Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Πέμπτη 11 Μαΐου 2017
Current FDA-approved injection pattern versus targeted peripheral nerve–directed injection pattern. The current FDA-approved injection pattern includes chemodenervation of 7 head and neck muscle groups (A–C). The total units of BOTOX injected for each site bilaterally include: corrugators 10U, procerus 5U, frontalis 20U (A), temporalis 40U (B), occipitalis 30U, cervical paraspinal 20U, and trapezius 30U (C). By comparison, peripheral nerve–directed BOTOX injection targets fewer sites with a smaller total quantity of BOTOX (D–F). The total units of BOTOX injected for each site bilaterally include: supraorbital nerve/supratrochlear nerve 25U (D), zygomaticotemporal nerve 37.5U (E), and greater occipital nerve 50U (F). Source Targeted Peripheral Nerve-directed Onabotulinumtoxin A Injection for Effective Long-term Therapy for Migraine Headache
Autologous Platelet-rich Plasma Glue : Seroma and hematoma formations are the most common complications after plastic surgery. The aim of this study was to assess the efficacy of autologous platelet-rich plasma (A-PRP) glue to reduce postoperative wound complications and improve surgical outcomes.
http://otorhinolaryngology-crete.blogspot.com/2017/05/autologous-platelet-rich-plasma-glue.html
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
PhotoExam: adoption of an iOS-based clinical image capture application at Mayo Clinic
Abstract
Background
Mayo Clinic developed an internal iOS-based, point-of-care clinical image capture application for clinicians. We aimed to assess the adoption and utilization of the application at Mayo Clinic.
Methods
Metadata of 22,784 photos of 6417 patients taken by 606 users over 8040 clinical encounters between 3/1/2015 and 10/31/2015 were analyzed. A random sample of photos from 100 clinical encounters was assessed for quality using a five-item rubric. Use of traditional medical photography services before and after application launch were compared.
Results
The largest group of users was residents/fellows, accounting for 31% of users but only 18% of all photos. Attending physicians accounted for 29% of users and 30% of photos. Nurses accounted for 14% of users and 28% of photos. Surgical specialties had the most users (36% of users), followed by dermatology (14% of users); however, dermatology accounted for 54% of all photos, and surgery accounted for 26% of photos. Images received an average of 91% of possible points on the quality scoring rubric. Most frequent reasons for missing points were the location on the body not clearly being demonstrated (19% of encounters) and the perspective/scale not being clearly demonstrated (12% of encounters). There was no discernible pre-post effect of the application's launch on use of traditional medical photography services.
Conclusions
Point-of-care clinical photography is a growing phenomenon with potential to become the new standard of care. Patient and provider attitudes and the impact on patient outcomes remain unclear.
http://ift.tt/2r6zuH6
Tattooing and psoriasis: a case series and review of the literature
Abstract
Background
Koebner phenomenon (KP) affects from a quarter to a third of the patients with psoriasis and can occur on tattoos
Material and methods
We retrospectively reviewed a case series of seven tattooed patients with an isomorphic response on their tattoos or partial psoriasis patches on their tattoos. We collected the demographic data, the past history of psoriasis, the clinical presentation, and the outcomes. We also performed a review of the literature. We tried to classify the different clinical profile of KP/psoriasis on tattoos accordingly.
Results
Six men and one woman with a median age of 36 ± 6.4 years old were included. Five disclosed a KP in a recent tattoo within days to 1 month after its completion. Fifteen additional cases were collected from the literature (8 men, median age 22 ± 8.2 years old). The delay of psoriasis flare-up after tattooing was rather short, from a few weeks to several months. We found a high variability in the clinical presentation with five clinical subtypes/profiles of psoriasis on tattoos. A possible confusion between "genuine" KP on tattoos and the coincidental occurrence of psoriasis patches on tattoos is possible in some cases of the literature. Patients were mainly managed locally, rarely by systemic treatments or biologics.
Conclusion
Koebner phenomenon on tattoos may occur in patients with psoriasis under various forms. The evolution is benign, and psoriasis is not a contraindication for tattooing, but patients need proper counseling before getting tattooed.
http://ift.tt/2q7RBzf
Quality assurance trials for Ki67 assessment in pathology
Abstract
Ki67 is a broadly used proliferation marker in surgical pathology with an obvious need for standardization to improve reproducibility of assessment. Here, we present results of the so far only existing round robin tests on Ki67, organized annually in Germany, Austria, and Switzerland from 2010 to 2015 with up to 160 participating laboratories (QuIP). In each quality assessment trial, eight probes from each breast cancer, neuroendocrine tumor, and malignant lymphoma were compiled on a tissue microarray (TMA). TMAs were stained in the participants' laboratories with antibodies and procedures also applied in their daily routine. Participating pathologists were expected to assign Ki67 values to one of four different categories for each tumor type. All local stainings and evaluations were reassessed by the organizing panel and compared to a preset standard. On average, 95% of participants reached the benchmark of over 80% concordance rates with the Ki67 category pre-established by the panel. Automatization and type of antibody did not affect the success rate. Concordance rates differed between tumor entities being highest in each tumor type with either very high or very low labeling indices. Lower rates were seen for intermediate Ki67 levels. Staining quality improved during the observation period as did inter-observer concordance with 85% of participants achieving excellent agreement (kappa > 0.8) in the first year and over 95% in 2015. In conclusion, regular external quality assurance trials have been established as a tool to improve the reproducibility and reliability of the prognostic and predictive proliferation marker Ki67.
http://ift.tt/2pEQ9Bb
Quantification of rat supraglottic laryngeal sensation threshold
Objective
Laryngeal adductor response (LAR) to air puff is used as a reliable method in evaluating sensation thresholds (ST) in human laryngeal sensory disorders. This method has been difficult to perform in small subjects such as rodents. The aims of this study were to 1) evaluate ST to air puff under binocular microlaryngoscopy in rats to evaluate laryngeal sensory disorders, 2) determine sensory thresholds at varying target locations, and 3) determine the ideal depth of anesthesia.
Study Design
Animal study.
Methods
Rats were induced with ketamine/xylazine. The level of anesthesia was monitored by spontaneous glottic closure and corneal reflex testing. Air puffs were delivered to the epiglottis, arytenoid, and piriform sinus at varied pressures with pulse time kept constant. Sensation thresholds were determined by direct visualization of the larynx using a binocular microscope. Topical lidocaine was then applied to the larynx and ST was determined. Trials were repeated in a small subset of animals.
Results
Twenty-six trials were performed in 14 rats. Mean STs were 39 ± 9.7 mm Hg at the epiglottis, 48.8 ± 10.5 at the arytenoid, and not detectable at the pyriform sinus. Repeated trials demonstrated consistent results. Lidocaine effectively ablated the LAR in each trial. The LAR was difficult to induce while corneal reflex was absent and was difficult to distinguish from spontaneous glottic closures while under lighter sedation.
Conclusion
Air pulse stimulation in rats is a simple, reliable, and effective way to determine laryngopharyngeal STs in rats and can be used as an efficient and affordable method for experimentation involving laryngeal sensory disorders.
Level of Evidence
NA. Laryngoscope, 2017
http://ift.tt/2q926BY
Homozygous EDNRB mutation in a patient with Waardenburg syndrome type 1
Source:Auris Nasus Larynx
Author(s): Noriko Morimoto, Hideki Mutai, Kazunori Namba, Hiroki Kaneko, Rika Kosaki, Tatsuo Matsunaga
ObjectiveTo examine and expand the genetic spectrum of Waardenburg syndrome type 1 (WS1).MethodsClinical features related to Waardenburg syndrome (WS) were examined in a five-year old patient. Mutation analysis of genes related to WS was performed in the proband and her parents. Molecular modeling of EDNRB and the p.R319W mutant was conducted to predict the pathogenicity of the mutation.ResultsThe proband showed sensorineural hearing loss, heterochromia iridis, and dystopia canthorum, fulfilling the clinical criteria of WS1. Genetic analyses revealed that the proband had no mutation in PAX3 which has been known as the cause of WS1, but had a homozygous missense mutation (p.R319W) in endothelin receptor type B (EDNRB) gene. The asymptomatic parents had the mutation in a heterozygote state. This mutation has been previously reported in a heterozygous state in a patient with Hirschsprung's disease unaccompanied by WS, but the patient and her parents did not show any symptoms in gastrointestinal tract. Molecular modeling of EDNRB with the p.R319W mutation demonstrated reduction of the positively charged surface area in this region, which might reduce binding ability of EDNRB to G protein and lead to abnormal signal transduction underlying the WS phenotype.ConclusionsOur findings suggested that autosomal recessive mutation in EDNRB may underlie a part of WS1 with the current diagnostic criteria, and supported that Hirschsprung's disease is a multifactorial genetic disease which requires additional factors. Further molecular analysis is necessary to elucidate the gene interaction and to reappraise the current WS classification.
