Αρχειοθήκη ιστολογίου

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

Παρασκευή 2 Ιουνίου 2017

Mehr Honorar für Ärzte

Ambulante Operationen bleiben für Vertragsärzte ein Wachstumsfeld: Die Fallzahlen steigen kontinuierlich, die Honorarumsätze etwas schneller. Anders sieht es bei belegärztlichen Operationen aus, wie der aktuelle Honorarbericht der KBV beweist.



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Nasopharynxkarzinom: Man kann noch mehr tun

Beim fortgeschrittenen, aber nicht metastasierten Nasopharynxkarzinom hat sich die zeitgleiche Gabe von Strahlen- und Chemotherapie (CRT) etabliert. Wäre eine zusätzliche adjuvante oder Induktions-CT hilfreich?



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Arbeiten im Spannungsfeld zwischen Medizin und Recht

Begutachtungsfragen sind seit jeher immanenter Bestandteil der ärztlichen Tätigkeit. In der Musterweiterbildungsordnung und in der Musterberufsordnung der Bundesärztekammer (BÄK) [1] sind die Begutachtung bzw. Ärztliche Gutachten und Zeugnisse aufgeführt. Sowohl im Medizinstudium als auch in der Weiter- und Fortbildung wird dieses Thema bisher allerdings zu wenig berücksichtigt [2]. Der folgende Beitrag wendet sich vor allem an diejenigen Kolleginnen und Kollegen, die am Anfang einer gutachterlichen Tätigkeit stehen.



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Ist nach einer Mononukleose eine Tonsillektomie generell anzuraten?



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Ernährungsberatung bei Krebs

Für den möglichst günstigen Verlauf einer Tumorerkrankung ist es wichtig, häufig auftretende Ernährungsstörungen fortlaufend im Blick zu haben. Eine der jeweiligen Situation angepasste Ernährungstherapie gilt als Bestandteil der Supportivbetreuung jedes Krebspatienten.



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Studie: Studium der Medizin ist lukrativ

Je höher der Bildungsabschluss, desto größer ist im Schnitt das Einkommen, so das Ergebnis einer kürzlich durchgeführten Analyse des Ifo-Institutes in Frankfurt. Wie hoch sind da heutzutage die Differenzen?



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Arzthaftung: Auf der sicheren Seite bleiben

Kaum ein anderer Beruf lebt so sehr vom Vertrauen wie der Arztberuf. Vertrauen darauf, dass der Arzt alles weiß, alles gut kann und alles heilt. Wenn aber der Eindruck entsteht, dass die Erwartungen nicht erfüllt wurden, kann Vertrauen in Enttäuschung und Misstrauen umschlagen und die Situation sogar in einem Rechtsstreit enden. Wie kann man ein Verfahren vermeiden oder so vorbereitet sein, dass man ein Verfahren nicht fürchten muss?



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Step by step zum ePaper



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Gezielte Muskeldehnung gegen den Kloß im Hals

Zusammenfassung

Bei Patienten mit Globusgefühl, bei denen alle „gängigen" Differenzialdiagnosen ausgeschlossen sind, lohnt es sich, neue Therapieansätze in Betracht zu ziehen. Denn eine nach unserer Erfahrung häufige Ursache für das Globusgefühl ist eine vermehrte Anspannung der paralaryngealen Muskulatur mit nach-weisbarer Überanstrengung. Hier hilft das manuelle „Entspannen" und Dehnen der Muskulatur. Die bekannteste Technik ist die laryngeale osteopathische Manipulation nach Jacob Lieberman.



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Sind Tief- und Mitteltonhörverluste mit einer Lärmschwerhörigkeit vereinbar?

Bei Lärmschwerhörigkeitsverfahren ist es häufig strittig, ob Hörverluste im Tieftonbereich und Mitteltonbereich neben einer Hochtonsenke auf die berufliche Lärmbelastung zurückgeführt werden können oder nicht. Zur Beantwortung dieser Frage sind verschiedene Kriterien zu berücksichtigen, die im Folgenden erläutert werden.



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Inhaltsverzeichnis



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Mehr Effizienz durch Apps & Co im Praxisalltag

Bei einer Fortbildungsveranstaltung der Deutschen Apotheker- und Ärztebank Anfang April in Magdeburg gab es für die Teilnehmer eine Orientierung, wie die Nutzung moderner Medien den Praxisalltag verändern könnte.



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Berufskrankheiten: Die Verdachtsanzeige ist Pflicht

Unter den in der Berufskrankheiten-Verordnung insgesamt 77 gelisteten Krankheiten finden sich eine ganze Reihe von Gesundheitsstörungen, die in das Fachgebiet des HNO-Arztes fallen können. Kollegen zögern allerdings oft, den Verdacht auf eine Berufskrankheit anzuzeigen. Neben der Unsicherheit, ob es sich tatsächlich um eine Berufskrankheit handeln könnte, werden als Gründe Mehrarbeit, Verwaltungsaufwand und schlechte Vergütung genannt. Aber nichts davon trifft wirklich zu. Und: Die Anzeige bei Verdacht ist Pflicht!



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Immer wieder Tonsillitis: OP oder erstmal abwarten?

Werden Kindern mit rezidivierenden Tonsillitiden die Rachenmandeln entfernt, erkranken sie offenbar im darauffolgenden Jahr seltener an Racheninfektionen als ohne Operation.



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Sicherheit von SCIT und SLIT unter Real-Life-Bedingungen

Wie reagieren Patienten auf eine Allergen-Immuntherapie im Praxisalltag? Wie oft ereignen sich systemische Reaktionen nach subkutaner oder sublingualer Immuntherapie? Wie oft kommt es zu anaphylaktischen Notfallsituationen? Ein europäisches Team aus Allergologen ist diesen Fragen nachgegangen.



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Fahrverbot auch Tage nach THC-Konsum

Per Gesetz ist seit März 2017 der Einsatz von Cannabisarzneimitteln als Therapiealternative zugelassen. Autofahrer sollten ärztlicherseits auf die Eigenschaften des Cannabiswirkstoffs hingewiesen werden.



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Von Joseph-Ignace Guillotin zu Greenfield Sluder

Beide Erfinder waren Ärzte, und von der technischen Seite der Erfindung stimmt alles überein: Eine scharfe Metallschneide wird in einem stabilen Rahmen geführt. Nur die Öffnung des Rahmens musste dem abzutrennenden Objekt angepasst sein: Bei Joseph-Ignace Guillotin (1738–1814 ) war es der ganze Kopf bei Greenfield Sluder (1865–1928) eben „nur" die Tonsille.



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Wischen statt blättern!

Was Sie gerade auf Papier gedruckt in den Händen halten, könnten Sie auch online auf Ihrem Tablet lesen, denn ab sofort gibt es Ihre „HNO-Nachrichten" auch als ePaper: Es steht auf SpringerMedizin.de, dem Fachportal für Ärzte, kostenlos zum Download bereit. Dort finden Sie auch das Archiv der Zeitschrift und noch vieles mehr ...



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BIBB-Bericht 2017: Ausbildung in Praxen ist beliebt



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Multiple laser pulses in conjunction with an optical clearing agent to improve the curative effect of cutaneous vascular lesions

Abstract

Port-wine stains (PWSs) usually respond poorly to pulsed dye laser treatment because of the shallow penetration and light absorption of melanin in the epidermis. Multiple laser pulses (MLPs) Nd:YAG laser in conjunction with an optical clearing agent can help to reduce the total laser energy required for blood coagulation. The quantitative optical clearing effect (OCE) of glycerol was investigated by using a tissue-like phantom. Thereafter, an in vitro capillary tube experimental system and an in vivo hamster dorsal skin chamber experiment for the laser treatment of PWSs were established to visually obtain the quantitative relationship between the OCE and the blood coagulation properties under the irradiation of 1064 nm MLPs. Diffuse reflection coefficient decreases by 36.69% and transmission coefficient increases by 38.73% at 1064 nm, after applying 0.5 mL anhydrous glycerol for 10 min on the surface of the tissue-like phantom. The number of laser pulses required for blood coagulation decreases by 25% after the application of 0.5 mL anhydrous glycerol for 4 min, thrombosis appears after 10 min, and the 0.0854 clotting area completely blocks the capillary tubes in 6 pulses. For 10 min, the incident energy can be reduced by 35.09 and 29.82%. When the 0.3-mm vessel's buried depths are 1 and 0.5 mm, the pulse number can be reduced from 11 to 8 and from 6 to 4, respectively. Adding anhydrous glycerol directly on the hamster dorsal skin is an effective way to reduce the number of laser pulses from 4∼5 to 2∼3 for similar capillary tube diameter. Therefore, the MLPs of 1064 nm Nd:YAG demonstrates a substantial curative effect for large capillary tubes. In conjunction with glycerol, this approach may treat deeply buried cutaneous capillary tubes and prevent the unwanted thermal damage of normal dermal tissue.



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Präoperative Evaluation erwachsener Patienten vor elektiven, nicht herz-thoraxchirurgischen Eingriffen1*

Anästhesiol Intensivmed Notfallmed Schmerzther
DOI: 10.1055/s-0043-111784

Die präoperative Anamnese und körperliche Untersuchung sind anerkannter Standard bei der Risikoevaluation von Patienten vor elektiven chirurgischen Eingriffen. Ob und unter welchen Umständen technische Voruntersuchungen dazu beitragen können, das perioperative Risiko zu reduzieren, ist bislang nur unzureichend untersucht. Auch besteht unter Anästhesisten, Chirurgen und Internisten vielfach Unsicherheit im perioperativen Umgang mit der Dauermedikation. Die deutschen wissenschaftlichen Fachgesellschaften für Anästhesiologie und Intensivmedizin (DGAI), Chirurgie (DGCH) und Innere Medizin (DGIM) haben daher eine gemeinsame Empfehlung zur präoperativen Evaluation erwachsener Patienten vor elektiven, nicht herz-thoraxchirurgischen Eingriffen erarbeitet und erstmals im Jahr 2010 publiziert. Die vorliegende Fassung ist eine Überarbeitung der Stellungnahme von 2010 unter Einbeziehung der seither publizierten Literatur sowie von aktuellen Leitlinien internationaler Fachgesellschaften. Zunächst werden die allgemeinen Prinzipien der präoperativen Evaluation dargestellt (Teil A). Das Vorgehen bei Patienten mit bekannten oder vermuteten kardiovaskulären Vorerkrankungen wird gesondert betrachtet (Teil B: „Erweiterte kardiale Diagnostik"). Abschließend wird der perioperative Umgang mit der Dauermedikation diskutiert (Teil C). Die vorgestellten Konzepte stellen fachübergreifende Empfehlungen dar, die ein strukturiertes und gemeinsames Vorgehen ermöglichen sollen. Ihr Ziel ist es, durch transparente und verbindliche Absprachen eine hohe Patientenorientierung unter Vermeidung unnötiger Voruntersuchungen zu gewährleisten, präoperative Untersuchungsabläufe zu verkürzen sowie letztlich Kosten zu reduzieren. Die gemeinsamen Empfehlungen von DGAI, DGCH und DGIM spiegeln den gegenwärtigen Kenntnisstand, aber auch die Meinungen von Experten wider, da nicht für jede Fragestellung wissenschaftliche Evidenz besteht. Daher werden eine regelmäßige Überprüfung und Aktualisierung der Empfehlungen erfolgen, sobald gesicherte neue Erkenntnisse vorliegen.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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



