Scalp Block: Tool for Diagnosis in Postoperative Headache of Unknown Origin.

No abstract available

http://ift.tt/2gM6EeM

Role of anesthesia in endovascular stroke therapy.

Purpose of review: Recent randomized clinical trials have demonstrated strong efficacy of endovascular therapy (EVT) for acute ischemic stroke (AIS) from large vessel occlusions; in the USA alone, tens of thousands of patients annually may benefit. The impact of the type of anesthesia used during mechanical thrombectomy on patient outcomes remains controversial. This review discusses the current literature on the effects of anesthesia type on patient outcome following endovascular stroke therapy. Recent findings: EVT is the standard of treatment for intracranial large vessel occlusions. Recent studies show that general anesthesia is associated with negative clinical outcome in AIS patients undergoing EVT. Two of the possible mechanisms of this finding are systolic hypotension and hypocapnia. However, the only published randomized controlled studies to date, sedation vs. intubation for endovascular stroke treatment and anesthesia during stroke showed no difference in short-term clinical outcome between EVT patients treated with general anesthesia and conscious sedation and improved longer-term outcome in the general anesthesia group. Summary: Retrospective reports, and the 2015 American Heart Association/American Stroke Association Guideline (focused update of the 2013 guidelines for the early management of patients with AIS regarding endovascular treatment) based on these reports, are in favor of sedation (conscious sedation) over general anesthesia for endovascular stroke thrombectomy. However, the two randomized controlled prospective studies published provide inconclusive evidence as to the best anesthetic practice for endovascular stroke therapy. More randomized clinical trials are needed to optimize anesthetic patient care in AIS. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2vlisYT

Subacute cutaneous lupus erythematosus induced by nivolumab

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajd.12681

Dermoscopy is useful for the diagnosis of milia-like idiopathic calcinosis cutis

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajd.12675

Survey of Australian dermatologists’ perceptions and experiences with isotretinoin-induced depression and suicide

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajd.12602

Eczema exacerbation caused by Coxsackie virus A6

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajd.12677

Sorafenib-induced erythema annulare centrifugum with spontaneous resolution after skin biopsy

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajd.12623

Dermoscopy of pigmented invasive ductal carcinoma mimicking basal cell carcinoma

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajd.12671

Mohs micrographic surgery using paraffin sections for the treatment of dermatofibroma of the face: A preliminary case series

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajd.12601

Facial annular elastolytic giant cell granuloma treated with pulsed dye laser and intralesional polydeoxyribonucleotide

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajd.12688

Localised longitudinal erythronychia caused by subungual capillary hemangioma

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajd.12576

Fixed drug eruption probably induced by azithromycin

http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajd.12563

Role of Computed Tomography Findings in the Quest of Understanding Origin of Antrochoanal Polyp

Abstract

Aetio pathogenesis of antrochoanal polyp (ACP) remains unclear. Correlation of clinical, computed tomography (CT) and histopathological findings is attempted in this study for understanding of their origin. A retrospective chart and image review of 22 patients having ACP was done for clinical, histopathological and CT findings on affected and non affected side for extent of opacificattion, thickness of alveolar bone (AB) in the region of medial wall and the floor of maxillary sinus. Also, widening of accessory ostium was measured and compared. The mean of average thickness of AB medially on affected side was [30.91/11.27] [mean (mm)/SD)] compared to non affected side [55.60/20.74] p = 0.0001 (p < 0.05). The vertical AB thickness at floor on affected side [34.05/14.69] versus [68.14/35.29] p = 0.0001. Ipsilateral side accessory ostium widening on affected was measuring [91.45/57.00] against [55.32/38.96] p = 0.018. The additional CT findings in present study showed reduction in thickness of AB in the medial part and floor of maxillary sinus region. These findings to our knowledge have not been reported in the literature till date. The reduction in bone thickness of AB substantiates theory of antral cyst in origin of ACP. However, their association with embryonic dental lamellae needs further evaluation.

http://ift.tt/2uEOu44

Functioning metastatic paraganglioma of the urinary bladder in a 10-year-old child

Paragangliomas of the urinary bladder are very rare tumours representing less than 1% of bladder tumours. Preoperative diagnosis is essential to avoid perioperative complications related to catecholamine release. A high index of suspicion should be maintained when the classical symptoms of voiding-related paroxysms of headache, palpitation and dizziness are present. We present a rare case of malignant paraganglioma of the urinary bladder in a 10-year-old boy. The patient had the classic presentation. We review the radiological diagnostic tools and findings of this rare entity.

http://casereports.bmj.com/cgi/content/short/2017/jul19_2/bcr-2017-220533?rss=1

Abundant dystrophic calcifications mimicking aortic valve abscess in a patient undergoing elective aortic valve replacement

Dystrophic calcifications of the aortic valve may cause symptomatic aortic stenosis and account for a significant portion of patients who undergo elective valve replacement. Calcifications appearing grossly as a cloudy fluid surrounding the aortic valve leaflets are an uncommon finding. Normally, calcified aortic valves are characterised by large, nodular masses within the aortic cusps. We report a case of dystrophic calcifications on a stenotic aortic valve encountered intraoperatively, which was suggestive of infective endocarditis and abscess formation. Aortic valve leaflets and necrotic-appearing thymic lymph node tissue were submitted for histology and special stains. Cultures were negative and histology did not show evidence of infection. Tissue histology demonstrated extensive dystrophic calcifications, which were polarised to reveal abundant calcium oxalate crystals. The benign nature of this unique pathological finding ruled out any suspicion of infection, avoiding a prolonged course of intravenous antibiotics in this patient.

http://casereports.bmj.com/cgi/content/short/2017/jul19_2/bcr-2017-220368?rss=1

Very early great saphenous vein graft aneurysm treated by percutaneous coronary intervention under ChromaFlo imaging guidance

A 73-year-old man, who had undergone coronary artery bypass grafting (CABG) 10 days prior, presented with a great saphenous vein graft aneurysm (SVGA). CT revealed the increasing size of the aneurysm. Since the SVGA occurred immediately after CABG and there were no other complications, the aneurysm was treated percutaneously. While intravascular ultrasonography (IVUS) and optical coherence tomography failed to detect the entry point, an IVUS catheter with the addition of ChromaFlo imaging clearly revealed the entry point, size and length of the SVGA. To prevent migration and edge restenosis associated with covered stents, the covered stent (3.0x19 mm) was superimposed on a drug-eluting stent (3.0x28 mm) that covered the entry site. A follow-up study demonstrated the absence of flow into the aneurysm.

http://casereports.bmj.com/cgi/content/short/2017/jul19_2/bcr-2017-220443?rss=1

Arthroscopic excision of an intra-articular osteoid osteoma in the elbow joint

An osteoid osteoma is a rare, small, benign and painful tumour occurring in the extra-articular portion of long bones seen most commonly in the lower extremities. This is a case report of a 23-year-old female patient who underwent arthroscopic resection of an intra-articular osteoid osteoma. The nidus was completely removed by arthroscopic excision. The diagnosis was confirmed by postoperative histopathological analysis. In the case presented we have shown that intra-articular arthroscopy can be successful in the surgical management of benign bony lesions involving the elbow joint. We also present a review of the literature which reports on similar cases or intra-articular disease, preferred methods of surgical management and limitations in histopathological specimen acquisition for diagnosis.

