Closing the gap in cochlear implant access for African-Americans: a story of outreach and collaboration by our cochlear implant program.

Purpose of review: Minorities often lag behind in hearing loss evaluation and treatment. Our cochlear implant program aimed to identify the socioeconomic and cultural barriers that prevented our African-American cochlear implant candidates from seeking help for their hearing loss, specifically cochlear implant surgery. Recent findings: Our pilot study surveyed 11 African-Americans with cochlear implants and identified obstacles that included patient-physician mistrust, social stigma, financial cost, and lack of education about the devices and procedures. Our experienced cochlear implant team then addressed these issues in its weekly meetings to review cases and potential cochlear implant candidates, and we partnered with community organizations to improve awareness about cochlear implants among healthcare professionals and the public. Summary: During our cochlear implant team's community outreach to African-Americans with hearing loss, we initiated several actions to address the various disparities in access to care and use of services: development of patient education, patient-run support group, tracking of clinical outcomes, and opportunities for involvement in health policy making for cochlear implants. Cochlear implant teams should deepen their involvement with African-Americans and other minorities with hearing loss to better support and ultimately improve cochlear implant access, performance, and function. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2u8Jy6R

Cochlear implantation in children under 12 months of age.

Purpose of review: Children with congenital hearing loss are being identified earlier, leading to earlier intervention. Current US Food and Drug Administration (FDA) criteria states a child must be 12 months or older for cochlear implantation. The purpose of this article is to review recent publications regarding the benefits of implanting infants under 12 months of age. Topics include: safety and efficacy of surgery, speech and language acquisition outcomes, audiologic components, and limitations. Recent findings: Since the early 1990s, the candidacy criteria evolved drastically. However, the FDA criteria for cochlear implantation in children has remained at 12 months of age or older since 2000. Recent research indicates implanting below 12 months of age a safe and effective procedure. Speech and language outcomes showed better speech and language advantages. In addition, infants implanted earlier showed normal auditory skills as early as 3 months post cochlear implant activation. This article will also address recent findings on the limitations of earlier implantation. Summary: Recent research demonstrates positive outcomes in children implanted under 12 months of age. Developing research on earlier implantation could lead to a change in the current FDA criteria allowing infants to reach their speech and hearing potential faster. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2uxmOi8

Closing the gap in cochlear implant access for African-Americans: a story of outreach and collaboration by our cochlear implant program.

Purpose of review: Minorities often lag behind in hearing loss evaluation and treatment. Our cochlear implant program aimed to identify the socioeconomic and cultural barriers that prevented our African-American cochlear implant candidates from seeking help for their hearing loss, specifically cochlear implant surgery. Recent findings: Our pilot study surveyed 11 African-Americans with cochlear implants and identified obstacles that included patient-physician mistrust, social stigma, financial cost, and lack of education about the devices and procedures. Our experienced cochlear implant team then addressed these issues in its weekly meetings to review cases and potential cochlear implant candidates, and we partnered with community organizations to improve awareness about cochlear implants among healthcare professionals and the public. Summary: During our cochlear implant team's community outreach to African-Americans with hearing loss, we initiated several actions to address the various disparities in access to care and use of services: development of patient education, patient-run support group, tracking of clinical outcomes, and opportunities for involvement in health policy making for cochlear implants. Cochlear implant teams should deepen their involvement with African-Americans and other minorities with hearing loss to better support and ultimately improve cochlear implant access, performance, and function. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2u8Jy6R

Cochlear implantation in children under 12 months of age.

Purpose of review: Children with congenital hearing loss are being identified earlier, leading to earlier intervention. Current US Food and Drug Administration (FDA) criteria states a child must be 12 months or older for cochlear implantation. The purpose of this article is to review recent publications regarding the benefits of implanting infants under 12 months of age. Topics include: safety and efficacy of surgery, speech and language acquisition outcomes, audiologic components, and limitations. Recent findings: Since the early 1990s, the candidacy criteria evolved drastically. However, the FDA criteria for cochlear implantation in children has remained at 12 months of age or older since 2000. Recent research indicates implanting below 12 months of age a safe and effective procedure. Speech and language outcomes showed better speech and language advantages. In addition, infants implanted earlier showed normal auditory skills as early as 3 months post cochlear implant activation. This article will also address recent findings on the limitations of earlier implantation. Summary: Recent research demonstrates positive outcomes in children implanted under 12 months of age. Developing research on earlier implantation could lead to a change in the current FDA criteria allowing infants to reach their speech and hearing potential faster. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2uxmOi8

Production of a Mouse Monoclonal Antibody Against Mortalin by Whole Cell Immunization

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.


http://ift.tt/2vh0UNC

Outpatient dermatology consultation impacts the diagnosis and management of pediatric oncology patients: A retrospective study

The impact of dermatology consultation on the care of children with oncologic conditions is unknown.

http://ift.tt/2uB2sE7

Phosphodiesterase type 5 inhibitors and risk of melanoma: A meta-analysis

The association between phosphodiesterase type 5 (PDE5) inhibitors and melanoma risk is controversial.

http://ift.tt/2uB52tC

Oropharyngeal lesions in pityriasis rosea

Pityriasis rosea (PR) is an exanthematous disease associated with the endogenous systemic reactivation of human herpesvirus-6 (HHV-6) and human herpesvirus-7 (HHV-7). Oropharyngeal lesions may be associated with the exanthema, but anecdotal evidence suggests that few dermatologists are aware of their occurrence.

http://ift.tt/2vAsIfb

PDL1 expression in desmoplastic melanoma is associated with tumor aggressiveness and progression

The prognostic role of programmed death ligand 1 (PDL1), CD8, and forkhead box p3 (FoxP3) expression in desmoplastic melanomas is unclear.

http://ift.tt/2uALJAG

Open treatment of unilateral mandibular condyle fractures in adults: a systematic review

Since the introduction of rigid internal fixation devices, more and more surgeons favour an open approach to treating condylar fractures of the mandible in adult patients. Different indications for open treatment have been published. Open treatment is associated with surgical complications because of the technique employed. The aim of this systematic review was to provide an overview of the studies published exclusively on open treatment, and to summarize the existing open treatment modalities and their clinical outcomes.

http://ift.tt/2uAI6uI

Information for Clinicians: Approach to the Patient with Progressive Radioiodine-Refractory Thyroid Cancer—When to Use Systemic Therapy

Thyroid , Vol. 0, No. 0.


http://ift.tt/2u8yuXs

Re: “Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum” by Alexander et al. (Thyroid 2017;27:315–389)

Thyroid , Vol. 0, No. 0.


http://ift.tt/2tEKCvO

Validation of American Thyroid Association Ultrasound Risk Assessment of Thyroid Nodules Selected for Ultrasound Fine-Needle Aspiration

Thyroid , Vol. 0, No. 0.


http://ift.tt/2u8zfjn

Subciliary vs. transconjunctival approach for the management of orbital floor and periorbital fractures: a systematic review and meta-analysis

This study compared complications between subciliary and transconjunctival approaches to the infraorbital rim/orbital floor using systematic review and meta-analysis.

http://ift.tt/2vzZ8X7

Further development of the MRONJ minipig large animal model

Medication-related osteonecrosis of the jaw (MRONJ) is a rare but serious and potentially severe side effect of antiresorptive therapy with bisphosphonates or denosumab. Recently, a large animal minipig MRONJ model was introduced which led to early necrotic lesions in the majority of extraction sites after bisphosphonate administration. The aim of this project was to modify the preoperative cumulative bisphosphonate dose (zoledronate) and hereby firstly to demonstrate the reliability and reproducibility of the established model.

http://ift.tt/2uAMR7l

Primary solitary plasmacytoma of the liver – successful treatment with fractionated stereotactic radiotherapy (Cyberknife®): a case report

Solitary plasmacytoma of the liver is a very rare and aggressive form of plasma cell dyscrasia. To the best of our knowledge, very few cases have been reported without systemic disease. We reported a rare case...

http://ift.tt/2to8o3Y

Calcified amorphous tumor of the heart with mitral annular calcification: a case report

Calcified amorphous tumor of the heart is a rare, non-neoplastic cardiac mass characterized by nodular calcium in the background of amorphous degenerating fibrinous material. Clinical diagnosis of calcified am...

http://ift.tt/2u6sIUy

Echocardiography and passive leg raising in the postoperative period: A prospective observational study.

BACKGROUND: Signs of hypovolaemia are frequent in the postoperative period, but not all patients need or respond to fluid administration. An increase in cardiac output (CO) after passive leg raising (PLR) has been demonstrated to be useful as a volume response predictor in non-surgical, spontaneously breathing patients. OBJECTIVE: The objective of this study was to evaluate the accuracy of transthoracic echocardiography after PLR to predict fluid responsiveness in post-surgical patients. DESIGN: A prospective observational study. SETTING: A tertiary hospital between January and July 2015. PATIENTS: Fifty-one spontaneously breathing postoperative patients with suspected hypovolaemia (arterial hypotension, oliguria, tachycardia or delayed capillary refill) were considered for the study. INTERVENTION: Demographic and personal data were collected, as well as heart rate variations, mean arterial pressure during PLR and after administering 500 ml of Ringer's lactate solution. CO was measured by transthoracic echocardiography. MAIN OUTCOME MEASURES: The primary outcome was measurement of CO before and after PLR and Ringer's lactate administration. RESULTS: Forty-one patients were included in the study (six patients were excluded because of a poor echocardiographic window and four because of misalignment of the Doppler and outflow tract of the left ventricle). Twenty-two patients (54%) were considered responders to fluid therapy, with an increase of stroke volume greater than or equal to 15% after 500 ml lactated Ringer's infusion. The highest area under the curve was found for an increase in CO (0.91 +/- 0.05; 95% confidence interval 0.78 to 0.97). An increase in CO greater than 11% after the PLR manoeuvre predicts a volume response with 68% sensitivity and 100% specificity. CONCLUSION: This is the first study showing that measurement of CO after PLR can predict volume response in spontaneously breathing postoperative patients. (C) 2017 European Society of Anaesthesiology

http://ift.tt/2tE0yhJ

Anaesthetic management of patients with myopathies.

