal intubation, and improves patient comfort and daily living activity. Objective The objective of this study is to assess the incidence, indications, timing, complications (early and late), and the outcome of tracheostomy on patients in the intensive care units (ICU) at a university hospital in a developing country. Methods This study is an observational prospective study. It was performed at the otolaryngology department and ICU new surgery hospital on 124 ICU admitted patients. We collected patients' demographic records, cause of admission, indications of tracheostomy, mechanical ventilation, and duration of ICU stay. We also gathered patientś tracheostomy records including the incidence, timing, technique, type, early and late complications, and outcome. All tracheostomized patients received follow-up for 12 months. Results The indication for tracheostomy in ICU patients was mostly prolonged intubation (80.5%), followed by diaphragmatic paralysis (19.5%). All tracheostomies were done by the open approach technique. Tracheostomy for prolonged intubation was done within 17 to 26 days after intubation with a mean of 19.4 ± 2.07 days. Complications after tracheostomy were 13.9% tracheal stenosis and 25% subglottic stenosis. Conclusion Prolonged endotracheal intubation is theman indication of tracheostomy, performed after two weeks of intubation. Although there were no major early complications, laryngotracheal stenosis is still a challenging sequel for tracheostomy that needs to be investigated to be prevented.

http://ift.tt/2pDLFf4

Thyroid Carcinoma Pattern Presentation According to Age

Abstract Introduction Patients with thyroid cancer in different age groups present with different prognosis. Objective The objective of this study is to analyze the clinicopathological pattern of thyroid carcinoma presentation according to age groups. Methods This is a retrospective study. From 2000 to 2010, 623 patients underwent thyroidectomy for cancer in our institution, with 596 enrolled. Patients were divided into groups of 10 years and then in four age subgroups (≤ 24, 25-44, 45-64, and ≥65 years) for statistical analysis. We compared age, gender, and histopathological characteristics between groups. Results Individuals belonging to the earlier age group presented with a highest prevalence of neuro-vascular invasion, capsular invasion and lymph node metastasis. Together with individuals of advanced age, that group also had larger tumor diameter and higher prevalence of extra-glandular disease. Even when analyzed only cases with well-differentiated carcinoma, younger individuals remain with a highest prevalence of lymph node metastasis, neuro-vascular invasion and larger tumor diameter. Conclusion We observed a distinct pattern of clinicopathological manifestation of thyroid cancer according to age. Individuals belonging to age extremes resemble in several pathological features, and young people usually present with more aggressive disease characteristics.

http://ift.tt/2qqNYFa

Is There A Systemıc Inflammatory Effect of Cholesteatoma?

Abstract Introduction Inflammation causes squamous epithelial transformation of the mucosa in the middle ear cavity and plays a role in the onset, growth, spread, and recurrence of cholesteatoma. Objectives The objective of this study is to investigate the systemic inflammatory effect in chronic otitis with cholesteatoma. Methods The study included a total of 311 patients comprising 156 patients with a pathology diagnosis of cholesteatoma and a control group of 155 with no active inflammation. The Neutrophil-to-lymphocyte Ratio (NLR) was calculated by dividing the neutrophil value by the lymphocyte value. Results The mean NLR was 1.94 ± 0.91 in the patients with cholesteatoma and 1.94 ± 0.85 in the control group. We determined no statistically significant difference between the groups in respect of NLR (p = 0.983). We calculated the NLR as 2.01 ± 1.00 in patients with ossicle erosion and 1.82 ± 0.69 in those without ossicle erosion, 1.86 ± 0.85 in patients with bone erosion and 1.98 ± 0.95 in those without bone erosion. We determined no statistical difference between these values (p = 0.175). Conclusion The results of this study showed that NLR had no predictive value in respect of bone erosions and associated complications in patients with cholesteatoma. The inflammatory effect of cholesteatoma is not systemic but remains more local.

http://ift.tt/2pDMEvF

Tonic Investigation Concept of Cervico-vestibular Muscle Afferents

Abstract Introduction Interdisciplinary research has contributed greatly to an improved understanding of the vestibular system. To date, however, very little research has focused on the vestibular system's somatosensory afferents. To ensure the diagnostic quality of vestibular somatosensory afferent data, especially the extra cranial afferents, stimulation of the vestibular balance system has to be precluded. Objective Sophisticated movements require intra- and extra cranial vestibular receptors. The study's objective is to evaluate an investigation concept for cervico-vestibular afferents with respect to clinical feasibility. Methods A dedicated chair was constructed, permitting three-dimensional trunk excursions, during which the volunteer's head remains fixed. Whether or not a cervicotonic provocation nystagmus (c-PN) can be induced with static trunk excursion is to be evaluated and if this can be influenced by cervical monophasic transcutaneous electrical nerve stimulation (c-TENS) with a randomized test group. 3D-video-oculography (VOG) was used to record any change in cervico-ocular examination parameters. The occurring nystagmuses were evaluated visually due to the small caliber of nystagmus amplitudes in healthy volunteers. Results The results demonstrate: no influence of placebo-controlled c-TENS on the spontaneous nystagmus; a significant increase of the vertical nystagmus on the 3Dtrunk- excursion chair in static trunk flexion with cervical provocation in all young healthy volunteers (n = 49); and a significant difference between vertical and horizontal nystagmuses during static trunk excursion after placebo-controlled c-TENS, except for the horizontal nystagmus during trunk torsion. Conclusion We hope this cervicotonic investigation concept on the 3D trunk-excursion chair will contribute to new diagnostic and therapeutic perspectives on cervical pathologies in vestibular head-to-trunk alignment.

http://ift.tt/2qqmNKM

Adaptation and Assessment of Reliability and Validity of the Greek Version of the Ohkuma Questionnaire for Dysphagia Screening