http://casereports.bmj.com/cgi/content/short/2017/jul19_2/bcr-2017-220868?rss=1

Long-term peritoneal port-catheter in a patient with cardiac ascites

A peritoneal port-catheter was inserted in a 70-year-old man because of repeated paracentesis due to cardiac ascites. Instead of frequent hospital admissions, the patient could drain his ascites at home, which dramatically improved his quality of life and enabled him to perform his daily activities.

http://casereports.bmj.com/cgi/content/short/2017/jul19_2/bcr-2017-219258?rss=1

Serum levels of squamous cell carcinoma antigens 1 and 2 reflect disease severity and clinical type of atopic dermatitis in adult patients

Publication date: Available online 19 July 2017
Source:Allergology International
Author(s): Tomoko Okawa, Yukie Yamaguchi, Kenzen Kou, Junya Ono, Yoshinori Azuma, Noriko Komitsu, Yusuke Inoue, Masumi Kohno, Setsuko Matsukura, Takeshi Kambara, Shoichiro Ohta, Kenji Izuhara, Michiko Aihara
BackgroundRecent studies have indicated that serum levels of squamous cell carcinoma antigen (SCCA) 1 and 2 induced by type 2 cytokines such as IL-4 and IL-13, are increased in patients with atopic dermatitis (AD). However, no clinical studies have analyzed serum levels of SCCA2 in larger series of AD patients or their association with various clinical characteristics. This study was performed to clarify whether serum levels of SCCA2 are associated with disease severity and clinical phenotypes of adult AD patients.MethodsAn enzyme-linked immunosorbent assay was performed to examine serum SCCA2 levels in 240 adult patients with AD and 25 healthy controls in this study. Serum SCCA2 levels were analyzed with clinical characteristics and laboratory parameters including thymus and activation-regulated chemokine (TARC), lactate dehydrogenase (LDH), blood eosinophils, total IgE, and specific IgE (Japanese cedar pollen, Dermatophagoides farina, Candida, malassezia, Staphylococcal enterotoxin B). Expression of SCCA2 in AD eruption was examined by immunohistochemistry. The effect of treatment on serum SCCA2 was also assessed.ResultsSerum SCCA2 level showed a positive correlation with disease severity, levels of TARC, LDH, eosinophil counts, and IgE levels. Robust expression of SCCA2 was detected in the supra basal keratinocytes in the epidermis of AD patients. Serial measurements of serum SCCA2 revealed decreased levels of SCCA2 after treatment for AD.ConclusionsSerum SCCA2 levels reflected disease severity and clinical type of AD. Serum SCCA2 may thus be a relevant biomarker for AD.



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Immediate-type allergic reactions to local anesthetics

Publication date: Available online 19 July 2017
Source:Allergology International
Author(s): Naomi Nakamura, Risa Tamagawa-Mineoka, Koji Masuda, Norito Katoh




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Expression of planar cell polarity genes during mouse tooth development

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Nobuko Obara, Yuko Suzuki, Kazuharu Irie, Shunichi Shibata
ObjectivePlanar cell polarity (PCP) refers to the cell polarity across the tissue plane and controls various cell behaviors and structures. Although the expression of several PCP signaling components has been detected in tooth germs, knowledge of the gene expression patterns of these PCP components during tooth development remains incomplete. The aim of this study is to characterize the temporal and spatial changes in PCP gene expression during tooth development.DesignExpression of Celsr1 and 2, Fzd3 and 6, Vangl1 and 2, and Dvl1-3 genes was analyzed in mouse molar germs from the bud to the bell stage using in situ hybridization.ResultsAt the bud stage, all target genes were expressed in all areas of the tooth bud. In the enamel organ at the cap stage, expression of Fzd3 was suppressed in the enamel knot, whereas Fzd6 was strongly expressed there. Expression of Vangl2 was strongly expressed in the inner dental epithelium from the cap stage onwards. In the inner dental epithelium, strong expression of Fzd3, Dvl2 and Vangl2 was noted at the early bell stage, and of Celsr1, Fzd3, Fzd6, Vangl2 and Dvl2 at the bell stage. Furthermore, differentiated odontoblasts strongly expressed Celsr1, Vangl2, and Dvl2.ConclusionThe gene expression patterns delineated in this study improve our understanding of the role(s) of PCP components during tooth development.



http://ift.tt/2thl5cB

Role of Computed Tomography Findings in the Quest of Understanding Origin of Antrochoanal Polyp

Abstract

Aetio pathogenesis of antrochoanal polyp (ACP) remains unclear. Correlation of clinical, computed tomography (CT) and histopathological findings is attempted in this study for understanding of their origin. A retrospective chart and image review of 22 patients having ACP was done for clinical, histopathological and CT findings on affected and non affected side for extent of opacificattion, thickness of alveolar bone (AB) in the region of medial wall and the floor of maxillary sinus. Also, widening of accessory ostium was measured and compared. The mean of average thickness of AB medially on affected side was [30.91/11.27] [mean (mm)/SD)] compared to non affected side [55.60/20.74] p = 0.0001 (p < 0.05). The vertical AB thickness at floor on affected side [34.05/14.69] versus [68.14/35.29] p = 0.0001. Ipsilateral side accessory ostium widening on affected was measuring [91.45/57.00] against [55.32/38.96] p = 0.018. The additional CT findings in present study showed reduction in thickness of AB in the medial part and floor of maxillary sinus region. These findings to our knowledge have not been reported in the literature till date. The reduction in bone thickness of AB substantiates theory of antral cyst in origin of ACP. However, their association with embryonic dental lamellae needs further evaluation.

http://ift.tt/2uEOu44

Results of Screening in Familial Non-Medullary Thyroid Cancer

Thyroid , Vol. 0, No. 0.


http://ift.tt/2uBzWCM

Immediate implant placement: the fate of the buccal crest. A retrospective cone beam computed tomography study

This retrospective study aimed to analyse the fate of the buccal crest after immediate implant placement (IIP) through the use of cone beam computed tomography (CBCT). In 16 consecutive patients, an implant was placed in a more palatal position after extraction, thereby creating a gap of at least 2mm between the implant and the buccal crest. Subsequently, this gap was filled with a bone substitute. Preoperatively, immediate postoperatively, and late postoperatively, a CBCT was made to measure the thickness of the buccal crest.

http://ift.tt/2uL5dDG

Cytological study of DNA content and nuclear morphometric analysis for aid in the diagnosis of high-grade dysplasia within oral leukoplakia