http://ift.tt/2r5EN9W
Cystic adventitial disease of the common femoral vein
We present the case of a 46-year-old commercial pilot with a history of unilateral leg swelling following a flight to Geneva. Although initial clinical examination suggested a deep vein thrombosis, the swelling only partially resolved with anticoagulation and further imaging suggested the presence of adventitial cystic disease (ACD). The patient underwent initial anticoagulation to allow any thrombus to be lysed, followed by excision of the ACD from the venous wall and venous reconstruction. Following the excision of the ACD, providing the patient remains asymptomatic and further imaging finds normal venous anatomy, we hope the patient will discontinue anticoagulation and return to flying.
http://ift.tt/2q9XlGT
Bilateral corneal injury after face-paint application to upper eyelids
A 40-year-old woman with no known medical conditions or allergies presented with severely painful, watery eyes and blurred vision. She reported topical application of face-paint onto both upper eyelids prior to attending a Halloween party. She subsequently noticed a burning sensation, epiphora and misty vision within a few hours. On examination, bilateral large corneal epithelial defects were highlighted with fluorescein dye under cobalt-blue light. Antibiotic ointment, mydriatic and sodium ascorbate 10% eye-drops were given, and patient was advised to keep the eyelids shut to promote healing. No corneal defects were visible by day 4 and the patient was discharged with vision recovering to normal levels.
http://ift.tt/2q7aC4R
Mixed cryoglobulinemia: a diagnostic and therapeutic challenge
Mixed cryoglobulinemia is frequently secondary to hepatitis C virus infection. Diagnosis and therapeutic management are challenging, depending on the spectrum and severity of manifestations, as well as on the presence of comorbidities. We describe a case of a 79-year-old woman with a non-cirrhotic hepatitis C virus infection presenting with weakness, arthralgias, purpuric rash with left leg ulcerative lesions, bilateral peripheral sensorimotor polyneuropathy, renal impairment and cardiac failure. The investigation was compatible with a severe type II mixed cryoglobulinemia with multisystemic involvement, including a low-grade B cell lymphoma and concomitant intestinal tuberculosis. Initial management with immunosuppressive therapy with glucocorticoids to control symptoms and simultaneous tuberculosis treatment was required. Unavailability of adequate antiviral treatment led to the need to control the severity of systemic manifestations with rituximab, before the effective aetiological treatment with sofosbuvir and ledipasvir was possible, allowing the definitive resolution of the disease.
http://ift.tt/2qaj29P
A rare view: giant liver abscess with underlying liver metastases
Description
Liver abscess (LA) refers to a suppurated cavity caused by the invasion of liver parenchyma, most commonly by Gram-negative bacteria. Although rare, it is potentially life-threatening. Giant LA (>10 cm) is even more uncommon.1 Symptoms and signs are non-specific and the diagnosis relies essentially on imaging with ultrasound (US) and CT scan. Treatment is based on antimicrobials, abscess drainage and approach to the underlying disease.2 For pyogenic LA, prompt initiation of empirical broad-spectrum intravenous antibiotics,2 usually a third-generation cephalosporin plus metronidazole, is essential with subsequent adjustment to culture and sensitivity, usually for 10–14 days, depending on clinical and radiological response. Together with CT scan or US-guided percutaneous catheter drainage (PD), it is the initial treatment of choice.1 However, large LA >5 cm predicts failure of PD and the need for surgical drainage.3 Malignancy and multiloculation are also risk factors for therapy...
http://ift.tt/2q7cCdo
Vitamin A deficiency due to chronic malabsorption: an ophthalmic manifestation of a systemic condition
A 47-year-old woman presented with a 4-week history of progressive loss of vision, first manifesting as night blindness. Additionally, the patient reported frequent severe episodes of diarrhoea over the past month. Her medical history included end-stage renal failure for which she was currently on haemodialysis after a failed renal transplant, chronic pancreatitis and autonomic diabetes mellitus. Ophthalmological examination revealed severe bilateral corneal xerosis, bilateral Bitot's spots and inferior ulceration of the right cornea. A diagnosis of xerophthalmia due to vitamin A deficiency was made, most likely due to the presence of small intestinal bacterial overgrowth and the patient's chronic malabsorptive state. Standard management using oral vitamin A tablets was ineffective, resulting in the patient requiring intravenous supplementation. The extent of visual deterioration on presentation and the difficulties encountered managing the patient resulted in the patient's vision failing to improve.
http://ift.tt/2qa5NWs
Long-term follow-up of patients undergoing autologous noncultured melanocyte-keratinocyte transplantation for vitiligo and other leukodermas
Persistence of pigmentation after a melanocyte-keratinocyte transplantation procedure (MKTP) is an important consideration for efficacy.
http://ift.tt/2pDrqMQ
Blocking of stromal interaction molecule 1 expression influence cell proliferation and promote cell apoptosis in vitro and inhibit tumor growth in vivo in head and neck squamous cell carcinoma
by Ping Li, Xue-yan Bian, Qing Chen, Xiao-feng Yao, Xu-dong Wang, Wen-chao Zhang, Ying-jie Tao, Rui Jin, Lun Zhang
Calcium signal plays an important role in a variety of cancer cell metabolism, but knowledge on its role in head and neck squamous cell carcinoma (HNSCC) is limited. Store-operated calcium entry (SOCE) is the principal Ca2+ entry mechanism that maintains calcium concentration and produces calcium signal in non-excitable cells. SOCE is triggered by stromal interaction molecule 1 (STIM1), which is located in endoplasmic reticulum (ER) as Ca2+ sensor. Although, many studies demonstrated that STIM1 and SOCE play important functions in the regulation of many cancer progressions, their clinical relevance in HNSCC remains unclear. In this study, STIM1 expression levels notably increased in 89% HNSCC tissues compared with those in adjacent normal tissues. Meanwhile, this overexpression was close associated with tumor size but not with neck lymph node metastasis. Thus, this study mainly focuses on STIM1 function in HNSCC tumor growth. Three HNSCC cell lines, namely, TSCCA (oral cancer cell line) and Hep2 (laryngeal cell line) with high STIM1 expression levels and Tb3.1 (oral cancer cell line) with STIM1 expression level lower than previous two cell lines, were selected for in vitro study. Downregulated STIM1 expression levels in TSCCA and Hep2 arrested cells in G0/G1 stages, promoted cell apoptosis, and inhibited cell proliferation. By contrast, upregulated STIM1 expression in Tb3.1 inhibited cell apoptosis and promoted cell proliferation. Induced by thapsigargin (TG), ER stress was amplified when STIM1 expression was downregulated but was attenuated as STIM1 expression was upregulated. Furthermore, TSCCA cell xenograft models confirmed that STIM1 could promote HNSCC tumor growth in vivo. The present study provides new insight into HNSCC molecular mechanism and potential therapeutic target through targeting SOCE-dependent process. However, whether STIM1 participates in HNSCC metastasis requires further study.http://ift.tt/2r6FtN3
Homozygous EDNRB mutation in a patient with Waardenburg syndrome type 1
To examine and expand the genetic spectrum of Waardenburg syndrome type 1 (WS1).
http://ift.tt/2qxQ0Uk
Possible effects of some agents on the injured nerve in obese rats: A stereological and electron microscopic study
The main aim of this study was to research new treatments following peripheral nerve injury involving melatoniin (Mel), acetyl-L-carnitine (ALCAR), and leptin (Lep) using updated unbiased methods at the stereological and electron microscopic levels.
http://ift.tt/2pq7FgN
Patient-specific biodegradable implant in pediatric craniofacial surgery
We would like to briefly comment on this paper, as we believe that every new surgical technique should be scrutinized with regard to its real value in craniofacial treatment methods. It is important to realize that individual computerized implants represent progress in the area of specific issues of craniofacial surgery. Different techniques for successful correction of the stigmata of various forms of monosutural craniosynostosis have already been established.
http://ift.tt/2r5Ve5Q
The effect of pressure-controlled inverse ratio ventilation on lung protection in obese patients undergoing gynecological laparoscopic surgery
Abstract
Specific aim
To examine the effects of pressure-controlled inverse ratio ventilation (PCIRV) and volume-control ventilation (VCV) on arterial oxygenation, pulmonary function, hemodynamics, levels of surfactant protein A (SP-A), and tumor necrosis factor-α (TNF-α) in obese patients undergoing gynecological laparoscopic surgery.