: The anaesthetic management of patients with myopathies is challenging. Considering the low incidence and heterogeneity of these disorders, most anaesthetists are unfamiliar with key symptoms, associated co-morbidities and implications for anaesthesia. The pre-anaesthetic assessment aims at the detection of potentially undiagnosed myopathic patients and, in case of known or suspected muscular disease, on the quantification of disease progression. Ancillary testing (e.g. echocardiography, ECG, lung function testing etc.) is frequently indicated, even at a young patient age. One must differentiate between myopathies associated with malignant hyperthermia (MH) and those that are not, as this has significant impact on preoperative preparation of the anaesthesia workstation and pharmacologic management. Only few myopathies are clearly associated with MH. If a regional anaesthetic technique is not possible, total intravenous anaesthesia is considered the safest approach for most patients with myopathies to avoid anaesthesia-associated rhabdomyolysis. However, the use of propofol in patients with mitochondrial myopathies may be problematic, considering the risk for propofol-infusion syndrome. Succinylcholine is contra-indicated in all patients with myopathies. Following an individual risk/benefit evaluation, the use of volatile anaesthetics in several non-MH-linked myopathies (e.g. myotonic syndromes, mitochondrial myopathies) is considered to be well tolerated. Perioperative monitoring should specifically focus on the cardiopulmonary system, the level of muscular paralysis and core temperature. Given the high risk of respiratory compromise and other postoperative complications, patients need to be closely monitored postoperatively. (C) 2017 European Society of Anaesthesiology

http://ift.tt/2u7zCuo

Sialylation of IgG antibodies inhibits IgG-mediated allergic reactions

Publication date: Available online 18 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Alexandra Epp, Juliane Hobusch, Yannic C. Bartsch, Janina Petry, Gina-Maria Lilienthal, Carolien A.M. Koeleman, Simon Eschweiler, Christian Möbs, Ashley Hall, Suzanne C. Morris, Dominique Braumann, Christine Engellenner, Josephine Bitterling, Johann Rahmöller, Alexei Leliavski, Robina Thurmann, Mattias Collin, Kelley W. Moremen, Richard T. Strait, Véronique Blanchard, Arnd Petersen, Timo Gemoll, Jens K. Habermann, Frank Petersen, Andreas Nandy, Helga Kahlert, Michael Hertl, Manfred Wuhrer, Wolfgang Pfützner, Uta Jappe, Fred D. Finkelman, Marc Ehlers

Teaser

In presence of high allergen dosis besides IgE also IgG antibodies can induce allergic reactions, whose severity is dependent on the induced type of IgG Fc glycosylation, what should be considered for new AIT protocols containing new adjuvants.


http://ift.tt/2tDWD4x

Histamine H2 receptor stimulation up-regulates Th2 chemokine CCL17 production in human M2a macrophages

Publication date: Available online 18 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Susanne Mommert, Karl Gregor, Kristine Rossbach, Katrin Schaper, Torsten Witte, Ralf Gutzmer, Thomas Werfel

Teaser

Stimulation of the histamine H2 receptor significantly increased CCL17 production in human monocyte derived M2a macrophages. These results may be helpful to identify novel therapeutical target structures in diseases driven at least in part by histamine.


http://ift.tt/2u7WjPc

Prevalence of Primary Immunodeficiencies in France is underestimated

Publication date: Available online 18 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Nizar Mahlaoui, Jean-Philippe Jais, Pauline Brosselin, Cecile Mignot, Beatrice Beaurain, Carolina Brito, Laurence Costes, Virginie Courteille, Nathalie De Vergnes, Alexandre Alcaïs, Alain Fischer
Prevalence of PID has not been precisely determined. A field epidemiology study shows that prevalence of PIDs in registries is under-estimated and that minimal prevalence is 11 per 100,000 inhabitants instead of 8 per 100,000 inhabitants.



http://ift.tt/2tEoly2

Airway microbiota signals anabolic and catabolic remodeling in the transplanted lung

Publication date: Available online 18 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Stéphane Mouraux, Eric Bernasconi, Céline Pattaroni, Angela Koutsokera, John-David Aubert, Johanna Claustre, Christophe Pison, Pierre-Joseph Royer, Antoine Magnan, Romain Kessler, Christian Benden, Paola M. Soccal, Benjamin J. Marsland, Laurent P. Nicod
BackgroundHomeostatic turnover of the extracellular matrix conditions the structure and function of the healthy lung. In lung transplantation, long-term management remains limited by Chronic Lung Allograft Dysfunction (CLAD), an umbrella term used for a heterogeneous entity ultimately associated with pathological airway and/or parenchyma remodeling.ObjectiveTo assess whether the local cross-talk between the pulmonary microbiota and host cells is a key determinant in the control of lower airway remodeling post-transplantation.MethodsMicrobiota DNA and host total RNA were isolated from 189 bronchoalveolar lavages obtained from 116 patients post-lung transplantation. Expression of a set of 11 genes encoding either matrix components, or factors involved in matrix synthesis or degradation (anabolic and catabolic remodeling, respectively), was quantified by real-time quantitative PCR. Microbiota composition was characterized using 16S ribosomal RNA gene sequencing and culture.ResultsWe identified four host gene expression profiles, amongst which catabolic remodeling, associated with high expression of metallopeptidase-7, -9, and -12, diverged from anabolic remodeling linked to maximal thrombospondin and platelet-derived growth factor D expression. While catabolic remodeling aligned with a microbiota dominated by pro-inflammatory bacteria (e.g. Staphylococcus, Pseudomonas and Corynebacterium), anabolic remodeling was linked to typical members of the healthy steady state (e.g. Prevotella, Streptococcus and Veillonella). Mechanistic assays provided direct evidence that these bacteria can impact upon host macrophage-fibroblast activation and matrix deposition.ConclusionHost-microbes interplay potentially determines remodeling activities in the transplanted lung highlighting new therapeutic opportunities to ultimately improve long-term lung transplant outcome.

Teaser

The rate of matrix deposition varies with the microbial composition in the transplanted lung, potentially impacting upon graft survival.


http://ift.tt/2u88Odx

Subacute Granulation Tissue of the Fornix after Resorbable Orbital Implant: An Unusual Case and Review of the Literature

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1604069

Orbital blow-out fractures are very common. Goals of surgical treatment are to reestablish form and function with excellent cosmetic results. Materials used for orbital floor repair include autologous grafts and a variety of alloplastic materials. In this article, we present a case of subacute granulation tissue of the fornix that developed as a foreign body reaction 4 months after placing a resorbable implant to repair an orbital floor fracture. The implant was removed and the patient continued to heal uneventfully. Management of the case and biomaterials employed are discussed in light of current research.
[...]

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

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

http://ift.tt/2tE20AT

Fluid-Structure Finite-Element Modelling and Clinical Measurement of the Wideband Acoustic Input Admittance of the Newborn Ear Canal and Middle Ear

Abstract

The anatomical differences between the newborn ear and the adult one result in different input admittance responses in newborns than those in adults. Taking into account fluid-structure interactions, we have developed a finite-element model to investigate the wideband admittance responses of the ear canal and middle ear in newborns for frequencies up to 10 kHz. We have also performed admittance measurements on a group of 23 infants with ages between 14 and 28 days, for frequencies from 250 to 8000 Hz with 1/12-octave resolution. Sensitivity analyses of the model were performed to investigate the contributions of the ear canal and middle ear to the overall admittance responses, as well as the effects of the material parameters, measurement location and geometrical variability. The model was validated by comparison with our new data and with data from the literature. The model provides a quantitative understanding of the canal and middle-ear resonances around 500 and 1800 Hz, respectively, and also predicts the effects of the first resonance mode of the middle-ear cavity (around 6 kHz) as well as the first and second standing-wave modes in the ear canal (around 7.2 and 9.6 kHz, respectively), which may explain features seen in our high-frequency-resolution clinical measurements.

http://ift.tt/2uwCT7G

Quiz: Capnography for kids: unique considerations

By Sean Hulsman Airway control and ventilation in adults differs in many ways from airway control and ventilation in children. Anatomical layout and physiologic responses are not the same when oxygenating and ventilating kids. Read Capnography for kids: 5 applications for EMS providers to consider and take this quiz to test your knowledge.

http://ift.tt/2uAf12D

FOXA1 and CK14 as markers of luminal and basal subtypes in histologic variants of bladder cancer and their associated conventional urothelial carcinoma

Abstract

Invasive bladder cancer is diverse, and includes several named histomorphologies that differ from conventional urothelial carcinoma, termed "histologic variants." By transcriptional analysis, bladder cancers can be divided into luminal and basal subtypes. In this paper, we study associations between markers of transcriptional subtypes and variant histology in a retrospective cohort of 309 cystectomy specimens. Histology slides were methodically reviewed for all cases, and variant histology was documented. Immunohistochemistry for FOXA1 (luminal marker) and CK14 (basal maker) was performed on histologic variants and their associated conventional urothelial carcinomas. Invasive carcinoma was present in 270 of the cystectomy specimens, 35% of which contained a histologic variant. Squamous carcinomas expressed higher CK14 levels than micropapillary, nested, and plasmacytoid carcinomas (p < 0.001, Kruskal-Wallis), keeping with the basal character of squamous carcinoma. Likewise, squamous carcinomas expressed lower FOXA1 levels than micropapillary, nested, and plasmacytoid carcinomas (p < 0.001, Kruskal-Wallis), keeping with the luminal character of micropapillary carcinoma, and suggesting that nested and plasmacytoid cancers have luminal character. FOXA1 was expressed at lower levels in conventional urothelial carcinoma associated with squamous carcinoma than conventional urothelial carcinoma associated with micropapillary carcinoma (p = 0.0072, Wilcoxon rank sum). CK14 expression did not differ between conventional urothelial carcinomas associated with squamous versus micropapillary carcinoma (p = 0.89, Wilcoxon rank sum). Instead, CK14 expression was higher in squamous carcinoma than conventional urothelial carcinoma present in the same bladder (p = 0.014, Wilcoxon rank sum, paired). Overall, the findings show that squamous and micropapillary cancers have different expression patterns of CK14 and FOXA1 and suggest that they arise from distinct precursors.

http://ift.tt/2to6mB2

Fluid-Structure Finite-Element Modelling and Clinical Measurement of the Wideband Acoustic Input Admittance of the Newborn Ear Canal and Middle Ear

Abstract

The anatomical differences between the newborn ear and the adult one result in different input admittance responses in newborns than those in adults. Taking into account fluid-structure interactions, we have developed a finite-element model to investigate the wideband admittance responses of the ear canal and middle ear in newborns for frequencies up to 10 kHz. We have also performed admittance measurements on a group of 23 infants with ages between 14 and 28 days, for frequencies from 250 to 8000 Hz with 1/12-octave resolution. Sensitivity analyses of the model were performed to investigate the contributions of the ear canal and middle ear to the overall admittance responses, as well as the effects of the material parameters, measurement location and geometrical variability. The model was validated by comparison with our new data and with data from the literature. The model provides a quantitative understanding of the canal and middle-ear resonances around 500 and 1800 Hz, respectively, and also predicts the effects of the first resonance mode of the middle-ear cavity (around 6 kHz) as well as the first and second standing-wave modes in the ear canal (around 7.2 and 9.6 kHz, respectively), which may explain features seen in our high-frequency-resolution clinical measurements.

http://ift.tt/2uwCT7G

Blunt Traumatic Injury to the Aortic Root and Aortic Valve.