Publication date: Available online 18 July 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Xi Yang, Xuan Xiao, Wenyan Wu, Xuemin Shen, Zengtong Zhou, Wei Liu, Linjun Shi
ObjectiveTo quantitatively examine the DNA content and nuclear morphometric status of oral leukoplakia (OL) and investigate its association with the degree of dysplasia in a cytologic study.Study DesignOral cytobrush biopsy was carried out to obtain exfoliative epithelial cells from lesions before scalpel biopsy at the same location in a blinded series of 70 patients with OL. Analysis of nuclear morphometry and DNA content status using image cytometry was performed with oral smears stained with the Feulgen-thionin method.ResultsNuclear morphometric analysis revealed significant differences in DNA content amount, DNA index, nuclear area, nuclear radius, nuclear intensity, sphericity, entropy, and fractal dimension (all P < .01) between low-grade and high-grade dysplasia. DNA content analysis identified 34 patients with OL (48.6%) with DNA content abnormality. Nonhomogeneous lesion (P = .018) and high-grade dysplasia (P = .008) were significantly associated with abnormal DNA content. Importantly, the positive correlation between the degree of oral dysplasia and DNA content status was significant (P = .004, correlation coefficient = 0.342).ConclusionCytology analysis of DNA content and nuclear morphometric status using image cytometry may support their use as a screening and monitoring tool for OL progression.



http://ift.tt/2uKMtnT

Long-term outcome of eosinophilic fasciitis: A cross-sectional evaluation of 35 patients

Eosinophilic fasciitis (EF) is a connective tissue disease with an unknown long-term course.

http://ift.tt/2uBcWUp

Treatment of pharyngotympanic tube dysfunction

Eustachian tube dysfuntion intends to describe a variety of signs, symptoms, and physical findings that result from the impairment of ET function. A large variety of methods have been employed to assess ET function in the literature. Due to the lack of high level evidence, it is difficult to draw conclusions on the effectiveness of medical and surgical treatments. There are various medical and surgical interventions available for chronic obstructive ET dysfunction including balloon Eustachian tuboplasty (BET) and laser or microdebrider tuboplasty.

http://ift.tt/2ucwAFk

Evaluation of the effects of photobiomodulation on vertebras in two rat models of experimental osteoporosis

Abstract

The aim of this study was to evaluate the effects of photobiomodulation (PBM) on cancellous bone in rat models of ovariectomized induced osteoporosis (OVX-D) and glucocorticoid-induced osteoporosis (GIOP). The experiment comprised of nine groups. A group of healthy rats was used for baseline evaluations. The OVX-D rats were further divided into groups as follows: control rats with osteoporosis, OVX-D rats that received alendronate (1 mg/kg 60 days), OVX-D rats treated with pulsed wave laser (890 nm, 80 Hz, 900 s, 0.0061 W/cm², 5.5 J/cm², three times a week, 60 days), and OVX-D rats treated with alendronate + pulsed laser. Dexamethasone was administered to the remaining rats that were split into four groups: control, alendronate-treated rats, laser-treated rats, and GIOP rats treated with alendronate + laser. T12, L1, L2, and L3 vertebrae were subjected to laser. Results of the current study demonstrated that OVX-D and GIOP significantly decreased some stereological parameters, and type 1 collagen gene expression compared to the healthy group. There was a significant increase in osteoclast number in both OVX-D and glucocorticoid administration compared to the healthy group. However, the detrimental effect of the OVX-D procedure on bone was more serious than glucocorticoid administration. Results showed that laser alone had a detrimental effect on trabecular bone volume, and cortical bone volume in groups GIOP and OVX-D compared to those in the healthy group. Alendronate significantly improved total vertebral bone volume, trabecular bone volume, and cortical bone volume, in GIOP and OVX-D groups compared to the laser-treated groups. Furthermore, the alendronate + laser in OVX-D rats and GIOP rats produced significantly increased osteoblast number and type 1 collagen gene expression and caused a significant decrease in osteoclast number compared to the controls.

http://ift.tt/2tgR7pj

Osteopontin induced vascular endothelial growth factor production in dispersed nasal polyp cells through the phosphatidylinositol 3-kinase‐protein kinase B and the extracellular signal-regulated kinase 1/2 pathways

http://ift.tt/2u9EkGt

A randomized, double-blind, placebo controlled trial of sublingual immunotherapy with house-dust mite extract for allergic rhinitis

http://ift.tt/2trEBap

Dollars, dust, and Draf

http://ift.tt/2u9CrcD

Sinonasal T2R-mediated nitric oxide production in response to Bacillus cereus

http://ift.tt/2trzhnz

The personal financial burden of chronic rhinosinusitis: A Canadian perspective

http://ift.tt/2ua46dK

The relationship between chronic rhinosinusitis and metabolic syndrome

http://ift.tt/2trON2S

Central compartment atopic disease

http://ift.tt/2u9zKbd

Association between symptoms of allergic rhinitis with decreased general health‐related quality of life

http://ift.tt/2trvvuw

Are prophylactic systemic antibiotics necessary with nasal packing? A systematic review

http://ift.tt/2u9sdJw

Systematic review of patient-reported outcomes after revision endoscopic sinus surgery

http://ift.tt/2trZbrg

Influence of hyaluronan nasal dressing on clinical outcome after endoscopic sinus surgery: A systematic review and meta-analysis

http://ift.tt/2u9UShm

Septal extension graft in “closed” revision rhinoplasty: A simplified technique

http://ift.tt/2ts0ruD

Short-term morbidity after the endoscopic modified Lothrop (Draf-III) procedure compared with Draf-IIa

http://ift.tt/2ua45GI

Surgical treatment of chronic rhinosinusitis after sinus lift

http://ift.tt/2trngPc

Endoscopic septoplasty: “How I do it”

http://ift.tt/2u9CGVe

Prevalence of polyp recurrence after endoscopic sinus surgery for chronic rhinosinusitis with nasal polyposis.

http://ift.tt/2trOMfk

Proteolytic effects of gingipains on trefoil factor family peptides

Abstract

Objectives

The present study was aimed to determine whether trefoil factor family (TFF) peptides which were generally considered to be resistant to proteolysis could be digested by gingipains, a major proteinases produced by Porphyromonas gingivalis.

Materials and methods

Recombinant human TFF1, TFF2, and TFF3 peptides were used as substrates. Gingipains including arginine gingipain (RgpB) and lysine gingipain (Kgp) were used as enzymes. Trypsin was used as a control protease. Matrix-assisted laser desorption/ionization with time-of-flight/time-of-flight (MALDI-TOF/TOF) and liquid chromatography mass spectrometry (LC-MS) were used for analyzing peptide mass signals and amino acid sequences of digested TFF peptides.

Results

MALDI-TOF/TOF analyses demonstrated that Kgp, RgpB, and trypsin were able to cleave TFF1 and TFF2 peptides, resulting in different patterns of digested fragments. However, impurity in recombinant TFF3 peptide substrates affected the interpretations of enzymatic reaction by MALDI-TOF/TOF. LC-MS analyses demonstrated that identified fragments of TFF1, TFF2, and TFF3 from digestion by gingipains were similar to those by trypsin.

Conclusions

Using MALDI-TOF/TOF and LC-MS, the present study provides new information that gingipains containing trypsin-like activities are able to digest TFF peptides.