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Light-emitting diode modulates carbohydrate metabolism by pancreatic duct regeneration

Abstract

Pancreatic lesions can produce metabolic disorders. Light-emitting diode (LED) has been used as a safe and effective phototherapy for cell proliferation and regeneration. We investigate the effects of phototherapy using LED irradiation on the pancreas after the injection of streptozotocin (STZ) to induce experimental diabetes and evaluate that the β cells can regenerate in the pancreas in an in vivo model and observe its implications on the control of carbohydrate metabolism. Twenty Wistar rats were randomized into three groups: non-diabetic control, diabetic control, and diabetic treated with LED. Except for the non-diabetic control group, all were induced to diabetes type I by streptozotocin injection. Treated groups were irradiated by LED: λ = 805 nm; 40 mW, 22 s; spot diameter 5 mm, spot area 0.196 cm2, 0.88 J that it was applied on pancreas projection area for 5 consecutive days and monitored for 30 days. Diabetic group treated with LED showed regeneration of islets and ducts (p = 0.001) on the pancreas. Intraperitoneal insulin tolerance test showed differences between the diabetic control and diabetic treated groups (p = 0.03). In diabetic control group, the hepatic glycogen content was 296% lower when compared with diabetic treated with LED. Furthermore, in the diabetic control group, the glycogen content of the gastrocnemius muscle was 706% smaller when compared with diabetic treated with LED. This study shows that LED was able to modify morphological and metabolic features and also altered carbohydrate metabolism on irradiated pancreas in experimental model of diabetes.



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Letter to the editor



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Predictive validity of the GOSLON Yardstick index in patients with unilateral cleft lip and palate: A systematic review

by Cindy Buj-Acosta, Vanessa Paredes-Gallardo, José María Montiel-Company, Alberto Albaladejo, Carlos Bellot-Arcís

Among the various indices developed for measuring the results of treatment in patients born with unilateral cleft lip and palate (UCLP), the GOSLON Yardstick index is the most widely used to assess the efficacy of treatment and treatment outcomes, which in UCLP cases are closely linked to jaw growth. The aim of this study was to conduct a systematic review to validate the predictability of growth using the GOSLON Yardstick in patients born with UCLP. A systematic literature review was conducted in four Internet databases: Medline, Cochrane Library, Scopus and Embase, complemented by a manual search and a further search in the databases of the leading journals that focus on this topic. An electronic search was also conducted among grey literature. The search identified a total of 131 articles. Duplicated articles were excluded and after reading titles and abstracts, any articles not related to the research objective were excluded, leaving a total of 21 texts. After reading the complete text, only three articles fulfilled the inclusion criteria. The results showed a predictive validity of between 42.2% and 64.7%, which points to a lack of evidence in the literature for the predictive validity of the GOSLON Yardstick index used in children born with UCLP.

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Letter to the editor



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The effect of training level on complications after free flap surgery of the head and neck

Analyze postoperative complications after free flap surgery based on PGY training level.

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Phosphaturic mesenchymal tumor of the nasal cavity and paranasal sinuses: A clinical curiosity presenting a diagnostic challenge

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Publication date: Available online 1 June 2017
Source:Auris Nasus Larynx
Author(s): Shubhada V. Kane, Aanchal Kakkar, Nikita Oza, Epari Sridhar, Prathamesh S. Pai
Phosphaturic mesenchymal tumor (PMT) is a rare mesenchymal neoplasm associated with tumor-induced osteomalacia (TIO) and elevated serum FGF-23. Common in extremities, PMT rarely occurs in sinonasal region. We report a series of sinonasal PMT diagnosed at our institute over a 6-year period.Six cases of sinonasal PMT were identified during this period, of which five presented with features of TIO. Median age of patients was 45.5 years. All six tumors were composed of stellate to spindled cells, with prominent staghorn vasculature in four cases. Typical smudgy matrix was seen in all cases, but only focally; grungy calcification was absent.Accurate diagnosis of PMTs is imperative, as complete excision leads to dramatic resolution of TIO symptoms. Lack of knowledge of this entity prevents clinicians from ordering relevant investigations. Absence of specific morphological features, like grungy calcification, and presentation at atypical locations makes the diagnosis challenging. Awareness of this entity is essential in order to suspect PMT in patients presenting with a soft tissue mass and features of TIO, however unusual the location may be.



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A novel mutation in the MYO7A gene is associated with Usher syndrome type 1 in a Chinese family

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Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Xiaoguang He, Qi Peng, Siping Li, Pengyuan Zhu, Chunqiu Wu, Chunbao Rao, Jingqi Lin, Xiaomei Lu
ObjectivesWe aimed to investigate the genetic causes of hearing loss in a Chinese proband with autosomal recessive congenital deafness.MethodsThe targeted capture of 159 known deafness genes and next-generation sequencing were performed to study the genetic causes of hearing loss in the Chinese family. Sanger sequencing was employed to verify the variant mutations in members of this family.ResultsThe proband harbored two mutations in the MYO7A gene in the form of compound heterozygosity. She was found to be heterozygous for a novel insertion mutation c.3847_3848 ins TCTG (p.N1285LfsX24) in exon 30 and for the known mutation c.2239_2240delAG (p.R747S fsX16)in exon 19. The novel mutation was absent in the 1000 Genomes Project. These variants were carried in the heterozygous state by the parents and were therefore co-segregated with the genetic disease. Clinical re-assessment, including detailed audiologic and ocular examinations, revealed congenital deafness and retinitis pigmentosa in the proband. Collectively, the combination of audiometric, ophthalmologic and genetic examinations successfully confirmed the phenotype of Usher syndrome type 1 (USH1).ConclusionThis study demonstrates that the novel mutation c.3847_3848insTCTG (p. N1285LfsX24) in compound heterozygosity with c.2239_2240delAG in the MYO7A gene is the main cause of USH1 in the proband. Our study expands the mutational spectrum of MYO7A and provides a foundation for further investigations elucidating the MYO7A-related mechanisms of USH1.



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Utility of intraoperative and postoperative radiographs in pediatric cochlear implant surgery

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Publication date: August 2017
Source:International Journal of Pediatric Otorhinolaryngology, Volume 99
Author(s): Samantha Anne, Jose Miguel Juarez, Amber Shaffer, David Eleff, Dennis Kitsko, Sarah Sydlowski, Erika Woodson, David Chi
ObjectiveRoutine plain film radiographs are often obtained to confirm proper placement of electrode after pediatric cochlear implant surgery. Objective is to evaluate necessity of routine radiographs in pediatric cochlear implant cases.Study designRetrospective review.SettingTwo tertiary care academic centers.Subjects and methodsReview of all children that underwent cochlear implantation from January 2003 thru June 2015. Exclusions include patients without intraoperative evoked compound action potential (ECAP) data or radiographs and patients undergoing revision surgeries.Results235 pediatric patients underwent 371 cochlear implants. ECAP measurements were not available in two cases and were excluded from study. Radiographs were obtained in 35/369 cases due to intraoperative concern and four had abnormal findings. All four cases underwent change in management. One other patient had an x-ray because of difficult insertion and abnormal ECAP. Radiograph was normal; however, incision was opened and electrodes inserted further. Overall, 5/369 cases had changes in management intraoperatively. In all five cases, abnormalities were suspected by clinician judgment or abnormal ECAP measurements. Routine radiographs were completed in 349/369 cases and one was abnormal. This patient had known partial insertion due to cochlear fibrosis from meningitis and abnormal radiograph did not result in change in management.ConclusionClinician suspicion and/or abnormal ECAP prompted suspicion for abnormal electrode placement prior to evaluation with radiograph in all cases in which change in management occurred. Intraoperative radiographs may be valuable in setting of clinical suspicion. Routine radiographs do not result in change in management and are, therefore, unnecessary.



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Unusual neoplasm on the hard palate of a child: a case report

Myoepitheliomas account for less than 1% of salivary gland tumors. They mostly affect the parotid glands of adults during the third to fifth decades.

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Dissection of the internal carotid artery and stroke after mandibular fractures: a case report and review of the literature

We present a report of a patient with blunt trauma and mandibular fractures who developed a significant cerebral infarction due to an initially unrecognized injury of her left internal carotid artery. We belie...

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Assessment of treatment response during chemoradiation therapy for pancreatic cancer based on quantitative radiomic analysis of daily CTs: An exploratory study

by Xiaojian Chen, Kiyoko Oshima, Diane Schott, Hui Wu, William Hall, Yingqiu Song, Yalan Tao, Dingjie Li, Cheng Zheng, Paul Knechtges, Beth Erickson, X. Allen Li

Purpose

In an effort for early assessment of treatment response, we investigate radiation induced changes in quantitative CT features of tumor during the delivery of chemoradiation therapy (CRT) for pancreatic cancer.

Methods

Diagnostic-quality CT data acquired daily during routine CT-guided CRT using a CT-on-rails for 20 pancreatic head cancer patients were analyzed. On each daily CT, the pancreatic head, the spinal cord and the aorta were delineated and the histograms of CT number (CTN) in these contours were extracted. Eight histogram-based radiomic metrics including the mean CTN (MCTN), peak position, volume, standard deviation (SD), skewness, kurtosis, energy and entropy were calculated for each fraction. Paired t-test was used to check the significance of the change of specific metric at specific time. GEE model was used to test the association between changes of metrics over time for different pathology responses.

Results

In general, CTN histogram in the pancreatic head (but not in spinal cord) changed during the CRT delivery. Changes from the 1st to the 26th fraction in MCTN ranged from -15.8 to 3.9 HU with an average of -4.7 HU (p Conclusions

Significant changes in CT radiomic features, such as the MCTN, skewness, and kurtosis in tumor were observed during the course of CRT for pancreas cancer based on quantitative analysis of daily CTs. These changes may be potentially used for early assessment of treatment response and stratification for therapeutic intensification.



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Vowel production of Mandarin-speaking hearing aid users with different types of hearing loss

by Yu-Chen Hung, Ya-Jung Lee, Li-Chiun Tsai

In contrast with previous research focusing on cochlear implants, this study examined the speech performance of hearing aid users with conductive (n = 11), mixed (n = 10), and sensorineural hearing loss (n = 7) and compared it with the speech of hearing control. Speech intelligibility was evaluated by computing the vowel space area defined by the Mandarin Chinese corner vowels /a, u, i/. The acoustic differences between the vowels were assessed using the Euclidean distance. The results revealed that both the conductive and mixed hearing loss groups exhibited a reduced vowel working space, but no significant difference was found between the sensorineural hearing loss and normal hearing groups. An analysis using the Euclidean distance further showed that the compression of vowel space area in conductive hearing loss can be attributed to the substantial lowering of the second formant of /i/. The differences in vowel production between groups are discussed in terms of the occlusion effect and the signal transmission media of various hearing devices.