Methods
Sixty patients, body mass index (BMI) ≥30 kg/m2, scheduled for elective gynecological laparoscopic surgery were enrolled in the study. Patients were randomly allocated to receive either PCIRV with an inspiratory–expiratory (I:E) ratio of 1.5:1 (PCIRV group n = 30) or VCV with an I:E ratio of 1:2 (VCV group n = 30). Ventilation variables, viz. tidal volume (V T), dynamic respiratory-system compliance (C RS), driving pressure (ΔP = V T/C RS), arterial blood oxygen partial pressure/fraction of inspiration oxygen (PaO2/FiO2) and arterial blood carbon dioxide partial pressure (PaCO2), were measured. Hemodynamic variables, viz. mean arterial pressure (MAP), heart rate (HR), and serum levels of SP-A and TNF-α, were also measured.
Results
When compared to patients in the VCV group, patients in the PCIRV group had higher V T, dynamic CRS, and PaO2/FiO2, and lower ΔP and PaCO2 at 20 and 60 min after the start of pneumoperitoneum (p < 0.05). Patients in the PCIRV group had lower SP-A and TNF-α levels at 24 and 48 h after surgery than those in the VCV group (p < 0.05).
Conclusion
In obese patients undergoing gynecological laparoscopic surgery, PCIRV can improve ventilation, promote gas exchange and oxygenation, and is associated with decreased levels of SP-A and TNF-α. These effects demonstrate improved lung protection provided by PCIRV in this patient population.
http://ift.tt/2pDpvbg
Synovial cellular and molecular markers in rheumatoid arthritis
Abstract
The profound alterations in the structure, cellular composition, and function of synovial tissue in rheumatoid arthritis (RA) are the basis for the persistent inflammation and cumulative joint destruction that are hallmarks of this disease. In RA, the synovium develops characteristics of a tertiary lymphoid organ, with extensive infiltration of lymphocytes and myeloid cells. Concurrently, the fibroblast-like synoviocytes undergo massive hyperplasia and acquire a tissue-invasive phenotype. In this review, we summarize key components of these processes, focusing on recently-described roles of selected molecular markers of these cellular components of RA synovitis.
http://ift.tt/2q8iwKO
An open, multicenter, randomized clinical study in patients with bullous pemphigoid comparing methylprednisolone and azathioprine with methylprednisolone and dapsone
Abstract
Background
Current treatment of bullous pemphigoid (BP) is based on the long-term use of topical and/or systemic corticosteroids associated with a high rate of adverse events and increased mortality.
Objective
To study the corticosteroid-sparing potential of azathioprine and dapsone.
Method
A prospective, multicenter, randomized, non-blinded clinical trial that compares efficacy and safety of two parallel groups of BP patients treated with oral methylprednisolone 0.5 mg/kg/d in combination with either azathioprine 1.5-2.5 mg/kg/d or dapsone 1.5 mg/kg/d. Nine German and Austrian departments of dermatology included 54 patients based on clinical lesions, positive direct immunofluorescence (IF) microscopy and detection of serum autoantibodies by indirect IF microscopy, immunoblotting or ELISA. The primary end point was time until complete tapering of methylprednisolone, the most important secondary end point the cumulative corticosteroid dose.
Results
In eight patients (5 azathioprine, 3 dapsone), methylprednisolone could be discontinued after a median time of 251 days in the azathioprine and 81 days in the dapsone group. The median cumulative corticosteroid dose was 2,654 mg for azathioprine compared to 1,917 mg for dapsone (p=0.06). The median number of days when corticosteroids were applied was 148 and 51, respectively (p=0.24). No significant difference in the number of adverse events was seen between the treatment arms. Four patients (8%) died within the observation period of 12 months.
Conclusions
Due to the lower than intended number of patients, results of primary and secondary endpoints were not or only barely significant. Dapsone appeared to have a moderately higher corticosteroid-sparing potential compared to azathioprine. The combination regimen of both drugs with oral methylprednisolone is associated with a relatively low one-year mortality in this vulnerable patient population.
This article is protected by copyright. All rights reserved.
http://ift.tt/2pEfw6e
Paracrine regulation of melanogenesis
Summary
Melanocytes are generally characterized by the basic ability of melanin synthesis and transfer to adjacent keratinocytes to constitute individual skin phenotype and provide epidermal protection from various stimuli, such as ultraviolet (UV) irradiation, through a complex process called melanogenesis, which can be regulated by autocrine or paracrine factors. Recent evidences have revealed the paracrine effects of keratinocytes on melanogenesis by secreting cytokines, including alpha-melanocyte stimulating hormone (α-MSH) and endothelin-1. In addition to keratinocytes, there are other types of cells in the skin, such as fibroblasts and immune cells that are also actively involved in the regulation of melanocyte behavior through the production of paracrine factors. In addition, extracellular matrix (ECM) proteins, which are mainly secreted by skin resident cells, not only play direct roles in regulating melanocyte morphology and functions but also provide structural support between the epidermis and dermis to control the distribution of various secreted cytokines from keratinocytes and/or fibroblasts, which are potentially involved in the regulation of melanogenesis. Moreover, with respect to the origin of melanocytes (neural crest cells) and the presence of nerve endings in the epidermis, it is considerable to reveal the intimate contact between melanocytes and cutaneous specific nervous system-proteins. Melanocytes are associated with all these networks with corresponding receptors expressed on the cell surface. In this review, we provide an overview of recent advances in the intimate relationships between melanocytes and their surrounding elements, which provide insights into the complex nature of the regulation of melanogenesis.
This article is protected by copyright. All rights reserved.
http://ift.tt/2q8l2kg
Incidence of human cytomegalovirus (HCMV) infection and T-cell response in psoriatic patients before and during anti-TNF-α therapy
Abstract
psoriasis is a chronic inflammatory skin disease that affects approximately 2-3% of the world population.1 Among the cytokines produced by T cells, TNF-α has a crucial role in psoriasis.2 Thus, TNF-α blocking therapy is efficient in the treatment of psoriasis.
This article is protected by copyright. All rights reserved.
http://ift.tt/2pEfvPI
Recommendation to test limonene hydroperoxides 0.3% and linalool hydroperoxides 1.0% in the British Baseline patch test series
Abstract
Background
There is a significant rate of sensitisation worldwide to the oxidised fragrance terpenes limonene and linalool. Patch testing to oxidised terpenes is not routinely carried out; the ideal patch test concentration is unknown.
Objectives
To determine the best test concentrations for limonene and linalool hydroperoxides, added to the British baseline patch test series, to optimise detection of true allergy and minimise irritant reactions.
Methods
During 2013-2014, 4563 consecutive patients in 12 UK centres were tested to hydroperoxides of limonene in petrolatum (pet.) 0.3%, 0.2% and 0.1%, and hydroperoxides of linalool 1.0%, 0.5% and 0.25% pet. Irritant (IR) reactions were recorded separately from doubtful (?+) reactions. Concomitant reactions to other fragrance markers and clinical relevance were documented.
Results
Limonene hydroperoxide 0.3% gave positive reactions in 241 (5.3%) patients, irritant reactions in 93 (2.0%) and doubtful reactions in 110 (2.4%). Linalool hydroperoxide 1.0% gave positive reactions in 352 (7.7%), irritant reactions in 178 (3.9%), and doubtful reactions in 132 (2.9%). 119 patients with crescendo reactions to 0.3% limonene would have been missed if only tested with 0.1%. 131 patients with crescendo reactions to 1.0% linalool would have been missed if only tested with 0.25%. In almost two-thirds of patients with positive patch tests to limonene and linalool the reaction was clinically relevant. The majority of patients did not react to any fragrance marker in the baseline series.
Conclusions
We recommend that limonene hydroperoxides be tested at 0.3% and linalool hydroperoxides at 1.0% in the British baseline patch test series.