No abstract available

http://ift.tt/2tDpPsu

Opioid Reduction Following Interventional Procedures for Chronic Pain: A Synthesis of the Evidence.

The past decade has witnessed the tremendous growth of procedures to treat chronic pain, which has resulted in increased third-party scrutiny. Although most of these procedures appear to be associated with significant pain relief, at least in the short and intermediate term, their ability to improve secondary outcome measures, including function and work status is less clear-cut. One of these secondary outcome measures that has garnered substantial interest in the pain and general medical communities is whether interventions can reduce opioid intake, which is associated with significant risks that in most cases outweigh the benefits in the long term. In the article, we examine whether procedural interventions for chronic pain can reduce opioid intake. Most studies that have examined analgesic reduction as a secondary outcome measure have not separated opioid and nonopioid analgesics, and, among those studies that have, few have demonstrated between-group differences. Reasons for failure to demonstrate opioid reduction can be broadly classified into procedural, design-related, clinical, psychosocial, biological, and pharmacological categories, all of which are discussed. In the future, clinical trials in which this outcome is examined should be designed to evaluate this, at least on a preliminary basis. (C) 2017 International Anesthesia Research Society

http://ift.tt/2u7qUMM

Blood Product Utilization Among Trauma and Nontrauma Massive Transfusion Protocols at an Urban Academic Medical Center.

BACKGROUND: Hospital-wide massive transfusion protocols (MTPs) primarily designed for trauma patients may lead to excess blood products being prepared for nontrauma patients. This study characterized blood product utilization among distinct trauma and nontrauma MTPs at a large, urban academic medical center. METHODS: A retrospective study of blood product utilization was conducted in patients who required an MTP activation between January 2011 and December 2015 at an urban academic medical center. Trauma MTP containers included 6 red blood cell (RBC) units, 5 plasma units, and 1 unit of apheresis platelets. Nontrauma MTP containers included 6 RBC and 3 plasma units. RESULTS: There were 334 trauma MTP activations, 233 nontrauma MTP activations, and 77 nontrauma MTP activations that subsequently switched to a trauma MTP ("switched activations"). All nontrauma MTP activations were among bleeding patients who did not have a traumatic injury (100% [233/233]). Few patients with a nontrauma activation required ad hoc transfusion of RBC units (1.3% [95% confidence interval (CI), 0.3%-3.7%]) or plasma (3.4% [95% CI, 1.5%-6.7%]), and only 45.5% (95% CI, 39.0%-52.1%) required ad hoc transfusion of apheresis platelets. Compared to trauma and switched activations, nontrauma activations transfused a lower median number of RBC, plasma, and apheresis platelet units (P

http://ift.tt/2tDZk6i

Maternal Salvage With Extracorporeal Life Support: Lessons Learned in a Single Center.

The American Heart Association scientific statement on cardiac arrest in pregnancy did not endorse extracorporeal life support for lack of cohort data. We studied all pregnancy and peripartum cases of extracorporeal life support in 1 medical center (n = 11), including collapse due to infection (n = 6, 55%), thromboembolism (n = 3, 27%), and cardiac disease (n = 2, 18%). Half of the cases (n = 5, 45%) involved extracorporeal cardiopulmonary resuscitation. Most mothers survived (n = 7, 64% [95% confidence interval, 32%-88%]). Deaths were attributable to oxygenator blockage (n = 1) and late sepsis (n = 3). The 2 unique clinical challenges were maintenance of high peripartum cardiac outputs and balancing anticoagulation with hemostasis. (C) 2017 International Anesthesia Research Society

http://ift.tt/2u7e2Gk

High-Sensitivity Cardiac Troponin T Improves the Diagnosis of Perioperative MI.

BACKGROUND: The diagnosis of myocardial infarction (MI) after noncardiac surgery has traditionally relied on using relatively insensitive contemporary cardiac troponin (cTn) assays. We hypothesized that using a recently introduced novel high-sensitivity cTnT (hscTnT) assay would increase the detection rate of perioperative MI. METHODS: In this ancillary study of the Vitamins in Nitrous Oxide trial, readjudicated incidence rates of myocardial injury (new isolated cTn elevation) and MI were compared when diagnosed by contemporary cTnI versus hscTnT. We probed various relative (eg, >50%) or absolute (eg, +5 ng/L) hscTnT change metrics. Inclusion criteria for this ancillary study were the presence of a baseline and at least 1 postoperative hscTnT value. RESULTS: Among 605 patients, 70 patients (12%) had electrocardiogram changes consistent with myocardial ischemia; 82 patients (14%) had myocardial injury diagnosed by contemporary cTnI, 31 (5.1%) of which had an adjudicated MI. After readjudication, 67 patients (11%) were diagnosed with MI when using hscTnT, a 2-fold increase. Incidence rates of postoperative myocardial injury ranged from 12% (n = 73) to 65% (n = 393) depending on the hscTnT metric used. Incidence rates of MI using various hscTnT change metrics and the presence of ischemic electrocardiogram changes, but without event adjudication, ranged from 3.6% (n = 22) to 12% (n = 74), a >3-fold difference. New postoperative hscTnT elevation, either by absolute or relative hscTnT change metric, was associated with an up to 5-fold increase in 6-month mortality. CONCLUSIONS: The use of hscTnT compared to contemporary cTnI increases the detection rate of perioperative MI by a factor of 2. Using different absolute or relative hscTnT change metrics may lead to under- or overdiagnosis of perioperative MI. (C) 2017 International Anesthesia Research Society

http://ift.tt/2tDkYaU

Bispectral Index Measurements Are Not Degraded During Aeromedical Evacuations.

For a decade, depth of anesthesia monitoring has become a reality in the operating room. It provides valuable help for managing anesthesia, especially for unstable patients. This might be particularly relevant during aeromedical evacuation. In this study, we aimed to assess the validity of the bispectral index (BIS) during long-range patient transportation aboard fixed-wing aircraft. BIS was recorded in 30 patients, 25 under anesthesia and 5 awake, during aeromedical evacuations performed by the French Air Force. BIS index was available and analyzable (signal quality index above 50%) more than 90% of time. Despite potential pitfalls related to mechanical or electrical interference, BIS monitor can be reliably used to monitor depth of anesthesia during individual strategic aeromedical evacuations. (C) 2017 International Anesthesia Research Society

http://ift.tt/2u7aio9

Perioperative Fluid Management.

No abstract available

http://ift.tt/2tDHIHG

Organizational Contributors to the Variation in Red Blood Cell Transfusion Practices in Cardiac Surgery: Survey Results From the State of Michigan.

BACKGROUND: While large volumes of red blood cell transfusions are given to preserve life for cardiac surgical patients, indications for lower volume transfusions (1-2 units) are less well understood. We evaluated the relationship between center-level organizational blood management practices and center-level variability in low volume transfusion rates. METHODS: All 33 nonfederal, Michigan cardiac surgical programs were surveyed about their blood management practices for isolated, nonemergent coronary bypass procedures, including: (1) presence and structure of a patient blood management program, (2) policies and procedures, and (3) audit and feedback practices. Practices were compared across low (N = 14, rate: 0.8%-10.1%) and high (N = 18, rate: 11.0%-26.3%) transfusion rate centers. RESULTS: Thirty-two (97.0%) of 33 institutions participated in this study. No statistical differences in organizational practices were identified between low- and high-rate groups, including: (1) the membership composition of patient blood management programs among those reporting having a blood management committee (P= .27-1.0), (2) the presence of available red blood cell units within the operating room (4 of 14 low-rate versus 2 of 18 high-rate centers report that they store no units per surgical case, P= .36), and (3) the frequency of internal benchmarking reporting about blood management audit and feedback practices (low rate: 8 of 14 versus high rate: 9 of 18; P= .43). CONCLUSIONS: We did not identify meaningful differences in organizational practices between low- and high-rate intraoperative transfusion centers. While a larger sample size may have been able to identify differences in organizational practices, efforts to reduce variation in 1- to 2-unit, intraoperative transfusions may benefit from evaluating other determinants, including organizational culture and provider transfusion practices. (C) 2017 International Anesthesia Research Society

http://ift.tt/2u7da4r

Bendamustine-Induced Acute Generalized Exanthematous Pustulosis Confirmed by Patch Testing

No abstract available

http://ift.tt/2uAbctZ

Allergic Contact Dermatitis From Methylisothiazolinone in Residential Wall Paint

A 33-year-old woman presented to our clinic for suspected photoallergic contact dermatitis with a recent episode of severe, vesicular dermatitis involving exposed skin and correlating with relocation to a new home. Biopsy results showed spongiotic and lichenoid dermatitis with eosinophils. Patch test results showed a very strong (+++) reaction to methylisothiazolinone (MI), mild (+) reaction to MI/methylchloroisothiazolinone, and no reaction to benzisothiazolinone. These allergens were found in several personal products. However, the patient was suspicious of 4 wall paints recently used in her home. Semiopen patch tests to 3 Behr interior paints showed positive results. Nine controls showed negative results. High-performance liquid chromatography demonstrated MI and benzisothiazolinone in all 4 paints at concentrations ranging from 50 to 100 ppm and 290 to 340 ppm, respectively. Although MI has been reported to cause occupational airborne contact dermatitis in European household painters, to our knowledge, this is the first documented case of paint-related MI allergy in the United States.

http://ift.tt/2uzODpk

Contact Sensitization to Allergens in Nail Cosmetics

Abstract: Ingredients found in the nail cosmetic industry, including but not limited to methacrylate and acrylate monomers, formaldehyde, and toluene sulfonamide-formaldehyde resin, can incite allergic contact dermatitis. An eczematous outbreak presents on areas surrounding the nail plate and may spread through contact transfer of the allergen, commonly to the face and neck. Even components that were originally deemed nonsensitizing, such as the ubiquitous cyanoacrylate adhesive family, have been found to be allergenic. They do not, however, cross-react with methacrylates and acrylates. Alternative options for individuals with allergic contact dermatitis reactions to these ingredients can be avoidance of these procedures or use of products that are "3, 4, 5 free" in which the common allergens dibutyl phthalate, toluene, and formaldehyde are absent. In cases where strengthening of the nail is the sole purpose, nail wraps or preformed nails can be applied for non–cyanoacrylate-sensitive individuals.