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SERPINB2 is regulated by dynamic interactions with pause-release proteins and enhancer RNAs

Publication date: August 2017
Source:Molecular Immunology, Volume 88
Author(s): Lihua Shii, Li Song, Kelly Maurer, Zhe Zhang, Kathleen E. Sullivan
The SERPINB2 gene is strongly upregulated in inflammatory states. In monocytes, it can constitute up to 1% of total cellular protein. It functions in protection from proteotoxic stress and plays a role in angioedema. The purpose of this study was to define the roles of enhancer RNAs embedded in the SERPIN gene complex. We found that the upstream enhancer RNAs upregulated SERPINB2 and the enhancer RNAs were expressed prior to those of SERPINB2 mRNA. Studies of the SERPINB2 promoter demonstrated the presence of an RNA polymerase II pause-inducing protein, NELF. Stimulation with LPS led to recruitment of the pause-releasing kinase P-TEFb and departure of the pause-inducing protein NELF. RNA immunoprecipitation revealed that NELF and the CDK9 component of P-TEFb bound to the enhancer RNAs after stimulation with distinct kinetics. Knock-down of the enhancer RNAs compromised stimulus induction of promoter and enhancer chromatin changes. Conversely, over-expression was associated with enhanced recruitment of c-JUN and increased expression of SERPINB2 mRNA expression. This study is the first to associate enhancer RNAs with SERPINB2 and is the first demonstration of acquisition of NELF binding by enhancer RNAs on chromatin.

Graphical abstract

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No prolongation of skin allograft survival by immunoproteasome inhibition in mice

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Publication date: August 2017
Source:Molecular Immunology, Volume 88
Author(s): Sarah Mundt, Michael Basler, Birgit Sawitzki, Marcus Groettrup
The immunoproteasome, a distinct class of proteasomes, which is inducible under inflammatory conditions and constitutively expressed in monocytes and lymphocytes, is known to shape the antigenic repertoire presented on major histocompatibility complex (MHC) class I molecules. Moreover, inhibition of the immunoproteasome subunit LMP7 ameliorates clinical symptoms of autoimmune diseases in vivo and was shown to suppress the development of T helper cell (Th) 1 and Th17 cells and to promote regulatory T-cell (Treg) generation independently of its function in antigen processing. Since Th1 and Th17 cells are detrimental and Treg cells are critical for transplant acceptance, we investigated the influence of the LMP7-selective inhibitor ONX 0914 in a mixed lymphocyte reaction (MLR) in vitro as well as on allograft rejection in a MHC-disparate (C57BL/6 to BALB/c) and a multiple minor histocompatibility antigen (miHA)-disparate (B10.Br to C3H) model of skin transplantation in vivo. Although we observed reduced allo-specific IL-17 production of T cells in vitro, we found that selective inhibition of LMP7 had neither an influence on allograft survival in an MHC-mismatch model nor in a multiple minor mismatch skin transplantation model. We conclude that inhibition of the immunoproteasome is not effective in prolonging skin allograft survival in skin allotransplantation.



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The great fluid debate: time for Flexit?

'Insanity is doing the same thing over and over again and expecting different results'—attributed to A. Einstein

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Bank blood shortage, transfusion containment and viscoelastic point-of-care coagulation testing in cardiac surgery

In January 2017, many Italian hospitals (including my own institution) were forced to reduce the number of major surgical operations because of a severe shortage of packed red blood cells (RBCs). Blood banks warned that donors with blood group O (both O+ and O–) were scarce, and imposed that units of RBCs of this group were to be reserved for non-postponable major surgeries. Subsequently, other blood groups were affected by the shortage. On January 12, 2017 the National Blood Center warned that about 2600 RBC units were lacking in nine Italian regions. This emergency, resulting from the combination of Christmas holidays and an outbreak of influenza, came to an end by the end of January.

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Hydrogen peroxide: more harm than good?

Editor—Hydrogen peroxide remains a frequently used agent in operating theatres despite its marginal benefits and potential for serious complications. We are writing to remind anaesthetists of the risks of hydrogen peroxide use and pose the question: does hydrogen peroxide cause more harm than good?

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More or less? The Goldilocks Principle as it applies to red cell transfusions

The quest for the optimal haemoglobin threshold (previously referred to as 'trigger') for red blood cell transfusion seems a never-ending journey. As if we are chasing a mirage, the closer we seem to think we get to the 'just right' haemoglobin level, the further it seems to move away. Applying the 'Goldilocks Principle' to transfusion of red cells, regardless of the population queried, appears to yield results that satisfy some investigators but leave many practitioners still wondering what is best for the patient.

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Maintaining oxygenation with high-flow nasal cannula during emergent awake surgical tracheostomy

Editor—Patients presenting with acute upper airway obstruction are at significant risk of morbidity and continue to be managed poorly.1 Although several approaches can be taken, surgical tracheostomy placement under local anaesthesia is recommended because it ensures patients are kept awake, maintaining airway patency.2 This poses several challenges for the anaesthetist, including limited access to the surgical field and risk of complete airway obstruction in a patient with potentially limited reserve.

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Oesophageal Doppler guided goal-directed haemodynamic therapy in thoracic surgery - a single centre randomized parallel-arm trial

Abstract
Background: Postoperative pulmonary and renal complications are frequent in patients undergoing lung surgery. Hyper- and hypovolaemia may contribute to these complications. We hypothesized that goal-directed haemodynamic management based on oesophageal Doppler monitoring would reduce postoperative pulmonary complications in a randomized clinical parallel-arm trial.Methods: One hundred patients scheduled for thoracic surgery were randomly assigned to either standard haemodynamic management (control group) or goal-directed therapy (GDT group) guided by an oesophageal Doppler monitoring-based algorithm. The primary endpoint was postoperative pulmonary complications, including spirometry. Secondary endpoints included haemodynamic variables, renal, cardiac, and neurological complications, and length of hospital stay. The investigator assessing outcomes was blinded to group assignment.Results: Forty-eight subjects of each group were analysed. Compared to the control group, fewer subjects in the GDT group developed postoperative pulmonary complications (6 vs. 15 patients; P = 0.047), while spirometry did not differ between groups. Compared to the control group, patients of the GDT group showed higher cardiac index (2.9 vs. 2.1 [l min1 m − 2]; P < 0.001) and stroke volume index (43 vs. 34 [ml m2]; P < 0.001) during surgery. Renal, cardiac and neurological complications did not differ between groups. Length of hospital stay was shorter in the GDT compared to the control group (9 vs. 11 days; P = 0.005).Conclusions: Compared to standard haemodynamic management, oesophageal Doppler monitor-guided GDT was associated with fewer postoperative pulmonary complications and a shorter hospital stay.Clinical trial registration. The study was registered in the German Clinical Trials Register (DRKS 00006961). http://ift.tt/2lU1COS

http://ift.tt/2smEgSs

Perioperative use of beta-blockers in vascular and endovascular surgery

Editor—We were disappointed to read the content of the recent article by Hajibandeh and colleagues1 in the British Journal of Anaesthesia. Since the early, implausible reports of long-term benefit attributable to short-term perioperative beta-blockade, there has been increasing scepticism of this treatment among both anaesthetists and cardiologists.2–8 Following the early criticisms of publications by Mangano and colleagues and Poldermans' group, the specialty of anaesthesia has discovered that the conclusions of these workers were baseless.9 This is because of a flawed analysis on the basis of 'intention to treat' with respect to the study by Mangano and colleagues and a seriously discredited first author in the case of the Poldermans' study.283

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Deep neuromuscular block to optimize surgical space conditions during laparoscopic surgery: a systematic review and meta-analysis

Abstract
Neuromuscular block (NMB) is frequently used in abdominal surgery to improve surgical conditions by relaxation of the abdominal wall and prevention of sudden muscle contractions. The evidence supporting routine use of deep NMB is still under debate. We aimed to provide evidence for the superiority of routine use of deep NMB during laparoscopic surgery. We performed a systematic review and meta-analysis of studies comparing the influence of deep vs moderate NMB during laparoscopic procedures on surgical space conditions and clinical outcomes. Trials were identified from Medline, Embase, and Central databases from inception to December 2016. We included randomized trials, crossover studies, and cohort studies. Our search yielded 12 studies on the effect of deep NMB on the surgical space conditions. Deep NMB during laparoscopic surgeries improves the surgical space conditions when compared with moderate NMB, with a mean difference of 0.65 (95% confidence interval (CI): 0.47–0.83) on a scale of 1–5, and it facilitates the use of low-pressure pneumoperitoneum. Furthermore, deep NMB reduces postoperative pain scores in the postanaesthesia care unit, with a mean difference of − 0.52 (95% CI: −0.71 to − 0.32). Deep NMB improves surgical space conditions during laparoscopic surgery and reduces postoperative pain scores in the postanaesthesia care unit. Whether this leads to fewer intraoperative complications, an improved quality of recovery, or both after laparoscopic surgery should be pursued in future studies. The review methodology was specified in advance and registered at Prospero on July 27, 2016, registration number CRD42016042144.

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Perioperative use of beta-blockers in vascular and endovascular surgery

Editor—I thank Drs Bolsin and Conroy1 for raising their concerns regarding a recent publication by Hajibandeh and colleagues2 in the British Journal of Anaesthesia. There is no doubt that the role of perioperative beta-blockade has come under close scrutiny since the 1990s,34 but it is misleading to describe the conclusions of the trial by Mangano and colleagues5 as 'baseless' despite there being some legitimate criticisms of its design and interpretation. The Mangano data have been used by others in other systematic reviews.67 We agree that data derived from the DECREASE trials are unreliable.

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Raw EEG characteristics, bispectral index, and suppression ratio variations during generalized seizure in electroconvulsive therapy

Editor—We wish to report our findings of an observational prospective study of raw EEG characteristics, bispectral index (BIS) and suppression ratio (SR) variations during a generalized tonic–clonic seizure induced by electroconvulsive therapy (ECT). After obtaining the approval of the Ethics Committee for biomedical research, 20 patients were included for a total of 39 sessions. The BIS sensor (BIS Quatro, Medtronic-minneapolis USA) was connected to the BIS-VISTA® (Medtronic-minneapolis USA) monitor (smoothing rate, 10 s). The BIS and SR values were retained for analysis if their corresponding signal quality index were ≥50 and EMG ≤50. To overcome electromagnetic interference, we excluded from analysis all BIS and SR values obtained from the end of the electrical impulse to 15 s later. Sedation was induced with a bolus of propofol [(median dose 0.86 (interquartile range 0.68–1) mg kg−1] after 3 min of preoxygenation. Suxamethonium [median dose 1.1 (range 1–1.2) mg kg−1] was injected 30 s after loss of the ciliary reflex. Electroconvulsive therapy began at least 30 s after the end of fasciculation and after the stabilization of BIS. The lungs were ventilated until ECT began, in order to avoid hypercapnia. Differences between BIS and SR values were analysed with the Friedman test, and when a significant difference was encountered the trend over time was analysed by a Mann–Kendall test. Statistical significance was assumed at P<0.05.