Abstract Introduction The Ohkuma questionnaire is a validated screening tool originally used to detect dysphagia among patients hospitalized in Japanese nursing facilities. Objective The purpose of this study is to evaluate the reliability and validity of the adapted Greek version of the Ohkuma questionnaire. Methods Following the steps for cross-cultural adaptation, we delivered the validated Ohkuma questionnaire to 70 patients (53 men, 17 women) who were either suffering from dysphagia or not. All of them completed the questionnaire a second time within a month. For all of them, we performed a bedside and VFSS study of dysphagia and asked participants to undergo a second VFSS screening, with the exception of nine individuals. Statistical analysis included measurement of internal consistency with Cronbach's α coefficient, reliability with Cohen's Kappa, Pearson's correlation coefficient and construct validity with categorical components, and One-Way Anova test. Results According to Cronbach's α coefficient (0.976) for total score, there was high internal consistency for the Ohkuma Dysphagia questionnaire. Test-retest reliability (Cohen's Kappa) ranged from 0.586 to 1.00, exhibiting acceptable stability. We also estimated the Pearson's correlation coefficient for the test-retest total score, which reached high levels (0.952; p = 0.000). The One-Way Anova test in the two measurement times showed statistically significant correlation in bothmeasurements (p = 0.02 and p = 0.016). Conclusion The adapted Greek version of the questionnaire is valid and reliable and can be used for the screening of dysphagia in the Greek-speaking patients.

http://ift.tt/2pDT7ad

Tinnitus in Elderly Individuals: Discomfort and Impact in the Quality of Life

Abstract Introduction Tinnitus is a symptom that affects mainly the elderly and can negatively influence their quality of life. Objective The objective of our study is to evaluate the existence of a relationship between the quality of life and the impact caused by tinnitus in elderly individuals, considering the age and gender variables. Method We conducted a cross-sectional study in elderly people of both genders who participate in the extension activities at the university. The evaluation was composed of anamnesis and WHOQOL-OLD instruments, to evaluate the quality of life, and Tinnitus Handicap Inventory (THI) for the evaluation of the tinnitus impact. Result We evaluated 36 elderly individuals with an average age of 68.6 ± 6.8 years old, 72.2 % of them were women. We verified that most of the subjects classified their tinnitus as weak (44.4%) ormedium (36.1%). The score average in the THI was 20 points, with predominant classification of tinnitus impact as negligible (41.7%) or mild (30.6%). In the WHOQOL-OLD, the average score was 15.6 ± 1.6 points (total score). The negative correlation between the THI score and the WHOQOL-OLD score was found in the sensory domain operation and total score. Conclusion The results obtained in the study prove that the quality of life of the elderly individuals evaluated is related to a discomfort caused by the tinnitus.

http://ift.tt/2qqXs38

Auditory Processing Assessment in Children with Attention Deficit Hyperactivity Disorder: An Open Study Examining Methylphenidate Effects

Abstract Introduction Children with Attention Deficit Hyperactivity Disorder can present Auditory Processing (AP) Disorder. Objective The study examined the AP in ADHD children compared with non-ADHD children, and before and after 3 and 6 months of methylphenidate (MPH) treatment in ADHD children. Methods Drug-naive children diagnosed with ADHD combined subtype aging between 7 and 11 years, coming from public and private outpatient service or public and private school, and age-gender-matched non-ADHD children, participated in an open, non-randomized study from February 2013 to December 2013. They were submitted to a behavioral battery of AP tests comprising Speech with white Noise, Dichotic Digits (DD), and Pitch Pattern Sequence (PPS) and were compared with non-ADHD children. They were followed for 3 and 6 months of MPH treatment (0.5 mg/kg/day). Results ADHD children presented larger number of errors in DD (p < 0.01), and less correct responses in the PPS (p < 0.0001) and in the SN (p < 0.05) tests when compared with non-ADHD children. The treatment with MPH, especially along 6 months, significantly decreased the mean errors in the DD (p < 0.01) and increased the correct response in the PPS (p < 0.001) and SN (p < 0.01) tests when compared with the performance before MPH treatment. Conclusions ADHD children show inefficient AP in selected behavioral auditory battery suggesting impaired in auditory closure, binaural integration, and temporal ordering. Treatment with MPH gradually improved these deficiencies and completely reversed them by reaching a performance similar to non-ADHD children at 6 months of treatment.

http://ift.tt/2pDQR2u

Otoneurological Abnormalities in Patients with Friedreich's Ataxia

Abstract Introduction Friedreich's ataxia is a neurodegenerative disease and progressive by nature. It has autosomal recessive inheritance and early onset inmost cases. Nystagmus and hearing loss (in some cases) make up some of the common symptoms seen in this disorder. Objective The objective of this study is to examine vestibular disorders in patientswith Friedreich ataxia. Methods We conducted a retrospective cross-sectional study. We evaluated 30 patients with ages ranging from six to 72 years (mean age of 38.6 ( 14.7). The patients underwent the following procedures: anamnesis, ENT, and vestibular evaluations. Results Clinically, the patients commonly had symptoms of incoordination of movement (66.7%), gait disturbances (56.7%), and dizziness (50%). In vestibular testing, alterations were predominantly evident under caloric testing (73.4%), gaze nystagmus testing (50.1%), rotational chair testing (36.7%), and optokinetic nystagmus testing (33.4%). The presence of alterations occurred under examination in 90% of subjects, with the majority occurring in those with central vestibular dysfunction (70% of the examinations). Conclusion The most evident neurotological symptoms were incoordination of movement, gait disturbances, and dizziness. Alterations in vestibular examinations occurred in 90% of patients, mostly in the caloric test, with a predominance of deficient central vestibular system dysfunction.

http://ift.tt/2qqud0u

Auditory Alterations in Children Infected by Human Immunodeficiency Virus Verified Through Auditory Processing Test