http://ift.tt/2uAcmpp

SELF-ASSESSMENT

No abstract available

http://ift.tt/2vzspB7

Paternal vs. Maternal Factors in Childhood Atopic Dermatitis

Atopic dermatitis (AD) is a common inflammatory skin disease that chronically affects children and adults worldwide. Environmental exposures, heritable factors, immune dysregulation, and skin barrier malfunction all contribute to the multifactorial nature of AD. It is known that maternal and paternal influences are important predictors for the risk of AD in offspring. This review examines and compares the evidence and mechanisms behind specific maternal and paternal factors that may contribute to the pathogenesis of AD.

http://ift.tt/2vzhPtY

A Diabetic’s Allergy: Ethyl Cyanoacrylate in Glucose Sensor Adhesive

No abstract available

http://ift.tt/2vziziI

Positive Patch-Test Reactions to Essential Oils in Consecutive Patients From North America and Central Europe

Background: Synthetic fragrances and natural essential oils (EOs) are used in perfumery and found in various cosmetics. Essential oils are also increasingly used to promote wellness. In previous studies, the sensitization potential of some EOs has been identified; however, the current prevalence of sensitivity is largely unknown. Objectives: The aim of this study was to determine frequency of positive patch-test reactions to EOs tested in the baseline series, along with 3 fragrance markers (FMs) (fragrance mix I, fragrance mix II, and Myroxylon pereirae), in consecutive patients in the US/Canadian North American Contact Dermatitis Group (NACDG) (2009–2014) and the central European, trinational Information Network of Departments of Dermatology (IVDK) (2010–2014). Methods: This study used a retrospective analysis of patch-test results and relevant demographic/clinical data collected electronically by the networks, obtained with Santalum album 10% petrolatum (pet) (IVDK only); Cananga odorata 2% (NACDG) and 10% (IVDK) pet; Jasminum species 2% (NACDG) and 5% (IVDK) pet; Mentha piperita 2% pet; Melaleuca alternifolia, oxidized (tea tree oil), 5% pet; and Lavandula angustifolia 2% pet (latter 3 NACDG only). Results: Overall, 62,354 patients were tested to 3 FMs and EOs (NACDG, 13,398; IVDK, 48,956); 11,568 (18.6%) reacted to at least 1 FM or EO, whereas 857 (1.4%) reacted to 1 or more EOs but none of the 3 FMs. For both the NACDG and IVDK populations, individuals who were positive to 1 or more of the 9 study allergens were significantly less likely to be male, have occupational skin disease, or have hand involvement and significantly more likely to have leg dermatitis and be 40 years and older (P's ≤ 0.005). Prevalence rates for EOs were as follows: S. album, 1.4% IVDK; C. odorata, 1.1% NACDG and 2.4% IVDK; Jasminum species, 0.7% NACDG and 1.4% IVDK; M. piperita, 0.9% NACDG; L. angustifolia, 0.3% NACDG; and M. alternifolia, 0.3% NACDG. Of the 140 NACDG patients who reacted to 1 or more of the 5 NACDG EOs but none of the FMs, M. alternifolia yielded most positive reactions (45%); half of these reactions were strong (++ or +++, 50.8%) and of definite/probable clinical relevance (52.4%). Of the 717 IVDK patients who reacted to 1 or more of the 3 IVDK EOs but none of the 3 FMs, 38% were positive to C. odorata, 38% to S. album and 36% to Jasminum species. Conclusions: Testing to EOs may be important for detecting sensitivity not detected by FMs alone. In North America, M. alternifolia is an important and clinically relevant sensitizer often not detected by FM. In Europe, as well as in North America, clinical relevance is often difficult to evaluate because (1) labeling of EOs when used as fragrance is not mandatory, and (2) these mixtures may indicate sensitization to 1 or more of their individual constituents from other sources, including synthetic fragrances.

http://ift.tt/2vzHtiq

A Rare Case of Contact Urticaria and Allergic Contact Dermatitis to Maleic and Fumaric Acids

No abstract available

http://ift.tt/2vznSyR

Delayed Patch-Test Reading After 5 Days: An Update From the Mayo Clinic Contact Dermatitis Group

Background: Patch-test readings after day 5 have previously been used to identify delayed reactions to metals and topical antibiotics. Objective: The aims of this study were to identify allergens for which late readings (beyond day 5) would be most valuable and to compare our results with our previous study on delayed patch-test readings. Methods: This was a retrospective study of 298 patients who underwent metal and corticosteroid series patch testing from January 1, 2007, through December 31, 2013. Patch-test readings were conducted on days 3 and 5 and at least once sometime between days 7 and 14. All reactions were examined at each reading. Conclusions: These results were concordant with our previous findings that additional readings after day 7 are particularly useful for identifying reactions to metals (gold, cobalt, beryllium, palladium), specific preservatives (dodecyl gallate, propolis), and the topical antibiotic neomycin. New delayed reactions to bacitracin, p-phenylenediamine, and topical corticosteroids were not seen in this cohort.

http://ift.tt/2vzcx1q

Photographic Documentation and Hand Eczema Severity Index for Severity Assessment of Hand Eczema

Background: Hand eczema (HE) is a fluctuating disease, and an objective assessment of HE severity is coveted. Objectives: This study was undertaken to test the association between Hand Eczema Severity Index (HECSI) score and panel scores of photographs taken by dermatologists. Methods: A total of 33 patients with mild HE were included. The patients were part of an intervention study, and HECSI scores and standardized photographs were taken at baseline and at follow-up after 5 months. Actual change in HECSI score was compared with rating of change from photographs. A total of 15 dermatologists were engaged in blinded evaluation of photographs. Results: The highest correlation coefficients between delta HECSI scores and delta panel scores of photographs in the first and second evaluation rounds were found for moderate improvement and moderate worsening, rs = −0.46 (P = 0.009) and 0.52 (P = 0.003), respectively, and major worsening, r = 0.41 (P = 0.021). With respect to minor changes, no statistically significant correlations were found (P > 0.05). Conclusions: In patients with mild HE, photographic assessment was found useful for major and moderate changes only. Further studies would need to be performed in patients with moderate or severe HE, to evaluate whether clinical photographs are able to capture similar changes as HECSI scores.

http://ift.tt/2vzfCyM

Evaluation and Management of Patch Test-Negative Patients With Generalized Dermatitis

Background: Patients with generalized dermatitis are common in dermatology practices. Allergic contact dermatitis is often suspected, and patients frequently undergo patch testing. When the patch testing result is negative, further evaluation and management of these patients are challenging. Objective: The purpose of this study was to survey members of the American Contact Dermatitis Society regarding the evaluation and management of patch test–negative patients with generalized dermatitis. Results: Generalized dermatitis was the most common term identified for patch test–negative patients with diffuse dermatitis. After having negative expanded patch testing results, most physicians proceeded with additional testing including skin biopsy, complete blood cell count with differential, and liver and renal function tests. The most commonly used systemic treatment is prednisone, followed by methotrexate. Narrow-band ultraviolet B (UVB) is the most commonly used light source. Antihistamines are frequently prescribed. Food allergy is not felt to be causative. This cohort of patients experiences significant impairment in quality of life, stress on personal relationships, and time off work. Conclusions: The management of patch test–negative patients with generalized dermatitis is challenging. This study provides insight into management of these complex patients. It also demonstrates practice gaps in the management of these patients, indicating a need for further studies to direct the evaluation and management of this patient population.

http://ift.tt/2vzcZwL

Protein Contact Dermatitis to Suet

No abstract available

http://ift.tt/2vztRDw

A Survey Examining Photopatch Test and Phototest Methodologies of Contact Dermatologists in the United States: Platform for Developing A Consensus

Background: There is currently no standardized protocol for photopatch testing and phototesting in the United States. Certain testing paramaters (such as chemicals tested, time between test application and irradiation, and time of final interpretation) vary from provider to provider. These variations may impact comparability and consistency of test results. Objective: The goal of our survey-based study was to outline the photopatch test and phototest protocols used by US contact dermatologists. The information obtained will aid in the development of a national consensus on testing methodologies. Methods: Based on a literature search conducted on differences in testing methodologies, we constructed a questionnaire. The survey was distributed at the American Contact Dermatitis Society annual meeting and via the American Contact Dermatitis Society Web site. Standard descriptive analysis was performed on data obtained. Results: Of the 800 dermatologists contacted, 117 agreed to participate in the survey. Among these respondents, 64 (54.8%) conduct photopatch testing. Results of the survey are presented, and they confirm that a variety of techniques and testing materials are used. Conclusions: It would be beneficial to enlist a panel of expert contact dermatologists to create by formal consensus, using these research findings, a standard photopatch test protocol for use in this country.

http://ift.tt/2vzir2I

Contact Allergy to Salicylates and Cross-Reactions

No abstract available

http://ift.tt/2uAl8ng

Perianal Dermatitis

Background: Perianal complaints are often consulted in dermatology clinics, and in many cases, a conclusive diagnosis is not easily made. Objective: The aim of this study was to study and identify the epidemiological, clinical, and contact allergy features of patients with perianal dermatitis who attended at a contact dermatitis unit in a tertiary hospital in Spain. Methods: Adult patients with long-lasting (>4 weeks) perianal dermatitis were recruited during the past 10 years for investigation and follow-up. Every patient underwent a diagnostic workup consisting of dermatological exploration and patch tests with the standard and specific series, as well as the patients' own products. General surgical exploration was also performed in some patients. Results: One hundred twenty-four patients were included. The MOAHLFA index was as follows: 43.5, 0, 4.8, 11.3, 1.6, 8.1, and 75. The main final diagnoses were allergic contact dermatitis (32.3%), psoriasis (24.2%), irritant contact dermatitis (17.7%), and lichen simplex (neurodermatitis) (10%). Eighty-one patients (66.1%) showed 1 or more positive reactions, and in 52 patients (43%), positive reactions relevant to the present disease were found. Conclusions: Contact allergy in patients with long-lasting perianal complaints is frequent. It is mandatory for these patients to be referred to a dermatologist for an adequate evaluation and patch testing. Methylchloroisothiazolinone/methylisothiazolinone seems as the most common allergen implicated in perianal contact dermatitis.

http://ift.tt/2uAl5YC

Multifactorial Dermatitis With Probable Systemic Contact Dermatitis to Carmine

No abstract available

http://ift.tt/2vzfT4P

Eczema, Atopic Dermatitis, or Atopic Eczema: Analysis of Global Search Engine Trends

Background: The lack of standardized nomenclature for atopic dermatitis (AD) creates challenges for scientific communication, patient education, and advocacy. Objective: We sought to determine the relative popularity of the terms eczema, AD, and atopic eczema (AE) using global search engine volumes. Methods: A retrospective analysis of average monthly search volumes from 2014 to 2016 of Google, Bing/Yahoo, and Baidu was performed for eczema, AD, and AE in English and 37 other languages. Google Trends was used to determine the relative search popularity of each term from 2006 to 2016 in English and the top foreign languages, German, Turkish, Russian, and Japanese. Results: Overall, eczema accounted for 1.5 million monthly searches (84%) compared with 247 000 searches for AD (14%) and 44 000 searches for AE (2%). For English language, eczema accounted for 93% of searches compared with 6% for AD and 1% for AE. Search popularity for eczema increased from 2006 to 2016 but remained stable for AD and AE. Conclusions: Given the ambiguity of the term eczema, we recommend the universal use of the next most popular term, AD.

http://ift.tt/2vzv51C

Alkyl Glucosides: 2017 “Allergen of the Year”

No abstract available

http://ift.tt/2uA7XTv

Warning criteria for intraoperative neurophysiologic monitoring.

