Δευτέρα 12 Ιουνίου 2017
Cover Image
The cover image, by Andrew J. Rosko et al., is based on the Case Report Dorsal scapular artery as a recipient vessel in the vessel-depleted neck during free tissue transfer in head and neck reconstruction, DOI: 10.1002/hed.24785.
http://ift.tt/2tfSAMe
Auslagen
Die im Rahmen von Eingriffen und Operationen anfallenden Material- und Sachkosten werden in der Gebührenordnung für Ärzte (GOÄ) unterschiedlich behandelt. Der Beitrag klärt auf, welche Auslagen in welcher Form abrechenbar sind.
http://ift.tt/2rcqv7V
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 „ästhetische dermatologie & kosmetologie" 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 ...
http://ift.tt/2svyUHl
Die neue Medizinprodukteverordnung EU
Spürbare Veränderungen gibt es derzeit im Medizinprodukterecht. Die Europäische Union hat mit der EU-Medizinprodukteverordnung 2017 (MDR) das Rechtsgebiet in wesentlichen Teilen novelliert. Betroffen von den Neuerungen sind in erster Linie die Hersteller von Medizinprodukten. Aber auch Anwender von Medizinprodukten, so auch niedergelassene Ärzte, die in ihrer Praxis Medizinprodukte zum Einsatz bringen, sollten über die neuen Regelungen Bescheid wissen.
http://ift.tt/2rcLcAk
Dermatologen trafen sich zum zweiten Mal im CityCube in Berlin
Ende April 2017 fand die 49. Tagung der Deutschen Dermatologischen Gesellschaft (DDG) in Berlin statt. Die Vielzahl der vorgetragenen Themen und die Beteiligung zahlreicher Arbeitsgemeinschaften spiegelt die im Fachbereich vorhandene Innovationskraft wider. Eine Zusammenfassung über neue Ansätze bei der Behandlung der Psoriasis, die Lasertherapie beim malignen Melanom, die Fortschritte in der molekularen Diagnostik entzündlicher Erkrankungen sowie die Möglichkeiten und Grenzen der Off-Label-Medikation lesen Sie im folgenden Kongressbericht.
http://ift.tt/2svQKtF
Schutz vor UV-Strahlung lässt sich offenbar schlucken
Schlucken statt cremen: Karotinoide, wie sie in Tomaten und Grünkohl enthalten sind, schützen die Haut laut Ergebnissen einer Studie womöglich vor Schäden durch Sonnenlicht.
http://ift.tt/2rcCsu4
Ungleichgewicht im Mikrobiom
Mikrobiome sind beste Beispiele für gelungene Symbiosen — solang sich kein einzelnes Mitglied der Gemeinschaft in den Vordergrund drängt. Denn dann können sich bis dahin harmlose Kommensalen der Haut zu pathogenen Keimen aufschaukeln und Krankheiten wie Akne oder atopische Dermatitis begünstigen.
http://ift.tt/2rcCty8
Supermodels verkörpern Typwandel
Der Modefotograf Peter Lindbergh richtete als Erster den Fokus auf die Persönlichkeit seiner Modelle: Statt menschlicher „Kleiderständer" zeigte er selbstbewusste, ausdrucksstarke Frauen und begründete damit das Supermodels-Phänomen der 1990er-Jahre. Sein ikonisches Werk in Bild und Film ist bis 27. August 2017 in der Kunsthalle München zu sehen.
http://ift.tt/2rcL7N2
Fraktioniertes Radiofrequenz-Microneedling
Die anspruchsvolle ästhetische Klientel von heute wünscht sich zur Hautverschönerung weitgehend schmerzfreie Behandlungen ohne große Nebenwirkungen oder lange Downtime, aber mit deutlich sichtbarem Ergebnis. Entsprechend steht der ästhetisch tätige Dermatologe heute vor der Qual der Wahl aus mehreren hunderten Laser-, IPL- und Radiofrequenz-Geräten, die am Markt zur nicht invasiven Hautverbesserung angeboten werden.
http://ift.tt/2rcJZt3
Papillary Thyroid Cancer: The Good and Bad of the “Good Cancer”
Thyroid , Vol. 0, No. 0.
http://ift.tt/2rcmX5D
Does the Risk of Metabolic Syndrome Increase in Thyroid Cancer Survivors?
Thyroid , Vol. 0, No. 0.