Abstract Introduction The auditory system of HIV-positive children may have deficits at various levels, such as the high incidence of problems in the middle ear that can cause hearing loss. Objective The objective of this study is to characterize the development of children infected by the Human Immunodeficiency Virus (HIV) in the Simplified Auditory Processing Test (SAPT) and the Staggered Spondaic Word Test. Methods We performed behavioral tests composed of the Simplified Auditory Processing Test and the Portuguese version of the Staggered SpondaicWord Test (SSW). The participants were 15 children infected by HIV, all using antiretroviral medication. Results The children had abnormal auditory processing verified by Simplified Auditory Processing Test and the Portuguese version of SSW. In the Simplified Auditory Processing Test, 60% of the children presented hearing impairment. In the SAPT, the memory test for verbal sounds showed more errors (53.33%); whereas in SSW, 86.67% of the children showed deficiencies indicating deficit in figure-ground, attention, and memory auditory skills. Furthermore, there aremore errors in conditions of background noise in both age groups, where most errors were in the left ear in the Group of 8-yearolds, with similar results for the group aged 9 years. Conclusion The high incidence of hearing loss in children with HIV and comorbidity with several biological and environmental factors indicate the need for: 1) familiar and professional awareness of the impact on auditory alteration on the developing and learning of the children withHIV, and 2) access to educational plans and follow-up with multidisciplinary teams as early as possible to minimize the damage caused by auditory deficits.

http://ift.tt/2pE0TRv

Satisfaction of Elderly Hearing Aid Users

Abstract Introduction The impact of auditory sensory deprivation in the life of an individual is enormous because it not only affects one's ability to properly understand auditory information, but also the way people relate to their environment and their culture. The monitoring of adult and elderly subjects with hearing loss is intended to minimize the difficulties and handicaps that occur as a consequence of this pathology. Objective To evaluate the level of user satisfaction with hearing aids. Methods A clinical and experimental study involving 91 elderly hearing aid users. We used the questionnaire Satisfaction with Amplification in Daily Life to determine the degree of the satisfaction provided by hearing aids. We evaluated mean global score, subscales, as well as the variables time to use, age, and degree of hearing loss. Results Mean global score was 4.73, the score for Positive Effects 5.45, Negative Factors 3.2, demonstrating that they were satisfied; Services and Costs 5.98: very satisfied ; 3.65 Personal Image: dissatisfied. We observed statistically significant difference for the time of hearing aid use, age, and degree of hearing loss. Conclusion The SADL is a tool, simple and easy to apply and in this study we can demonstrate the high degree of satisfaction with the hearing aids by themajority of the sample collected, increasing with time of use and a greater degree of hearing loss.

http://ift.tt/2qqx9tS

Rhinoplasty Complications and Reoperations: Systematic Review

Abstract Introduction This article is related to complications of rhinoplasty and its main causes of reoperations. Objectives The objective of this study is to perform a systematic review of literature on complications in rhinoplasty. Data Synthesis The authors conducted a survey of articles related to key terms in the literature by using three important databases within 11 years, between January 2002 and January 2013. We found 1,271 abstracts and selected 49 articles to this review. Conclusion Themain results showed that the number of primary open rhinoplasty was 7902 (89%) and 765 closed (11%) and the percentage of reoperations in primary open complete rhinoplasties was 2.73% and closed complete was 1.56%. The statistical analysis revealed a value of p = 0.071. The standardization of terms can improve the quality of scientific publications about rhinoplasty. There is no difference between primary open or closed rhinoplasty techniques in relation to reoperations.

http://ift.tt/2pDAzHa

Cochlear Implantation through the Middle Fossa Approach: A Review of Related Temporal Bone Studies and Reported Cases

Abstract Introduction Middle fossa approach has been suggested as an alternative for patients in whom other routes of electrode insertion are contraindicated. Even though there are temporal bone studies about the feasibility of introducing the cochlear implant through the middle fossa, until now, very few studies have described results when cochlear implant surgery is done through this approach. Objective The objective of this study is to review a series of temporal bone studies related to cochlear implantation through the middle fossa and the results obtained by different surgical groups after cochlear implantation through this approach. Data Sources PubMed, MD consult and Ovid-SP databases. Data Synthesis A total of 8 human cadaveric temporal bone studies and 6 studies reporting cochlear implant surgery through the middle fossa approach met the inclusion criteria. Temporal bone studies show that it is feasible to perform cochlear implantation through this route. So far, only two surgical groups have performed cochlear implantation through the middle fossa with a total of 15 implanted patients. One group entered the cochlea in the most upper part of the basal turn, inserting the implant in the direction of the middle and apical turns; meanwhile, the other group inserted the implant in the apical turn directed in a retrograde fashion to the middle and basal turns. Results obtained in both groups were similar. Conclusions Themiddle fossa approach is a good alternative for cochlear implantation when other routes of electrode insertion are contraindicated.

http://ift.tt/2qqGp1f

Asymptomatic Brain Edema after Hemodialysis Initiation in a Patient with Severe Uremia

A 66-year-old man with severe renal insufficiency presented with mild confusion associated with uremia. Cranial magnetic resonance imaging (MRI) showed no remarkable changes. The patient was placed on short-duration hemodialysis (2 hours) with smaller surface area and low blood flow (100 mL/min) to avoid dialysis disequilibrium syndrome (DDS). His consciousness gradually improved and he did not develop apparent DDS symptoms. However, T2-weighted FLAIR MRI showed increased signal intensities bilaterally in the cortical and subcortical areas of the occipital lobe on day 15. In other words, cranial MRI showed cerebral edema, indicating asymptomatic DDS. On day 29, cranial MRI showed a return to findings on admission. In this case, because the patient did not have apparent DDS symptoms despite MRI changes, we diagnosed asymptomatic cerebral edema. The patient was discharged on regular intermittent HD without any neurological deficits. No further neurological disturbances were noted during 1-year follow-up. MRI findings in ESKD patients without DDS symptoms help to clarify the diagnosis of cerebral edema. In this case, the patient did not have apparent DDS symptoms and was therefore diagnosed with asymptomatic cerebral edema.

http://ift.tt/2qwNric

Late rebound of dabigatran levels after idarucizumab reversal in two patients with severe renal failure

No abstract available

http://ift.tt/2p6VaCx

Clinical guidelines: How can we improve adherence and implementation?