Purpose of review: Intraoperative changes in somatosensory (SEP) and motor evoked potentials (MEPs) may indicate potential injury to the spinal cord and will require timely intervention to prevent permanent damage. This review focuses on the validity of currently recommended warning criteria for intraoperative evoked potential monitoring. Recent findings: Current guideline recommends a decrease in SEP amplitude by 50% and MEP amplitude by 50-100% as warning signals for injury to the ascending sensory and descending motor pathway, respectively. On the basis of cohort studies, the diagnostic accuracy of SEP and MEP to predict postoperative neurologic deficits was variable. Importantly, 0.1-4.1% of monitored patients suffered postoperative neurologic deficit despite apparently normal SEP and MEP recordings (i.e. false negative events). These data suggested that the true warning criteria may be lower than previously acknowledged. A systematic review of studies that reported changes in SEP or MEP monitoring and postoperative neurological outcome showed an association between changes in monitoring signals and postoperative neurological deficits. However, the confidence intervals were wide and it is not possible to determine a threshold value in SEP or MEP amplitude beyond which may indicate neurologic deficit. Summary: Current recommendations for warning criteria during intraoperative evoked potential monitoring are empirically derived. Until a threshold that predicts spinal cord injury can be accurately determined, it remains difficult to define the clinical utility of intraoperative neurophysiologic monitoring. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2u5SUPi

Regional anesthesia in diabetic peripheral neuropathy.

Purpose of review: The aim of this review is to summarize recent relevant literature regarding regional anesthesia in the diabetic neuropathic patient and formulate recommendations for clinical practice. Recent findings: Diabetic neuropathic nerves, but not nerves of diabetic patients per se, exhibit complex functional changes. As a result, they seem more sensitive to local anesthetics, and are more difficult to stimulate. When catheters are used postoperatively, diabetes is an independent risk factor for infection. Summary: The pathophysiologic mechanisms underlying diabetic polyneuropathy are complex. Several pathways are thought to contribute to the development of diabetic neuropathy, triggered most importantly by chronic hyperglycemia. The latter induces inflammation and oxidative stress, causing microvascular changes, local ischemia and decreased axonal conduction velocity. Regional anesthesia is different in patients with diabetic neuropathy in several regards. First, the electric stimulation threshold of the nerve is markedly increased whereby the risk for needle trauma in stimulator-guided nerve blocks is theoretically elevated. Second, the diabetic nerve is more sensitive to local anesthetics, which results in longer block duration. Third, local anesthetics have been conjectured to be more toxic in diabetic neuropathy but the evidence is equivocal and should not be a cause to deny regional anesthesia to patients with a valid indication. Lastly, when peripheral nerve catheters are used, diabetes is an independent predisposing factor for infection. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2tmTCut

Acupuncture for chronic pain: an update and critical overview.

Purpose of review: Acupuncture is now recommended for several chronic pain conditions. Despite supportive evidence of its effectiveness, this ancient approach is often misunderstood, and may still be underused in mainstream practice. A critical review on its effectiveness and practice integration, and mechanisms of action is essential to the medical community that is continuing to seek nonopioid therapies for chronic pain. Recent findings: Mounting evidence supports the effectiveness of acupuncture to treat chronic low back, neck, shoulder, and knee pain, as well as headaches. Additional data are emerging that support the use of acupuncture as an adjunct or alternative to opioids, and in perioperative settings. Findings related to its mechanisms of action include transient receptor potential cation channel vanilloid 1 activation in the periphery, microglial suppression in the cerebral cortex and spinal cord, and regulation of cytokines and other key inflammatory factors in the spinal cord. Incremental integration of acupuncture into pain medicine practices and training programmes continues to grow. Summary: Acupuncture is effective, safe, and cost-effective for treating several chronic pain conditions when performed by well-trained healthcare professionals. Further studies on its use as an adjunct or alternative to opioids, and in perioperative settings are needed. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2u5D3QI

Coagulation management in patients undergoing neurosurgical procedures.

Purpose of review: Management of coagulation in neurosurgical procedures is challenging. In this contest, it is imperative to avoid further intracranial bleeding. Perioperative bleeding can be associated with a number of factors, including anticoagulant drugs and coagulation status but is also linked to the characteristic and the site of the intracranial disorder. The aim of this review will be to focus primarily on the new evidence regarding the management of coagulation in patients undergoing craniotomy for neurosurgical procedures. Recent findings: Antihemostatic and anticoagulant drugs have shown to be associated with perioperative bleeding. On the other hand, an increased risk of venous thromboembolism and hypercoagulative state after elective and emergency neurosurgery, in particular after brain tumor surgery, has been described in several patients. To balance the risk between thrombosis and bleeding, it is important to be familiar with the perioperative changes in coagulation and with the recent management guidelines for anticoagulated patients undergoing neurosurgical procedures, in particular for those taking new direct anticoagulants. We have considered the current clinical trials and literature regarding both safety and efficacy of deep venous thrombosis prophylaxis in the neurosurgical population. These were mainly trials concerning both elective surgical and intensive care patients with a poor grade intracranial bleed or multiple traumas with an associated severe traumatic brain injury (TBI). Summary: Coagulation management remains a major issue in patients undergoing neurosurgical procedures. However, in this field of research, literature quality is poor and further studies are necessary to identify the best strategies to minimize risks in this group of patients. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2tnf3ex

Role of regulatory T cells in acute myeloid leukemia patients undergoing relapse-preventive immunotherapy

Abstract

Regulatory T cells (T_regs) have been proposed to dampen functions of anti-neoplastic immune cells and thus promote cancer progression. In a phase IV trial (Re:Mission Trial, NCT01347996, http://ift.tt/PmpYKN) 84 patients (age 18–79) with acute myeloid leukemia (AML) in first complete remission (CR) received ten consecutive 3-week cycles of immunotherapy with histamine dihydrochloride (HDC) and low-dose interleukin-2 (IL-2) to prevent relapse of leukemia in the post-consolidation phase. This study aimed at defining the features, function and dynamics of Foxp3⁺CD25^highCD4⁺ T_regs during immunotherapy and to determine the potential impact of T_regs on relapse risk and survival. We observed a pronounced increase in T_reg counts in peripheral blood during initial cycles of HDC/IL-2. The accumulating T_regs resembled thymic-derived natural T_regs (nT_regs), showed augmented expression of CTLA-4 and suppressed the cell cycle proliferation of conventional T cells ex vivo. Relapse of AML was not prognosticated by T_reg counts at onset of treatment or after the first cycle of immunotherapy. However, the magnitude of T_reg induction was diminished in subsequent treatment cycles. Exploratory analyses implied that a reduced expansion of T_regs in later treatment cycles and a short T_reg telomere length were significantly associated with a favorable clinical outcome. Our results suggest that immunotherapy with HDC/IL-2 in AML entails induction of immunosuppressive T_regs that may be targeted for improved anti-leukemic efficiency.

http://ift.tt/2vfinpE

CT and MRI features in adult patients with orbital subperiosteal abscess secondary to paranasal sinus mucocele

Chang-Wei Ding, MD; Qiu-Shi Wang, MS; Qi-Yong Guo, MD; Jun Zhang, MD; Zhen-Hai Wang, MD

Abstract

Orbital subperiosteal abscess (OSPA) secondary to paranasal sinus mucocele (PSM) is rare, and it may be misdiagnosed as PSM with orbital invasion or even as a malignant neoplasm. The present study explored the computed tomography (CT) and magnetic resonance imaging (MRI) features of OSPA. The cases of 13 patients with OSPA secondary to PSM were retrospectively reviewed. CT had been performed in 12, MRI in 7, and postcontrast MRI in 4. OSPA was revealed as a well-demarcated, spindle-shaped mass that was broad-based and located beneath the superior orbital wall (orbital roof) in 11 and at the medial wall in 2. PSM appeared as an expansile cystic lesion in the ethmofrontal sinus in 7, frontal sinus in 5, and ethmoidal sinus in 1. Because the OSPA was connected to the PSM, it looked like a single lesion involving both the orbit and the sinus. All 12 OSPAs examined on CT were low-density; 9 of the 12 PSMs were low-density and 3 were iso-density. Densities of the OSPAs and PSMs were equal in 4 and slightly different in 8. Five of the 10 OSPAs occurring beneath the orbital roof had unclear boundaries with the PSMs on CT. On MRI, although both OSPAs and PSMs mainly demonstrated hypointensity on T1-weighted images and hyperintensity on T2-weighted images, the signal intensities were slightly different, and linear-shaped hypointensity could be found between them. Postcontrast MRI revealed arch- and ring-shaped enhancement, respectively, at the edge of the OSPA and the PSM. Septal enhancement separated them more clearly. PSM is an important cause of OSPA in adults. CT and MRI can accurately display these entities' characteristic findings and their anatomic relationship, as well as playing an important role in the differential diagnosis.