http://ift.tt/2svxGM5
Tinnitus alters resting state functional connectivity (RSFC) in human auditory and non-auditory brain regions as measured by functional near-infrared spectroscopy (fNIRS)
by Juan San Juan, Xiao-Su Hu, Mohamad Issa, Silvia Bisconti, Ioulia Kovelman, Paul Kileny, Gregory Basura
Tinnitus, or phantom sound perception, leads to increased spontaneous neural firing rates and enhanced synchrony in central auditory circuits in animal models. These putative physiologic correlates of tinnitus to date have not been well translated in the brain of the human tinnitus sufferer. Using functional near-infrared spectroscopy (fNIRS) we recently showed that tinnitus in humans leads to maintained hemodynamic activity in auditory and adjacent, non-auditory cortices. Here we used fNIRS technology to investigate changes in resting state functional connectivity between human auditory and non-auditory brain regions in normal-hearing, bilateral subjective tinnitus and controls before and after auditory stimulation. Hemodynamic activity was monitored over the region of interest (primary auditory cortex) and non-region of interest (adjacent non-auditory cortices) and functional brain connectivity was measured during a 60-second baseline/period of silence before and after a passive auditory challenge consisting of alternating pure tones (750 and 8000Hz), broadband noise and silence. Functional connectivity was measured between all channel-pairs. Prior to stimulation, connectivity of the region of interest to the temporal and fronto-temporal region was decreased in tinnitus participants compared to controls. Overall, connectivity in tinnitus was differentially altered as compared to controls following sound stimulation. Enhanced connectivity was seen in both auditory and non-auditory regions in the tinnitus brain, while controls showed a decrease in connectivity following sound stimulation. In tinnitus, the strength of connectivity was increased between auditory cortex and fronto-temporal, fronto-parietal, temporal, occipito-temporal and occipital cortices. Together these data suggest that central auditory and non-auditory brain regions are modified in tinnitus and that resting functional connectivity measured by fNIRS technology may contribute to conscious phantom sound perception and potentially serve as an objective measure of central neural pathology.http://ift.tt/2sucGWp
Umgang und Aufbereitung semikritischer Medizinprodukte in der HNO – eine prospektive Studie
Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-110858
Zahlreiche Gesetze, Vorgaben, Richtlinien und Empfehlungen regeln und beeinflussen den Umgang und die Aufbereitung semikritischer Medizinprodukte in der HNO. Obwohl als vorrangig zu verwenden charakterisiert, wird nach wie vor in den meisten HNO-Kliniken und Praxen aus Kosten- und Praktikabilitätsgründen die manuelle der maschinellen Aufbereitung vorgezogen. In der vorliegenden Studie wurde ein optimiertes Hygienekonzept erstellt. Es fand eine Bedarfsanalyse starrer Endoskope und des HNO-Instrumentariums bei ausschließlich maschineller Aufbereitung statt. Erstmals wurden zudem patientenferne Tätigkeiten im Rahmen der Patientenuntersuchung zeitlich untersucht. Im Ergebnis zeigt sich, dass patientenferne Tätigkeiten im Umgang mit dem HNO-Instrumentarium einen erheblichen Zeit- und damit auch Kostenfaktor in der Patientenversorgung darstellen. Die nötigen Investitionen für eine rein maschinelle Aufbereitung des Instrumentariums und ins Besondere starrer Endoskope sind erheblich, da die Durchlaufzeit und damit die Anzahl an vorzuhaltenden Endoskopen sehr hoch ist.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2rUdvGO
Phonochirurgie – eine retrospektive Analyse von 400 Eingriffen
Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-110859
Einleitung Stimmstörungen sind u. a. durch Pseudotumore der Stimmlippen oder durch Stimmlippenparesen mit inkomplettem Glottisschluss bedingt und können eine phonochirurgische Therapie erfordern. Es sollten derartige Eingriffe hinsichtlich postoperativem Stimmergebnis und Sicherheit des Verfahrens analysiert werden. Methode Im Rahmen einer retrospektiven Analyse von 400 konsekutiven phonochirurgischen Eingriffen wurden folgende Parameter erfasst: Verteilung der Pathologien, Einschätzung der Stimmqualität 6 Wochen nach dem chirurgischen Eingriff im Vergleich zu präoperativ durch den Patienten und Untersucher (RBH-System), Videolaryngostroboskopie, Komplikationen und histologisches Ergebnis. Ergebnisse Im Kollektiv dominierten Stimmlippenpolypen (36 %), -zysten (12 %) und -paresen (10 %). Nach dem Eingriff verbesserte sich die Stimmqualität in 90 % der Fälle.Bei 14 % war aufgrund einer Fehlkompensation eine postoperative Stimmtherapie erforderlich. Nach einer Stimmlippenaugmentation entwickelten sich je in einem Fall ein Larynxödem und eine temporäre Stimmlippenparese der Gegenseite. Die histologische Aufarbeitung erbrachte als Zufallsbefund einen malignen osteoklastären Riesenzelltumor, einen Granularzelltumor und ein Carcinoma in situ der Stimmlippe, welche einer weiterführenden chirurgischen Behandlung und Kontrollen zugeführt werden musste. Diskussion Die mikrolaryngoskopische Phonochirurgie ist ein sicheres und effektives Therapieverfahren. Die histologische Aufarbeitung ist auch bei makroskopisch primär unsuspekten Tumoren sinnvoll, damit seltene Tumorentitäten oder Malignome nicht übersehen werden. Eine postoperative Observation ist zur frühzeitigen Erkennung und Behandlung von Komplikationen wie Larynxschwellung oder Stimmlippenparese anzuraten.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2roXqFn
Prognostic value of programmed cell death ligand 1 expression in patients with head and neck cancer: A systematic review and meta-analysis
by Ji Li, Ping Wang, Youliang Xu
BackgroundProgrammed cell death ligand 1 (PD-L1) expression was reported to be correlated with poor prognosis in various cancers. However, the relationship between PD-L1 expression and the survival of patients with head and neck cancer (HNC) remains inconclusive. In the present study, we aimed to clarify the prognostic value of PD-L1 in HNC patients using meta-analysis techniques.
MethodsA comprehensive database searching was conducted in the PubMed, EMBASE, Web of Science and Cochrane Library from inception to August 2016. Studies meeting the inclusion criteria were included. The methodological quality of included studies was assessed by the Newcastle-Ottawa quality assessment scale. Hazard ratios (HRs) with their corresponding 95% confidence intervals (CIs) were pooled by STATA 11.0 for the outcome of overall survival (OS) and disease-free survival (DFS).
ResultsA total of 17 studies with 2,869 HNC patients were included in the meta-analysis. The results of meta-analysis showed that there was no significant correlation between PD-L1 expression and OS (HR, 1.23; 95% CI, 0.99–1.53; P = 0.065) or DFS (HR, 1.42; 95% CI, 1.00–2.03; P = 0.052) of HNC patients. However, the subgroup analysis suggested that positive expression of PD-L1 was associated with poor OS (HR, 1.38; 95% CI, 1.12, 1.70; P = 0.003) and DFS (HR, 1.99; 95% CI, 1.59, 2.48; P = 0.001) in HNC patients from Asian countries/regions. The subgroup analysis also showed that the correlations between PD-L1 and prognosis are variant among different subtypes of HNC. When performing sensitive analyses, we found that the results of meta-analyses were not robust.
ConclusionThe meta-analysis indicated that positive expression of PD-L1 could serve as a good predictor for poor prognosis of Asian patients with HNC. However, the findings still need to be confirmed by large-scale, prospective studies.
http://ift.tt/2rjhXjt
Stanford Professor Peter Koltai to Speak at ORL Frontiers 2017
Peter J. Koltai, MD will be the guest speaker at Otorhinolaryngology Frontiers 2017, which highlights research endeavors and emerging technology... Read the full article...