This article is protected by copyright. All rights reserved.
http://ift.tt/2q8pJux
Cochleotoxicity monitoring protocol
Publication date: Available online 10 May 2017
Source:Acta Otorrinolaringológica Española
Author(s): José Ferreira Penêda, Nuno Barros Lima, Leandro Ribeiro, Diamantino Helena, Bruno Domingues, Artur Condé
IntroductionCochlear damage is frequent in long-term aminoglycosides therapy or chemotherapeutic treatments with platinum-based agents. Despite its prevalence, it is currently underestimated and underdiagnosed. A monitoring protocol is vital to the early detection of cochleotoxicity and its implementation is widely encouraged in every hospital unit. Our aim was to elaborate a cochleotoxicity monitoring protocol for patients treated with platinum compounds or aminoglycosides antibiotics.MethodsPubMed® database was searched using terms relevant to drug cochleotoxicity in order to identify the most adequate protocol. Several articles and guidelines influenced our decision.ResultsThere is no consensus on a universal monitoring protocol. Its formulation and application rely heavily on available resources and personnel. High-frequency audiometry and otoacoustic emissions play an important role on early detection of cochleotoxicity caused by aminoglycoside antibiotics and platinum compounds.ConclusionA cochleotoxicity monitoring protocol consisting on an initial evaluation, treatment follow-up and post-treatment evaluation is proposed.
http://ift.tt/2ppAgTb
A new adenovector system for implementing thymulin gene therapy for inflammatory disorders
Source:Molecular Immunology, Volume 87
Author(s): María F. Zappa-Villar, Micaela López-León, Joaquín Pardo, Mariana Costa, Rosana Crespo, Mireille Dardenne, Rodolfo G. Goya, Paula C. Reggiani
Thymulin is a thymic peptide possessing anti-inflammatory effects. In order to manipulate thymulin expression in gene therapy studies, we built a bidirectional regulatable two-vector Tet-Off system and the corresponding control system. The experimental two-vector system, ETV, consists of a recombinant adenovector (RAd) harboring an expression cassette centered on a Tet-Off bidirectional promoter flanked by a synthetic gene for thymulin and the gene for humanized Green Fluorescent Protein (hGFP). The second adenovector of this system, RAd-tTA, constitutively expresses the regulatory protein tTA. When cells are co-transduced by the two adenovector components, tTA activates the bidirectional promoter and both transgenes are expressed. In the presence of the antibiotic doxycycline (DOX) transgene expression is deactivated. The control two-vector system, termed CTV, is similar to ETV but only expresses hGFP. In CHO-K1, BHK, and C2C12 cells, ETV and CTV induced a dose-dependent hGFP expression. In CHO-K1 cells, transgene expression was almost completely inhibited by DOX (1mg/ml). After intracerebroventricular injection of ETV in rats, thymulin levels increased significantly in the cerebrospinal fluid and there was high hGFP expression in the ependymal cell layer. When injected intramuscularly the ETV system induced a progressive increase in serum thymulin levels, which were inhibited when DOX was added to the drinking water. We conclude that our regulatable two-adenovector system is an effective molecular tool for implementing short and long-term anti-inflammatory thymulin gene therapy in animal models of acute or chronic inflammation.
http://ift.tt/2qZaaGI
Our Experience of Treating Wide Spectrum of External Ear Canal Atresia of Different Etiologies in Pediatric Patients
Abstract
External auditory canal atresia (EACA) is a common otologic condition. Etiology can vary from congenital to acquired causes. It causes considerable difficulty to the patient. Bilateral ear canal atresia in children can lead to speech delays due to hearing impairment caused by this condition. Though easily diagnosed it is one of the most difficult conditions to treat. Acquired conditions can affect any age group. Restenosis following treatment is very common. This article focuses on the treatment of EACA due to different etiologies and emphasizes on special points of surgical treatment and follow up. Five cases of external auditory canal atresia was treated between 2014 and 2016. Two of them were congenital cases and three were acquired. One congenital atresia patient had pinna abnormalities in the form of one sided anotia and other side microtia. Another patient of congenital ear canal atresia had congenital cholesteatoma. Acquired atresia was due to osteoma, external trauma and surgical trauma following a condylectomy surgery. All the patients were treated surgically. A wide meatoplasty with split thickness skin graft lining the canal/cavity was done to avoid restenosis. Merocel wicks were used in all cases. Removal of localized granulations on follow up helped keep the canal patent especially in congenital EACA. All patients had significant hearing improvement following surgery. Child with bilateral atresia and pinna anomaly has now achieved normal hearing and speech milestones. She does not use any hearing aid. None of the patients developed restenosis of their reconstructed ear canal. One of the patient developed granulations around the meatoplasty edges which was cauterized using silver nitrate. External auditory canal atresia surgery is a difficult surgery keeping in view the distorted anatomy and the propensity of restenosis of the newly constructed ear canal. Hearing restoration in the operated ear is all the more challenging. Meticulous planning with close discussion with patients and their caregivers regarding multiple surgeries has to be done. Using skin graft, doing a wide meatoplasty, using merocel wicks for ear canal dressing are few important aspects of this surgery which can give satisfactory results in long term.
http://ift.tt/2r4Zm6e
Our Experience of Treating Wide Spectrum of External Ear Canal Atresia of Different Etiologies in Pediatric Patients
Abstract
External auditory canal atresia (EACA) is a common otologic condition. Etiology can vary from congenital to acquired causes. It causes considerable difficulty to the patient. Bilateral ear canal atresia in children can lead to speech delays due to hearing impairment caused by this condition. Though easily diagnosed it is one of the most difficult conditions to treat. Acquired conditions can affect any age group. Restenosis following treatment is very common. This article focuses on the treatment of EACA due to different etiologies and emphasizes on special points of surgical treatment and follow up. Five cases of external auditory canal atresia was treated between 2014 and 2016. Two of them were congenital cases and three were acquired. One congenital atresia patient had pinna abnormalities in the form of one sided anotia and other side microtia. Another patient of congenital ear canal atresia had congenital cholesteatoma. Acquired atresia was due to osteoma, external trauma and surgical trauma following a condylectomy surgery. All the patients were treated surgically. A wide meatoplasty with split thickness skin graft lining the canal/cavity was done to avoid restenosis. Merocel wicks were used in all cases. Removal of localized granulations on follow up helped keep the canal patent especially in congenital EACA. All patients had significant hearing improvement following surgery. Child with bilateral atresia and pinna anomaly has now achieved normal hearing and speech milestones. She does not use any hearing aid. None of the patients developed restenosis of their reconstructed ear canal. One of the patient developed granulations around the meatoplasty edges which was cauterized using silver nitrate. External auditory canal atresia surgery is a difficult surgery keeping in view the distorted anatomy and the propensity of restenosis of the newly constructed ear canal. Hearing restoration in the operated ear is all the more challenging. Meticulous planning with close discussion with patients and their caregivers regarding multiple surgeries has to be done. Using skin graft, doing a wide meatoplasty, using merocel wicks for ear canal dressing are few important aspects of this surgery which can give satisfactory results in long term.
http://ift.tt/2r4Zm6e
Acute radiology rarely confirms sinus disease in suspected recurrent acute rhinosinusitis
Background
Episodic or recurrent sinonasal symptoms are often suspected as "sinus" in origin. With normal sinus radiology between events, the diagnosis of recurrent acute rhinosinusitis (RecARS) is made. However, other conditions can produce episodic symptoms. In this study we analyze acutely performed computed tomography (CT) in a population with suspected or self-diagnosed "sinus" disease.
Methods
Patients referred to a tertiary clinic for suspected RecARS were assessed. Sinus changes were defined by CT (initial assessment) and during the acute event, by a semiurgent CT performed during the symptomatic episode. Mucosal thickening, ostiomeatal compromise, and severe septal deformity were recorded. Symptom profile was assessed during both time-points with the 22-item Sino-Nasal Outcome Test (SNOT-22).
Results
Forty-eight patients (49.5 ± 14.7 years of age, 70.8% female) were assessed. At presentation, 75% were resolute in a diagnosis of "sinus." Baseline Lund-Mackay scores were <6 (median 0 [interquartile range 1]). Ostiomeatal compromise was 6.8% left and 4.5% right at baseline. Of the patients who returned for acute CT (n = 27), SNOT-22 and subdomains were similar to baseline. Septal deviation was similar (13.6% vs 15.3%). Acutely, ostiomeatal compromise was 0% left and 7.4% right (n = 2). Of these 2 patients with ostiomeatal compromise, 1 was diagnosed with RecARS (4%) and the other with triptan-responsive migraine, with incidental sinus changes. Final diagnosis was rhinitis (47%), headache/migraine (37%), and facial pain otherwise undefined (12.5%).