Clinical relevance

The proteolytic effects of gingipains on TFF peptides may be responsible for reduction of salivary TFF peptides in chronic periodontitis patients. Further investigations to determine the pathological effects of gingipains on TFF peptides in saliva and periodontal tissues of patients with chronic periodontitis would be of interest.

http://ift.tt/2uKnRvj

Sleep deprivation predisposes allergic mice to develop neutrophilic lung inflammation

Publication date: Available online 19 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jethe Nunes de Oliveira Filho, Juliana de Souza Apostolico, David Anibal Garrido Andrade, Francieli Ruiz da Silva, Edgar Ruz Fernandes, Monica Levy Andersen, Alexandre Castro Keller, Daniela Santoro Rosa
BackgroundAlthough different studies associated sleep deprivation with systemic inflammatory changes, the effect of sleep duration on the pathology of allergic chronic diseases is poorly understood.ObjectiveTo evaluate the influence of sleep deprivation on allergen-induced pulmonary inflammation.MethodsOvalbumin (OVA)-sensitized C57BL/6 mice were exposed to a first set of intranasal OVA challenge under sleep deprivation (SD) or healthy sleep (HS) conditions followed by a second OVA challenge, one week apart. Some groups were subjected to corticoid treatment with dexamethasone.ResultsOVA-sensitized SD mice developed a more severe airway inflammation than the HS allergic group. Analysis of lung parenchyma revealed that the inflammation in SD allergic mice was marked by an influx of neutrophils (mainly) and eosinophils and secretion of IL-6, TNF-α, and IL-17, in contrast to the eosinophilic inflammation and IL-4 production observed in HS allergic mice. The same cytokine profile was observed in ex vivo culture of cervical lymph nodes cells and splenocytes, indicating that in allergic mice SD favors immune responses towards a pro-inflammatory Th17 profile. This idea is supported by the fact that disruption of IL-17 signaling (IL-17RA^-/-) prevented airway neutrophilia in allergic SD mice. Furthermore, SD allergic mice became refractory to corticoid treatment, in contrast to HS allergic group.ConclusionCollectively, our data show that sleep quality participates in the progression of allergen-induced eosinophilic lung inflammation to corticoid refractory neutrophilic manifestation.

Teaser

Sleep plays a pivotal role in immune system homeostasis. Sleep disturbances influence immune-mediated allergic responses and improving sleep quality may contribute to asthma management.


http://ift.tt/2uB3znJ

Phosphatase Wip1 controls the development of Th9 cells and allergic airway inflammation

Publication date: Available online 19 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Peng Wang, Huiting Su, Lianjun Zhang, Hui Chen, Xuelian Hu, Fan Yang, Jun Lu, Lianfeng Zhang, Yong Zhao
BackgroundAllergic asthma is one of the most common diseases worldwide, resulting in a burden of diseases. No available therapeutic regimens can cure asthma so far.ObjectiveTo identify new molecular targets for Th9 cells-mediated allergic airway inflammation.MethodsWild-type p53-induced phosphatase 1 (Wip1) gene knockout mice, Wip1 inhibitor-treated mice and ovalbumin (OVA)-induced allergic airway inflammation mouse models were employed to characterize the roles of Wip1 in allergic airway inflammation. The induction of Th cell subsets in vitro, real-time PCR, immunoblots, luciferase assay and ChIP assays were employed to determine the regulatory pathways of Wip1 in Th9 differentiation.ResultsWe herein demonstrate that Wip1-deficient mice are less prone to allergic airway inflammation as indicated by the decreased pathological alterations in lungs. Short-term treatment of Wip1-specific inhibitor significantly ameliorates allergic inflammation progression. Intriguingly, Wip1 selectively impaired Th9 cell but not Th1, Th2 and Th17 cell differentiation. Biochemical assays show that Wip1 deficiency increases c-Jun/c-Fos activity in a JNK-dependent manner and that c-Jun/c-Fos directly binds to Il-9 promoter and inhibits Il-9 transcription.ConclusionPhosphatase Wip1 controls Th9 cell development through regulating c-Jun/c-Fos activity on Il-9 promoter and is important for the pathogenesis of allergic airway inflammation. These findings shed lights on the previously unrecognized roles of Wip1 in Th9 cell differentiation. The inhibitory effects of a Wip1 inhibitor on the pathogenesis of allergic airway inflammation may have important implications for clinical application of Wip1 inhibitors in allergy therapies.

Graphical abstract

Teaser

Phosphatase Wip1 specifically regulates Th9 cell differentiation and Wip1 inhibition may represent a promising strategy to treat allergic airway inflammation.


http://ift.tt/2vl4VAj

Medical Graduate’s Basic Knowledge and Clinical Skills Assessment in Otorhinolaryngology Post Internship

Abstract

Exposure to otorhinolaryngology in India has been shadowed by an inadequate curriculum. Our study brings forth the lacunae in medical education setup related to ENT. We introspect why the subject is not a first choice for specialization. 100 medical graduates were assessed at the end of internship postings for: (1) subject knowledge, (2) basic and emergency procedures, (3) diagnosis and investigation of common and emergency conditions. 84% take ENT as a minor subject. Least awareness is seen regarding its relation with skull base, head and neck and plastic surgery. Very few knew about advanced surgeries and instruments in the field. Majority rejected ENT as a primary choice and its upgradation as major subject. Routine and emergency procedures based on ENT were not a matter of ease by majority of subjects. Post internship doctors lagged in doing basic clinical and diagnostic steps. Diagnosis of various pathologies was not a skill of majority of subjects under study. A lack of basic knowledge of important emergency conditions in ENT was noticed. Our study points at inadequate training in ENT and under estimation of its scope. The outcome raises a need to revise the curriculum and methodology to come at par with world standards, reflecting its true expanse and tremendous scope.

http://ift.tt/2vkfWly

Medical Graduate’s Basic Knowledge and Clinical Skills Assessment in Otorhinolaryngology Post Internship

Abstract

Exposure to otorhinolaryngology in India has been shadowed by an inadequate curriculum. Our study brings forth the lacunae in medical education setup related to ENT. We introspect why the subject is not a first choice for specialization. 100 medical graduates were assessed at the end of internship postings for: (1) subject knowledge, (2) basic and emergency procedures, (3) diagnosis and investigation of common and emergency conditions. 84% take ENT as a minor subject. Least awareness is seen regarding its relation with skull base, head and neck and plastic surgery. Very few knew about advanced surgeries and instruments in the field. Majority rejected ENT as a primary choice and its upgradation as major subject. Routine and emergency procedures based on ENT were not a matter of ease by majority of subjects. Post internship doctors lagged in doing basic clinical and diagnostic steps. Diagnosis of various pathologies was not a skill of majority of subjects under study. A lack of basic knowledge of important emergency conditions in ENT was noticed. Our study points at inadequate training in ENT and under estimation of its scope. The outcome raises a need to revise the curriculum and methodology to come at par with world standards, reflecting its true expanse and tremendous scope.