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Laryngotracheal Reconstruction: A Long-awaited Resolution for Jayda Hector
Pediatric otolaryngologist Sancak Yuksel, MD has provided care for Jayda Hector since shortly after she was born in October 2010... Read the full article...
http://ift.tt/2sVK05Q
Dr. Michael Byrd Named Chief of Surgery
Michael Byrd, MD has been elected chief of surgery at Memorial Hermann Southeast Hospital, a 274-bed facility serving families in... Read the full article...
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Dr. Ibrahim Alava Recognized as a Texas Super Doctors Rising Star
Ibrahim "Trey" Alava, MD, an assistant professor in the Department of Otorhinolaryngology-Head & Neck Surgery at McGovern Medical School at... Read the full article...
http://ift.tt/2sVC2cX
Your help changes the future of thyroid disease – Make a spring donation to the ATA!
This spring, we would like to extend a note of thanks to all the Friends of the American Thyroid Association (ATA.) We are grateful that you have chosen to be part of the ATA community.
It is our mission and privilege to provide reliable thyroid education and awareness information, patient care resources, and research grants to help you and all those patients and families who seek answers, information, and guidance on thyroid conditions and treatments. Read more
The post Your help changes the future of thyroid disease – Make a spring donation to the ATA! appeared first on American Thyroid Association.
http://ift.tt/2temLmQ
The Gut: A Key to the Pathogenesis of Type 2 Diabetes?
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
http://ift.tt/2teH5o4
Re: “Plasminogen Activator Inhibitor-1 and Pericardial Fat in Individuals with Type 2 Diabetes Mellitus” by Bayomi et al. (Metab Syndr Relat Disord DOI:10:1089/met.2017.0031)
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
http://ift.tt/2sgP32U
Diagnostic Value of Circulating microRNA-95 and -190 in the Differential Diagnosis of Thyroid Nodules: A Validation Study in 1000 Consecutive Patients
Thyroid , Vol. 0, No. 0.
http://ift.tt/2s48FFk
Prognostic value of programmed cell death ligand 1 expression in patients with head and neck cancer: A systematic review and meta-analysis
by Ji Li, Ping Wang, Youliang Xu
BackgroundProgrammed cell death ligand 1 (PD-L1) expression was reported to be correlated with poor prognosis in various cancers. However, the relationship between PD-L1 expression and the survival of patients with head and neck cancer (HNC) remains inconclusive. In the present study, we aimed to clarify the prognostic value of PD-L1 in HNC patients using meta-analysis techniques.
MethodsA comprehensive database searching was conducted in the PubMed, EMBASE, Web of Science and Cochrane Library from inception to August 2016. Studies meeting the inclusion criteria were included. The methodological quality of included studies was assessed by the Newcastle-Ottawa quality assessment scale. Hazard ratios (HRs) with their corresponding 95% confidence intervals (CIs) were pooled by STATA 11.0 for the outcome of overall survival (OS) and disease-free survival (DFS).
ResultsA total of 17 studies with 2,869 HNC patients were included in the meta-analysis. The results of meta-analysis showed that there was no significant correlation between PD-L1 expression and OS (HR, 1.23; 95% CI, 0.99–1.53; P = 0.065) or DFS (HR, 1.42; 95% CI, 1.00–2.03; P = 0.052) of HNC patients. However, the subgroup analysis suggested that positive expression of PD-L1 was associated with poor OS (HR, 1.38; 95% CI, 1.12, 1.70; P = 0.003) and DFS (HR, 1.99; 95% CI, 1.59, 2.48; P = 0.001) in HNC patients from Asian countries/regions. The subgroup analysis also showed that the correlations between PD-L1 and prognosis are variant among different subtypes of HNC. When performing sensitive analyses, we found that the results of meta-analyses were not robust.
ConclusionThe meta-analysis indicated that positive expression of PD-L1 could serve as a good predictor for poor prognosis of Asian patients with HNC. However, the findings still need to be confirmed by large-scale, prospective studies.
http://ift.tt/2rjhXjt
Thymic large cell neuroendocrine carcinoma – a rare and aggressive tumor: a case report
Neuroendocrine tumors are a large group of tumors with a wide spectrum of behavior, affecting mainly the digestive system and the lung. The thymus is very rarely affected.
http://ift.tt/2rjT2fR
Bullous pemphigoid and chronic kidney graft rejection
Abstract
Bullous pemphigoid (BP) is a disease caused by antibodies against components of the basement membrane, mainly two proteins: BP180 and BP230. We present two cases of BP related to chronic renal rejection.
This article is protected by copyright. All rights reserved.
http://ift.tt/2rSPhg0
Phase I trial of antigen-targeted autologous dendritic cell-based vaccine with in vivo activation of inducible CD40 for advanced prostate cancer
Abstract
This phase I trial reports the safety and activity of BPX101, a second-generation antigen-targeted autologous antigen presenting cell (APC) vaccine in men with metastatic castration-resistant prostate cancer (mCRPC). To manufacture BPX101, APCs collected in a single leukapheresis were transduced with adenoviral vector Ad5f35 encoding inducible human (ih)-CD40, followed by incubation with protein PA001, which contains the extracellular domain of human prostate-specific membrane antigen. The ih-CD40 represents a modified chimeric version of the dendritic cell (DC) co-stimulatory molecule, CD40, which responds to a bioinert membrane-permeable activating dimerizer drug, rimiducid (AP1903), permitting temporally controlled, lymphoid-localized, DC-specific activation. Eighteen men with progressive mCRPC following ≤1 prior chemotherapy regimen were enrolled to evaluate three doses of BPX101 (4 × 106, 12.5 × 106 and 25 × 106 cells) administered intradermally every 2–4 weeks followed by rimiducid (0.4 mg/kg) intravenous (IV) infusion 24 h after each BPX101 dose. There were no dose-limiting toxicities. Immune upregulation as well as anti-tumor activity was observed with PSA declines, objective tumor regressions and robust efficacy of post-trial therapy. This novel antigen-targeted and in vivo activated immunotherapy platform may warrant further development as monotherapy and as a component of rational combinations.
http://ift.tt/2su9QjW
Direct cost comparison of minimally invasive punch technique versus traditional approaches for percutaneous bone anchored hearing devices
Abstract
Background
Minimally Invasive Ponto Surgery (MIPS) was recently described as a new technique to facilitate the placement of percutaneous bone anchored hearing devices.