No abstract available

http://ift.tt/2oVDSvT

European resuscitation council should have gone further to promote cardiopulmonary resuscitation awareness

No abstract available

http://ift.tt/2p6I87R

Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: First update 2016

The management of perioperative bleeding involves multiple assessments and strategies to ensure appropriate patient care. Initially, it is important to identify those patients with an increased risk of perioperative bleeding. Next, strategies should be employed to correct preoperative anaemia and to stabilise macrocirculation and microcirculation to optimise the patient's tolerance to bleeding. Finally, targeted interventions should be used to reduce intraoperative and postoperative bleeding, and so prevent subsequent morbidity and mortality. The objective of these updated guidelines is to provide healthcare professionals with an overview of the most recent evidence to help ensure improved clinical management of patients. For this update, electronic databases were searched without language restrictions from 2011 or 2012 (depending on the search) until 2015. These searches produced 18 334 articles. All articles were assessed and the existing 2013 guidelines were revised to take account of new evidence. This update includes revisions to existing recommendations with respect to the wording, or changes in the grade of recommendation, and also the addition of new recommendations. The final draft guideline was posted on the European Society of Anaesthesiology website for four weeks for review. All comments were collated and the guidelines were amended as appropriate. This publication reflects the output of this work.

http://ift.tt/2oVGQ3w

Use of anaesthetics in young children: Consensus statement of the European Society of Anaesthesiology, the European Society of Paediatric Anaesthesiology, the European Association of Cardiothoracic Anaesthesiology and the European Safe Tots Anaesthesia Research Initiative

No abstract available

http://ift.tt/2p6UOf7

Is the central venous pressure an obsolescent model or a valuable puzzle stone in haemodynamic monitoring?

No abstract available

http://ift.tt/2oVL3V0

Reply to: European resuscitation council should have gone further to promote cardiopulmonary resuscitation awareness

No abstract available

http://ift.tt/2p6SIM8

Reply to: is the central venous pressure an obsolescent model or a valuable puzzle stone in haemodynamic monitoring?

No abstract available

http://ift.tt/2oVDQUN

Ultrasound Guided Regional Anaesthesia; 2nd edition

No abstract available

http://ift.tt/2p6UNYB

The Edinburgh modification of the minimal access zygomatic osteotomy, used for the correction of zygomatic orbital hypoplasia

Zygomatic hypoplasia can be an exceedingly difficult proposition for the surgeon treating facial deformity. The classical approach would be a coronal access, which is time-consuming, leaves a long scar on the scalp that shows in patients with balding patterns, and carries the risk of permanent facial weakness. The Edinburgh technique presents a minimal access approach to the zygomatic osteotomy. This is performed through local incisions and a bone cut made using hand-held diamond-coated wire that mobilizes the entire zygoma.

http://ift.tt/2qwfy0S

Bioresorbable versus titanium space-maintaining mesh in maxillary sinus floor elevation: a split-mouth study

Maxillary sinus pneumatization limits implant placement in the edentulous posterior maxilla. Grafted sinus floor augmentation through Schneiderian membrane elevation and space obliteration with autogenous bone grafts, bone substitutes, or a combination of the two has often been used to resolve this problem. More recently, non-grafted sinus floor elevation has been established. This is based on the concept of membrane elevation and support either by tenting technique or using space-maintaining mesh.

http://ift.tt/2puP5Cl

Angioedema attacks related to endometrial hyperplasia in a case of estrogen-dependent factor XII hereditary angioedema

Hereditary angioedema (HAE) with normal C1-esterase inhibitor (C1-INH) is characterized by recurrent skin or mucosal angioedema attacks, lack of urticaria, and nonresponsiveness to antihistamines and corticosteroids, affecting mainly women with family history of angioedema and no C1-INH abnormalities.1–3 Missense mutations in the coagulation factor XII (FXII) gene (mainly Thr328Lys and Thr328Arg) have been associated with this type of HAE, causing an increase in FXII activity and leading to enhanced bradykinin production.

http://ift.tt/2qqko2H

Incidence and Risk Factors of Inferior Rectus Muscle Palsy in Pediatric Orbital Blowout Fractures

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1601884

The aim of this study was to evaluate the incidence, clinical features, and risk factors of sustaining inferior rectus (IR) palsy in a group of pediatric patients with orbital floor blowout fractures. We performed a retrospective case review of sequential cases of pediatric orbital floor blowout fractures (<18 years old) from 2000 to 2013 in a tertiary ophthalmic center in Singapore. A total of 48 patients were included in our study, of whom 5 had IR palsy (10.4%). Patients with IR palsy had a higher mean age (16.4 ± 1.5 years) compared with patients without IR palsy (12.4 ±3.3 years), had significantly (p < 0.05) worse preoperative motility, and had significantly greater proportion developing postoperative hypertropia (100%) compared with patients without IR palsy (4.7%). Our series of pediatric blowout fractures demonstrated IR palsy prevalence and clinical features for IR palsy which may be distinct to the pediatric group.
[...]

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

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

http://ift.tt/2pusR3i

Surgical Anatomy of the Cervical Part of the Hypoglossal Nerve

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1601863

Iatrogenic injuries to cranial nerves, half of which affect the hypoglossal nerve, occur in up to 20% of surgical procedures involving the neck. The risk of injury could be minimized by in-depth knowledge of its positional and relational anatomy. Forty-one hypoglossal nerves were dissected from cadaveric specimens and positions described in relation to the internal carotid artery (ICA), external carotid artery (ECA), carotid bifurcation, mandible, hyoid bone, mastoid process, and the digastric tendon. The distance of the nerve from where it crossed the ICA and ECA to the carotid bifurcation was 29.93 (±5.99) mm and 15.19 (±6.68) mm, respectively. The point where it crossed the ICA was 12.24 (±3.71) mm superior to the greater horn of hyoid, 17.16 (±4.40) mm inferior to the angle of the mandible, and 39.08 (±5.69) mm from tip of the mastoid. The hypoglossal nerve loop was inferior to the digastric tendon in 73% of the cases. The hypoglossal nerves formed high loops in this study population. Caution should be exercised during surgical procedures in the neck. The study also revealed that the mastoid process is a reliable fixed landmark to locate the hypoglossal nerve.
[...]