http://ift.tt/2vkfWly

Sinonasal tumour presenting as status epilepticus in a child

Publication date: Available online 18 July 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): H. Dimassi, S. Kedous, I. Ben Said




http://ift.tt/2vD2dpi

Acute Thyroid Profile Changes During External Beam Irradiation of Neck

Abstract

Thyroid gland is irradiated to a considerable dose in conventional radiotherapy of head neck cancer and significant proportion of patients later develop hypothyroidism. This study is an effort to shed light on acute changes in thyroid function after irradiation those are less clearly defined. Values were recorded before radiation treatment, after 4 week of irradiation, after completion of treatment, 1 month after completion of treatment and after 4 months of completion of treatment. A repeated measures ANOVA with a Greenhouse–Geisser correction determined that mean T3, T4 and TSH levels differed statistically significantly between time points. Post hoc test using the Bonferroni correction revealed statistical significance difference in values of T3, T4 and TSH done at specific intervals. External irradiation in cancer therapeutic doses affects thyroid function and sets at a new point with increased TSH, but in reference ranges, to maintain required thyroxin level.

http://ift.tt/2uJF5Jj

Bone Metastases in Follicular Carcinoma of Thyroid

Abstract

Though the association between follicular carcinoma and bone metastasis is well established, the site-wise distribution is not known. One hundred seventy-three patients of follicular carcinoma presenting between 2003 and 2011 were selected from 1093 patients of follicular lesions presenting at a single institution. Of these, 59 (34%) with bone metastasis were included in the study. Fifty of the 59 patients (84.7%) had metastasis at presentation, while 9 developed bone metastasis during follow-up. Sixty-one percent had solitary metastasis, 15 (25.4%) had multiple bone involvement, while 8 patients (13.6%) had synchronous lung metastasis. Overall, the spine was the commonest site of bone metastases, seen in 20 patients (33.9%), followed by the pelvis, skull, long bones and sternum. Bone metastasis is a known phenomenon in follicular carcinoma. The spine is the commonest site followed by the pelvis.

http://ift.tt/2uzOcfr

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/2ubkfRE

Prospective Endoscopic Follow-up of Patients With Submucosal Esophageal Adenocarcinoma (The PREFER Trial)

Conditions:   Submucosal Esophageal Adenocarcinoma;   Barrett Esophagus
Intervention:   Procedure: Endoscopic follow-up
Sponsor:   Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Recruiting - verified July 2017

http://ift.tt/2uaqPI8

Distribution of Lymph Node Metastases in Esophageal Carcinoma

Conditions:   Esophageal Neoplasms;   Lymph Node Metastases
Intervention:  
Sponsor:   Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Not yet recruiting - verified July 2017

http://ift.tt/2tGV1Hs

Combination of Radiotherapy and SHR-1210 to Treat Patients With ESCC

Condition:   Esophageal Cancer
Intervention:   Drug: SHR-1210
Sponsors:   Tianjin Medical University Cancer Institute and Hospital;   Jiangsu HengRui Medicine Co., Ltd.
Recruiting - verified July 2017

http://ift.tt/2tH58Mw

A Study of ABBV-181 in Participants With Advanced Solid Tumors

Condition:   Advanced Solid Tumors
Interventions:   Drug: ABBV-181;   Drug: Rovalpituzumab Tesirine
Sponsor:   AbbVie
Recruiting - verified July 2017

http://ift.tt/2uaNqo4

Acute Thyroid Profile Changes During External Beam Irradiation of Neck

Abstract

Thyroid gland is irradiated to a considerable dose in conventional radiotherapy of head neck cancer and significant proportion of patients later develop hypothyroidism. This study is an effort to shed light on acute changes in thyroid function after irradiation those are less clearly defined. Values were recorded before radiation treatment, after 4 week of irradiation, after completion of treatment, 1 month after completion of treatment and after 4 months of completion of treatment. A repeated measures ANOVA with a Greenhouse–Geisser correction determined that mean T3, T4 and TSH levels differed statistically significantly between time points. Post hoc test using the Bonferroni correction revealed statistical significance difference in values of T3, T4 and TSH done at specific intervals. External irradiation in cancer therapeutic doses affects thyroid function and sets at a new point with increased TSH, but in reference ranges, to maintain required thyroxin level.

http://ift.tt/2uJF5Jj

Bone Metastases in Follicular Carcinoma of Thyroid

Abstract

Though the association between follicular carcinoma and bone metastasis is well established, the site-wise distribution is not known. One hundred seventy-three patients of follicular carcinoma presenting between 2003 and 2011 were selected from 1093 patients of follicular lesions presenting at a single institution. Of these, 59 (34%) with bone metastasis were included in the study. Fifty of the 59 patients (84.7%) had metastasis at presentation, while 9 developed bone metastasis during follow-up. Sixty-one percent had solitary metastasis, 15 (25.4%) had multiple bone involvement, while 8 patients (13.6%) had synchronous lung metastasis. Overall, the spine was the commonest site of bone metastases, seen in 20 patients (33.9%), followed by the pelvis, skull, long bones and sternum. Bone metastasis is a known phenomenon in follicular carcinoma. The spine is the commonest site followed by the pelvis.

http://ift.tt/2uzOcfr

Perineural Invasion Ups Mortality Risk in Squamous Cell Skin CA

Patients with cutaneous squamous cell carcinoma (CSCC) and perineural invasion (PNI) are at increased risk of death, particularly when PNI is identified clinically or radiologically and not only microscopically, researchers say.
Reuters Health Information

http://ift.tt/2sVeRPB

Further development of the MRONJ minipig large animal model

Publication date: Available online 18 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Sven Otto, Christoph Pautke, Olga Martin Jurado, Dirk Nehrbass, Martin J. Stoddart, Michael Ehrenfeld, Stephan Zeiter
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. Secondly, the MRONJ lesions should be carefully investigated using clinical and μCT as well as detailed histological analyses.Twelve 1.5-year-old Göttingen minipigs were divided into three groups. In group 1 (n=3) minipigs received weekly doses of zoledronate intravenously (0.05 mg/kg body weight) for 20 weeks. No interventions were performed. In group 2 (n=6) animals received the identical zoledronate dosage as animals in group 1 and tooth extractions of two premolars (PM 2 and 4) in each jaw (maxilla and mandible) were performed after 12 weeks. Group 3 (n=3) served as tooth extraction only control (no zoledronate administrations). The jaw-bones were subjected to detailed macroscopic, radiological and histological investigations.All extraction sites (24/24) in animals of group 2 showed clinical, radiological and histological signs of MRONJ (mainly stage II), whereas no bone necrosis was found in group 3. Animals of group 1 and group 2 showed further MRONJ lesions in areas where infections (periodontitis) were present.This is the first large animal model to show a 100% incidence of MRONJ at all extraction sites in bisphosphonate pretreated animals (group 2). In addition, in this preclinical model for MRONJ it is shown that tooth extractions are not mandatory for a MRONJ manifestation. MRONJ also developed in areas of gingival or periodontal infections.