The procedure has resulted in a simplification of the surgical steps and a dramatic reduction in surgical time while maintaining excellent patient outcomes. Given these developments, our group sought to move the procedure from the main operating suite where they have traditionally been performed. This study aims to test the null hypothesis that MIPS and open approaches have the same direct costs for the implantation of percutaneous bone anchored hearing devices in a Canadian public hospital setting.
Methods
A retrospective direct cost comparison of MIPS and open approaches for the implantation of bone conduction implants was conducted. Indirect and future costs were not included in the fiscal analysis.
A simple cost comparison of the two approaches was made considering time, staff and equipment needs. All 12 operations were performed on adult patients from 2013 to 2016 by the same surgeon at a single hospital site.
Results
MIPS has a total mean reduction in cost of CAD$456.83 per operation from the hospital perspective when compared to open approaches. The average duration of the MIPS operation was 7 min, which is on average 61 min shorter compared with open approaches.
Conclusion
The MIPS technique was more cost effective than traditional open approaches. This primarily reflects a direct consequence of a reduction in surgical time, with further contributions from reduced staffing and equipment costs. This simple, quick intervention proved to be feasible when performed outside the main operating room. A blister pack of required equipment could prove convenient and further reduce costs.
http://ift.tt/2tdCOBc
Granulomatöses Reaktionsmuster in der Haut
Zusammenfassung
Eine besondere diagnostische Situation bei der Einordung einer granulomatösen Dermatitis ergibt sich, wenn keine umschriebenen Granulome, sondern ein diffuses interstitielles histiozytäres Entzündungsinfiltrat, eine granulomatöse Vaskulitis oder ein neoplastisches lymphozytäres Infiltrat vorliegen. Die interstitielle granulomatöse Dermatitis wurde erstmals bei Patienten mit einer Arthritis beschreiben. Später erkannte man, dass Assoziationen zu weiteren, meist immunologischen Erkrankungen bestehen. Die Abgrenzung zu einer interstitiellen Form eines Granuloma anulare, einer frühen Morphea und Varianten einer Borreliose oder eines Skleromyxödems sowie einer Arzneimittelreaktion können mitunter sehr schwierig sein. Bei lange bestehenden granulomatösen Infiltraten sollte ein granulomatöses T‑Zell-Lymphom mit ausgeschlossen werden. Gelegentlich lassen sich nur wenige atypische Lymphozyten finden. Besonders hilfreich ist dann der Nachweis einer monoklonalen T‑Zell-Expansion. Erst kürzlich wurde das CD8-positive granulomatöse kutane T‑Zell-Lymphom beschrieben, das bei Patienten mit Immundefekten auftritt. Eine granulomatöse Vaskulitis in der Haut ist sehr selten. Gemäß der Chapel-Hill-Klassifikation von 2012 werden die systemischen granulomatösen Vaskulitiden mit Riesenzellarteriitiden gleichgesetzt. Sie betreffen extrakutane große Arterien. Selten kann es bei Befall der A. temporalis zu Hautnekrosen kommen. Viel häufiger findet man eine granulomatöse Entzündung kombiniert mit einer Vaskulitis, unter anderem bei infektiösen Dermatosen, einer Sarkoidose und einer Nodularvaskulitis. Bei der Granulomatose mit Polyangiitis (früher Wegener-Granulomatose) zeigt sich an der Haut eine leukozytoklastische Vaskulitis. Granulome sind hierbei Raritäten.
http://ift.tt/2s2vPM5
Insulin Resistance and Metformin Use on Volume of Benign Thyroid Nodules
Conditions: Thyroid Nodule; Insulin Resistance
Interventions: Drug: Metformin; Drug: Placebo
Sponsor: Hospital Universitário Clementino Fraga Filho
Recruiting - verified June 2017
http://ift.tt/2sU9tNb
Interventions: Drug: Metformin; Drug: Placebo
Sponsor: Hospital Universitário Clementino Fraga Filho
Recruiting - verified June 2017
http://ift.tt/2sU9tNb
Effect of Pre-warming on Perioperative Hypothermia During HoLEPunder Spinal Anesthesia
Condition: Hypothermia
Interventions: Other: pre-warming; Other: no warming
Sponsor: Hallym University Kangnam Sacred Heart Hospital
Not yet recruiting - verified June 2017
http://ift.tt/2skUrTg
Interventions: Other: pre-warming; Other: no warming
Sponsor: Hallym University Kangnam Sacred Heart Hospital
Not yet recruiting - verified June 2017
http://ift.tt/2skUrTg
HIV‑assoziiertes plasmoblastisches Lymphom der Nasennebenhöhlen
Zusammenfassung
Es wird der Fall einer 48-jährigen Patientin beschrieben, die sich mit einer einseitigen Nasenatmungsbehinderung, linksbetonten Zephalgien und subfebrilen Temperaturen in der HNO-Klinik der Universitätsmedizin Mainz vorstellte. Die klinische Untersuchung und die CT der Nasennebenhöhlen zeigte eine Raumforderung der linken Nasenhaupthöhle und des linken Nasennebenhöhlensystems. Die histopathologische Aufarbeitung ergab ein HIV-assoziiertes plasmoblastisches Lymphom der Nasennebenhöhlen. Diese Kasuistik mit Übersicht über die Literatur stellt die Diagnostik und Therapie dieses seltenen Nasentumors dar.
http://ift.tt/2skomeo
Apical extrusion of debris during the preparation of oval root canals: a comparative study between a full-sequence SAF system and a rotary file system supplemented by XP-endo finisher file
Abstract
Objectives
The purpose of this study was to assess the amount of apically extruded debris during the preparation of oval canals with either a rotary file system supplemented by the XP-endo Finisher file or a full-sequence self-adjusting file (SAF) system.