Conclusion
Patients with a history of "recurrent acute sinusitis" and normal CT scans between episodes rarely have abnormal CT findings during acute exacerbations of symptoms. Antibiotics and surgical intervention are often inappropriate in this population.
http://ift.tt/2pCALEY
Current status of chimeric antigen receptor engineered T cell-based and immune checkpoint blockade-based cancer immunotherapies
Abstract
Adoptive cell therapies with chimeric antigen receptor (CAR) engineered T cells (CAR-T) and immune checkpoint inhibition (ICI)-based cancer immunotherapies have lately shown remarkable success in certain tumor types. CAR-T cell-based therapies targeting CD19 can now induce durable remissions as well as prolong disease-free survival of patients with CD19 positive treatment refractory B cell malignancies and ICI-based therapies with humanized monoclonal antibodies against the T cell inhibitory receptors CTLA-4 and PD-1 as well as against the PD-1 ligand, PD-L1, can now achieve durable remissions as well as prolongation of life of a sizeable fraction of patients with melanoma and Hodgkin's lymphoma and non-small cell cancers. Most importantly, these immuno-therapeutic treatment modalities have raised the possibility of achieving long-term "containment" as well as "cures" for certain types of cancer. While this represents major advances in cancer immunotherapy, both modalities come with considerable toxicities, including fatalities. Although more work will be needed to bring CAR-T cell-based therapies to the bedside for most major cancers and a good deal more will be needed to make ICI—alone or in combination with other treatment modalities—work more consistently and across most major cancers, these two treatment modalities stand out as superb examples of successful translation of bench research to the bedside as well as represent real progress in the field of cancer immunotherapy.
http://ift.tt/2q9V7as
Blocking of stromal interaction molecule 1 expression influence cell proliferation and promote cell apoptosis in vitro and inhibit tumor growth in vivo in head and neck squamous cell carcinoma
by Ping Li, Xue-yan Bian, Qing Chen, Xiao-feng Yao, Xu-dong Wang, Wen-chao Zhang, Ying-jie Tao, Rui Jin, Lun Zhang
Calcium signal plays an important role in a variety of cancer cell metabolism, but knowledge on its role in head and neck squamous cell carcinoma (HNSCC) is limited. Store-operated calcium entry (SOCE) is the principal Ca2+ entry mechanism that maintains calcium concentration and produces calcium signal in non-excitable cells. SOCE is triggered by stromal interaction molecule 1 (STIM1), which is located in endoplasmic reticulum (ER) as Ca2+ sensor. Although, many studies demonstrated that STIM1 and SOCE play important functions in the regulation of many cancer progressions, their clinical relevance in HNSCC remains unclear. In this study, STIM1 expression levels notably increased in 89% HNSCC tissues compared with those in adjacent normal tissues. Meanwhile, this overexpression was close associated with tumor size but not with neck lymph node metastasis. Thus, this study mainly focuses on STIM1 function in HNSCC tumor growth. Three HNSCC cell lines, namely, TSCCA (oral cancer cell line) and Hep2 (laryngeal cell line) with high STIM1 expression levels and Tb3.1 (oral cancer cell line) with STIM1 expression level lower than previous two cell lines, were selected for in vitro study. Downregulated STIM1 expression levels in TSCCA and Hep2 arrested cells in G0/G1 stages, promoted cell apoptosis, and inhibited cell proliferation. By contrast, upregulated STIM1 expression in Tb3.1 inhibited cell apoptosis and promoted cell proliferation. Induced by thapsigargin (TG), ER stress was amplified when STIM1 expression was downregulated but was attenuated as STIM1 expression was upregulated. Furthermore, TSCCA cell xenograft models confirmed that STIM1 could promote HNSCC tumor growth in vivo. The present study provides new insight into HNSCC molecular mechanism and potential therapeutic target through targeting SOCE-dependent process. However, whether STIM1 participates in HNSCC metastasis requires further study.http://ift.tt/2r6FtN3
Cochlear implant electrode sealing techniques and related intracochlear pressure changes
The inserted cochlear implanted electrode is covered at the site of the round window or cochleostomy to prevent infections and leakage. In a surgically hearing preservational concept, low intracochlear pressur...
http://ift.tt/2qYqFTn
Health Literacy in Patients With Head and Neck Cancer
This Viewpoint discusses the impact of health literacy on treatment compliance and outcomes in a number of medical conditions, focusing on a general measure and a cancer-specific measure of health literacy.
http://ift.tt/2pCbTgB
http://ift.tt/2pCbTgB
Cholesteatoma Risk Among Patients With Chronic Rhinosinusitis
This population-based study evaluates the risk of cholesteatoma in patients with chronic rhinosinusitis.
http://ift.tt/2qYyI2u
http://ift.tt/2qYyI2u
Conservative Treatment of Isolated Cricoid Cartilage Fractures From Blunt Trauma
This case series examines the conservative treatment of laryngotracheal traumas.
http://ift.tt/2pCiYO4
http://ift.tt/2pCiYO4
Automated Posttonsillectomy Bleed Capture vs Self-report
This medical record review evaluates the feasibility and accuracy of an algorithm to capture posttonsillectomy bleeding in a single health care system compared with traditional self-reported bleeding by the surgical team.
http://ift.tt/2qXZsjW
http://ift.tt/2qXZsjW
Allergen immunotherapy for allergic rhinoconjunctivitis: a systematic review and meta-analysis
Abstract
Background
The European Academy of Allergy and Clinical Immunology (EAACI) is in the process of developing Guidelines on Allergen Immunotherapy (AIT) for Allergic Rhinoconjunctivitis. In order to inform the development of clinical recommendations, we undertook a systematic review to assess the effectiveness, cost-effectiveness and safety of AIT in the management of allergic rhinoconjunctivitis
Methods
We searched 15 international biomedical databases for published, in progress and unpublished evidence. Studies were independently screened by two reviewers against pre-defined eligibility criteria and critically appraised using established instruments. Our primary outcomes of interest were symptom, medication and combined symptom and medication scores. Secondary outcomes of interest included cost-effectiveness and safety. Data were descriptively summarized and then quantitatively synthesized using random-effects meta-analyses.
Results
We identified 5932 studies of which 160 studies satisfied our eligibility criteria. There was a substantial body of evidence demonstrating significant reductions in standardized mean differences (SMD) of symptom (SMD -0.53, 95%CI -0.63, -0.42), medication (SMD -0.37, 95%CI -0.49, -0.26) and combined symptom and medication (SMD -0.49, 95%CI -0.69, -0.30) scores whilst on treatment that were robust to pre-specified sensitivity analyses. There was in comparison a more modest body of evidence on effectiveness post-discontinuation of AIT, this suggesting a benefit in relation to symptom scores.
Conclusions
AIT is effective in improving symptom, medication and combined symptom and medication scores in patients with allergic rhinoconjunctivitis whilst on treatment, and there is some evidence suggesting that these benefits are maintained in relation to symptom scores after discontinuation of therapy.
This article is protected by copyright. All rights reserved.
http://ift.tt/2q7prE1
Superior parathyroid gland approach to the recurrent laryngeal nerve
ABSTRACT
Background
The superior parathyroid gland is known to be almost constant in its location under the false thyroid capsule. Could it be a landmark to point to the site of incision of the false thyroid capsule and find the plane of the recurrent laryngeal nerve (RLN) during thyroidectomy?
Methods
The study included 48 patients with benign goiter scheduled for hemithyroidectomy or total thyroidectomy; there were 16 cases of solitary thyroid nodules, 27 cases of multinodular goiter, and 5 cases of toxic goiter.
Results
This study included 80 lobectomies. All patients showed no evidence of postoperative RLN palsy, bleeding, or hypoparathyroidism. The superior parathyroid gland was consistently found within the false capsule in all cases, whereas the inferior parathyroid was found within the same layer in 64 sides (80%).
Conclusion
The described approach can accurately guide dissection between true and false capsules of the thyroid to reach and preserve both the RLN and the superior parathyroid gland. © 2017 Wiley Periodicals, Inc. Head Neck, 2017
http://ift.tt/2qvWPWJ
Perioperative practices in thyroid surgery: An international survey
Abstract
Background
Perioperative practices in thyroid surgery vary from one specialty, institution, or country to the next. We evaluated the preoperative, intraoperative, and postoperative practices of thyroid surgeons focusing on preoperative ultrasound, vocal cord evaluation, wound drains, and hospitalization duration, among others.
Methods
A survey was sent to 7 different otolaryngology and endocrine/general surgery associations.
Results
There were 965 respondents from 52 countries. Surgeon-performed ultrasound is practiced by more than one third of respondents. Otolaryngologists perform preoperative and postoperative vocal cord evaluation more often than endocrine/general surgeons (p < .001). Sixty percent of respondents either never place drains or place drains <50% of the time in thyroid lobectomies (43% for total thyroidectomies). Outpatient thyroid surgery is most frequently performed by surgeons in the United States (63%).
Conclusion
This epidemiologic study is the first global thyroid survey of its kind and clearly demonstrates the variability and evolving trends in thyroid surgery. © 2017 Wiley Periodicals, Inc. Head Neck, 2017
http://ift.tt/2q9aVKA
Comparison of risk of malignancy in a subgroup with atypia of undetermined significance/follicular lesion of undetermined significance: A meta-analysis
Abstract
Background
As heterogeneous findings are included in the atypia of undetermined significance (AUS)/follicular lesion of undetermined significance (FLUS) category, differing risks of malignancy in subgroups have been reported in several articles.
Methods
We performed a meta-analysis of full-text publications written in English found in the Embase and PubMed databases.
Results
The 4-tiered subgroup proportion meta-analysis showed that the 95% confidence interval (95% CI) of the risk of malignancy in the cellular atypia group did not overlap with the other 3 subgroups and demonstrated a significant difference. Two-tiered analysis using the cytologic and architectural atypia groups showed that cytologic atypia group had a 2.64-fold increase in the risk of malignancy compared with the architectural atypia group.