http://ift.tt/2vk13zK

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

Publication date: Available online 19 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Essam Ahmed Al-Moraissi, Seth R. Thaller, Edward Ellis
PurposeThis study compared complications between subciliary and transconjunctival approaches to the infraorbital rim/orbital floor using systematic review and meta-analysis.Methodsand Methods: A systematic review with meta-analysis was conducted according to the PRISMA guidelines. An electronic search in PubMed, Embase and Cochrane Library was performed. Randomized controlled and controlled (retrospective or prospective) clinical studies with aims of comparing subciliary to transconjunctival approaches in the management of infraorbital rim/orbital floor fractures were included. Outcomes variables were lower lid malposition including ectropion, entropion, scleral shows, canthal malpositions and others complications. An Odds ratio (OR) using Mantel-Haenszel (M-H) test with 95% confidence intervals (95% CIs) of outcomes variables was calculated using a Comprehensive Meta-analysis software. A descriptive analysis of postoperative complications was also presented.ResultsSubciliary approach had a significantly higher incidence of ectropion and scleral show when compared to the subconjunctival approach (p<0.001). The subconjunctival approach had a significantly higher incidence of entropion than the subciliary approach (p<0.001).ConclusionsBoth the subciliary and the transconjunctival approaches are associated with specific complications. Overall, the transconjunctival approach showed the lowest incidence of complications.



http://ift.tt/2uJh30Z

Asthma in the Elderly and Late-onset Adult Asthma

Abstract

Elderly asthmatics are at a higher risk for morbidity and mortality from their asthma than younger patients. There are important age-related physiologic and immunologic changes that complicate the presentation, diagnosis and management of asthma in the aged population. Evidence suggests that elderly asthmatics are more likely to be under-diagnosed and under-treated. Additionally, elderly patients with asthma have highest rates of morbidity and mortality from their disease than younger patients. The underlying airway inflammation of asthma in this age group likely differs from younger patients and is felt to be non-Type 2 mediated. While elderly patients are underrepresented in clinical trials, subgroup analysis of large clinical trials suggests they may be less likely to respond to traditional asthma therapies (i.e., corticosteroids). As the armamentarium of pharmacologic asthma therapies expands, it will be critical to include elderly asthmatics in large clinical trials so that therapy may be better tailored to this at-risk and growing population.

This article is protected by copyright. All rights reserved.

http://ift.tt/2vCIENO

The potential of anti-infectives and immunomodulators as therapies for asthma and asthma exacerbations

Abstract

Asthma is responsible for approximately 25,000 deaths annually in Europe despite available medicines that maintain asthma control and reduce asthma exacerbations. Better treatments are urgently needed for the control of chronic asthma and reduction of asthma exacerbations, the major cause of asthma mortality. Much research spanning >20 years shows a strong association between microorganisms including pathogens in asthma onset, severity and exacerbation, yet with the exception of antibiotics, few treatments are available that specifically target the offending pathogens. Recent insights into the microbiome suggest that modulating commensal organisms within the gut or lung may also be a possible way to treat/prevent asthma. The European Academy of Allergy & Clinical Immunology Task Force on Anti-infectives in Asthma was initiated to investigate the potential of anti-infectives and immunomodulators in asthma. This review provides a concise summary of the current literature and aims to identify and address key questions that concern the use of anti-infectives and both microbe and host based immunomodulators and their feasibility for use in asthma.

This article is protected by copyright. All rights reserved.

http://ift.tt/2uCYhrx

Oral Macrolides for the Dermatologic Manifestations of Blau Syndrome

This case report describes the use of oral macrolides to treat the dermatologic manifestations of Blau syndrome.

http://ift.tt/2uJmxc9

Selecting Patients With Thin Melanoma for Sentinel Lymph Node Biopsy

Thin (T1) melanomas, defined in the 8th edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual for melanoma as any primary cutaneous melanoma of Breslow thickness 1.0 mm or thinner, account for more than 70% of newly diagnosed cutaneous melanoma in the United States. (The AJCC Cancer Staging Manual, 8th edition, staging system for melanoma mandates reporting of Breslow thickness measurements to the nearest 0.1 mm, not the nearest 0.01 mm, and this convention will be used in this editorial. The AJCC recommends measuring thin melanomas to the nearest 0.01 mm if practical but then reporting the thickness rounded to the nearest 0.1 mm. With this convention, T1 melanomas include those as thick as 1.04 mm, and T1b melanomas are those reported as 0.8 to 1.0 mm, regardless of mitotic count or ulceration. Melanomas 0.75 to 0.84 mm in thickness would all be reported as 0.8 mm and included in T1b.) It is estimated that in 2017, 87 110 individuals will be diagnosed as having invasive melanoma of any thickness, and it is quite possible this represents an underestimate owing to the many thin melanomas that are treated in dermatologists' offices and other settings where they would not be routinely reported to regional or national registries. Nevertheless, even assuming that this figure is correct, this represents more than 60 000 thin melanoma cases in 1 year alone, and virtually all of them present initially with clinically negative regional lymph nodes. While the average individual with a thin melanoma may have a very low chance of developing distant metastases and dying of their disease, owing to the large number of cases in aggregate 29% of melanoma deaths now come from the T1 patient population, more than from the T2, T3, or T4 melanoma categories.

http://ift.tt/2vjmlNK

Scrotal Ulceration and Pyrexia

A man in his 30s was diagnosed with promyelocytic leukemia; he began treatment with all-trans retinoic acid and idarubicin, and after 12 days of treatment, he developed pyrexia, was started on antibiotics, and subsequently developed black spots on the scrotum that became painful ulcers. What is your diagnosis?

http://ift.tt/2uJhGHQ

Gain-Switched 311-nm Titanium:Sapphire Laser for Vitiligo

This observational pilot study evaluates the efficacy and safety of the 311-nm titanium:sapphire laser in the treatment of vitiligo.

http://ift.tt/2vjwwCj

Association Between Age and Lymph Node Positivity in Thin Melanoma

This cohort study using data from the US National Cancer Database examines the association between age and regional lymph node positivity in patients with thin melanoma.

http://ift.tt/2uIV76e

Topical Corticosteroid Phobia in Atopic Dermatitis

This systematic review examines the nomenclature and prevalence of topical corticosteroid phobia, as well as its effect on adherence, in patients with atopic dermatitis.

http://ift.tt/2vjmkta

Immunoglobulin and B-cell disturbances in patients with chronic idiopathic neutropenia

Publication date: Available online 18 July 2017
Source:Clinical Immunology
Author(s): Irene Mavroudi, Aristides G. Eliopoulos, Charalampos Pontikoglou, Katerina Pyrovolaki, Athina Damianaki, Helen Koutala, Maria I. Zervou, Maria Ximeri, Semeli Mastrodemou, Peggy Kanellou, George N. Goulielmos, Helen A. Papadaki
Chronic idiopathic neutropenia (CIN) is a granulocytic disorder associated with presence of activated, myelosuppressive T-lymphocytes. In the present study we have evaluated constituents of humoral immunity in CIN patients (n=48) compared to healthy controls (n=52). CIN patients displayed lower serum IgG levels due to a reduction in IgG1, IgG3, IgG4 but not IgG2, lower IgA and increased IgM levels compared to controls. The proportion of CD19⁺ cells did not differ between patients and controls; however the proportion of the naïve IgD⁺/CD27⁻ B-cells was increased and the proportion of class-switched memory IgD⁻/CD27⁺ B-cells was decreased in the patients. The percentage of CD40⁺ B-cells did not differ between patients and controls and no aberrations in the CD40-meadiated signal transduction pathway or in CD40-gene polymorphisms were identified. These data provide further evidence that immune disturbances are associated with the pathophysiology of CIN and point out for the first time the implication of the B-cell system.



http://ift.tt/2uD9uIj

Radioembolisation mit Yttrium-90-Mikrosphären

Zusammenfassung

Hintergrund

Die selektive interne Radioembolisation ist eine innovative endovaskuläre minimalinvasive Therapie zur Behandlung von primären Leberneoplasien und Lebermetastasen.