Materials and methods
Sixty mandibular incisors were randomly assigned to two groups: group A: stage 1—glide path preparation with Pre-SAF instruments. Stage 2—cleaning and shaping with SAF. Group B: stage 1—glide path preparation with ProGlider file. Stage 2—cleaning and shaping with ProTaper Next system. Stage 3—Final cleaning with XP-endo Finisher file. The debris extruded during each of the stages was collected, and the debris weights were compared between the groups and between the stages within the groups using t tests with a significance level set at P < 0.05.
Results
The complete procedure for group B resulted in significantly more extruded debris compared to group A. There was no significant difference between the stages in group A, while there was a significant difference between stage 2 and stages 1 and 3 in group B, but no significant difference between stages 1 and 3.
Conclusions
Both instrumentation protocols resulted in extruded debris. Rotary file followed by XP-endo Finisher file extruded significantly more debris than a full-sequence SAF system. Each stage, in either procedure, had its own contribution to the extrusion of debris.
Clinical relevance
Final preparation with XP-endo Finisher file contributes to the total amount of extruded debris, but the clinical relevance of the relative difference in the amount of apically extruded debris remains unclear.
http://ift.tt/2sTZ1VS
Vit D deficiency is a possible risk factor in ARS
Abstract
Vitamin D deficiency is effective in the development of acute rhinosinusitis and prolongation of inflammation by increasing inflammation in the sinonasal epithelium. Vitamin D deficiency is important in the development of bone barriers that prevent the complication of acute rhinosinusitis. Although Vitamin D levels may be a variable risk factor for various respiratory tract disorders, there are limited data on the role in sinonasal infections. Our aim was to investigate the association of 25-hydroxy-vitamin D (25OHD) levels with acute rhinosinusitis (ARS) and preseptal cellulitis complications. The type of the study is prospective case–control study. Fifteen patients in the pediatric age group with ARS-induced preseptal cellulitis complication were identified as Group 1, fifteen patients with ARS and without complication were identified as Group 2, and fifteen healthy volunteers were identified as Group 3. Serum 25OHD levels (nmol/l) were measured in addition to routine blood tests at the first admission of patients participating in the study. Statistical analysis was performed between groups. The ages of the cases ranged from 1 to 14 years with a mean of 5.62 ± 3.42 years. 55.6% of the cases (n = 25) were male; 44.4% (n = 20) were female children. As a result of classification in which vitamin D levels were compared with normal values, there was a statistically significant difference according to the presence of ARS (Group-1 and Group 2) and absence of ARS (Group-3) (p < 0.05). A statistically significant difference was also found between Group 1 and Group-3 (p < 0.05). Statistically significant difference between Group 1 and Group 3 suggests that lack of vitamin D predisposes to the complication of preseptal cellulitis. Comparison of Group 1 and 2 with Group 3 (normal subjects) suggests that Vit D has a protective effect against developing sinusitis.
http://ift.tt/2skGdSE
Femoral nerve block with propofol sedation versus general anesthesia in patients with severe cardiac dysfunction undergoing autologous myoblast sheet transplantation
Abstract
Purpose
Regional anesthesia is more favorable than general anesthesia in patients with severe comorbidity; however, data on the superiority of peripheral nerve blocks over general anesthesia in patients with severe cardiac dysfunction are lacking. We aimed to demonstrate that peripheral nerve blocks reduce perioperative analgesic requirements and promote faster recovery compared to general anesthesia.
Methods
We retrospectively evaluated intraoperative blood pressure, perioperative medications, and postoperative recovery in patients who underwent skeletal muscle harvesting for autologous myoblast sheet transplantation. We compared patients who received general anesthesia (group G, n = 27) to those who received femoral nerve block with propofol sedation (group B, n = 22).
Results
Left ventricular ejection fraction was 24% on average, with no significant difference between groups. Compared with group G, a lower dose of propofol was used intraoperatively (1.25 versus 2.0 µg/mL, respectively; P < 0.001) and fewer patients required opioids (13.6 versus 100%, P < 0.01) in group B. Additionally, the lowest intraoperative mean blood pressure was higher (54 versus 48 mmHg, respectively; P = 0.02) in group B. More patients received postoperative analgesic drugs (51.9 versus 13.6%, P = 0.01) and they received them more frequently (1 [0–3] versus 0 [0–1], P = 0.02) in group G. The length of heart care unit stay was shorter in group B than group G (0 [0–18.5] versus 17 [0–47] h, respectively; P < 0.0001).
Conclusions
Femoral nerve block with sedation was more beneficial than general anesthesia in patients with severe cardiac dysfunction who underwent skeletal muscle harvesting for autologous myoblast sheet transplantation.
http://ift.tt/2sUhy4k
What's in a name?: Atopic dermatitis or atopic eczema, but not eczema alone
Abstract
Background
The ideal nomenclature of atopic dermatitis or atopic eczema (AD/AE) has long been contested. It is becoming increasingly clear that the disparate nomenclature of this disease may have important deleterious ramifications for clinical care, research and drug development.
Objective
To reach consensus among an international group of experts in AD/AE on the nomenclature for AD/AE.
Methods
A 3-question survey was sent to the councilors and associates of the International Eczema Council. Consensus was reached with at least 90% response and more than 90% agreement on nomenclature.
Results
Seventy-one of 77 (92.2%) IEC councilors and associates responded to the survey. Consensus was reached on the preference for the atopic prefix, i.e. AD or AE (69 of 71 [97.2%]). However, consensus was not reached preference of AD (40 [58.0%]) or AE (30 [43,5%]). Sixty-three respondents (88.7%) and 55 (77.5%) felt that the terms AD and AE were acceptable, whereas only 11 (15.5%) felt that eczema was acceptable.