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

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

http://ift.tt/2pum9L2

Reenergizing T cell anti-tumor immunity by harnessing immunometabolic checkpoints and machineries

Ping-Chih Ho | Susan M Kaech

http://ift.tt/2pG7wEy

The role of AMPK in T cell metabolism and function

Eric H Ma | Maya C Poffenberger | Alison H-T Wong | Russell G Jones

http://ift.tt/2pGdS7b

Novel application of a rigid curved larygno-pharyngoscope for examination and treatment of hypopharyngeal lesions

Publication date: Available online 2 May 2017
Source:Auris Nasus Larynx
Author(s): Kenichi Watanabe, Daisuke Yamauchi, Yoshitaka Takanashi, Hiroshi Hidaka, Yukio Katori
In endoscopic laryngo-pharyngeal surgery (ELPS), a rigid curved laryngo-pharyngoscope, which was invented by Dr. Sato et al., is necessary to obtain excellent surgical view of both hypopharynx and even the entrance of the esophagus. We have used this instrument for the examination and treatment of several diseases other than cancer located in the hypopharynx, such as difficult-to-find buried fish bones, retropharyngeal abscess, and congenital pyriform sinus fistula. In the result, we could acquire better view of hypopharynx and completed the intended procedure safely, especially for uncovering difficult-to-find fish bone buried in the mucosa. Even in the cases hardly to operate under this instrument, just use for detailed observation of the lesion was available. A rigid curved laryngo-pharyngoscope provides a wide and clear view of a challenging space, the hypopharynx. We recommend using this technique in cases such as difficult-to-find buried fish bones or retropharyngeal abscesses while avoiding a neck incision.

http://ift.tt/2p3HJCj

Rhabdomyosarcoma, Spindle Cell/Sclerosing Variant: A Clinical and Histopathological Examination of this Rare Variant with Three New Cases from the Oral Cavity

Abstract

Spindle cell/sclerosing rhabdomyosarcoma (S-ScRMS) was recently recognized in 2013 by the World Health Organization (WHO) as a stand-alone entity (Parham et al., WHO classification of tumours of soft tissue and bone, IARC Press, Lyon, 2013). Historically, the spindle cell and sclerosing variants were subcategorized under embryonal type rhabdomyosarcoma. Current data supports that certain S-ScRMS cases have a more aggressive clinical course with reduction of long-term survival, and those found in the head and neck region often exhibit extensive local recurrence. Furthermore, due to variable histopathologic appearances and immunohistochemical findings, misdiagnosis is common. We aim to report the variability in histopathologic patterns, immunohistochemical findings, radiographic features, and clinical data on three new cases of S-ScRMS presenting in the oral cavity of young adult males (ages 22, 24, and 39 years). The English-language literature on S-ScRMS is briefly reviewed as well.

http://ift.tt/2pEjnDq

Evaluating the biomechanical effects of implant diameter in case of facial trauma to an edentulous atrophic mandible: a 3D finite element analysis

Rehabilitation using an implant supported overdenture with two implants inserted in the interforaminal region is the easiest and currently accepted treatment modality to increase prosthetic stabilization and p...

http://ift.tt/2qpO5AZ

Future Meetings

Thyroid May 2017, Vol. 27, No. 5: 750-750.

http://ift.tt/2pFlQNE

Optimization strategies aimed to increase the efficacy of H. pylori eradication therapies

Abstract

Background

As with any other infectious disease, we should aim for treatments offering ≥90% Helicobacter pylori eradication rates in clinical practice.

Aim

To summarize optimization strategies aimed to increase the efficacy of H. pylori eradication therapies.

Methods

A systematic bibliographic search (in PubMed up to August 2016) was designed to identify studies investigating optimization strategies aimed to increase the efficacy of H. pylori eradication therapies.

Results

The most direct way to optimize a treatment is using higher doses of drugs unless it has been shown that lower doses are equally effective. Similarly, prescriptions should use 14-day duration unless a shorter scheme has been shown locally to be equally effective. Double-dose proton-pump inhibitor therapy is recommended for triple therapy and may probably increase the efficacy of nonbismuth concomitant regimen as well. The efficacy of triple therapies in the presence of resistance can be significantly improved by the addition of bismuth salts, which offer an additive effect in combination with antibiotics. Overall, probiotics seem to reduce antibiotic side effects, but the increase in eradication rates is not so evident; therefore, they cannot be generally recommended for clinical practice yet.

Conclusions

Using potent acid inhibition and/or higher antibiotic doses—especially by increasing the number of daily intakes—and lengthening treatments up to 14 days improves efficacy in most regimens and should be generally recommended. Triple therapies can be efficiently improved by the addition of bismuth salts, turning them into quadruple therapies. Finally, some treatments will require a combination of optimization strategies to significantly improve results.

http://ift.tt/2pEZb46

Rhabdomyosarcoma, Spindle Cell/Sclerosing Variant: A Clinical and Histopathological Examination of this Rare Variant with Three New Cases from the Oral Cavity

Abstract

http://ift.tt/2pEjnDq

Case of myoepithelial carcinoma on scalp

http://ift.tt/2p2gEiY

Prevalence of coronary artery calcification in Japanese patients with psoriasis: A close correlation with bilateral diagonal earlobe creases