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Perioperative use of beta-blockers in vascular and endovascular surgery

Editor—Thank you for the opportunity to respond to the letter from Bolsin and Conroy1 in reference to our systematic review and meta-analysis of randomized clinical trials and observational studies investigating the effect of perioperative use of beta-blockers in vascular and endovascular surgery.2 They express their concerns regarding the inclusion of two observational studies34 and a randomized clinical trial,5 and suggest that these studies should be excluded from the meta-analysis because of allegations of scientific misconduct of the senior (or first) author, D. Poldermans, of these studies. Of note, the randomized trial5 (related to the DECREASE-1 study) has already been excluded from our analysis in light of the expression of concern published by the editors of the European Heart Journal.6

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Ventilation through an extraglottic tracheal tube: a technique for deep extubation and airway control

Editor—Tracheal extubation after general anesthesia is a critical event of an anaesthetic, probably more important than induction and intubation of the airway; minor complications can result in significant morbidity and even mortality.12 Both the Fourth National Audit Project and the ASA closed claims analysis reported complications from extubation.34 The Difficult Airway Society developed a systematic approach to anticipated easy extubations and to those deemed difficult. Asleep extubation (commonly referred to as deep extubation), as opposed to awake extubation, is in a different arm of the Difficult Airway Society algorithm from the easy airway extubation.5

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25-Hydroxyvitamin D deficiency among anaesthesiologists and anaesthesiology residents in Chile

Editor—Approximately one billion people worldwide have 25-hydroxyvitamin D (25OHD) deficiency.1–3 The Endocrine Society considers plasma levels equal or lower than 20 ng mL−1 as a deficiency and levels higher than 30 ng mL−1 as optimal levels.4 Low sunlight exposure is the determining factor for 25OHD deficiency. Such factor relies on the season and the latitude of residence, among others.56 Indoor work is associated with a low sunlight exposure. Therefore, anaesthesiologists may be at risk of developing deficient levels of 25OHD. The prevalence of 25OHD deficiency in this population remains unknown.

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Characterization of peripheral and central sensitization after dorsal root ganglion intervention in patients with unilateral lumbosacral radicular pain: a prospective pilot study

Abstract
Background. Quantitative sensory testing (QST) has been used to predict the outcome of epidural steroid injections in lumbosacral radicular pain and has the potential to be an important tool in the selection of appropriate treatment (such as epidural steroid injections vs surgery) for patients with chronic radicular pain. In addition, QST assists in identification of the pain pathways of peripheral and central sensitization in selected groups of patients.Methods. Twenty-three patients were given dorsal root ganglion (DRG) infiltration with local anaesthesia and steroid ('DRG block'), and those who demonstrated at least 50% pain relief were offered pulsed radiofrequency (PRF) to the DRG. Questionnaires and QST scores were measured before the DRG blocks and at 1 week and 3 months after their procedure. Those who received PRF also answered questionnaires and underwent QST measurements at 1 week and 3 months after their procedure.Results. There was a significant increase in pressure pain threshold scores after DRG blocks. A reduced conditioned pain modulation response was seen before DRG, which increased after the procedure. Ten out of 23 patients underwent PRF to the DRG, and an increase in pressure pain threshold scores after PRF was observed. The conditioned pain modulation response was maintained in this group and increased after PRF.Conclusions. The study demonstrates that patients with unilateral radicular low back pain who receive dorsal root ganglion interventions show changes in pressure pain thresholds and conditioned pain modulation that are consistent with a 'normalization' of peripheral and central sensitization.

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Prediction of postoperative mortality in elderly patients with hip fracture: are specific and geriatric scores better than general scores?

Editor—Elderly patients with hip fracture are at high risk of mortality. An accurate prediction of postoperative mortality is important for communicating information, in guiding decision-making, and management. Among preoperative scores, the ASA physical status score does not consider the surgery, makes no adjustment for age, and is subjective.1 The PreOperative Score to predict PostOperative Mortality (POSPOM) is more accurate but has not been validated specifically in elderly patients.2 Many geriatric scores focusing on multimorbidity, such as the Cumulative Illness Rating Scale (CIRS)3 and Charlson comorbidity index,4 have been proposed but not validated for postoperative prediction, and specific scores, such as the Nottingham Hip Fracture Score (NHFS), have also been proposed.5 We tested the hypothesis that specific or geriatric scores predict postoperative mortality better than general scores in this frail population.

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In This Issue



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Effects of arterial load variations on dynamic arterial elastance: an experimental study

Abstract
Background. Dynamic arterial elastance (Eadyn), the relationship between pulse pressure variation (PPV) and stroke volume variation (SVV), has been suggested as a functional assessment of arterial load. The aim of this study was to evaluate the impact of arterial load changes during acute pharmacological changes, fluid administration, and haemorrhage on Eadyn.Methods. Eighteen anaesthetized, mechanically ventilated New Zealand rabbits were studied. Arterial load changes were induced by phenylephrine (n=9) or nitroprusside (n=9). Thereafter, animals received a fluid bolus (10 ml kg−1), followed by stepwise bleeding (blood loss: 15 ml kg−1). The influence of arterial load and cardiac variables on PPV, SVV, and Eadyn was analysed using a linear mixed-effects model analysis.Results. After phenylephrine infusion, mean (sd) Eadyn decreased from 0.89 (0.14) to 0.49 (0.12), P<0.001; whereas after administration of nitroprusside, Eadyn increased from 0.80 (0.23) to 1.28 (0.21), P<0.0001. Overall, the fluid bolus decreased Eadyn [from 0.89 (0.44) to 0.73 (0.35); P<0.01], and haemorrhage increased it [from 0.78 (0.23) to 0.95 (0.26), P=0.03]. Both PPV and SVV were associated with similar arterial factors (effective arterial elastance, arterial compliance, and resistance) and heart rate. Furthermore, PPV was also related to the acceleration and peak velocity of aortic blood flow. Both arterial and cardiac factors contributed to the evolution of Eadyn throughout the experiment.Conclusions. Acute modifications of arterial load induced significant changes on Eadyn; vasodilatation increased Eadyn, whereas vasoconstriction decreased it. The Eadyn was associated with both arterial load and cardiac factors, suggesting that Eadyn should be more properly considered as a ventriculo-arterial coupling index.

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Pharmacokinetics and pharmacodynamics of propofol: changes in patients with frontal brain tumours

Abstract
Background: Models of propofol pharmacokinetics and pharmacodynamics developed in patients without brain pathology are widely used for target-controlled infusion (TCI) during brain tumour excision operations. The goal of this study was to determine if the presence of a frontal brain tumour influences propofol pharmacokinetics and pharmacodynamics and existing PK-PD model performance.Methods: Twenty patients with a frontal brain tumour and 20 control patients received a propofol infusion to achieve an induction–emergence–induction anaesthetic sequence. Propofol plasma concentration was measured every 4 min and at each transition of the conscious state. Bispectral index (BIS) values were continuously recorded. We used non-linear mixed-effects modelling to analyse the effects of the presence of a brain tumour on the pharmacokinetics and pharmacodynamics of propofol. Subsequently we calculated the predictive performance of Marsh, Schnider, and Eleveld models in terms of median prediction error (MdPE) and median absolute prediction error (MdAPE).Results: Patients with brain tumours showed 40% higher propofol clearance than control patients. Performance of the Schnider model (MdPEpk −20.0%, MdAPEpk 23.4%) and Eleveld volunteer model (MdPEpk −8.58%, MdAPEpk 21.6%) were good. The Marsh model performed less well (MdPEpk −14.3%, MdAPEpk 41.4%), as did the Eleveld patient model (MdPEpk −30.8%, MdAPEpk 32.1%).The first-order rate constant (ke0; 0.108 min−1), the concentration in the effects compartment associated with 50% of the maximum effect (Ce50; 2.77 ml litre−1) and γ (1.49) did not significantly differ between groups. Lower baseline BIS values were found in patients with brain tumours (90 vs 95).Conclusions: Brain tumours might alter the pharmacokinetics of propofol. Caution should be exerted when using propofol TCI in patients with frontal brain tumours due to higher clearance.Trial registry number: NCT01060631.

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Randomized equivalence trial of the King Vision aBlade videolaryngoscope with the Miller direct laryngoscope for routine tracheal intubation in children <2 yr of age

Abstract
Background. We conducted a randomized equivalence trial to compare direct laryngoscopy using a Miller blade (DL) with the King Vision videolaryngoscope (KVL) for routine tracheal intubation. We hypothesized that tracheal intubation times with DL would be equivalent to the KVL in children <2 yr of age.Methods. Two hundred children were randomly assigned to tracheal intubation using DL or KVL. The primary outcome was the median difference in the total time for successful tracheal intubation. Secondary outcomes assessed were tracheal intubation attempts, time to best glottic view, time for tracheal tube entry, percentage of glottic opening score, airway manoeuvres needed, and complications.Results. The median difference between the groups was 5.7 s, with an upper 95% confidence interval of 7.5 s, which was less than our defined equivalence time difference of 10 s. There were no differences in the number of tracheal intubation attempts and the time to best glottic view [DL median 5.3 (4.1–7.6) s vs KVL 5.0 (4.0–6.3) s; P=0.19]. The percentage of glottic opening score was better when using the KVL [median 100 (100–100) vs DL median 100 (90–100); P<0.0001]. Use of DL was associated with greater need for airway manoeuvres during tracheal intubation (33 vs 7%; P<0.001). Complications did not differ between devices.Conclusions. In children <2 yr of age, the KVL was associated with equivalent times for routine tracheal intubation when compared with the Miller blade.Clinical trial registration NCT02590237.

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Predictive performance of the modified Marsh and Schnider models for propofol in underweight patients undergoing general anaesthesia using target-controlled infusion

Abstract
Background: In our preliminary study, the modified Marsh (M-Marsh) model caused an inadvertent underdosing of propofol in underweight patients. However, the predictive performance of the M-Marsh and Schnider models incorporated in commercially available target-controlled infusion (TCI) pumps was not evaluated in underweight patients.Methods: Thirty underweight patients undergoing elective surgery were randomly allocated to receive propofol via TCI using the M-Marsh or Schnider models. The target effect-site concentrations (Ces) of propofol were, in order, 2.5, 3, 4, 5, 6 and 2 μg ml−1. Arterial blood samples were obtained at least 7 min after achieving each pseudo-steady-state.Results: A total of 172 plasma samples were used to determine the predictive performance of both models. The pooled median (95% confidence interval) biases and inaccuracies at a target Ce ≤ 3 μg ml−1 were −22.6 (−28.8 to −12.6) and 31.9 (24.8–36.8) for the M-Marsh model and 9.0 (1.7–16.4) and 28.5 (21.7–32.8) for the Schnider model, respectively. These values at Ce ≥ 4 μg ml−1 were −9.6 (−16.0 to −6.0) and 24.7 (21.1–27.9) for the M-Marsh model and 19.8 (12.9–25.7) and 36.2 (31.4–39.7) for the Schnider model, respectively.Conclusions: The pooled biases and inaccuracies of both models were clinically acceptable. However, the M-Marsh and Schnider models consistently produced negatively and positively biased predictions, respectively, in underweight patients. In particular, the M-Marsh model showed greater inaccuracy at target Ce3 μg ml−1 and the Schnider model showed greater inaccuracy at target Ce ≥ 4 μg ml−1. Therefore, it is necessary to develop a new pharmacokinetic model for propofol in underweight patients.Clinical trial registration: KCT0001502.