Conclusion
The cytologic atypia had a significantly higher risk of malignancy than the architectural atypia group, and it should be considered as a separate category.
http://ift.tt/2q5WfOr
Saliva-based Detection of CD44
Conditions: Oral Cavity Squamous Cell Carcinoma; Oropharynx Squamous Cell Carcinoma; Squamous Cell Carcinoma of the Oropharynx; Squamous Cell Carcinoma of the Head and Neck
Intervention: Device: OncAlert
Sponsors: Joseph Califano; Vigilant Biosciences, Inc.; Greater Baltimore Medical Center; San Diego Veterans Healthcare System; New York University School of Medicine
Recruiting - verified May 2017
http://ift.tt/2qXQ0wA
Intervention: Device: OncAlert
Sponsors: Joseph Califano; Vigilant Biosciences, Inc.; Greater Baltimore Medical Center; San Diego Veterans Healthcare System; New York University School of Medicine
Recruiting - verified May 2017
http://ift.tt/2qXQ0wA
PROCLAIM-CX-2009: A Trial to Find Safe and Active Doses of an Investigational Drug CX-2009 for Patients With Selected Solid Tumors
Conditions: Solid Tumor, Adult; Breast Cancer; Non Small Cell Lung Cancer; Prostate Cancer; Ovarian Cancer; Endometrial Cancer; Head and Neck Cancer; Cholangiocarcinoma
Intervention: Drug: CX-2009
Sponsor: CytomX Therapeutics
Not yet recruiting - verified May 2017
http://ift.tt/2pBud9q
Intervention: Drug: CX-2009
Sponsor: CytomX Therapeutics
Not yet recruiting - verified May 2017
http://ift.tt/2pBud9q
Durvalumab in Combination With Docetaxel, Cisplatin and 5-FU for Locally Advanced Head and Neck Squamous Cell Carcinoma
Condition: Head and Neck Cancers
Interventions: Drug: Durvalumab; Drug: Docetaxel; Drug: Cisplatin; Drug: 5 Fluorouracil
Sponsors: Gustave Roussy, Cancer Campus, Grand Paris; French National Cancer Institute
Recruiting - verified May 2017
http://ift.tt/2qXSI5l
Interventions: Drug: Durvalumab; Drug: Docetaxel; Drug: Cisplatin; Drug: 5 Fluorouracil
Sponsors: Gustave Roussy, Cancer Campus, Grand Paris; French National Cancer Institute
Recruiting - verified May 2017
http://ift.tt/2qXSI5l
Case 14-2017: A 20-Year-Old Man with Pain and Swelling of the Left Calf and a Purpuric Rash
Presentation of Case. Dr. Lauren R. Zeitels (Medicine): A 20-year-old man was seen in an outpatient clinic of this hospital because of pain and swelling of the left calf and a purpuric rash. The patient had been well until 3 weeks before presentation to this hospital, when sore throat,…
http://ift.tt/2r3JlO2
ALK-positive anaplastic large cell lymphoma undiagnosed in a patient with tuberculosis: a case report and review of the literature
Due to a similarity between the features of lymphoma and the features of tuberculosis, lymphoma may go unrecognized and undiagnosed in patients with tuberculosis.
http://ift.tt/2r5qvXE
A giant squamous cell carcinoma of the skin of the thoracic wall: a case report and review of the literature
We report a case of a 48-year-old white woman who presented with a huge cutaneous protruding tumor of the thoracic wall below her left breast.
http://ift.tt/2qvVv5U
Efficacy and safety of inhaled anaesthetic for postoperative sedation during mechanical ventilation in adult cardiac surgery patients: a systematic review and meta-analysis
<span class="paragraphSection"><div class="boxTitle">Abstract</div>The aim was to evaluate the efficacy and safety of volatile anaesthetic for postoperative sedation in adult cardiac surgery patients through a systematic review and meta-analysis. We retrieved randomized controlled trials from MEDLINE, EMBASE, CENTRAL, Web of Science, clinical trials registries, conference proceedings, and reference lists of included articles. Independent reviewers extracted data, including patient characteristics, type of intraoperative anaesthesia, inhaled anaesthetic used, comparator sedation, and outcomes of interest, using pre-piloted forms. We assessed risk of bias using the Cochrane Tool and evaluated the strength of the evidence using the GRADE approach. Eight studies enrolling 610 patients were included. Seven had a high and one a low risk of bias. The times to extubation after intensive care unit (ICU) admission and sedation discontinuation were, respectively, 76 [95% confidence interval (CI) −150 to − 2, <span style="font-style:italic;">I</span><sup>2</sup>=79%] and 74 min (95% CI − 126 to − 23, <span style="font-style:italic;">I</span><sup>2</sup>=96%) less in patients who were sedated using volatile anaesthetic. There was no difference in ICU or hospital length of stay. Patients who received volatile anaesthetic sedation had troponin concentrations that were 0.71 ng ml<sup>−1</sup> (95% CI 0.23–1.2) lower than control patients. Reporting on other outcomes was varied and not suitable for meta-analysis. Volatile anaesthetic sedation may be associated with a shorter time to extubation after cardiac surgery but no change in ICU or hospital length of stay. It is associated with a significantly lower postoperative troponin concentration, but the impact of this on adverse cardiovascular outcomes is uncertain. Blinded randomized trials using intention-to-treat analysis are required. PROSPERO registry number: 2016:CRD42016033874. Available from <a href="http://ift.tt/2pCmIQf">http://ift.tt/2q6Jv9z;
http://ift.tt/2pCtl5d
Efficacy and safety of carbetocin given as an intravenous bolus compared with short infusion for Caesarean section - double-blind, double-dummy, randomized controlled non-inferiority trial
<span class="paragraphSection"><div class="boxTitle">Abstract</div><strong>Background.</strong> Carbetocin is a synthetic oxytocin-analogue, which should be administered as bolus according to manufacturer's recommendations. A higher speed of oxytocin administration leads to increased cardiovascular side-effects. It is unclear whether carbetocin administration as short infusion has the same efficacy on uterine tone compared with bolus administration and whether haemodynamic parameters differ.<strong>Methods.</strong> In this randomized, double-blind, non-inferiority trial, women undergoing planned or unplanned Caesarean section (CS) under regional anaesthesia received a bolus and a short infusion, only one of which contained carbetocin 100 mcg (double dummy). Obstetricians quantified uterine tone two, three, five and 10 min after cord-clamping by manual palpation using a linear analogue scale from 0 to 100. We evaluated whether the lower limit of the 95% CI of the difference in maximum uterine tone within the first five min after cord-clamping did not include the pre-specified non-inferiority limit of −10.<strong>Results.</strong> Between December 2014 and November 2015, 69 patients were randomized to receive carbetocin as bolus and 71 to receive it as short infusion. Maximal uterine tone was 89 in the bolus and 88 in the short infusion group (mean difference −1.3, 95% CI −5.7 to 3.1). Bp, calculated blood loss, use of additional uterotonics, and side-effects were comparable.<strong>Conclusions.</strong> Administration of carbetocin as short infusion does not compromise uterine tone and has similar cardiovascular side-effects as a slow i.v. bolus. In accordance with current recommendations for oxytocin, carbetocin can safely be administered as short -infusion during planned or unplanned CS.<strong>Clinical trial registration.</strong> ClinicalTrials.gov NCT02221531 and <a href="http://www.kofam.ch">http://ift.tt/2pCMX9m; SNCTP000001197.</span>
http://ift.tt/2q6Jsup
Diagnosis of primary ciliary dyskinesia: When and how?