Abstract

Psoriasis is a multifactorial inflammatory disorder, in which the inflammation affects not only the skin but also the other internal organs, and can induce cardiovascular and cerebrovascular involvements. However, few predictive factors of cardiovascular diseases have been clarified in patients with psoriasis. This study was performed to verify whether diagonal earlobe creases (ELC) can reflect the hidden comorbidities in Japanese psoriatic patients. Prevalence and subtypes of ELC were analyzed in patients with psoriatic and with non-psoriatic skin diseases, and the correlation with coronary artery calcification (CAC) or fatty liver (FL) detected by computed tomography. Prevalence of CAC was approximately twice higher than data of a Japanese resident-based study previously reported. Generally, prevalence of ELC in a psoriatic group and mean age of psoriatic groups accompanied by ELC were higher and younger than those of a non-psoriatic skin disease group, respectively. Statistically significant differences were detected in the mean age of total or male subjects accompanied by bilateral ELC with complete and incomplete length. Bilateralism of ELC was closely correlated with prevalence of CAC and CAC on multiple branches in psoriatic patients (P = 6.6e-6 and odds ratio [OR] = 14.1, P = 0.00884 and OR = 10.7, respectively), but not with that of FL. On the contrary, body mass index of more than 25 was closely correlated with prevalence of FL, but not that of CAC. Comorbidities of psoriatic patients are frequently unnoticed. ELC, an apparatus-related feature, can be a useful predictive factor for hidden coronary artery involvements in psoriatic patients.

http://ift.tt/2pF6uJ7

Combined method to treat periungual pyogenic granuloma: Nail corner plasty, taping and topical bismuth subgallate

http://ift.tt/2p2hVXl

Lichen planus-like keratosis emerging in a pediatric case of xeroderma pigmentosum group A

http://ift.tt/2pESH5g

The effects of the stem cell on ciliary regeneration of injured rabbit sinonasal epithelium

Abstract

Defects in mucosal healing after sinonasal surgery cause infection, scar formation causing obstruction, relapse of the disease within a shorter period and revision surgery. The present study aimed to create a functional ciliated epithelium using a stem cell and stem cell sheet of adipose tissue origin and to show such regeneration ultra-structurally on experimentally injured rabbit nasal epithelium. This was an experimental animal study and basic research. A total of 18 white New Zealand rabbits were divided into three groups. The medial wall of the maxillary sinus of the subjects was peeled off bilaterally. No additional procedure was applied to the subjects in Group 1. In Group 2, adipose tissue-derived mesenchymal stem cell was implanted on the wound edges of the subjects. In Group 3, a stem cell sheet of three layers was laid onto the defect area. All subjects were killed after 3 weeks. The presence of the stem cell stained with bromo-deoxyuridine was assessed with a light microscope, whereas cilia density, ciliated orientation and cilia structure were evaluated with a scanning electron microscope. Ciliary densities in Group 2 and Group 3 were statistically superior compared to the control group (p < 0.001, p = 0.007). Cilia morphology in Group 2 and Group 3 was also better than the control group (p < 0.01, p = 0.048). Ciliary orientation in Group 2 was scored highest (p < 0.01). The ratio of BrDu-stained cells was observed to be 27% in Group 3 and 8% in Group 2. Sub-epithelial recovery was observed to be better in Group 3. Adipose tissue-derived mesenchymal stem cell increased the healing of the injured maxillary sinus mucosa of the rabbits in terms of cilia presence, density and morphology regardless of the implementation technique.

Level of evidence NA

http://ift.tt/2p4phud

Current studies of immunotherapy in head and neck cancer

Abstract

Background

Recently enormous progress in cancer therapy has been achieved by the use of immune checkpoint inhibitors. Activating the body's own immune system has added a novel and powerful therapeutic option for the treatment of melanoma and lung cancer. Furthermore, the potential use of immunotherapy is being extensively explored also in other malignancies.

Objective of review

This review summarizes current clinical studies using immune checkpoint modulators for the treatment of head and neck cancer (HNSCC).

Type of review

Systematic review.

Search strategy

A PubMed search from 2010 onward was performed for the use of immune checkpoint inhibitors in clinical trials of HNSCC. An equivalent search was performed at clinicaltrials. gov. Additionally, the abstracts from the annual meetings of the ASCO, ESMO and AACR were screened.

Results

45 relevant studies using immune checkpoint inhibitors in HNSCC were identified. In the majority of these studies antagonistic antibodies targeting the immune checkpoint receptors PD-1 are used either solely or combined, mostly with other immune modulatory antibodies, such as inhibitors of CTLA-4. Most studies are still recruiting patients (26/45). In the primary setting we identified 16 studies using checkpoint inhibition as neoadjuvant/adjuvant modality for treatment with curative intent. The response rate upon treatment with PD-1 antagonists in relation to the PD-L1 status is being investigated in 12 trials. Novel immune checkpoint modulators combined with the inhibition of the PD-1/PD-L1 axis or CTLA-4 have been set up in 5 trials. So far only 4 studies that use immune checkpoint inhibition in HNSCC have presented results and all of these explored the inhibition of the PD-1/PD-L1 axis. The studies demonstrated overall response rates (ORR) in the range of 20%. These preliminary data suggest that a PD-L1 expression ≥1% is associated with a higher response rate compared to a PD-L1 expression ≤1%. The anti-PD-1-antibody pembrolizumab extended the duration of response in recurrent and/or metastatic (R/M) HNSCC (by approximately 53 weeks) in a phase Ib study. Therefore, pembrolizumab was granted accelerated approval for the treatment of platinum refractory R/M HNSCC by the FDA.

Conclusion

Numerous clinical trials are addressing the suitability and efficacy of immune checkpoint modulators in HNSCC with the predominant targets being the established immune checkpoint receptors PD-1/PD-L1 and CTLA-4. Recently presented results have shown a survival benefit, a favorable safety profile and an extended duration of response in favor of using immune checkpoint modulation in R/M HNSCC.

http://ift.tt/2oUf7jW

Objective and subjective assessment of outcomes after sinus surgery in sixty patients

Abstract

Chronic rhinosinusitis is one of the most prevalent chronic diseases. Improving the objectivity of diagnosis without neglecting the subjective burden of disease may aid to an individualized treatment of chronic rhinosinusitis with better outcomes. Several tests for the determination of the quality of life are available ¹.

http://ift.tt/2p5bFiy

Renewal of peritonsillar abscess: Impact of the bacterial species of the infection and clinical features of the patient- prospective comparative aetiological study

Abstract

Objectives

To compare the bacterial species and patient clinical features in peritonsillar abscesses between patients who had renewal (renewal group) and those who did not (recovery group).