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Anchors for sutures to fix pedicled flaps to the floor of the mouth in reconstructions for cancer

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Publication date: Available online 1 June 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): G. Tirelli, M. Tofanelli, F. Boscolo Nata, V. Ramella, Z. Marij Arnež




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Dentigerous cysts associated with impacted third molars in adults after decompression: a prospective survey of reduction in volume using computerised analysis of cone-beam computed tomographic images

Publication date: Available online 1 June 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): G. Lizio, L. Tomaselli, L. Landini, C. Marchetti
We prospectively investigated in adults the decompression of dentigerous cysts associated with impacted third molars at high risk of iatrogenic damage during extraction. The computerised calculated volumetric postoperative reductions measured by cone-beam computed tomography at four and eight months were correlated with the duration of treatment, initial volume, and patient's age. We prospectively monitored 14 adult patients with 14 dentigerous cysts that were associated with impacted third molars, for eight months after decompression. The mean (SD) reduction in volume during the first eight months was 71 (14) % (51% after the first four months and 20% after the second four months), with a monthly reduction rate of 9%. Both the total decrease in volume (a) and the monthly rate of reduction (b) were significantly associated (p<0.01) and linearly correlated with the duration of decompression [r (a)=−0.89, r (b)=−0.61] and initial volume [r (a)=r (b)=0.92], but not with the patient's age (p=0.49) [r (a)=r (b)=0.04]. The trend towards reduction in volume within a period of eight months of treatment allowed us to better understand the duration of decompression required.



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Setting up a successful special interest study group: five-year reflection

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Publication date: Available online 1 June 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): J.J. Hulbert, S.F. Mustafa




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Neocondylar formation after resection of the mandible and reconstruction with a vascularised iliac crest free flap: rare case

Publication date: Available online 1 June 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S. Bin, Z. Bin, D. Baoxia, W. Yue, Z. Wei
Tumours in the mandible often necessitate the removal of both mandibular and condylar bone. A free vascularised bone flap is a common choice for reconstruction, but it is rare for adults to form a new condyle after it. We describe a patient in whom a new condyle did form after reconstruction with a vascularised iliac crest free flap.



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Impact of tobacco smoke on upper airway dendritic cell accumulation and regulation by sinonasal epithelial cells

Background

In these studies we examined the impact of environmental tobacco smoke (ETS) and active smoking on sinonasal dendritic cell (DC) subsets in controls or patients with chronic rhinosinusitis with nasal polyps (CRSwNP). In subsequent in-vitro investigations, we examined the influence of cigarette smoke extract (CSE) on human sinonasal epithelial cells' (HSNECs) ability to regulate DC functions.

Methods

Sinonasal tissue, blood, and hair were collected from patients undergoing sinus surgery. Smoking status and ETS exposure were determined by hair nicotine. DC subsets were examined by flow cytometric analysis. Monocyte-derived dendritic cells (moDCs) were treated with conditioned medium from non-smoked-exposed HSNECs (NS-HSNECs) or cigarette-smoke-extract-exposed HSNECs (CSE-HSNECs) to assess the impact of CSE exposure on HSNEC regulation of moDC functions.

Results

Control subjects who were active smokers displayed increased sinonasal moDC and myeloid dendritic 1 (mDC1) cells and reduced mDC2 cells, whereas, in CRSwNP patients, only moDC and mDC2 cells were altered. ETS was found to increase only moDCs in the CRSwNP patients. In vitro, CSE stimulated HSNEC secretion of the moDC regulatory products chemokine (C-C motif) ligand 20, prostaglandin E2, and granulocyte-macrophage colony-stimulating factor. CSE exposure also promoted HSNECs to stimulate monocyte and moDC migration. moDCs treated with CSE-HSNEC media stimulated an increase in antigen uptake and expression of CD80 and CD86. Last, CSE-HSNEC-treated moDCs secreted increased levels of interleukin-10, interferon-γ, and thymic stromal lymphopoietin.

Conclusion

Active smoking, and to a lesser degree ETS, alters the sinonasal composition of DCs. A potential mechanism to account for this is that cigarette smoke stimulates HSNECs to induce moDC migration, maturation, and activation.



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STAT3 gain-of-function mutations associated with autoimmune lymphoproliferative syndrome like disease deregulate lymphocyte apoptosis and can be targeted by BH3 mimetic compounds

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Publication date: Available online 1 June 2017
Source:Clinical Immunology
Author(s): Schafiq Nabhani, Cyrill Schipp, Hagit Miskin, Carina Levin, Sergey Postovsky, Tal Dujovny, Ariel Koren, Dan Harlev, Anne-Marie Bis, Franziska Auer, Baerbel Keller, Klaus Warnatz, Michael Gombert, Sebastian Ginzel, Arndt Borkhardt, Polina Stepensky, Ute Fischer
Autoimmune lymphoproliferative syndrome (ALPS) is typically caused by mutations in genes of the extrinsic FAS mediated apoptotic pathway, but for about 30% of ALPS-like patients the genetic diagnosis is lacking. We analyzed 30 children with ALPS-like disease of unknown cause and identified two dominant gain-of-function mutations of the Signal Transducer And Activator Of Transcription 3 (STAT3, p.R278H, p.M394T) leading to increased transcriptional activity. Hyperactivity of STAT3, a known repressor of FAS, was associated with decreased FAS-mediated apoptosis, mimicking ALPS caused by FAS mutations. Expression of BCL2 family proteins, further targets of STAT3 and regulators of the intrinsic apoptotic pathway, was disturbed. Cells with hyperactive STAT3 were consequently more resistant to intrinsic apoptotic stimuli and STAT3 inhibition alleviated this effect. Importantly, STAT3-mutant cells were more sensitive to death induced by the BCL2-inhibitor ABT-737 indicating a dependence on anti-apoptotic BCL2 proteins and potential novel therapeutic options.



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Endoplasmic reticulum stress regulates tumor growth and anti-tumor immunity: a promising opportunity for cancer immunotherapy

Abstract

The endoplasmic reticulum (ER) stress is a cellular process that occurs as a consequence of several stress circumstances, such as the accumulation of unfolded proteins in the lumen of the ER or distinct insults that disturb the ER normal function. Different conditions in the tumor microenvironment (TME), including hypoxia, nutrient deprivation, and the elevated production of reactive oxygen and nitrogen species destabilize the loading and dispatching of the newly synthesized proteins, triggering ER stress in cancer cells and tumor-infiltrating leukocytes. In order to cope with TME-induced ER stress, tumor and stromal cells initiate an adaptive response process that aims to resolve ER stress and to restore cellular homeostasis, which is referred as the unfolded protein responses (UPR). Paradoxically, the UPR can also induce cell death under severe and/or permanent ER stress. The UPR is started through three mediators, the activation of the inositol-requiring enzyme-1α, the pancreatic ER kinase-like ER kinase, and the activating transcription factor 6. In this minireview, we will discuss the pro- and anti-tumorigenic role of the UPR in cancer cells. In addition, we will describe the effects of the TME-induced ER stress in the immunosuppressive activity of tumor-infiltrating myeloid cells. Also, we will review the results of emerging therapeutic interventions that target ER stress and the UPR mediators in cancer. We postulate that the inhibition of ER stress or the UPR-related elements could represent a significant approach to increase the efficacy of various forms of cancer immunotherapy.



http://ift.tt/2smss2p

Regenerative properties of collagenated porcine bone grafts in human maxilla: demonstrative study of the kinetics by synchrotron radiation microtomography and light microscopy

Abstract

Objectives

Recently, it has been reported that heterologous biomaterials, where the collagen matrix is preserved, seem to facilitate blood clotting and the subsequent invasion of repairing and regenerative cells. This study aimed at evaluating the healing of human extraction sockets grafted with a collagenated cortico-cancellous porcine bone (mp3®, OsteoBiol®, Tecnoss®, Giaveno, Italy) by synchrotron radiation X-ray microtomography (microCT) and histology in order to have a 3D quantitative characterization over time.

Materials and methods

Ridge preservation with porcine bone and collagen membrane was performed on 21 patients using a flapless approach and a secondary soft tissue closure. At the time of implant placement, six bone samples were harvested, two in the 3-month group, two in the 6-month group, one in the 12-month group post-surgery, and one spontaneously healed control, and evaluated by microCT and histology.

Results

MicroCT revealed that in the grafted sites there were a greater number of trabeculae, although they appeared thinner than in the control sites; these trabeculae homogenously filled the defects, suggesting an improved strength of the socket. Histology showed that over time, the amount of biomaterial decreased and the newly formed bone increased, while less dense bone with wider marrow spaces was detected in the control sample, supporting synchrotron findings.

Conclusions

The morphometric data converge to indicate the suitability of porcine bone for the preservation of post-extraction sockets.

Clinical relevance

The use of mp3 is encouraged to preserve and heal sockets.



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Issue Information



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BSACI guideline for the diagnosis and management of peanut and tree nut allergy

Summary

Peanut nut and tree nut allergy are characterised by IgE mediated reactions to nut proteins. Nut allergy is a global disease. Limited epidemiological data suggest varying prevalence in different geographical areas. Primary nut allergy affects over 2% of children and 0.5% of adults in the UK. Infants with severe eczema and/or egg allergy have a higher risk of peanut allergy. Primary nut allergy presents most commonly in the first five years of life, often after the first known ingestion with typical rapid onset IgE-mediated symptoms. The clinical diagnosis of primary nut allergy can be made by the combination of a typical clinical presentation and evidence of nut specifc IgE shown by a positive skin prick test (SPT) or specific IgE (sIgE) test. Pollen food syndrome is a distinct disorder, usually mild, with oral/pharyngeal symptoms, in the context of hay fever or pollen sensitisation, which can be triggered by nuts. It can usually be distinguish clinically from primary nut allergy. The magnitude of a SPT or sIgE relates to the probability of clinical allergy, but does not relate to clinical severity. SPT of ≥ 8 mm or sIgE ≥ 15 KU/L to peanut is highly predictive of clinical allergy. Cut off values are not available for tree nuts. Test results must be interpreted in the context of the clinical history. Diagnostic food challenges are usually not necessary but may be used to confirm or refute a conflicting history and test result. As nut allergy is likely to be a long-lived disease, nut avoidance advice is the cornerstone of management. Patients should be provided with a comprehensive management plan including avoidance advice, patient specific emergency medication and an emergency treatment plan and training in administration of emergency medication. Regular re-training is required.



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Cover Image

Thumbnail image of graphical abstract

The cover image, by S. El-Heis et al., is based on the Original Article Maternal stress and psychological distress preconception: association with offspring atopic eczema at age 12 months, DOI 10.1111/cea.12910



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Forthcoming Meetings



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Nut allergy guideline



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Delivering irrigation to the anterior ethmoid region: evaluation of a lacrimal diversion device in a cadaver model

Background

Topical solutions to the sinus cavity are primarily administered via a transnasal route with inherent limitations of distribution. Here we describe an alternate method of sinus access via lacrimal sinus diversion using a novel lacrimal diversion device (LDD).