Conclusions
Use of the atopic prefix, i.e. either AE or AD, is recommended. Whereas, use of the term eczema is not recommended. We encourage physicians in all specialties and in every country to shift their own use of terminology to AD or AE in writing, presentations and discussions with patients and other health care personnel as a first step.
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Do laryngoscopic findings reflect the characteristics of reflux in patients with laryngopharyngeal reflux?
Abstract
Objective
To analyze the association between 24-hour multichannel intraluminal impedance-pH (24h MII-pH) parameters and each item of the reflux finding score (RFS) to determine whether the laryngoscopic findings of the RFS could reflect the characteristics of reflux in patients with laryngopharyngeal reflux (LPR).
Study Design
Prospective cohort study.
Settings
Tertiary care referral medical center.
Participants
Patients complaining of LPR symptoms were evaluated via a 24h MII-pH. Among them, 99 patients whose LPR was confirmed via 24h MII-pH were enrolled in this study.
Main outcome measures
Correlations between RFS ratings and 24h MII-pH parameters were evaluated and compared between patients with or without each laryngoscopic finding used in the RFS.
Results
Subglottic edema had a statistically significant positive correlation with number of non-acid LPR and non-acid full column reflux events. Ventricular obliteration and posterior commissure hypertrophy showed a significant correlation with non-acid exposure time and total reflux exposure time. We also found a significant correlation between granuloma/ granulation score and number of acid LPR events. The numbers of non-acid LPR and full column reflux events in patients with subglottic edema were significantly higher than those without subglottic edema.
Conclusion
Among the laryngoscopic findings used in the RFS, subglottic edema is specific for non-acid reflux episodes and granuloma/ granulation is specific for acid reflux episodes.
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Higher expression of WNT5A protein in oral squamous cell carcinoma compared with dysplasia and oral mucosa with a normal appearance
WNT5A is a secreted signaling protein that promotes migration and invasion of oral squamous cell carcinoma (OSCC) cells through activation of non-canonical WNT signaling. Here, we examined expression of WNT5A, β-catenin, and E-cadherin by immunohistochemistry in 21 human diagnostic incision biopsies that each had regions of oral mucosa with a normal appearance adjacent to the affected tissue, dysplasia, and OSCC. We also investigated the effect of recombinant WNT5A (rWNT5A) on expression of the cell-adhesion proteins E-cadherin and β-catenin by western blot analysis. No expression of WNT5A protein was present in oral mucosa with a normal appearance or in mild grade dysplasia. However, expression of WNT5A increased along with increasing grade of dysplasia, and the highest expression was detected in OSCCs. Expression of membranous β-catenin and of E-cadherin was lower, whereas expression of cytoplasmic β-catenin was higher, in OSCCs than in non-cancerous regions. However, there was no correlation between expression of WNT5A and expression of either β-catenin or E-cadherin. Furthermore, treatment of OSCC cells with rWNT5A had no effect on the expression of β-catenin or E-cadherin. Taken together with previous results, we conclude that WNT5A influences the progression of OSCC without affecting the canonical WNT/β-catenin pathway and without down-regulating E-cadherin. WNT5A may have potential as a biological marker for malignant transformation of dysplasia to OSCC.
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REGγ accelerates melanoma formation by regulating Wnt/β-catenin signaling pathway
Abstract
It has been reported that the proteasome activator REGγ is associated with multiple oncogenic pathways in human cancers. However, the role of REGγ in the development of melanoma and the underlying mechanisms remain unclear. In this study, we attempted to investigate the effects of REGγ on human melanoma cell proliferation in vitro and in vivo. We demonstrated that knockdown of REGγ inhibited melanoma cell growth and arrested melanoma cell at G1 phase. Furthermore depletion of REGγ also inhibited the xenograft growth of human melanoma.. Mechanistically, REGγ activates Wnt/β-catenin signal pathway by degrading GSK-3β in melanoma cell lines and mouse models. Transient knockdown of β-catenin effectively blocked cell proliferation in REGγ wild type melanoma cells. In human melanoma samples, REGγ was overexpressed and positively correlated with β-catenin levels. This study demonstrates that REGγ is a central molecule in the development of melanoma by regulating Wnt/β-catenin pathway. This suggesting that targeting REGγ could be an alternative therapeutic approach for melanoma.
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Characterization of the chloroquine-induced mouse model of pruritus using an automated behavioural system
Abstract
Pruritus is a major symptom of several dermatological diseases but has limited therapeutic options available. Animal models replicating the pathophysiology of pruritus are needed to support the development of new drugs. Induction of pruritus by chloroquine (CQ) in mice is widely used, although, as with similar models, it has low throughput and does not distinguish between anti-pruritic effects and confounding factors such as sedation. To overcome these issues, we incorporated into the model an automated system that measures both scratching and locomotor behaviour simultaneously. We combined this system with the determination of CQ levels in different tissues to understand the impact of the route of CQ administration on the pruritogenic response. We concluded that whereas oral CQ does not induce pruritus due to insufficient skin levels, the bell-shaped curve of pruritus observed following subcutaneous administration is due to toxicity at high doses. We validated the model with several drugs currently used in humans: nalfurafine, aprepitant, cyproheptadine and amitriptyline. By comparing the effects of the drugs on both scratching and locomotor activity, we concluded that nalfurafine and aprepitant can exhibit efficacy at doses devoid of central effects, whereas central effects drove the efficacy of the other two drugs. This was further confirmed using non-brain-penetrant drugs. Moreover, as anticipated, anti-inflammatory drugs showed no efficacy. In conclusion, the use of an automated integrated behavioural assessment in CQ-induced pruritus makes the assay suitable for screening purposes and allows for a correct interpretation of the anti-pruritic effect of the compounds evaluated.
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Response to DC Whiteman, CM Olsen and AC Green: In-Deed Wise To Get Some Sensible Sun Exposure
Abstract
Whiteman, Olsen and Green noted the Felton study (1) was short term and limited by the number of biopsies. What this study demonstrated was that even for only 6 weeks of repeated exposures to sensible suberythemal doses of simulated solar ultraviolet radiation (UVR), there was a marked increase in the skin's defense mechanisms to overcome the damaging effects caused by the DNA absorbing the UVR. Whiteman et al. acknowledge that within 24 hours after the final exposure the levels of photo damage were significantly lower.