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Prospective, randomized, controlled trial using best-selling smoking-cessation book

James P. Foshee, MD; Anita Oh, MD; Adam Luginbuhl, MD; Joseph Curry, MD; William Keane, MD; David Cognetti, MD

Abstract

Our prospective, randomized, controlled trial aimed to evaluate the efficacy of the self-help book, The Easy Way to Stop Smoking, by Allen Carr, in promoting smoking cessation in patients with head and neck cancer. We assessed active smokers for their willingness to read a smoking cessation book. Participants were randomized to either receive the book from our department or recommended to purchase the book. All patients received smoking cessation counseling at recruitment. Phone surveys were conducted at short- and long-term intervals to determine if the patients had purchased and/or read the book and whether they were still smoking. One hundred twelve patients were recruited, 52 of whom completed follow-up surveys. Those who received the book for free were more likely to read the book (p = 0.05). Reading the book did not correlate with successful smoking cessation (p = 0.81). Some 26% of the 27 patients who received the book quit smoking compared with 32% of the 25 patients who were recommended the book (p = 0.76). Patients who indicated motivation to quit smoking were more likely to succeed. In our study, smoking cessation did not appear to be influenced by reading The Easy Way to Stop Smoking. Despite 80.8% of the cohort indicating at least a readiness to quit smoking at recruitment, only 28.8% of patients managed to achieve successful smoking cessation at long-term follow-up. Patient motivation remains an important factor in achieving long-term smoking abstinence. Quitting smoking remains a daunting challenge for patients, with multiple interventions likely needed to achieve cessation.

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The Sophono bone-conduction system: Surgical, audiologic, and quality-of-life outcomes

Timothy Mclean, MBBS; Irumee Pai, FRCS; Andrew Philipatos, BSc; Michael Gordon, FRACS

Abstract

We prospectively evaluated the surgical, audiologic, and quality-of-life outcomes in 5 patients-2 men and 3 women, aged 22 to 64 years (mean: 41.8)-who were implanted with the Sophono Alpha 2 MPO Processor. The indications for implantation of this bone-conduction device included recurrent ear canal infections with hearing aids (n = 3), single-sided deafness (n = 1), and patient preference in view of difficulty using a conventional hearing aid (n = 1). In addition to the patient with single-sided deafness, 3 patients had a bilateral mixed hearing loss and 1 had a bilateral conductive hearing loss. Outcomes measures included surgical complications, functional gain (FG), speech discrimination in quiet and noise, and patient satisfaction as determined by the Glasgow Benefit Inventory (GBI) and the Entific Medical Systems bone-anchored hearing aid questionnaire (BAQ). The only postsurgical complication noted was a minor skin reaction and pain in 1 patient that resolved with conservative management. In the 3 patients with the mixed hearing loss, the mean FG was 13.3, 20.0, 11.7, and 11.7 dB at 0.5, 1, 2, and 4 kHz, respectively; in the patient with the bilateral conductive hearing loss, the FG was 10, 25, 10, and 15 dB at the same frequencies. Speech discrimination scores with the Sophono device were comparable to those seen with conventional hearing aids. After implantation, all 5 patients experienced a positive quality-of-life outcome according to the GBI, although 1 of them had only a marginal improvement. On follow-up, all patients reported that they remained satisfied with their implant and that they used their device all day long. We conclude that the Sophono bone-conduction system is a safe and effective option that should be considered for patients with a mixed or conductive hearing loss who are unable to use a conventional hearing aid, as well as for those with single-sided deafness.

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Long-term recurrence-free survival after an unplanned reduction in radiotherapy for HPV-positive oropharyngeal SCC: Two cases and a review of the literature

Jason Liu, BS; David Goldenberg, MD; Salah Almokadem, MD; Henry Crist, MD; Heath B. Mackley, MD, FACRO

Abstract

There is currently no clear distinction between the treatment of HPV-positive and HPV-negative oropharyngeal squamous cell carcinoma (OPSCC). HPV-positive OPSCC has been demonstrated to be more radiosensitive than its HPV-negative counterpart. Despite this, patients with HPV-positive OPSCC continue to receive a full dose of radiation (70 Gy) outside clinical trials. However, this high dose comes with considerable morbidities, including severe mucositis, dysphagia, and xerostomia. We describe the cases of 2 patients with HPV-positive OPSCC who received two cycles of high-dose cisplatin at 100 mg/m2 on 3 separate days, along with concurrent radiotherapy at 50 Gy in 25 fractions for one and 46 Gy in 23 fractions for the other. During treatment, both patients experienced significant acute-phase toxicities-including grade 3 mucositis, grade 3 nausea, and grade 2 dermatitis-and their treatment regimen was stopped before its planned completion. Nevertheless, after a follow-up of 75 and 78 months, respectively, neither patient exhibited any evidence of disease. Late toxicities included grade 1 xerostomia, grade 1 pharyngeal-phase dysphagia, and grade 1 dysgeusia with some foods. We conclude that de-escalating the dose of radiation for HPV-positive patients by 30% and identifying which patients can safely be treated with this level of dose reduction warrants further study.

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Cochlear implant electrode array exposure: A delayed complication

Christina Mishu, AuD; David A. Klodd, PhD; Miriam Redleaf, MD, FACS

Abstract

Exposure of the cochlear implant electrode array as a late complication has been reported rarely in the literature. A retrospective analysis revealed 4 patients presenting with exposure of their cochlear implant electrode arrays from 2 to 17 years after implantation. Data collected from these 4 patients were surgical implantation approach, type of implant, age at implant, interval between implant and complication, surgical correction of the problem, pathology at the time of correction, and length of follow-up after intervention. All 4 patients presented with otitis or mastoiditis. Each had undergone a transmastoid approach with facial recess and cochleostomy and full implant insertion. In 3 cases, the tympanic membrane had retracted to expose the electrode array. In 1 patient, the electrode array had eroded through the external canal, lateral to the facial recess. The exposed arrays were addressed surgically, including explantation/reimplantation for 1 patient. Cochlear implant electrode arrays can become exposed by relative migration of the array and the tympanic membrane. Implant surgeons and audiologists need to be aware of the possibility of this complication. Closure of the ear canal appears to be the most effective surgical intervention.

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Choanal polyp originating from the superior meatus: An endoscopic view

Jae Hoon Lee, MD

In most cases, a choanal polyp is identified as an ipsilateral polypoid mass on endoscopy. Therefore, the main symptom of CP is unilateral nasal obstruction.

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Thyrocervical trunk pseudoaneurysm presenting as a neck mass

Taha A. Mur, BS; Mursalin M. Anis, MD, PhD; Ahmed M. Soliman, MD

The typical "yin-yang" appearance of a pseudoaneurysm on ultrasound is readily identified.

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Lymph-node-positive cutaneous nonmelanoma skin cancer: A poor-prognosis disease in need of treatment intensification

Lora S. Wang, MD; Elizabeth A. Handorf, PhD; John A. Ridge, MD, PhD; Barbara A. Burtness, MD; Miriam N. Lango, MD; Ranee Mehra, MD; Jeffrey C. Liu, MD; Thomas J. Galloway, MD

Abstract

Locoregionally advanced nonmelanoma skin cancer (NMSC) has an aggressive clinical course characterized by high rates of treatment failure and poor survival compared with localized skin cancers. Our goal was to investigate multimodal therapy for lymph-node-positive NMSC. Data from patients with lymph-node-positive NMSC who underwent surgery and adjuvant therapy at a single tertiary center from 2002 to 2012 were retrospectively reviewed. Median follow-up was 1.8 years (range: 0.5 to 8.5). Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method. The chi-square test and logistic regression were used to determine the association between locoregional control (LRC) and the following variables: evidence of extracapsular extension, number of lymph nodes positive, largest involved lymph node, presence of a positive margin, and use of concurrent chemoradiation (CRT). Forty-six patients were evaluated, 13 (28%) of whom received adjuvant CRT. CRT patients were younger (p < 0.001) and had a significantly greater number of positive lymph nodes (p = 0.016) than patients who received adjuvant radiation alone. At 5 years, LRC was 76%, PFS was 65%, and OS was 49%. Univariate analysis demonstrated that CRT (p = 0.006), largest lymph node measurement (p = 0.039), and ≥3 involved lymph nodes (p = 0.001) predicted local recurrence. CRT (p = 0.035, odds ratio [OR] 0.20 [95% confidence interval 0.05 to 0.90]) and ≥3 involved lymph nodes (p = 0.017, OR 0.07 [95% confidence interval 0.01 to 0.62]) remained significant on multivariate analysis. CRT was well tolerated. No grade ≥3 toxicities were observed except for 1 asymptomatic grade-4 thrombocytopenia. Patients with lymph-node-positive NMSC do poorly. Patient selection for intensification of adjuvant therapy needs clarification.

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An embedded earring backing in the tragus

Ta-Chin Wang, MD; Kai-Chieh Chan, MD

If signs of infection occur, the earring(s) should be removed and antiseptics or antibiotics applied.

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Lobular capillary hemangioma (pyogenic granuloma) of the oral cavity

Lester D. Thompson, MD

The most common site is the anterior maxillary gingiva, while posterior, mandibular, and facial gingiva may also be affected.

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Soft tissue profile changes after Functional Mandibular Advancer or Herbst appliance treatment in class II patients

Abstract

Objective

The objective of the present study is to compare the effects on soft tissue profile in class II patients after treatment with either "Functional Mandibular Advancer" (FMA) or Herbst appliance.

Materials and methods

The study included n = 42 patients treated with either FMA (n = 21) or Herbst appliance (n = 21) by the same experienced orthodontist. The treatment followed a single-step advancement protocol. Lateral cephalograms were analyzed through a set of customized measurements. The actual therapeutic effect was calculated using data from a growth survey. After testing for normal distribution and homogeneity of variance, data were analyzed by one-sample Student's t tests and independent Student's t tests. Statistical significance was set at p < 0.05.

Results

For both FFAs, significant upper lip retrusion, increase in lower lip's thickness, and length of the lower face occurred. Additionally, significant lower lip retrusion and straightening of the profile were found in FMA and Herbst appliance patients. All remaining variables revealed no significant differences.

Conclusions

Treatment-related changes on the facial soft tissue profile could be regarded similar in class II patients treated with FMA or Herbst appliance. No treatment-related changes that were specific for FMA or Herbst appliance could be identified. Only moderate changes were noted comparing pre- and posttreatment soft tissue profiles.

Clinical relevance

Despite proven differences in skeletal and dental treatment effects, the facial profile has not to be taken into consideration when choosing between FMA and Herbst appliance for class II treatment.

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Quality in pathology

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Immersive virtual reality as a teaching tool for neuroanatomy

Background

Three-dimensional (3D) computer modeling and interactive virtual reality (VR) simulation are validated teaching techniques used throughout medical disciplines. Little objective data exists supporting its use in teaching clinical anatomy. Learner motivation is thought to limit the rate of utilization of such novel technologies. The purpose of this study is to evaluate the effectiveness, satisfaction, and motivation associated with immersive VR simulation in teaching medical students neuroanatomy.