Methods

A cadaveric study was performed using 12 disarticulated fresh heads. The LDD was implanted in 23 sides meeting insertion criteria. Time to placement was recorded and patency was assessed via nasal endoscopy. Methylene blue was administered via the LDD and 16 sides underwent surgical ethmoidectomy to assess distribution of mucosal staining. Four cadavers underwent computed tomography (CT) imaging to demonstrate stent position.

Results

Mean time of placement was 3.66 ± 2.37 minutes (mean ± standard deviation [SD]). Patency rate was 100%. Six sides (37.5%) had anterior ethmoid staining, 6 sides (37.5%) had posterior ethmoid staining, and the remaining 4 sides (25%) had mixed anterior and posterior ethmoid staining. Stents placed optimally resulted in anterior ethmoid staining without complication. Malpositioned stents resulted in posterior ethmoid staining and some inadvertent ethmoid vertical lamella trauma in 2 instances.

Conclusion

Sinus irrigation can be delivered to the ethmoid sinuses directly via a lacrimal diversion stent. Technique modification or image guidance may be helpful in ensuring optimal placement.



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An unusual cause of neonatal ascites

Description

A 30-year-old primigravida was referred to our institution due to an isolated fetal ascites (IFA). The gestation was uneventful until the 32nd week when the mother was hospitalised due to refractory hypertension. An ultrasound revealed a fetal abdominal circumference above percentile 99. Fetal parameters and amniotic fluid volume were normal.and

The investigation of IFA was started on the mother: blood type was ARh+, indirect Coombs test and infectious serology (toxoplasmosis, syphilis, varicella-zoster, parvovirus B19, rubella, cytomegalovirus and herpes (TORCH)) were negative.

A spontaneous vaginal delivery occurred at 34 weeks. As the ascites compromised ventilation, the neonate was intubated and an urgent paracentesis was performed evacuating 175 mL of a transudate, and thereafter, the caucasian female neonate with 2235 g was stable with spontaneous breathing.

As the ascites persisted, the investigation continued on the neonate: blood group ARh+, negative direct Coombs test and normal echocardiography. Abdominal ultrasound showed dilated bowel loops. The abdominal X-ray...



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Carboplatin, Nab-Paclitaxel, Durvalumab Before Surgery and Adjuvant Therapy in Head and Neck Squamous Cell Carcinoma

Conditions:   Carcinoma, Squamous Cell;   Oral Cancer;   Oropharynx Cancer;   Larynx Cancer;   Lip Cancer;   Esophageal Cancer
Interventions:   Drug: Durvalumab;   Drug: Carboplatin;   Drug: Nab-paclitaxel;   Drug: Cisplatin;   Procedure: Surgical resection;   Radiation: IMRT
Sponsors:   UNC Lineberger Comprehensive Cancer Center;   AstraZeneca;   Celgene
Not yet recruiting - verified May 2017

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Effects of an OT Workstation Intervention on Knowledge, Self-efficacy, and Habit Formation

Condition:   Occupational Injuries
Intervention:   Behavioral: Ergonomic Computer Workstation Training
Sponsor:   Virginia Commonwealth University
Recruiting - verified May 2017

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Hidden Causes of Anaphylaxis

Abstract

Purpose of Review

This study aimed to review important hidden causes of anaphylaxis in ingestants, non-ingestants, and uncommon settings.

Recent Findings

Multiple new and elusive causes of anaphylaxis have been described over the past 35 years.

Summary

Further research is required to identify the epidemiology, pathophysiology, and clinical impact of these hidden causes. Although these culprits should be considered in the appropriate clinical scenarios, many remain exceedingly rare.



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Imaging of pediatric congenital cystic neck masses

Publication date: Available online 1 June 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Jennifer A. Vaughn
Congenital neck lesions are a common indication for imaging in the pediatric population. While the clinical history and physical examination can narrow the differential diagnosis, imaging is often obtained to distinguish among possible entities and provide additional information needed to guide appropriate treatment. In this review, congenital cystic neck masses including thyroglossal duct cysts, dermoid/epidermoids, branchial apparatus anomalies, thymic cysts, and cervical teratomas will be discussed, with a focus on characteristic imaging features and locations that define these lesions.



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First Branchial Cleft Anomalies

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Publication date: Available online 1 June 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Andrea D. Olivas, Jonathan M. Sherman
First branchial cleft anomalies are rare congenital malformation of the head and neck. They occur above the level of the hyoid bone and have a close anatomic relationship to the facial nerve due to their embryologic origin. In this article, we will review the development and derivatives of the first branchial apparatus followed by the epidemiology and classification of these lesions. The treatment of choice for first branchial anomalies is surgical resection, which will be the focus of this article.



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Third branchial cleft anomalies

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Publication date: Available online 1 June 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery
Author(s): Janet Lee, Jamie Funamura
Third branchial cleft anomalies are rare congenital abnormalities with a complicated anatomic course. The traditional standard of treatment is complete open excision of the entire tract, but newer endoscopic and combined approaches are becoming more common. We summarize the anatomy, presentation, and evaluation of these anomalies. A review of the literature regarding the various surgical options and their associated risks and benefits is discussed. We then review the details of open excision, endoscopic treatment, and combined open/endoscopic surgical options. Given the higher risk of complications with open excision and the similar rates of recurrence with open and endoscopic procedures, we recommend endoscopic management of third branchial cleft anomalies as the first-line treatment.



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Intra-operative radiological diagnosis of a tip roll-over electrode array displacement using fluoroscopy, when electrophysiological testing is normal: the importance of both techniques in cochlear implant surgery

Publication date: Available online 1 June 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Octavio Garaycochea, Raquel Manrique-Huarte, Manuel Manrique




http://ift.tt/2sm3Jvm

Undifferentiated high-grade pleomorphic sarcoma of ethmoid sinus: one case report and literatures review

Publication date: Available online 1 June 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Yupeng Zhu, Dapeng Hao, Xiaoyan Tang, Lei Sun




http://ift.tt/2rMlYNk

Mothers of Children With Atopic Dermatitis Are Not More Prone to Obsessive-Compulsive Symptoms

J. Olivera Pueyo
Actas Dermosifiliogr.2017;108:392

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Super U Technique for Ingrown Nails

M. Sánchez-Regaña
Actas Dermosifiliogr.2017;108:393

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Tumor Necrosis Factor Inhibitors, Antinuclear Antibodies, and Autoimmunity in Patients With Psoriasis

P. de la Cueva Dobao
Actas Dermosifiliogr.2017;108:393-4

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Cutaneous Angiosarcoma: The Importance of Clinical Suspicion

A. Toll
Actas Dermosifiliogr.2017;108:394

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Hospitalization of Dermatologic Patients: Why, When, and Where?

C. Martínez-Morán, J. Borbujo
Actas Dermosifiliogr.2017;108:395-9

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Adult Xanthogranulomatous Disease of the Orbit: Clinical Presentations, Evaluation, and Management

J.M. Ortiz Salvador, D. Subiabre Ferrer, A. Pérez Ferriols
Actas Dermosifiliogr.2017;108:400-6

Abstract - Full text - PDF

http://ift.tt/2slSe74

Sturge-Weber Syndrome: A Review

E. Higueros, E. Roe, E. Granell, E. Baselga
Actas Dermosifiliogr.2017;108:407-17

Abstract - Full text - PDF

http://ift.tt/2rMImGq

Microwave Treatment for Axillary Hyperhidrosis and Bromhidrosis

I. Sánchez-Carpintero, A. Martín-Gorgojo, R. Ruiz-Rodríguez
Actas Dermosifiliogr.2017;108:418-22

Abstract - Full text - PDF

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Omalizumab in the Treatment of Chronic Inducible Urticaria

P. Chicharro, P. Rodríguez, D. de Argila
Actas Dermosifiliogr.2017;108:423-31

Abstract - Full text - PDF

http://ift.tt/2rN1ROW

Obsessive Compulsive Symptoms and Quality of Life in mothers of Children With Atopic Dermatitis

S. Gunduz, E. Usak, S. Ozen, C. Gorpelioglu
Actas Dermosifiliogr.2017;108:432-7

Abstract - Full text - PDF

http://ift.tt/2sm7uRi

Super U Technique for Ingrown Nails

J. Correa, J. Magliano, C. Agorio, C. Bazzano
Actas Dermosifiliogr.2017;108:438-44

Abstract - Full text - PDF

http://ift.tt/2rMuP1x

Induction of Autoantibodies and Autoimmune Diseases in Patients with Psoriasis Receiving Tumor Necrosis Factor Inhibitors

B. Oter-López, M. Llamas-Velasco, J. Sánchez-Pérez, E. Dauden
Actas Dermosifiliogr.2017;108:445-56

Abstract - Full text - PDF

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Cutaneous Angiosarcoma: Clinical and Pathology Study of 16 Cases

C. Requena, E. Sendra, B. Llombart, O. Sanmartín, C. Guillén, J. Lavernia, V. Traves, J. Cruz
Actas Dermosifiliogr.2017;108:457-65

Abstract - Full text - PDF

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Dermoscopy of Disseminated Superficial Actinic Porokeratosis

A. Nicola, J. Magliano
Actas Dermosifiliogr.2017;108:e33-7

Abstract - Full text - PDF

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Congenital Umbilical Nodule in a 1-Year-Old Infant

R. Pérez-Mesonero, V. Melgar-Molero, A. Martín-Fuentes
Actas Dermosifiliogr.2017;108:467-8

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Horizontal melanonychia

A. Salman, A. Eser, I. Kaygusuz Atagunduz, T. Ergun
Actas Dermosifiliogr.2017;108:469-70

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RF-Neutrophilic Dermatoses of the Hands: Different Names for the Same Condition?

F. Tous-Romero, M. Prieto-Barrios, V. Velasco-Tamariz, S. Burillo-Martínez
Actas Dermosifiliogr.2017;108:471-2

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Giant Melanoma on the Buttock

A. Abascal Amo, E. Torres Mínguez, M. Marín Gutzke
Actas Dermosifiliogr.2017;108:473

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Long-standing Erythematous Plaque in a Perianal Skin Fold

I. Pérez-López, G. Blasco-Morente, A. Martínez-López, S. Arias-Santiago
Actas Dermosifiliogr.2017;108:474

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Segmental Infantile Hemangioma With Minimal or Arrested Growth in LUMBAR Syndrome

X. Calderón-Castrat, J. Peceros-Escalante, F. Velásquez, R.M. Lipa-Chancolla, R. Ballona
Actas Dermosifiliogr.2017;108:475-7

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Reporting quality of case reports in international dermatology journals

Medical case reports provide new and often important information about diseases, pathogeneses, adverse effects, or treatments. [1] However, they have been shown to favor positive results and can lead to publication bias. [2, 3] Some leading journals have been reducing space for case reports or even declining them because of concerns about impact factor. [4]

This article is protected by copyright. All rights reserved.