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Congenital Infantile Fibrosarcoma Causing Intestinal Perforation in a Newborn
Congenital infantile fibrosarcoma (CIF) is a rare malignant mesenchymal tumor and only 14 cases have been reported with gastrointestinal manifestation. We report about a female newborn delivered per emergency cesarean section at 34 weeks of gestation. Postnatally, she rapidly developed an acute abdomen and sonographic evidence of intestinal perforation requiring laparotomy on the first day of life. A perforated 2 × 3 cm sized spherical tumorous structure of the jejunum was identified. Due to unknown histopathology at this point and unclear resectional margins, she received a temporary ileostomy, which was closed two months later. Histopathology revealed a congenital intestinal fibrosarcoma without the characteristic ETV6-NTRK3 fusion transcript. In conclusion, this rare tumor must be considered as differential diagnosis of intestinal perforations in newborns.
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Transcanal surgery for vestibular schwannomas: a pictorial review of radiological findings, surgical anatomy and comparison to the traditional translabyrinthine approach
Abstract
The most popular approaches for vestibular schwannoma (VS) removal are retrosigmoid, middle cranial fossa and translabyrinthine (TL). All require a certain degree of invasivity, bone removal, or brain manipulation. Recently, the authors described the transcanal transpromontorial approaches (TTA), which allow the inner ear to be accessed directly through the external auditory canal (EAC), either with a microscopic (Expanded TTA, or ExpTTA) or even an exclusive endoscopic technique (Endoscopic TTA, or EndoTTA). The advantages compared to traditional approaches are a direct view of the internal auditory canal (IAC) from lateral to medial, very little or no superficial tissue dissection and very little petrous bone drilling. In summary, from an anatomical point of view, they could be considered to be minimally invasive approaches. The radiologic outcome and the anatomical correspondence of these new approaches are described so as to share with the readers the possible radiologic findings and to compare and differentiate them from classic transpetrous approaches such as the TL approach.
Level of evidence
4.
http://ift.tt/2s25aiC
Modified Le Fort III Osteotomy: Different Applications
Abstract
Summary
Based on the new concepts of the modified Le Fort III osteotomy (MLFIIIO), Three variations of this technique are implemented: (A) the modified osteotomy Le Fort III Champy (1980) technique to be described with the use of surgical guides, and subciliary approach or an transconjunctival approach. Excellent technique for horizontal advancement no further to 6 mm, without requiring any type of graft.. (B) The modified Le Fort III osteotomy in "Z": to solve horizontal (posterior anterior) problems of more than 6 mm without bone grafting. It is itself a modification of the technique described by Champy. (C) The modified Le Fort III osteotomy ascending: modified the original technique described by Bell and Epker with interpositional grafts, was modified by the called ascendant, making it higher in cases where the patient has an acceptable nasal bridge, but exorbitism the lateral wall of the orbit. Le Fort III osteotomy combined with a Le Fort I osteotomy and a front implant.
Method
As pointed out in Part I for the modified oblique Le Fort III osteotomy, methods for the design of the osteotomy Le Fort III property will depend on the requirements of individual patients, and this has led us to design specific techniques for the deformity.
Results
Patients have a right projection of the middle third, and protection of the eyeball.
Conclusions
The techniques presented for the advancement of the middle third have excellent results with the ability to be tailored to each patient deformity.
http://ift.tt/2tcapvk
Identification of PTPN22, ST6GAL1 and JAZF1 as Psoriasis Risk Genes Demonstrates Shared Pathogenesis between Psoriasis and Diabetes
Abstract
The biological connections between psoriasis and diabetes have been suggested by epidemiological, immunological and genetic studies. To identify additional shared susceptibility loci and investigate shared pathogenesis between these two diseases, we genotyped 89 reported diabetes susceptibility loci in 4,456 psoriasis cases and 6,027 controls of Chinese population using the MassARRAY system from Sequenom. We discovered three significant associations at rs6679677 on 1p13.2 (P = 6.15 × 10-5, OR = 5.07), rs16861329 on 3q27.3 (P = 2.02 × 10-4, OR = 0.87), and rs849135 on 7p15.1 (P = 6.59 × 10-9, OR = 1.78), which suggested PTPN22, ST6GAL1 and JAZF1 as novel susceptibility genes for psoriasis in Chinese population. Our findings implicated the involvement of T-cell receptor signaling pathway in the pathogenesis of psoriasis and further confirmed the shared genetic susceptibility between psoriasis and diabetes.
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Getting to the root of scales, feather and hair: as deep as odontodes?
Abstract
While every jawed vertebrate, or its recent ancestor, possesses teeth, skin appendages are characteristic of the living clades: skin denticles (odontodes) in chondrichthyians, dermal scales in teleosts, ducted multicellular glands in amphibians, epidermal scales in squamates, feathers in birds, and hair-gland complexes in mammals, all of them showing a dense periodic patterning. While the odontode origin of teleost scales is generally accepted, the origin of both feather and hair is still debated. They appear long before mammals and birds, at least in Jurassic in mammaliaforms and in ornithodires (pterosaurs and dinosaurs), and are contemporary to scales of early squamates. Epidermal scales might have appeared several times in evolution, and basal amniotes could not have developed a scaled-dry integument, as the function of hair follicle requires its association with glands. In areas such as amnion, cornea or plantar pads, the formation of feather and hair is prevented early in embryogenesis, but can be easily reverted by playing with the Wnt/BMP/Shh pathways, which both imply the plasticity and the default competence of ectoderm. Conserved ectodermal/mesenchymal signaling pathways lead to placode formation, while later the crosstalk differs, as well as the final performing tissue(s): both epidermis and dermis for teeth and odontodes, mostly dermis for teleosts scales, only epidermis for squamate scale, glands, feather and hair. We therefore suggest that tooth, dermal scale, epidermal scale, feather and hair evolved in parallel from a shared placode/dermal cells unit, which was present in a common ancestor, an early vertebrate gnathostome, c.a. 420 million years ago.