Methods

Images of normal cerebral anatomy were reconstructed from human Digital Imaging and Communications in Medicine (DICOM) computed tomography (CT) imaging and magnetic resonance imaging (MRI) into 3D VR formats compatible with the Oculus Rift VR System, a head-mounted display with tracking capabilities allowing for an immersive VR experience. The ventricular system and cerebral vasculature were highlighted and labeled to create a focused interactive model. We conducted a randomized controlled study with 66 medical students (33 in both the control and experimental groups). Pertinent neuroanatomical structures were studied using either online textbooks or the VR interactive model, respectively. We then evaluated the students' anatomy knowledge, educational experience, and motivation (using the Instructional Materials Motivation Survey [IMMS], a previously validated assessment).

Results

There was no significant difference in anatomy knowledge between the 2 groups on preintervention, postintervention, or retention quizzes. The VR group found the learning experience to be significantly more engaging, enjoyable, and useful (all p < 0.01) and scored significantly higher on the motivation assessment (p < 0.01).

Conclusion

Immersive VR educational tools awarded a more positive learner experience and enhanced student motivation. However, the technology was equally as effective as the traditional text books in teaching neuroanatomy.

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Cernunnos deficiency associated with BCG adenitis and autoimmunity: First case from the national Iranian registry and review of the literature

Publication date: Available online 17 July 2017
Source:Clinical Immunology
Author(s): Reza Yazdani, Hassan Abolhassani, Javad Tafaroji, Gholamreza Azizi, Raif S. Geha, Asghar Aghamohammadi
Non-homologous end-joining (NHEJ) is a pathway that repairs double-strand breaks (DSB) in DNA and plays a vital role in V(D)J recombination of immunoglobulin genes. Cernunnos is a DNA repair factor that is involved in nonhomologous end-joining (NHEJ) process. Impairment in Cernunnos leads to a genetic disease characterized by neural disorders, immunodeficiency and increased radiosensitivity. We herein describe a severe combined immunodeficiency (SCID) patient with T- B+ phenotype who had a mutation in Cernunnos gene and manifested recurrent infections, microcephaly and growth retardation with hypogammaglobulinemia. Furthermore, our patient was associated with BCG adenitis and autoimmunity that less is observed in patients with Cernunnos deficiency. In contrast to previous reported Cernunnos-deficient patients, our patient had normal B-cell number along with normal IgA and IgM, suggesting a leaky form of the Cernunnos deficiency due to residual count of B cells in our patient. Cernunnos deficiency should be considered in children with recurrent bacterial infections, microcephaly and growth retardation, in spite of having normal B-cell as well as normal IgM and IgA level.



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Water protection after tympanostomy (Shepard) tubes does not decrease otorrhea incidence – retrospective cohort study

Publication date: Available online 17 July 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): João Subtil, Ana Jardim, Andre Peralta Santos, João Araújo, José Saraiva, João Paço
IntroductionMyringotomy for tube insertion is the most common otologic surgery. Otorrhea is a frequent complication of this procedure and, to prevent it, most surgeons strongly recommend avoiding contact with water as this is thought to adversely impact on post-operative quality of life.ObjectiveTo understand the benefit of this recommendation.MethodsObservational study – retrospective cohort study comparing the incidence of post-operative otorrhea and its impact on patients' quality of life, in two groups of patients comprising children under 10 years of age who underwent bilateral myringotomy and tube placement for chronic otitis media with effusion between May 2011 and May 2012. One group received water protection care after surgery, the other did not. Data was collected through telephonic interview, after one year of follow up (one year after the procedure). Water exposure without protection was considered the exposure event. Incidence of otorrhea and perceived impact on quality of life were the outcome measures. Results were compared after logistic regression.ResultsWe included 143 children: 116 were not exposed to water without protection and 27 were exposed. In the not exposed group 36.2% had at least one episode of otorrhea, compared to 40.0% of the exposed group. Odds ratio for otorrhea on exposed was 1.21 (95% CI 0.51–2.85, p=0.6). Negative impact on quality of life was reported by parents of 48.2% on the not exposed children, compared to 40.7% on the exposed group. This difference was not significant (p=0.5).ConclusionWe found that recommending water protection did not have beneficial effect on the incidence of otorrhea after myringotomy with tubes on chronic otitis media with effusion. However, such measures did not appear to have a negative impact on quality of life.



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Giant fronto-ethmoidal osteoma – selection of an optimal surgical procedure

Publication date: Available online 17 July 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Maria Humeniuk-Arasiewicz, Grażyna Stryjewska-Makuch, Małgorzata Janik, Bogdan Kolebacz
IntroductionOsteomas of the paranasal sinuses are benign bone tumours that produce clinical signs depending on their size and location. In most reported cases large tumours are excised by an external approach or in conjunction with an endoscopic technique. Endoscopic treatment of such tumours is a huge challenge for the operator.ObjectiveDetermine the optimal surgical approach by analysing giant osteomas of the frontal and ethmoidal sinuses in the literature.MethodsGroup of 38 osteomas obtained from the literature review. A group of osteomas removed only by endoscopy was compared with a group in which an external approach (lateral rhynotomy or craniotomy) or combined external and endoscopic approach was applied.ResultsThe authors, based on the statistical analysis of the literature data, have found that the average size of osteomas excised endoscopically and those removed by external approaches does not differ statistically, when the osteomas are located in the ethmoidal cells (p=0.2691) and the frontal sinuses (p=0.5891).ConclusionThe choice of surgical method appears to be independent of the osteoma size and the decision is likely to be taken based on the experience of the surgeon, available equipment and knowledge of different surgical techniques.



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Bacteriology of peritonsillar abscess: the changing trend and predisposing factors

Publication date: Available online 17 July 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Yi-Wen Tsai, Yu-Hsi Liu, Hsing-Hao Su
IntroductionPeritonsillar abscess (PTA) is the most common deep neck infection. The infectious microorganism may be different according to clinical factors.ObjectiveTo identify the major causative pathogen of peritonsillar abscess and investigate the relationship between the causative pathogen, host clinical factors, and hospitalization duration.MethodsThis retrospective study included 415 hospitalized patients diagnosed with peritonsillar abscess who were admitted to a tertiary medical center from June 1990 to June 2013. We collected data by chart review and analyzed variables such as demographic characteristics, underlying systemic disease, smoking, alcoholism, betel nut chewing, bacteriology, and hospitalization duration.ResultsA total of 168 patients had positive results for pathogen isolation. Streptococcus viridans (28.57%) and Klebsiella pneumoniae (23.21%) were the most common microorganisms identified through pus culturing. The isolation rate of anaerobes increased to 49.35% in the recent 6 years (p=0.048). Common anaerobes were Prevotella and Fusobacterium spp. The identification of K. pneumoniae increased among elderly patients (age>65 years) with an odds ratio (OR) of 2.76 (p=0.03), and decreased in the hot season (mean temperature>26°C) (OR=0.49, p=0.04). No specific microorganism was associated with prolonged hospital stay.ConclusionThe most common pathogen identified through pus culturing was S. viridans, followed by K. pneumoniae. The identification of anaerobes was shown to increase in recent years. The antibiotics initially selected should be effective against both aerobes and anaerobes. Bacterial identification may be associated with host clinical factors and environmental factors.



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Histopathological comparison of bone healing effects of endonasal and percutaneous lateral osteotomy methods in rabbit rhinoplasty model

Publication date: Available online 17 July 2017
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Şahin Öğreden, Sedat Rüzgar, Hasan Deniz Tansuker, Ümit Taşkın, Yalcin Alimoglu, Salih Aydın, Mehmet Faruk Oktay, Uğur İzol
IntroductionLateral osteotomy is mainly performed either endonasally or percutaneously in rhinoplasty which is a frequently performed operation for the correction of nasal deformities. Both techniques have both advantages and disadvantages relative to each other.ObjectiveThe aim of this study was to compare the histopathological effects of endonasal and percutaneous osteotomy techniques performed in rhinoplasty on bone healing and nasal stability in an experimental animal model.MethodsEight one year-old New Zealand white rabbits were included. Xylazine hydrocloride and intramuscular ketamine anesthesia were administered to the rabbits. Endonasal osteotomy (8 bones) was performed in Group 1 (n=4), and percutaneous osteotomy (8 bones) in Group 2 (n=4). One month later the rabbits were sacrificed. Bone healing of the rabbits was staged according to the bone healing score of Huddleston et al. In both groups, nasal bone integrity was assessed subjectively.ResultsIn the percutaneous osteotomy group, Grade 1 bone healing was observed in two samples (25%), Grade 2 bone healing in two samples (25%), Grade 3 bone healing in four samples (50%). In the endonasal osteotomy group, Grade 1 bone healing was observed in 6 samples (75%) and Grade 2 bone healing was observed in 2 samples (25%). In the percutaneous group, fibrous tissue was observed in 2, predominantly fibrous tissue and a lesser amount of cartilage was observed in 2 and an equal amount of fibrous tissue and cartilage was observed in 4 samples. In the endonasal group, fibrous tissue was observed in 6 samples, and predominantly fibrous tissue with a lesser amount of cartilage was observed in 2 samples. In both groups, when manual force was applied to the nasal bones, subjectively the same resistance was observed.ConclusionPercutaneous lateral osteotomy technique was found to result in less bone and periost trauma and better bone healing compared to the endonasal osteotomy technique.



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Computational validation of the recently proposed pollen season definition criteria

Abstract

In a recently published paper (Pfaar et al., 2016), a Task Force of the Immunotherapy and Aerobiology and Pollution Interest Groups of the EAACI suggested specific criteria for the definition of pollen exposure times for three types of pollen events: (a) Pollen Season (PS) start and end, (b) high pollen season (or Peak Pollen Period-PPP) start and end, and (c) high pollen days. Species addressed included Birch, Grasses, Cypress, Olive, and Ragweed. Two important questions arise from the aforementioned definitions: (i) do they lead to a narrow (thus well defined) time interval identifying start and end event dates (robustness of the criteria) and (ii) if slightly altered, will they result to a narrow (thus again well defined) fluctuation of start and end event dates (sensitivity of the criteria)? In an effort to provide with responses to aforementioned questions, we analyzed Poaceae pollen count data coming from Germany (up to 40 pollen monitoring stations, years 2012-2016). The analysis addressed all pollen events for the first question, and focused on the PS and PPP start and end events for the second question.