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): J.-J. Braun, N. Boehm, C. Metz-Favre, I. Koscinski, M. Teletin, C. Debry
IntroductionPrimary ciliary dyskinesia (PCD) is a rare congenital disorder involving permanent ubiquitous structural and/or functional ciliary abnormalities.MethodsA single-center retrospective study included 56 cases of PCD (respiratory form) out of a cohort of 280 patients with suspected PCD. The main features of history-taking and clinical examination were analyzed, to formulate a pragmatic diagnostic procedure, easy to implement in clinical practice.ResultsChronic respiratory tract infectious symptoms are sensitive but non-specific for the diagnosis of PCD. Nasal brushing for phase-contrast microscopy study of ciliary morphology and activity proved to be a fast, easy, non-invasive, cost-effective and age-independent diagnostic method. In doubtful cases, depending on local availability, further tests are indicated: nasal nitric oxide level, electronic microscopy, genetic study and cell culture.ConclusionsIn suspected PCD, there being no gold standard method of screening and early diagnosis, nasal brushing with ciliary study is contributive, alongside numerous other complementary tests, on condition that the clinician is experienced and results are interpreted in the light of clinical examination and history-taking.
http://ift.tt/2qvb3aa
Ototoxicity associated with topical administration of diclofenac sodium as an otic drop: An experimental animal study
Publication date: July 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 98
Author(s): Engin Acioglu, Ozgur Yigit, Firat Onur, Ahmet Atas, Ela Araz Server, Eyup Kara
ObjectivesThe aim of the study is to evaluate the ototoxicity of topical diclofenac sodium in comparison to positive and negative controls prior to the investigation of analgesic and anti-inflammatory efficacy of the agent in otic administration.MethodsTwenty four ears of 12 guinea pigs were included in the study. Wide myringotomy was performed on all tympanic membranes under general anesthesia and auditory brainstem responses (ABR) were evaluated. The subjects were separated into four groups, two groups received diclofenac sodium at low and high doses, positive controls received gentamicin and negative controls received isotonic sodium chloride topically for 14 days and ABRs were reevaluated.ResultsNo significant difference were observed between the pre and post-treatment click response, 1 kHz and 8 kHz response threshold levels after isotonic sodium chloride administration. All threshold levels were elevated in the positive control group. In the low and high dose diclofenac sodium groups, click response, 1 kHz and 8 kHz response threshold levels were significantly higher compared to the baseline values. Pre and post-treatment mean threshold level changes were not significantly different between the low and high dose diclofenac sodium groups. Pre and post-treatment mean threshold level changes in the gentamicin group were not significantly different from low or high dose diclofenac sodium groups.ConclusionDiclofenac sodium, considered as an analgesic and anti-inflammatory otic preparation, is shown to be as ototoxic as gentamicin in chronic use which may lead to loss of hearing especially when used topically in chronic otitis cases with tympanic membrane damage.
http://ift.tt/2qvAxEz
Condylar surface CT value in sagittal plane before and after sagittal split ramus osteotomy
Abstract
Purpose
The purpose of this study was to evaluate the relationship between computed tomography (CT) values of the condylar surface and temporomandibular joint (TMJ) disc position in the sagittal plane before and after sagittal split ramus osteotomy (SSRO) setback surgery, retrospectively.
Materials and methods
The subjects were 75 patients (150 condyles) who underwent bilateral SSRO setback surgery. They were divided into two groups (42 symmetric patients and 33 asymmetric patients). Maximum CT values (pixel values) of five points of the condylar surface and condylar height, length, fossa height, fossa length, and ramus angle in the sagittal plane were measured preoperatively and 1 year postoperatively. Disc position was classified as anterior disc displacement, anterior type, fully covered type, and posterior type, both pre- and postoperatively, using magnetic resonance imaging (MRI).
Results
Postoperative value was significantly higher than preoperative one in CT value of 135° (P = 0.0199) and 180° (0.0363), in the non-deviation side in the asymmetry group. The anterior disc displacement group was significantly larger than those of some other areas pre- and postoperatively in the CT value of 0° point (P < 0.05).
Conclusions
This study suggested that CT value of the posterior site of the condylar surface could change in the non-deviation side in the asymmetry group after 1 year SSRO, and the condyle with anterior displacement showed high CT value at the anterior site of the condyle before and after surgery.
http://ift.tt/2quaPA8
Where to position osteotomies in genioglossal advancement surgery based on locations of the mental foramen, canine, lateral incisor, central incisor, and genial tubercle
Abstract
Purpose
The study aimed to provide precise measurements of anterior mandibular structural anatomy and to explore potential osteotomies for genioglossal advancement.
Methods
Cone beam computed tomography was used to analyze 33 randomly selected patients undergoing surgery for obstructive sleep apnea (OSA) between 2014 and 2016 at an academic surgical hospital. The locations of relevant mandibular structures were measured and statistical modeling was performed.
Results
Mean horizontal distances from midline to the mental foramina and the roots of the canine, lateral incisor, and central incisor were 22.11 ± 1.92, 13.56 ± 3.01, 6.19 ± 1.58, and 2.04 ± 0.87 mm, respectively. Mean vertical distances from the inferior border of the mandible were 15.15 ± 1.77, 17.11 ± 3.28, 20.48 ± 3.10, and 21.81 ± 3.49 mm, respectively. The superior border of the genial tubercle was 15.63 ± 2.75 mm, and the inferior border was 6.87 ± 3.29, from the inferior border of the mandible. The angle of decline of the best-fit line through the important structures was about 18° from the occlusion plane at the midline.
Conclusions
A straight line estimating the mental foramen, canine, lateral incisor, and central incisor tooth roots crosses at a mean of 22.3–22.6 mm above the inferior border of the mandible at the midline and has an angle of decline of about 18°. Potential osteotomies made parallel to and below this line result in tradeoffs between maximizing capture of the genioglossus muscle attachment and risk of dental/neurovascular injury.
http://ift.tt/2qtZvnA
The association between semaphorin 3A levels and gluten-free diet in patients with celiac disease
Publication date: Available online 11 May 2017
Source:Clinical Immunology
Author(s): Aharon Kessel, Chen Lin, Zahava Vadasz, Regina Peri, Nasren Eiza, Drora Berkowitz
Celiac disease (CD) is an inflammatory disease affecting the small intestine. We aim to assess serum level and expression of semaphorin 3A (Sema3A) on T regulatory (Treg) cells in CD patients. Twenty-six newly diagnosed celiac patients, 13 celiac patients on a gluten-free diet and 16 healthy controls included in the study. Sema3A protein level in the serum of celiac patients was significantly higher compared to healthy group (7.17±1.8ng/ml vs. 5.67±1.5ng/ml, p=0.012). Sema3A expression on Treg cells was statistically lower in celiac patients compared to healthy subjects (p=0.009) and significantly lower in celiac patients compared to celiac patients on gluten free diet (p=0.04). Negative correlation was found between Sema3A on Teg cells and the level of IgA anti-tTG antibodies (r=−0.346, p<0.01) and anti-DGP (r=−0.448, p<0.01). This study suggests involvement of the Sema3A in the pathogenesis of CD.
http://ift.tt/2pAsQI1
Semaphorin 3A: Is a key player in the pathogenesis of asthma
Publication date: Available online 11 May 2017
Source:Clinical Immunology
Author(s): Ronen Cozacov, Katlin Halasz, Tharwat Haj, Zahava Vadasz
Immune semaphorins are key players in regulating immune mediated inflammation. Semaphorin3A (sema3A) a secreted and membrane bound member of this family, is well reported for its properties in maintaining self-tolerance. Semaphorin3A was recognized to be a marker for T-regulatory cells (Tregs), and as such is a useful tool for assessing the status of these cells in preventing immune mediated diseases. This study was designed aiming to evaluate how sema3A is possibly involved in bronchial asthma. Here, we found sema3A serum levels and the expression of sema3A on Tregs significantly lower in patients with moderate to severe asthma when compared to healthy individuals. Co-culture of condition medium with 2mcg/ml of recombinant human sema3A with CD4+ T cells, increased the expression of FoxP3 in Tregs, suggesting sema3A a potent immune-regulator of inflammation including that of asthma. Further in-vivo studies will better establish the beneficial effect of sema3A in regulating inflammation in asthma.
http://ift.tt/2qWW34D
Genetic modifiers of multiple sclerosis progression, severity and onset
Publication date: Available online 10 May 2017
Source:Clinical Immunology
Author(s): A. Dessa Sadovnick, Anthony L. Traboulsee, Yinshan Zhao, Cecily Q. Bernales, Mary Encarnacion, Jay P. Ross, Irene M. Yee, Maria G. Criscuoli, Carles Vilariño-Güell
The genetic contribution to clinical outcomes for multiple sclerosis (MS) has yet to be defined. We performed exome sequencing analysis in 100 MS patients presenting opposite extremes of clinical phenotype (discovery cohort), and genotyped variants of interest in 2016 MS patients (replication cohort). Linear and logistic regression analyses were used to identify significant associations with disease course, severity and onset. Our analysis of the discovery cohort nominated 38 variants in 21 genes. Replication analysis identified PSMG4 p.W99R and NLRP5 p.M459I to be associated with disease severity (p=0.002 and 0.008). CACNA1H p.R1871Q was found associated with patients presenting relapsing remitting MS at clinical onset (p=0.028) whereas NLRP5 p.M459I and EIF2AK1 p.K558R were associated with primary progressive disease (p=0.031 and 0.023). In addition, PSMG4 p.W99R and NLRP5 p.R761L were found to correlate with an earlier age at MS clinical onset, and MC1R p.R160W with delayed onset of clinical symptoms (p=0.010–0.041).