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Atopic skin: In vivo Raman identification of global molecular signature, a comparative study with healthy skin
Abstract
Atopic dermatitis (AD) is the most common skin inflammatory disease, affecting up to 3% of adults and 20% of children. Skin barrier impairment is thought to be the primary factor in this disease. Currently, there is no method proposed to monitor non-invasively the different molecular disorders involved in the upper layer of AD skin. Raman microspectroscopy has proved to be a powerful tool to characterize some AD molecular descriptors such as lipid content, global hydration level, filaggrin and its derivatives. Our investigations aimed to extend the use of in vivo Raman microspectroscopy as a rapid and non-invasive diagnostic technique for lipid conformation and organisation, protein secondary structure and bound water content analysis in atopic skin. Our approach was based on the analysis of Raman data collected on the stratum corneum (SC) of 11 healthy and 10 mild to moderate atopic patients. Atopic skin revealed a modification of lipid organisation and conformation in addition to the decrease of the lipid to protein ratio. This study also highlighted a reduction of the bound water and an increase of protein organized secondary structure in atopic skin. All these descriptors worsen the barrier function, state and appearance of the skin in AD. These precise and relevant information will allow an in vivo follow-up of the pathology and a better evaluation of the pharmacological activity of therapeutic molecules for the treatment of AD.
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Comparison of a 2.0-mm locking system with conventional 2.0- and 2.4-mm systems in the treatment of mandibular fractures: a randomized controlled trial
Abstract
Purpose
A comparative study of the use of the 2.0-mm locking fixation system with conventional systems in the treatment of mandibular fractures was performed.
Methods
For this study, 87 consecutive patients with 112 mandibular fractures were randomized to receive either 2.0-mm locking plates (n = 45) or conventional 2.0- or 2.4-mm plates (n = 42) and had a minimum follow-up of 6 months. Fractures were classified based on the degree of displacement and complexity. Statistical analyses were used to verify possible differences between the groups when separately compared unfavourable and favourable cases (p ≤ 0.050).
Results
Despite randomization, systemic diseases were more frequent in the 2.0-mm locking group in favourable cases. Substance abuse occurred predominantly in the 2.0-mm locking group, in unfavourable and favourable fractures. There were more cases of complex fractures in the conventional group in unfavourable cases. One case involving a major postoperative complication occurred in the locking group (2.2%) and three cases occurred in the conventional group (7.1%) but with no significant difference between groups. In this study, there were no major differences between conventional and locking 2.0-mm locking systems with regard to the outcome of treated mandibular fractures, showing that both are adequate as long as the criteria of their indication and requirements for installation are met.
Conclusions
It was concluded that the 2.0-mm locking fixation system can replace conventional systems in the treatment of mandibular fractures; in addition, this approach was effective in the treatment of unfavourable fractures that typically require the 2.4-mm conventional system.
http://ift.tt/2sdfNBh
Endoluminal laser-assisted vascular anastomosis—an in vivo study in a pig model
Abstract
Microvascular surgery is time consuming and requires high expertise. Laser-assisted vascular anastomosis (LAVA) is a promising sutureless technique that has the potential to facilitate this procedure. In this study, we evaluate the handling of our soldering material and the 1-week patency rate in a porcine model. Six pigs were subjected to LAVA. For each pig, the saphenous artery on one side was transected while the contralateral side was used as control. A porous polycaprolactone scaffold soaked in 40% (w/w) bovine serum albumin solution in combination with 0.1% (w/w) indocyanine green was wrapped at the anastomosis site and at the control site. Both sides were then soldered with a diode laser coupled into a light diffuser fiber emitting radiation with a wavelength of 808 nm and a power of 2–2.2 W. Vessels were successfully soldered with a 100% immediate patency rate. The 1-week patency rate was 83% for the anastomoses versus 67% for the control side. Vessels irradiated for 80 to 90 s tended to maintain the highest patency rate. Macroscopically, there was no difference between the two sides. The patch was easy to handle provided that the environment could be kept dry. This study shows the potential and the limitations of endoluminal LAVA as a one-step procedure without the use of stay sutures. Further studies are needed to improve the soldering material, the long-term patency rate, and standardized irradiation parameters. The long-term effects of laser soldering on the vessel wall remain to be determined.
http://ift.tt/2r9MU5H
Comparison of a 2.0-mm locking system with conventional 2.0- and 2.4-mm systems in the treatment of mandibular fractures: a randomized controlled trial
Abstract
Purpose
A comparative study of the use of the 2.0-mm locking fixation system with conventional systems in the treatment of mandibular fractures was performed.
Methods
For this study, 87 consecutive patients with 112 mandibular fractures were randomized to receive either 2.0-mm locking plates (n = 45) or conventional 2.0- or 2.4-mm plates (n = 42) and had a minimum follow-up of 6 months. Fractures were classified based on the degree of displacement and complexity. Statistical analyses were used to verify possible differences between the groups when separately compared unfavourable and favourable cases (p ≤ 0.050).
Results
Despite randomization, systemic diseases were more frequent in the 2.0-mm locking group in favourable cases. Substance abuse occurred predominantly in the 2.0-mm locking group, in unfavourable and favourable fractures. There were more cases of complex fractures in the conventional group in unfavourable cases. One case involving a major postoperative complication occurred in the locking group (2.2%) and three cases occurred in the conventional group (7.1%) but with no significant difference between groups. In this study, there were no major differences between conventional and locking 2.0-mm locking systems with regard to the outcome of treated mandibular fractures, showing that both are adequate as long as the criteria of their indication and requirements for installation are met.
Conclusions
It was concluded that the 2.0-mm locking fixation system can replace conventional systems in the treatment of mandibular fractures; in addition, this approach was effective in the treatment of unfavourable fractures that typically require the 2.4-mm conventional system.
http://ift.tt/2sdfNBh
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