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A longitudinal study of changes in psychosocial well-being during orthognathic treatment

Publication date: Available online 1 June 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): O. Alanko, M.T. Tuomisto, T. Peltomäki, M. Tolvanen, T. Soukka, A.L. Svedström-Oristo
The aim was to evaluate changes in the psychosocial well-being of orthognathic surgery patients (n=22) during treatment and to compare results with those of adults not requiring orthognathic treatment (n=22). Patient data were collected before treatment (T0), after the first orthodontic examination (T1), three times during treatment (T2–T4), and 1 year after surgery (T5). In this article, only data corresponding to patient stage T5 are reported for the control subjects. Participants filled in a structured diary and the modified version of the Secord and Jourard body image questionnaire, the Orthognathic Quality of Life Questionnaire, the Rosenberg Self-Esteem Scale, and the Acceptance and Action Questionnaire II. Moreover, patients filled in the Symptom Checklist-90. After the placement of orthodontic appliances (T2), orthognathic quality of life, self-esteem, and psychological flexibility were lower and psychiatric symptoms increased. Improvements were observed from T2 to T5 in orthognathic quality of life, body image, self-esteem, psychological flexibility, and psychiatric symptoms. Treatment resulted in improvements from T0 to T5 in orthognathic quality of life, body image, and psychiatric symptoms. At T5, patient psychosocial well-being was comparable to or even better than that of control subjects. Orthognathic treatment seems to support psychological well-being, but the range of individual variation is wide.



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Importance of chewing, saliva, and swallowing function in patients with advanced oral cancer undergoing preoperative chemoradiotherapy: a prospective study of quality of life

Publication date: Available online 1 June 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): D. Nemeth, L. Zaleczna, A. Huremovic, J. Engelmann, P.W. Poeschl, M. Strasz, S. Holawe, G. Kornek, A. Laskus, C. Sacher, B.M. Erovic, C. Perisanidis
The primary objective of this study was to investigate the quality of life (QOL) of patients with oral squamous cell carcinoma (OSCC) undergoing curative neoadjuvant chemoradiotherapy followed by radical tumour resection and simultaneous oral cavity reconstruction, using two validated questionnaires. A secondary objective was to assess clinical variables predicting post-treatment dysfunction in chewing, saliva, and swallowing. Thirty-five patients with locally advanced OSCC who underwent preoperative chemoradiotherapy were recruited prospectively. All patients completed both the University of Washington Quality of Life version 4 questionnaire (UW-QOL) and the Functional Assessment of Cancer Therapy–Head & Neck version 4 questionnaire (FACT-H&N). UW-QOL and FACT-H&N items were associated with clinical variables. Nearly three-quarters of OSCC patients perceived good to excellent levels of overall QOL after preoperative chemoradiotherapy. Chewing difficulties, decreased salivary function, and swallowing dysfunction were the most frequent complaints of OSCC patients. Items related to food intake were significantly worse in OSCC patients older than 60 years and those with T4 tumours, as well as those without alcohol intake. Chewing, saliva, and swallowing are the most significant issues in patients with OSCC undergoing preoperative chemoradiotherapy. The results of this study may help guide treatment decisions for OSCC patients based on more accurate expectations of adverse effects of cancer treatment.



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Hidden Causes of Anaphylaxis

Abstract

Purpose of Review

This study aimed to review important hidden causes of anaphylaxis in ingestants, non-ingestants, and uncommon settings.

Recent Findings

Multiple new and elusive causes of anaphylaxis have been described over the past 35 years.

Summary

Further research is required to identify the epidemiology, pathophysiology, and clinical impact of these hidden causes. Although these culprits should be considered in the appropriate clinical scenarios, many remain exceedingly rare.



http://ift.tt/2riUD3N

Utility of intraoperative nerve monitoring in thyroid surgery: 20-year experience with 1418 cases

Abstract

Purpose

The efficacy of intraoperative nerve monitoring is controversial in the literature. This study of a single surgeon's experience seeks to determine if the use of intraoperative nerve monitoring influences recurrent laryngeal nerve injury during thyroid surgery.

Methods

Six hundred fifty-seven patients with normal pre-operative vocal fold function underwent thyroid surgery without the use of intraoperative nerve monitoring from September 1997 to January 2007, while 761 patients underwent thyroid surgery from February 2007 to February 2016 with routine use of nerve monitoring. Patients were followed for a minimum of 6 months after surgery, and postoperative nerve function was determined by fiberoptic laryngoscopy. A Fisher test was used to determine if nerve injury was statistically different between both groups.

Results

In patients operated on without nerve monitoring, 21 patients were found to have postoperative vocal fold paralysis with nine regaining functioning. In patients operated on with nerve monitoring, 27 were found to have vocal fold dysfunction with 17 regaining function. Fisher test analysis, both with and without patients regaining function, showed no difference in nerve injury between groups (p > 0.05, p > 0.05).

Conclusion

Intraoperative monitoring during thyroidectomy may not prevent injury to the recurrent laryngeal nerve.



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Cross-sectional study of the microbiological safety profile of reusing hyaluronic acid fillers

Summary

Introduction

Facial filling with hyaluronic acid (HA) is a dermatological procedure that has been emerging today. There are not many references regarding safety of reusing the remaining product for later touch-up in the same patient.

Objective

To determine the microbiological safety of reusing hyaluronic acid that is remnant from syringes used for facial filling, stored at room temperature or cooled in a refrigerator at 4°C.

Materials and methods

In culture medium, small aliquots of leftovers from 31 hyaluronic acid fillers, previously used for facial filling, were inoculated. The fillers were stored in their original syringes at room temperature or cooled in a standard refrigerator at 4°C for a period ranging from 1 week to 12 months after initial use.

Limitations

The small number of samples limits extrapolation of the results obtained.

Results

After 42 days of inoculation in culture medium, none of the samples showed any aerobic or anaerobic bacterial or fungal growth.

Conclusion

Hyaluronic acid fillers did not show any fungal or bacterial contamination after being opened and stored at room temperature in nonaseptic conditions. The possibility of reusing the remaining portion of the material in the syringe can be safe and economically viable.



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Efficacy and safety of a new microneedle patch for skin brightening: A Randomized, split-face, single-blind study

Summary

Background

Although microneedles are one of the best transdermal drug delivery systems for active compounds, few clinical trials have examined the safety and efficacy of brightening microneedle patches.

Aims

To determine the efficacy and safety of a newly developed whitening microneedle patch.

Patients/Methods

A split-face study was designed for efficacy assessment with 34 Korean women applying the tested product (a whitening microneedle patch) on one cheek and a control whitening essence on the other. We objectively measured changes in melanin index values and skin brightness by mexameter and chromameter. Each participant also used global assessment to determine skin whitening. In addition, 55 participants were selected for primary skin irritation tests and repeated insult patch tests for safety assessments.

Results

Mean skin brightness and melanin indexes improved (P<.05) 4 weeks and 8 weeks after product use in both the whitening patch and whitening essence groups. Significant differences (P<.05) were observed between the whitening patch and whitening essence groups 8 weeks after use. Global assessment by participants showed moderate cosmetic outcomes for both the whitening patch and whitening essence groups. No adverse effects were reported, and primary irritation and human repeated insult patch tests revealed no irritation from the test product.

Conclusions

A newly developed microneedle patch was effective and safe for skin brightening and would be a promising functional cosmetic product.



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Association of Gender With Financial Relationships Between Industry and Academic Otolaryngologists.

Association of Gender With Financial Relationships Between Industry and Academic Otolaryngologists.

JAMA Otolaryngol Head Neck Surg. 2017 Jun 01;:

Authors: Eloy JA, Bobian M, Svider PF, Culver A, Siegel B, Gray ST, Baredes S, Chandrasekhar SS, Folbe AJ

Abstract
Importance: Gender disparities continue to exist in the medical profession, including potential disparities in industry-supported financial contributions. Although there are potential drawbacks to industry relationships, such industry ties have the potential to promote scholarly discourse and increase understanding and accessibility of novel technologies and drugs.
Objectives: To evaluate whether gender disparities exist in relationships between pharmaceutical and/or medical device industries and academic otolaryngologists.
Design, Setting, and Participants: An analysis of bibliometric data and industry funding of academic otolaryngologists.
Main Outcomes and Measures: Industry payments as reported within the CMS Open Payment Database.
Methods: Online faculty listings were used to determine academic rank, fellowship training, and gender of full-time faculty otolaryngologists in the 100 civilian training programs in the United States. Industry contributions to these individuals were evaluated using the CMS Open Payment Database, which was created by the Physician Payments Sunshine Act in response to increasing public and regulatory interest in industry relationships and aimed to increase the transparency of such relationships. The Scopus database was used to determine bibliometric indices and publication experience (in years) for all academic otolaryngologists.
Results: Of 1514 academic otolaryngologists included in this analysis, 1202 (79.4%) were men and 312 (20.6%) were women. In 2014, industry contributed a total of $4.9 million to academic otolaryngologists. $4.3 million (88.5%) of that went to men, in a population in which 79.4% are male. Male otolaryngologists received greater median contributions than did female otolaryngologists (median [interquartile range (IQR)], $211 [$86-$1245] vs $133 [$51-$316]). Median contributions were greater to men than women at assistant and associate professor academic ranks (median [IQR], $168 [$77-$492] vs $114 [$55-$290] and $240 [$87-$1314] vs $166 [$58-$328], respectively). Overall, a greater proportion of men received industry contributions than women (68.0% vs 56.1%,). By subspecialty, men had greater median contribution levels among otologists and rhinologists (median [IQR], $609 [$166-$6015] vs $153 [$56-$336] and $1134 [$286-$5276] vs $425 [$188-$721], respectively).
Conclusions and Relevance: A greater proportion of male vs female academic otolaryngologists receive contributions from industry. These differences persist after controlling for academic rank and experience. The gender disparities we have identified may be owing to men publishing earlier in their careers, with women often surpassing men later in their academic lives, or as a result of previously described gender disparities in scholarly impact and academic advancement.

PMID: 28570741 [PubMed - as supplied by publisher]



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An HIV-Positive Child With a Gingival Mass.

An HIV-Positive Child With a Gingival Mass.

JAMA Otolaryngol Head Neck Surg. 2017 Jun 01;:

Authors: Kane AC, Stark M, Kanotra SP

PMID: 28570725 [PubMed - as supplied by publisher]



http://ift.tt/2rsekVu

Opsoclonus Recorded by a Smartphone.

Opsoclonus Recorded by a Smartphone.

JAMA Otolaryngol Head Neck Surg. 2017 Jun 01;:

Authors: Hsu SY, Young YH

PMID: 28570724 [PubMed - as supplied by publisher]



http://ift.tt/2swoy6B

Assumptions of Quality Medicine: The Role of Uncertainty.

Assumptions of Quality Medicine: The Role of Uncertainty.

JAMA Otolaryngol Head Neck Surg. 2017 Jun 01;:

Authors: Scott-Wittenborn N, Schneider JS

PMID: 28570721 [PubMed - as supplied by publisher]



http://ift.tt/2qNLdde

Free Flap Reconstruction Monitoring Techniques and Frequency in the Era of Restricted Resident Work Hours.

Free Flap Reconstruction Monitoring Techniques and Frequency in the Era of Restricted Resident Work Hours.