Design

Prospective comparative aetiological study.

Setting

Tertiary referral centre.

Participants

A total of 180 adult peritonsillar abscess patients were prospectively collected and treated as outpatients with incision and drainage and oral antibiotics. Bacteria from the pus was evaluated with a microarray assay. All contact with the health care system and renewal of the symptoms were recorded.

Main outcome measures

Different bacterial species and patient clinical features between the renewal and recovery groups.

Results

Of the 180 enrolled patients, 18 experienced a renewal of symptoms. Bacteria from the Streptococcus anginosus group was detected in the patient samples of the renewal group more often than the recovery group (p=0.002). No isolated Streptococcus pyogenes samples were reported in the renewal group, while in the recovery group it was reported on 24% of the patients (p=0.014). In the renewal group, patients over age 40 experienced symptom renewal faster than the younger patients (p=0.013) and were more likely to be male (p=0.036).

Conclusions

Bacteria in the Streptococcus anginosus group appear to predict renewal of PTA symptoms, while Streptococcus pyogenes was not found in our patients with symptom renewal. Certain subgroups of patients should be followed more closely.

http://ift.tt/2oUsT6d

Scleredema of Buschke with prominent periorbital edema

http://ift.tt/2pEYJD7

Quantitative pretreatment CT volumetry: Association with oncologic outcomes in patients with T4a squamous carcinoma of the larynx

Abstract

Background

The purpose of this study was to determine the impact of CT-determined pretreatment primary tumor volume on survival and disease control in T4a laryngeal squamous cell carcinoma (SCC).

Methods

We retrospectively reviewed 124 patients with T4a laryngeal cancer from 2000-2011. Tumor volume measurements were collected and correlated with outcomes.

Results

Five-year overall survival (OS) for patients with tumor volume ≥21 cm³ treated with larynx preservation (n = 26 of 41) was significantly inferior compared to <21 cm³ (42% vs 64%, respectively; P = .003). Five-year OS for patients with tumor volumes ≥21 cm³ in the cohort treated with total laryngectomy followed by radiotherapy (RT; n = 42 of 83) was not statistically significant when compared to <21 cm³ (50% vs 63%, respectively; P = .058). On multivariate analysis, tumor volume ≥21 cm³ was a significant independent correlate of worse disease-specific survival (DSS; P = .004), event-free survival (P = .005), recurrence-free survival (RFS; P = .04), noncancer cause-specific survival (P = .02), and OS (P = .0002).

Conclusion

Pretreatment CT-based tumor volume is an independent prognostic factor of outcomes in T4a laryngeal cancer.

http://ift.tt/2oUf0Vp

Changing trends in the management of the neck in oropharyngeal squamous cell carcinoma

Abstract

Background

Treatment for oropharyngeal squamous cell carcinoma (SCC) has changed toward a more oncologic approach. We evaluated treatment of the neck, the incidence of regional recurrences, and factors associated with regional recurrence during the treatment approach transition period in patients with regional lymph node metastasis.

Methods

All patients with oropharyngeal SCC diagnosed at the Helsinki University Hospital during 2000-2009 were analyzed for clinicopathological factors, treatment, p16 expression, and regional recurrence.

Results

Altogether, 169 patients had a complete response, and among them regional recurrence occurred in 5 patients (4.7%) treated with surgery ± radiotherapy (RT) or chemoradiotherapy (CRT) and in 2 patients (3.2%) treated with RT or CRT ± surgery. All these 7 patients had N2b disease or higher, and 5 of them had regional recurrence in the contralateral side of the neck.

Conclusion

The incidence of regional recurrence was low, and remained unchanged despite the increased use of RT or CRT ± surgery. Treatment and follow-up of the contralateral neck warrants special attention in patients with advanced neck disease (≥N2b).

http://ift.tt/2p5cEz2

Activation of transforming growth factor-β1 by thrombin via integrins αvβ1, αvβ3, and αvβ5 in buccal fibroblasts: Suppression by epigallocatechin-3-gallate

Abstract

Background

Transforming growth factor-beta (TGF-β) plays a central role in the pathogenesis of oral submucous fibrosis (OSF). Thrombin is a key player in tissue repair, inflammation, and fibrosis after injury.

Methods

Effects of thrombin on activated-TGF-β1 levels, Smad3 phosphorylation, and connective tissue growth factor (CTGF/CCN2) synthesis in primary human buccal mucosal fibroblasts (BMFs) were assessed by enzyme-linked immunosorbent assay or Western blot analysis.

Results

Thrombin and protease-activated receptor-1 (PAR-1) agonist induced TGF-β1 activation and Smad3 phosphorylation. Pretreatment with TGF-β-neutralizing antibody completely inhibited thrombin-induced CCN2 synthesis. Neutralizing antibodies to integrin αv, β1, αvβ3, αvβ5, and Rho-associated coiled-coil forming protein kinase (ROCK) inhibitor Y27632 completely blocked thrombin-induced TGF-β1 activation, Smad3 phosphorylation, and CCN2 synthesis. Epigallocatechin-3-gallate (EGCG) dose-dependently inhibited thrombin-induced TGF-β1 activation.

Conclusion

Thrombin induces αvβ1, αvβ3, and αvβ5 integrins-mediated TGF-β1 activations via ROCK signaling. EGCG inhibits thrombin-induced CCN2 synthesis in BMFs by suppressing latent TGF-β1 activation.

http://ift.tt/2oUjdsm

Amb a 1 isoforms: unequal siblings with distinct immunological features

Abstract

Background

Ragweed pollen represents a major allergy risk factor. Ragweed extracts contain five different isoforms of the major allergen Amb a 1. However, the immunologic characteristics of Amb a 1 isoforms are not fully investigated. Here we compared the physicochemical and immunological properties of three most important Amb a 1 isoforms.