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Long term effects: Galectin-1 and specific immunotherapy for allergic responses in the intestine

Abstract

Background and aims

Mast cell activation interferes with the effects of allergen-specific immunotherapy (SIT). Galectin-1 (Gal-1) is capable of regulating immune cells' functions. This study tests the hypothesis that administration of Gal-1 promotes and prolongs the efficacy of SIT via suppressing mast cell activation.

Methods

An intestinal allergy mouse model was developed. The co-administration of SIT and Gal-1 on suppression of the allergic responses, prevention of mast cell activation, and generation of antigen-specific regulatory T cells (Treg) in the intestine were observed in sensitized mice.

Results

The coadministration of Gal-1 and SIT markedly suppressed the allergic responses in the mouse intestine vs. the use of either SIT alone or Gal-1 alone. The Gal-1 binds to the IgE/FcɛRI complexes on the surface of mast cells to prevent mast cell activation during SIT. Gal-1 promoted the SIT-generated allergen-specific Tregs in the intestine of sensitized mice. Coadministration of Gal-1 and SIT significantly enhanced the efficacy of immunotherapy in suppressing allergic responses in the intestine, which lasted for at least for 12 months.

Conclusions

Long term effects of specific immunotherapy on intestinal allergy can be achieved with Gal-1/SIT therapy by inhibiting mast cell activation and facilitating Treg development.

This article is protected by copyright. All rights reserved.

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Health Economic Analysis of Allergen Immunotherapy (AIT) for the Management of Allergic Rhinitis, Asthma, Food Allergy and Venom Allergy: A Systematic Overview

Abstract

Background

The European Academy of Allergy and Clinical Immunology (EAACI) is developing guidelines for allergen immunotherapy (AIT) for the management of allergic rhinitis, allergic asthma, IgE-mediated food allergy and venom allergy. To inform the development of clinical recommendations, we undertook systematic reviews to critically assess evidence on the effectiveness, safety and cost-effectiveness of AIT for these conditions. This paper focusses on synthesizing data and gaps in the evidence on the cost-effectiveness of AIT for these conditions.

Methods

We produced summaries of evidence in each domain and then synthesized findings on health economic data identified from four recent systematic reviews on allergic rhinitis, asthma, food allergy and venom allergy, respectively. The quality of these studies were independently assessed using the Critical Appraisal Skills Programme (CASP) tool for health economic evaluations.

Results

23 studies satisfied our inclusion criteria. Of these, 19 studies investigated the cost-effectiveness of AIT in allergic rhinitis, of which seven were based on data from randomized controlled trials with economic evaluations conducted from a health system perspective. This body of evidence suggested that sublingual immunotherapy (SLIT) and subcutaneous immunotherapy (SCIT) would be considered cost-effective using the (English) National Institute for Health and Clinical Excellence (NICE) cost-effectiveness threshold of £20,000/quality adjusted life year (QALY). However, the quality of the studies and the general lack of attention to characterizing uncertainty and handling missing data should be taken into account when interpreting these results. For asthma, there were three eligible studies, all of which had significant methodological limitations; these suggested that SLIT, when used in patients with both asthma and allergic rhinitis, may be cost-effective with an incremental cost-effectiveness ratio (ICER) of £10,726 per QALY. We found one economic modelling study for venom allergy which, despite being based largely on expert opinion and plausible assumptions, suggested that AIT for bee and wasp venom allergy is only likely to be cost-effective for very high risk groups who may be exposed to multiple exposures to venom/year (e.g., bee keepers). We found no eligible studies investigating the cost-effectiveness of AIT for food allergy.

Conclusions

Overall the evidence to support the cost-effectiveness of AIT is limited and of low methodological quality, but suggests that AIT may be cost-effective for people with allergic rhinitis with or without asthma and in high risk subgroups for venom allergy. We were unable to draw any conclusions on the cost-effectiveness of AIT for food allergy.

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Rosacée : nouveautés pour une meilleure prise en charge

Publication date: Available online 17 July 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): B. Cribier
En moins de 10 ans, de multiples travaux ont été publiés, éclairant la rosacée d'un jour nouveau, dans tous les domaines de la maladie. Cette mise au point en résume les aspects essentiels, en partant de la bibliographie indexée sur Medline parue entre 2007 et 2017. Les données épidémiologiques récentes montrent que la prévalence de la maladie est sans doute supérieure à celle estimée jusqu'à présent (plus de 10 % des adultes dans certains pays) et qu'il ne faut pas négliger la rosacée survenant sur phototype V ou VI, la maladie existant dans tous les continents. Une nouvelle classification de la rosacée en phénotypes comprenant des signes majeurs et mineurs est proposée ; elle est plus rationnelle pour une prise en charge adaptée selon les symptômes, dont la sévérité peut être cotée en 5 classes. Les traitements dont l'efficacité est la mieux démontrée (étude Cochrane actualisée) sont le métronidazole, l'acide azélaïque et l'ivermectine en topiques, et la doxycycline per os ; l'isotrétinoïne est efficace dans les formes résistantes, mais reste hors Autorisation de mise sur le marché (AMM). Dans la rosacée oculaire, la doxycycline est le traitement de référence, en association avec des soins locaux des paupières. La physiopathologie est complexe : il existe des facteurs vasculaires (vasodilatation, facteurs de croissance vasculaires), neurovasculaires (hypersensibilité, douleur neuropathique, neuropeptides), infectieux (Demodex folliculorum et son microbiote) et inflammatoires (production anormale de peptides pro-inflammatoires de l'immunité innée). Il y a, en outre, une prédisposition génétique démontrée par le poids des antécédents familiaux et la comparaison de jumeaux homozygotes et hétérozygotes. De multiples gènes sont activés, impliqués notamment dans l'immunité, l'inflammation et le métabolisme des lipides ; la piste d'anomalies du film hydrolipidique est relancée. La rosacée a donc fait un grand bond en avant avec des progrès thérapeutiques et une meilleure connaissance des mécanismes en cause, qui devraient permettre d'envisager des traitements plus ciblés à l'avenir, sans oublier la prise en charge globale d'une maladie qui a un impact socio-affectif majeur sur la vie des patients.In the last 10 years, numerous studies have been published that throw new light on rosacea, in all areas of the disease. This overview summarises all the key developments, based on the indexed bibliography appearing in Medline between 2007 and 2017. Recent epidemiological data show that the prevalence of the disease is doubtless greater than estimated hitherto (more than 10% of adults in some countries) and that we should not overlook rosacea in subjects with skin phototypes V or VI, a condition that exists on all continents. A new classification of rosacea by phenotype comprising major and minor signs has been put forward; it provides a more rational approach to suitable management based upon symptoms, the severity of which may be graded into 5 classes. The treatments with the best-demonstrated efficacy (updated Cochrane study) are topical metronidazole, azelaic acid and ivermectin, and oral doxycycline; isotretinoin is effective against resistant forms but is off-label. In ocular rosacea, the reference treatment is doxycycline in combination with topical therapy of the eyelids. The physiopathology is complex and involves several factors: vascular (vasodilatation, vascular growth factors), neurovascular (hypersensitivity, neuropathic pain, neuropeptides), infectious (Demodex folliculorum and its microbiota) and inflammatory (abnormal production of pro-inflammatory peptides of the innate immune system). In addition, there is a genetic predisposition as demonstrated by the weight of familial history and comparison of homozygous and heterozygous twins. There is also activation of several genes involved in immunity, inflammation and lipid metabolism; the theory of hydrolipid film anomalies has been posited once more. There has thus been a tremendous leap forward in the field of rosacea research, with therapeutic progress and improved understanding of the underlying mechanisms, which should enable the future development of more targeted treatments as well as global management of this disease, which has major social and emotional consequences on the life of patients.



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Cicatrices « palimpsestes » en contexte de torture (Darfour, Soudan)

Publication date: Available online 17 July 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): P. Charlier, F. Bou Abdallah, Y. Mostefai Dulac, S. Deo, S. Jacqueline, L. Brun, C. Hervé
ContexteL'accueil actuellement en pleine croissance de réfugiés d'origine proche-orientale et d'Afrique orientale (Soudan, Darfour, Érythrée) expose le médecin clinicien (et notamment le médecin légiste) à l'observation de lésions cutanées atypiques, majoritairement de nature traumatique, mais pouvant s'ajouter à des lésions anciennes en rapport avec des pratiques ethniques.ObservationOn présente ici un cas de séquelles de torture chez un patient originaire du Darfour (Soudan) : à plusieurs reprises, des incisions cutanées auraient été pratiquées sur des scarifications anciennes.DiscussionLa présentation clinique des lésions de scarification et celle des plaies cicatrisées de façon atypique (vraisemblablement un effet de l'inflammation suscitée par l'introduction de corps étrangers irritants : sable, sel, etc.) est nettement différente : dans tous les cas, elle indique une chronologie relative des faits que le médecin clinicien ne devra pas ignorer pour reconstituer le parcours du patient et les coups et blessures auxquels il aura été soumis (d'où l'appellation proposée de « cicatrice palimpseste », au sens où le palimpseste est un manuscrit dont le parchemin, préalablement inscrit, a été gratté pour y écrire de nouveau). Ainsi, une « cicatrice palimpseste » constituerait une nouvelle cicatrice sur et pour cacher une autre cicatrice (rituelle) dans un contexte d'épuration ethnique. L'importance diagnostique et clinique vient de l'importance de bien différencier les lésions de type ethnique et celles induites par des violences et sévices corporels en contexte de guerre.BackgroundAs a result of the current exponentially growing refugee population from the Middle-East and East Africa (Sudan, Darfur, Eritrea), clinicians (including forensic pathologists) are seeing atypical skin lesions, mainly of a traumatic nature, but in some cases associated with long-standing lesions related to ethnic practices.Patients and methodsA case of torture sequelae is presented herein in a patient originally from Darfur (Sudan): cutaneous incisions were made on old scars several times using a knife.DiscussionThe clinical presentation of scarification lesions and that of atypically healed wounds (presumably an effect of inflammation induced by the introduction of irritating foreign bodies such as sand, salt, etc.) are completely different: in all cases they indicate a relative timeframe of the facts, which the clinician should not overlook in reconstructing the patient's course and the injuries to which he has been subjected (hence the proposed designation of "palimpsest scar", in the sense that a palimpsest is a manuscript on a parchment that previously contained writing but has been scratched clean to be overwritten). Thus, a "palimpsest scar" constitutes a fresh scar on top of and hiding another (ritual) scar in a context of ethnic cleansing. The diagnostic and clinical significance comes from the importance of differentiating between ethnic-type lesions and those induced by physical violence and abuse in a context of war.



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