Ziel

Es erfolgt eine Beschreibung der Technik und Anwendungsgebiete.

Ergebnisse

Die selektive interne Strahlentherapie (SIRT) stellt inzwischen eine wichtige Säule in der Erst- und Zweitlinientherapie beim Cholangio- und hepatozellulären Karzinom dar. Bei Lebermetastasen kommt die Radioembolisation (⁹⁰Y-RE) meist zum Einsatz, wenn die Metastasierung unter Chemotherapie progredient ist und sich auf die Leber beschränkt („liver only") oder dominant („liver dominant") ist. Diese Therapieindikation wird vereinzelt auch als Salvage-Situation oder chemorefraktäre Situation bezeichnet.

Schlussfolgerung

Die Evidenzlage für die SIRT wird durch neuere Studien deutlich verbessert. Inzwischen findet die SIRT als alternatives Therapiekonzept für die Behandlung von Leberneoplasien Einzug in die onkologischen Leitlinien.

http://ift.tt/2tprPtn

Spinal anaesthesia in neonates and infants: what about the cerebral oxygen saturation?

Abstract

Background. Spinal Anaesthesia (SA) has been firmly established as an efficient and safe technique, with minimal cardio-respiratory disturbance when administered in the neonatal period. Our objective was to assess the haemodynamic consequences of SA in infants, particularly its impact on cerebral perfusion using near-infrared spectroscopy (NIRS)-based cerebral oximetry (rSc_O2).Methods. All infants up to 60 weeks' postmenstrual age, whether formerly preterm or not, and undergoing spinal anaesthesia, were enrolled. Haemodynamic data records, rSc_O2 and mean arterial blood pressure (MAP), were prospectively collected before SA (T0) and every five min for 30 min (T30) after the puncture. Compared with baseline measures, any changes of > 10% in rSc_O2 and of > 20% in MAP were considered clinically significant. Relative variations of data between T0 and T30 were analysed.Results. Data of 103 infants were analysed. The mean relative changes in rSc_O2 were −2.25% (97.5% CI [−3.97; −0.5]) at T15, and 0.11% (97.5% CI [−1.67; 1.90]) at T30. No significant variation of rSc_O2 was recorded. The mean changes in MAP were respectively −13.94% (97.5% CI [−17.74; −10.14]) at T15 and −20.27% (97.5% CI [−24,25; −16.29]) at T30. MAP decrease was statistically and clinically significant 30 min after SA. No correlation between changes in MAP and rSc_O2 was found. The subgroup analysis did not reveal any effect of added intrathecal clonidine or preterm birth history on these results.Conclusions. In neonate and infants, SA did not cause clinically significant variation in cerebral oxygen saturation. Despite a significant decrease in MAP, cerebral auto-regulation seems to remain effective in neonates and not altered by spinal anaesthesia.

http://ift.tt/2viRzog

Viscoelastometric-guided early fibrinogen concentrate replacement during postpartum haemorrhage: OBS2, a double-blind randomized controlled trial

Abstract

Background: Postpartum haemorrhage (PPH) can be exacerbated by haemostatic failure. We hypothesized that early fibrinogen replacement, guided by viscoelastometric testing, reduces blood product usage and bleed size.Methods: Women with PPH 1000–1500 ml were enrolled. If Fibtem A5 was ≤15 mm and bleeding continued, subjects were randomized to fibrinogen concentrate or placebo. The primary outcome compared the number of units of red blood cells, plasma, cryoprecipitate and platelets transfused.Results: Of 663 women enrolled 55 were randomized. The adjusted incidence rate ratio (IRR) (95% CI) for the number of allogeneic units transfused in the fibrinogen group compared with placebo was 0.72 (0.3–1.7), P=0.45. In pre-specified subgroup analyses, subjects who had a Fibtem A5 ≤12 mm at the time of randomization and who received fibrinogen concentrate received a median (25th–75th centile) of 1 (0–4.5) unit of allogeneic blood products and had an additional 300 (100–350) ml blood loss whereas those who received placebo also received 3 (0–6) units of allogeneic blood products and had 700 (200–1550) ml additional blood loss; these differences were not statistically significantly different. There was one thrombotic event in each group.Conclusions: Infusion of fibrinogen concentrate triggered by Fibtem A5 ≤15 mm did not improve outcomes in PPH. Pre-specified subgroup analyses suggest that fibrinogen replacement is not required if the Fibtem A5 is > 12 mm or Clauss fibrinogen >2 g litre⁻¹, but an effect below these levels cannot be excluded. The raised fibrinogen at term appears to be a physiological buffer rather than required for haemostasis.Trial registration: ISRCTN46295339 (http://ift.tt/2uIJ5tt, last accessed 5 July 2017), EudraCT 2012-005511-11 (http://ift.tt/2vjagIm, last accessed 5 July 2017).

http://ift.tt/2uIYjP8

Sevoflurane activates hippocampal CA3 kainate receptors (Gluk2) to induce hyperactivity during induction and recovery in a mouse model

Abstract

Background: In addition to general anaesthetic effects, sevoflurane can also induce hyperactive behaviours during induction and recovery, which may contribute to neurotoxicity; however, the mechanism of such effects is unclear. Volatile anaesthetics including isoflurane have been found to activate the kainate (GluK2) receptor. We developed a novel mouse model and further explored the involvement of kainate (GluK2) receptors in sevoflurane-induced hyperactivity.Methods: Maximal speed, mean speed, total movement distance and resting percentage of C57BL/6 mice were quantitatively measured using behavioural tracking software before and after sevoflurane anaesthesia. Age dependence of this model was also analysed and sevoflurane-induced hyperactivity was evaluated after intracerebral injection of the GluK2 receptor blocker NS-102. Neurones from the hippocampal CA3 region were used to undertake in vitro electrophysiological measurement of kainate currents and miniature excitatory postsynaptic potential (mEPSP).Results: Sevoflurane induced significant hyperactivities in mice under sevoflurane 1% anaesthesia and during the recovery period, characterized as increased movement speed and total distance. The hyperactivity was significantly increased in young mice compared with adults (P<0.01) and pre-injection of NS-102 significantly prevented this sevoflurane-induced hyperactivity. In electrophysiological experiments, sevoflurane significantly increased the frequency of mEPSP at low concentrations and evoked kainate currents at high concentrations.Conclusions: We developed a behavioural model in mice that enabled characterization of sevoflurane-induced hyperactivity. The kainate (GluK2) receptor antagonist attenuated these sevoflurane-induced hyperactivities in vivo, suggesting that kainate receptors might be the underlying therapeutic targets for sevoflurane-induced hyperactivities in general anaesthesia.