http://ift.tt/2pAezLs
Neutrophil–lymphocyte ratio, platelet–lymphocyte ratio and mean platelet volume in Japanese patients with psoriasis and psoriatic arthritis: Response to therapy with biologics
Abstract
Recent studies indicate the presence of systemic inflammation in psoriatic patients, and this inflammatory status is significantly associated with a range of comorbidities. The aim of this study was to evaluate the clinical significance of novel inflammatory biomarkers, neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and mean platelet volume (MPV) in Japanese patients with plaque-type psoriasis (PsV) and psoriatic arthritis (PsA). One hundred and eighty-six patients with PsV and 50 patients with PsA treated with biologics, including infliximab, adalimumab and ustekinumab, were retrospectively analyzed before and after treatment. At baseline, NLR and PLR, as well as C-reactive protein (CRP), were significantly higher in PsA patients than those in PsV patients, and a significant correlation was found between NLR and PLR. In PsV patients, the NLR-high and PLR-high subgroups exhibited significantly higher Psoriasis Area and Severity Index scores compared with the NLR-low and PLR-low subgroups, respectively, and the NLR-high subgroup also showed higher CRP levels. MPV value was negatively associated with the presence of arthritis, but its association with inflammation was less clear than that of NLR or PLR. After treatment of the patients with biologics for up to 12 months, NLR and PLR decreased promptly in parallel with a decrease of CRP, irrespective of the type of biologics used. Altogether, these results indicate that both NLR and PLR may be useful markers to evaluate systemic inflammation in psoriatic patients. They may serve as simple, convenient and cost-effective biomarkers to monitor the disease course after systemic therapy.
http://ift.tt/2r2UgaC
Efficacy and safety of secukinumab in Taiwanese patients with moderate to severe plaque psoriasis: Subanalysis from ERASURE phase III study
Abstract
The efficacy and safety of secukinumab, a fully human anti-interleukin-17A monoclonal antibody, has been evaluated for moderate to severe plaque psoriasis in global trials which have included a low proportion of Asian subjects. We analyzed the efficacy and safety of secukinumab in Taiwanese patients in a phase III global clinical trial (ERASURE). Fifty-one Taiwanese patients were randomized into s.c. placebo, 150 and 300 mg secukinumab treatment groups. The proportions of patients who achieved 75% or more improvement in Psoriasis Area and Severity Index (PASI-75) at week 12 were 87.5% with 300 mg secukinumab, 70% with 150 mg secukinumab, 0% with placebo. Of the patients receiving 300 mg secukinumab, 68.8% achieved PASI-90 at week 12. Analysis of overall patients receiving 300 mg secukinumab for 12 weeks showed that the proportion of PASI-75 responders was less in patients with body mass index of 25 or more than less than 25. During the entire 52 weeks, the incidence of adverse events (AE) was consistent with the overall population in ERASURE. The most common AE (cases/per 100 patient-year) during the entire treatment period were upper respiratory tract infection and pruritus. The duration of upper respiratory tract infection per 100 patient-year was approximately 399 days in placebo, 1261 days in 150 mg secukinumab and 1805 days in 300 mg secukinumab. The safety and efficacy of secukinumab in Taiwanese patients was compatible with the global phase III study in the treatment of moderate to severe plaque psoriasis.
http://ift.tt/2pncvLD
Parotidectomy using the Harmonic scalpel: ten years of experience at a rural academic health center
Parotidectomy is one of the most commonly performed procedures by otorhinolaryngologists. Traditionally dissection is performed with a combination of a steel scalpel and bipolar cautery; however, starting in t...
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The Effects of Objective 3D Measures of Facial Shape and Symmetry on Perceptions of Facial Attractiveness
Publication date: Available online 10 May 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Cory D. Hatch, George L. Wehby, Nichole L. Nidey, Lina M. Moreno Uribe
PurposeMeeting patient desires for enhanced facial esthetics requires that providers have standardized and objective methods to measure esthetics. We evaluated the effects of objective 3-dimensional (3D) facial shape and asymmetry measurements derived from 3D facial images on perceptions of facial attractiveness.Patient and Methods3D facial images of 313 adults in Iowa were digitized with 32 landmarks and objective 3D facial measures capturing symmetric and asymmetric components of shape variation, centroid size and fluctuating asymmetry were obtained from the 3D coordinate data using geo-morphometric analyses. Frontal and profile images of study participants were rated for facial attractiveness by ten volunteers (5 females and 5 males) on a 5-point Likert-scale and a visual analogue scale (VAS). Multivariate regression was used to identify the effects of the objective 3D facial measurements on the attractiveness ratings.ResultsSeveral of the objective 3D facial measures had significant effects on attractiveness ratings. Shorter facial heights with protrusive chins, mid-face retrusion, faces with protrusive noses and thin lips, flat mandibular planes with deep labio-mental folds, any cants of the lip commissures and floor of the nose, larger faces overall and increased fluctuating asymmetry were rated as significantly (p<0.001) less attractive.ConclusionPerceptions of facial attractiveness can be explained by specific 3D measures of facial shapes and fluctuating asymmetry, which has important implications for clinical practice and research.
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Parathyroidectomy for the treatment of hyperparathyroidism: Thirty-day morbidity and mortality
Objectives/Hypothesis
Evaluate morbidity and mortality rates for patients with different levels of hyperparathyroidism (HPT) undergoing parathyroidectomy (PTX), specifically comparing primary hyperparathyroidism to secondary and tertiary hyperparathyroidism. Assess predictive factors of increased morbidity and mortality.
Study Design
Retrospective national database review.
Methods
Patients undergoing PTX, defined by Current Procedural Terminology codes 60500, 60502, 60505, for the treatment of HPT, were identified in the American College of Surgeons National Surgical Quality Improvement Program database between 2006 and 2014. Incidence of morbidity and mortality was calculated for primary, secondary, and tertiary HPT. A t test, analysis of variance, and χ2 analyses were used to assess preoperative characteristics among the three groups.
Results
A total of 21,267 patients were included in the analysis. There was an overall 7.2% morbidity and mortality rate, including 45 (0.21%) deaths, a 1.8% readmission rate, and a 1.9% reoperation rate, but morbidity and mortality rates were widely divergent when comparing primary to secondary and tertiary HPT. PTX resulted in a 4.9% morbidity and mortality rate for primary HPT (n = 14,500), 26.8% morbidity and mortality rate for secondary HPT (n = 1661), and 21.8% morbidity and mortality rate for tertiary HPT (n = 588). The primary reason for readmission was hypocalcemia (18.3%). Hematoma (7.2%) and postoperative hemorrhage (3.3%) were the two most common causes of reoperation. Elevated preoperative serum creatinine, alkaline phosphatase, and hypertension resulted in a higher rate of complications after PTX (P < .0001).
Conclusions
Although surgery for primary HPT is an extremely common and safe procedure with minimal morbidity and mortality rates, PTX for secondary and tertiary HPT has significantly higher rates of morbidity and mortality, requiring special attention in the postoperative period. Predictive factors of poor outcomes include hypertension, elevated creatinine, and elevated alkaline phosphatase.
Level of Evidence
4. Laryngoscope, 2017
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Adult acute supraglottitis: Analysis of 358 patients for predictors of airway intervention
Objectives/Hypothesis
Acute supraglottitis is a potentially life-threatening condition due to rapid onset upper airway obstruction. The study aimed to characterize adult acute supraglottitis patients and to recognize factors associated with an aggressive disease course.
Study Design
Retrospective chart review.
Methods
All adult acute supraglottitis patients admitted to a single academic medical center between 2000 and 2014 were included and their medical charts reviewed. The main outcome measures were airway intervention and mortality.
Results
Three hundred fifty-eight patients were enrolled. Mean age was 53 years (range, 16–92 years), with 62.8% males. Sore throat (79%) and dysphagia (70.9%) were the most common symptoms. Stridor (3.6%), tachypnea (5.7%), and dyspnea (6.4%) were uncommon but significantly associated with airway intervention. The epiglottis was most commonly involved (67%). Involvement of the epiglottis and aryepiglottic folds showed a trend of correlation to airway intervention. Blood glucose levels, C-reactive protein (CRP) levels, and relative neutrophilia were significantly higher in patients admitted to the intensive care unit or requiring airway intervention. Thirty-four patients (9.5%) required intensive care unit admission. Sixteen patients (4.4%) required airway intervention. Recurrent episodes of supraglottitis, seen in 19 patients, were more common in males (P = .048), and tended to have a more severe clinical course, requiring more airway interventions (P = .005) and intensive care unit admissions (P = .016).
Conclusions
The typical high risk patient—a male, with dyspnea and stridor, presenting with edema of the epiglottis and aryepiglottic folds, elevated CRP, hyperglycemia, and a history of recurrent episodes—should warrant more aggressive treatment and closer observation.
Level of Evidence
4 Laryngoscope, 2017
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