JAMA Otolaryngol Head Neck Surg. 2017 Jun 01;:

Authors: Patel UA, Hernandez D, Shnayder Y, Wax MK, Hanasono MM, Hornig J, Ghanem TA, Old M, Jackson RS, Ledgerwood LG, Pipkorn P, Lin L, Ong A, Greene JB, Bekeny J, Yiu Y, Noureldine S, Li DX, Fontanarosa J, Greenbaum E, Richmon JM

Abstract
Importance: Free flap reconstruction of the head and neck is routinely performed with success rates around 94% to 99% at most institutions. Despite experience and meticulous technique, there is a small but recognized risk of partial or total flap loss in the postoperative setting. Historically, most microvascular surgeons involve resident house staff in flap monitoring protocols, and programs relied heavily on in-house resident physicians to assure timely intervention for compromised flaps. In 2003, the Accreditation Council for Graduate Medical Education mandated the reduction in the hours a resident could work within a given week. At many institutions this new era of restricted resident duty hours reshaped the protocols used for flap monitoring to adapt to a system with reduced resident labor.
Objectives: To characterize various techniques and frequencies of free flap monitoring by nurses and resident physicians; and to determine if adapted resident monitoring frequency is associated with flap compromise and outcome.
Design, Setting, and Participants: This multi-institutional retrospective review included patients undergoing free flap reconstruction to the head and/or neck between January 2005 and January 2015. Consecutive patients were included from different academic institutions or tertiary referral centers to reflect evolving practices.
Main Outcomes and Measures: Technique, frequency, and personnel for flap monitoring; flap complications; and flap success.
Results: Overall, 1085 patients (343 women [32%] and 742 men [78%]) from 9 institutions were included. Most patients were placed in the intensive care unit postoperatively (n = 790 [73%]), while the remaining were placed in intermediate care (n = 201 [19%]) or in the surgical ward (n = 94 [7%]). Nurses monitored flaps every hour (q1h) for all patients. Frequency of resident monitoring varied, with 635 patients monitored every 4 hours (q4h), 146 monitored every 8 hours (q8h), and 304 monitored every 12 hours (q12h). Monitoring techniques included physical examination (n = 949 [87%]), handheld external Doppler sonography (n = 739 [68%]), implanted Doppler sonography (n = 333 [31%]), and needle stick (n = 349 [32%]); 105 patients (10%) demonstrated flap compromise, prompting return to the operating room in 96 patients. Of these 96 patients, 46 had complete flap salvage, 22 had partial loss, and 37 had complete loss. The frequency of resident flap checks did not affect the total flap loss rate (q4h, 25 patients [4%]; q8h, 8 patients [6%]; and q12h, 8 patients [3%]). Flap salvage rates for compromised flaps were not statistically different.
Conclusions and Relevance: Academic centers rely primarily on q1h flap checks by intensive care unit nurses using physical examination and Doppler sonography. Reduced resident monitoring frequency did not alter flap salvage nor flap outcome. These findings suggest that institutions may successfully monitor free flaps with decreased resident burden.

PMID: 28570718 [PubMed - as supplied by publisher]



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Transanal removal of a broken drinking glass self-inserted and retained in the rectum

Retained rectal foreign bodies are increasingly reported in current clinical practice, and there is no clear consensus in the literature as to whether transanal extraction should be performed in the emergency or in the operating room. A 47-year-old presented to the hospital for a retained drinking glass in the rectum that was broken after an attempt at self-extraction. Physical examination showed no evidence of abdominal guarding nor bleeding from the rectum; abdominal and pelvic X-rays confirmed the presence of a broken glass, 8x6 cm in size and no signs of perforation. Initial anoscopy performed in the emergency room confirmed the partial fracture of the glass. The patient was transferred to the operating room and transanal extraction was carried out under general anaesthesia without complications.



http://ift.tt/2qHLjE1

Abciximab-induced delayed profound thrombocytopaenia

Abciximab, the first approved glycoprotein (GP IIb/IIIa) inhibitor, is being widely used during acute coronary syndromes and offers the promising approach to antithrombotic therapy. We present a case of a young woman who initially received abciximab infusion for undergoing percutaneous coronary intervention of left anterior descending artery and was eventually diagnosed with abciximab-induced delayed thrombocytopaenia. This case outlines the importance of close follow-up of these patients to prevent serious adverse events.



http://ift.tt/2s150KZ

Peptoniphilus asaccharolyticus-associated septic arthritis and osteomyelitis in a woman with osteoarthritis and diabetes mellitus

Peptoniphilus asaccharolyticus, a Gram-positive obligatory anaerobic coccus, is a commensal of the human vagina and gut and can be an opportunistic pathogen in immunocompromised patients. It is usually part of polymicrobial anaerobic infections such as skin and soft tissue infections in diabetics, bone and joint infections and surgical site infections; however, infections caused by P. asaccharolyticus in pure culture have been reported as well. Herein, we describe a case of septic arthritis and osteomyelitis caused by P. asaccharolyticus in a woman with osteoarthritis and diabetes mellitus.



http://ift.tt/2qHfpaI

Large bilateral seminal vesicle calculi presenting with spermolithiasis

A 34-year-old male presented with an 8-month history of passing increasingly painful 'grit' in his ejaculate. Semen analysis was normal as were urinary and blood tests. T1-weighted MRI revealed several bilateral high-signal areas measuring up to 1 cm in diameter, located in the seminal vesicles. These were confirmed as calculi on T2-weighted imaging and a seminal vesiculogram, with no drainage from the left ejaculatory duct and only minimal from the right duct. He is currently awaiting a robot-assisted laparoscopic vesiculotomy after completion of family.



http://ift.tt/2s19JfI

Insular carcinoma arising on a background of follicular carcinoma, thyrolipomatosis and amyloid goitre

A 67-year-old man was referred with a history of a right-sided neck lump and dysphonia, secondary to a lesion in the thyroid gland. After undergoing a total thyroidectomy, he was found to have an exceedingly rare combination of follicular carcinoma, insular carcinoma, thyrolipomatosis and an amyloid goitre in his thyroid gland. He subsequently underwent further radioactive iodine ablation and has been in remission. He was also later incidentally diagnosed with systemic amyloidosis, which explained the amyloid deposition in his thyroid gland.



http://ift.tt/2qHkJe5

High-grade myxofibrosarcoma of the abdominal wall

The authors present a case of a 57-year-old man, who presented to the surgical clinic with a mass in the suprapubic region. A CT scan revealed a well-circumscribed lobular, heterogeneous soft tissue mass measuring 12x8.6x7.8 cm. The final histopathological diagnosis from the resection of the lesion was a myxofibrosarcoma (MFS), grade 3. The management of MFS includes surgical and oncological options which are reviewed here. These are aimed at complete excision and reducing the risk of local occurrence.



http://ift.tt/2s0VXd3

Do not treat the numbers: lithium toxicity

We describe the case of a 62-year-old man with a history of bipolar disorder, previously stable on lithium for over 20 years, who presented with a manic relapse and signs of lithium toxicity in the form of a coarse tremor. Serum lithium levels were in the normal range, and the patient had stage 3 chronic kidney disease. He was admitted for treatment under Section 2 of the Mental Health Act, and after stopping lithium was started on olanzapine. Signs of lithium toxicity improved after withdrawal of lithium. This case highlights the need to treat normal serum lithium levels with caution in patients showing signs of clinical lithium toxicity.



http://ift.tt/2qHLjnv

Fabry heterozygote mimicking multiple sclerosis

Fabry's disease (FD) is a recognised mimic of multiple sclerosis (MS). It is an X-linked storage lysosomal disorder with deficiency of α-galactosidase A and enzyme replacement therapy is available. Patients with FD may satisfy modified McDonald criteria if the diagnosis of FD has not been pursued. We present a case of FD in a 65-year-old woman masquerading as benign MS for 40 years. She has recurrent posterior circulation stroke-like symptoms, hearing loss and acroparaesthesia, but typical radiological features of MS on MRI brain. Later she developed an ischaemic stroke, infiltrative cardiomyopathy and chronic renal failure. There was a missense mutation at p.R342Q in the galactodisdase alpha (GLA) gene. Neurologists need to consider FD and look for red flags in atypical MS cases and should not be over-reliant on MRI findings. Missed diagnosis of FD could lead to unnecessary immunosuppression, inappropriate disease counselling and missed treatment opportunity.



http://ift.tt/2s0uI26

Increase body weight to treat superior mesenteric artery syndrome

Introduction

Superior mesenteric artery (SMA) syndrome is a rare cause of duodenal obstruction resulting from vascular compression of the third part of the duodenum in the angle between the abdominal aorta and SMA.

Case presentation

A 19-year-old woman with anorexia nervosa with upper gastrointestinal obstruction symptoms resorted to the emergency department. A diagnosis of SMA syndrome was made. Symptoms were solved with conservative treatment aimed at increase body weight.

Discussion

SMA syndrome is most commonly associated with debilitating illnesses. Patients present with acute or insidious upper gastrointestinal obstruction symptoms. Aortomesenteric artery angle of ≤25° is the most sensitive measure of diagnosis. Advances in both enteral and parenteral nutrition led to a shift towards conservative treatment.

Conclusions

Low threshold of suspicion is important to make a timely diagnosis and treatment. A conservative treatment aimed at increasing body weight is the first-line approach, leaving surgical intervention for failure cases.



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Omalizumab substantially improves dermatology-related quality of life in patients with chronic spontaneous urticaria

Abstract

Background

Chronic spontaneous/idiopathic urticaria (CSU/CIU) has substantial detrimental effects on health-related quality of life (HRQoL) with an effect comparable to or worse than many other skin diseases.

Objective

To assess the effect of omalizumab on CSU patients' HRQoL, measured by the Dermatology Life Quality Index (DLQI) in three phase III studies ASTERIA I, ASTERIA II, and GLACIAL.

Methods

A post-hoc analysis examined changes in DLQI scores, distribution of patients across DLQI bands and the proportion reaching minimal clinically important difference (MCID) following omalizumab vs placebo.

Results

Omalizumab 300 mg significantly improved total DLQI scores vs placebo, with a mean decrease from baseline to week 12 of -10.3 vs -6.1 (P<.0001) in ASTERIA I, -10.2 vs -6.1 (P=.0004) in ASTERIA II and -9.7 vs -5.1 (P<.0001) in GLACIAL. A significant shift from high disease impact on life at baseline towards less impact at week 12 was seen with omalizumab 300 mg vs placebo (P<.001; all studies). The proportion of patients where change in mean total DLQI score from baseline to week 12 reached an MCID of ≥4 was 74.1%, 76.0% and 77.2% in ASTERIA I, II and GLACIAL, respectively (P<.01; all studies).

Limitations

Maximum duration of omalizumab treatment was 24 weeks.

Conclusion

This additional analysis assessed the impact of CSU and benefit of treatment with omalizumab by exploring different facets of DLQI data by treatment arm at multiple assessment points. The original aspects of analysis included applying the concept of the recently validated score for the MCID of the DLQI, changes in DLQI domain scores and in the distribution of subjects based on validated total DLQI score bands. It showed consistently that omalizumab provides significant and clinically relevant improvements in many aspects of HRQoL that are important to patients with CSU. These results contribute to a better understanding of the impact of CSU and its treatment on patients and can support clinical decision making in routine medical practice.

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