Methods

After purification, the isoforms were physicochemically characterized, tested for antibody-binding and induction of human T cell proliferative responses. Their immunologic properties were further evaluated in vitro and in vivo in a mouse model.

Results

Amb a 1 isoforms exhibited distinct patterns of IgE-binding and immunogenicity. Compared to Amb a 1.02 or 03 isoforms, Amb a 1.01 showed higher IgE-binding activity. Isoforms 01 and 03 were the most potent stimulators of patients' T cells. In a mouse model of immunization, Amb a 1.01 induced higher levels of IgG and IgE antibodies when compared to isoforms 02 and 03. Interestingly, ragweed-sensitized patients also displayed an IgG response to Amb a 1 isoforms. However, unlike therapy-induced antibodies, sensitization-induced IgG did not show IgE-blocking activity.

Conclusion

The present study showed that naturally occurring isoforms of Amb a 1 possess different immunogenic and sensitizing properties. These findings should be considered when selecting sequences for molecule-based diagnosis and therapy of ragweed allergy. Due to its high IgE-binding activity, isoform Amb a 1.01 should be included in diagnostic tests. In contrast, due to their limited B and T cell cross-reactivity patterns, a combination of different isoforms might be a more attractive strategy for ragweed immunotherapy.

http://ift.tt/2pTWk8n

Survival of the fetus: fetal B and T cell receptor repertoire development

Abstract

A mature and diverse T and B cell receptor repertoire is a prerequisite for immunocompetence. In light of its increased susceptibility to infection, the human fetus has long been considered deficient in this regard. However, data accumulated since the 1990s and in earnest in the past couple of years paints a more complicated picture. As we describe in this review, mechanisms responsible for generating a diverse receptor repertoire, such as somatic recombination, class switch recombination, and somatic hypermutation, are all operational to surprising extents in the growing fetus. The composition of the fetal repertoire differs from that of adults, with preferential usage of certain variable (V), diversity (D), and joining (J) gene segments and a shorter complementarity determining (CDR3) region, primarily due to decreased terminal deoxynucleotidyl transferase (TdT) expression. Both T and B cell receptor repertoires are extremely diverse by the end of the second trimester, and in the case of T cells, are capable of responding to an invading pathogen with in utero clonal expansion. Thus, it would appear as though the T and B cell receptor repertoires are not a hindrance towards immunocompetence of the newborn. Our improved understanding of fetal receptor repertoire development is already bearing fruit in the early diagnosis of primary immunodeficiencies (PID) and may help clarify the pathogenesis of congenital infections, recurrent abortions, and autoimmune disorders in the near future.

http://ift.tt/2psotSq

Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology

Abstract

Human coronaviruses (hCoVs) can be divided into low pathogenic and highly pathogenic coronaviruses. The low pathogenic CoVs infect the upper respiratory tract and cause mild, cold-like respiratory illness. In contrast, highly pathogenic hCoVs such as severe acute respiratory syndrome CoV (SARS-CoV) and Middle East respiratory syndrome CoV (MERS-CoV) predominantly infect lower airways and cause fatal pneumonia. Severe pneumonia caused by pathogenic hCoVs is often associated with rapid virus replication, massive inflammatory cell infiltration and elevated pro-inflammatory cytokine/chemokine responses resulting in acute lung injury (ALI), and acute respiratory distress syndrome (ARDS). Recent studies in experimentally infected animal strongly suggest a crucial role for virus-induced immunopathological events in causing fatal pneumonia after hCoV infections. Here we review the current understanding of how a dysregulated immune response may cause lung immunopathology leading to deleterious clinical manifestations after pathogenic hCoV infections.

http://ift.tt/2qujWxj

Pain-relieving effects of clonazepam and amitriptyline in burning mouth syndrome: a retrospective study

Publication date: Available online 2 May 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): M. Fenelon, E. Quinque, E. Arrive, S. Catros, J.C. Fricain
This retrospective study aimed to evaluate the efficacy of clonazepam and amitriptyline in the treatment of burning mouth syndrome (BMS). A single-centre retrospective cohort study was performed among patients diagnosed with BMS. Either clonazepam or amitriptyline was administered. Patients were asked to evaluate their pain using a 10-point verbal numerical scale (VNS) at baseline, and at 6 weeks and 3 months of treatment. Mean pain-relief values were assessed according to the treatment received using the Kruskal–Wallis test. Thirty-nine patients (85% female) were included. The mean age was 65±10.5years. The mean VNS score at baseline was 7.1±2.0 in patients treated with clonazepam and 7.5±1.1 in those treated with amitriptyline. The mean VNS scores in the clonazepam and amitriptyline groups were 4.9±2.4 and 6.1±2.6, respectively, after 6 weeks of treatment (P=0.498) and 4.4±2.0 and 4.1±2.7, respectively, after 3 months (P=0.509). There was no difference between the two treatments in terms of pain reduction. Clonazepam as well as amitriptyline may be an effective treatment for BMS.

http://ift.tt/2pTTXmd

Αρχειοθήκη ιστολογίου

Τρίτη 2 Μαΐου 2017

Abstract

Purpose

Methods

Results

Conclusion

Abstract

Purpose

Methods

Results

Conclusion

Abstract

Abstract

Abstract

Background

Aim

Methods

Results

Conclusions

Abstract

Abstract

Abstract

Abstract

Background

Objective of review

Type of review

Search strategy

Results

Conclusion

Abstract

Abstract

Objectives

Design

Setting

Participants

Main outcome measures

Results

Conclusions

Abstract

Background

Methods

Results

Conclusion

Abstract

Background

Methods

Results

Conclusion

Abstract

Background

Methods

Results

Conclusion

Abstract

Background

Methods

Results

Conclusion

Abstract

Abstract