http://ift.tt/2viQBbJ

Randomized trial of near-infrared spectroscopy for personalized optimization of cerebral tissue oxygenation during cardiac surgery

Abstract

Background. We assessed whether a near-infrared spectroscopy (NIRS)-based algorithm for the personalized optimization of cerebral oxygenation during cardiopulmonary bypass combined with a restrictive red cell transfusion threshold would reduce perioperative injury to the brain, heart, and kidneys.Methods. In a randomized controlled trial, participants in three UK centres were randomized with concealed allocation to a NIRS (INVOS 5100; Medtronic Inc., Minneapolis, MN, USA)-based 'patient-specific' algorithm that included a restrictive red cell transfusion threshold (haematocrit 18%) or to a 'generic' non-NIRS-based algorithm (standard care). The NIRS algorithm aimed to maintain cerebral oxygenation at an absolute value of > 50% or at > 70% of baseline values. The primary outcome for the trial was cognitive function measured up to 3 months postsurgery.Results. The analysis population comprised eligible randomized patients who underwent valve or combined valve surgery and coronary artery bypass grafts using cardiopulmonary bypass between December 2009 and January 2014 (n=98 patient-specific algorithm; n=106 generic algorithm). There was no difference between the groups for the three core cognitive domains (attention, verbal memory, and motor coordination) or for the non-core domains psychomotor speed and visuo-spatial skills. The NIRS group had higher scores for verbal fluency; mean difference 3.73 (95% confidence interval 1.50, 5.96). Red cell transfusions, biomarkers of brain, kidney, and myocardial injury, adverse events, and health-care costs were similar between the groups.Conclusions. These results do not support the use of NIRS-based algorithms for the personalized optimization of cerebral oxygenation in adult cardiac surgery.Clinical trial registration.http://ift.tt/HkCGY7, ISRCTN 23557269.

http://ift.tt/2uIHJzg

Predicting successful supraclavicular brachial plexus block using pulse oximeter perfusion index

Abstract

Background. Supraclavicular nerve block is a popular approach for anaesthesia for upper limb surgeries. Conventional methods for evaluation of block success are time consuming and need patient cooperation. The aim of this study was to evaluate whether the perfusion index (PI) can be used to predict and provide a cut-off value for ultrasound-guided supraclavicular nerve block success.Methods. The study included 77 patients undergoing elective orthopaedic procedures under ultrasound-guided supraclavicular nerve block. After local anaesthetic injection, sensory block success was assessed every 3 min by pinprick, and motor block success was assessed every 5 min by the ability to flex the elbow and the hand against resistance. The PI was recorded at baseline and at 10, 20, and 30 min after anaesthetic injection in both blocked and non-blocked limbs. The PI ratio was calculated as the PI after 10 min divided by the PI at the baseline. Receiver operating characteristic curves were constructed for the accuracy of the PI in detection of block success.Results. The PI was higher in the blocked limb at all time points, and this was paralleled by a higher PI ratio compared with the unblocked limb. Both the PI and the PI ratio at 10 min after injection showed a sensitivity and specificity of 100% for block success at cut-off values of 3.3 and 1.4, respectively.Conclusions. The PI is a useful tool for evaluation of successful supraclavicular nerve block. A PI ratio of > 1.4 is a good predictor for block success.

http://ift.tt/2uINoVW

Orthodontic Extraction and Third Molar Eruption

Publication date: Available online 18 July 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Fangwei Pan, Wen Liao, Chunjie Li




http://ift.tt/2u8oQTa

Inverse correlation between galectin-4 and TTF-1 in lung adenocarcinoma

Abstract

We have previously shown that galectin-4 expression is an independent predictor for lymph node metastasis and serves as an adverse prognostic indicator in patients with acinar adenocarcinoma of the lung. In contrast, thyroid transcription factor-1 (TTF-1) expression in non-small cell lung carcinoma has been shown to be associated with a favorable prognosis. In the present study, 208 cases of acinar adenocarcinoma of the lung and 36 cases with distant metastatic lesions of lung adenocarcinoma were immunohistochemically examined for expression of galectin-4 and TTF-1 to elucidate their correlation with clinicopathological factors. TTF-1 expression was observed in 145 cases (69.7%) and associated with smaller tumor size, infrequent pleural invasion, and lower TNM stage. Galectin-4 expression was observed in 86 cases (41.3%). Furthermore, galectin-4-positive carcinoma cells and TTF-1-positive carcinoma cells existed exclusively within the same lesion. Expressions of TTF-1 and galectin-4 were favorable and adverse prognostic factors, respectively. Approximately 40% (15/36 cases) of lung adenocarcinoma at the distant metastatic sites were immunohistochemically negative for TTF-1. Four out of five galectin-4-positive metastatic lesions were negative for TTF-1. We found an inverse correlation between galectin-4 and TTF-1 expressions in acinar adenocarcinoma, and this phenomenon was also found to be present in metastatic sites. These findings suggest that we should not exclude the possibility of metastatic adenocarcinoma of the lung, even if the tumor cells are immunohistochemically negative for TTF-1 in the primary unknown tumor, because aggressive lung adenocarcinomas often lack TTF-1 expression.

http://ift.tt/2tqhxcp

Multifocal septic arthritis, gluteal abscess and spondylodiscitis by Streptococcus dysgalactiae subspecies equisimilis after an intramuscular injection

We present the case of a 63-year-old man, admitted for hand cellulitis and acute kidney injury. A Streptococcus dysgalactiae subsp equisimilis (SDSE) was isolated in blood cultures and despite directed intravenous antibiotherapy, the patient evolved unfavourably, with dorsolumbar spondylodiscitis, multifocal septic arthritis and abscesses. CT also showed densification of the gluteal muscles, multiple air bubbles in the psoas, paraspinal muscles and spinal canal that were associated with an intramuscular injection administered 1 week earlier for a backache. After escalation of the antibiotherapy and intensive supportive measures, the patient showed improvement and was discharged after 8 weeks of antibiotherapy.

The incidence of invasive SDSE infections has been growing, especially in immunosupressed patients. In this case, despite no predisposing factor identified, it evolved to severe sepsis. The intramuscular injection, a trivialised but not harmless procedure, was the assumed port of entry, as previously described in another case report.

http://ift.tt/2uCqi29

A case of congenital coronary-pulmonary fistulas presenting as spontaneous mediastinal haemorrhage

Coronary artery fistulas are rare anomalous vascular connections between coronary arteries and a cardiac chamber or a central vessel, without an intervening capillary bed. Coronary-pulmonary fistulas are a distinct subset of coronary artery fistulas. We present the case of a previously healthy 63-year-old-man who presented with chest pain and was found to have mediastinal haemorrhage. Upon further investigations, he was found to have multiple coronary-pulmonary fistulas with pseudoaneurysm formation in three of the fistulas. Two of these pseudoaneurysms showed inflammatory changes indicative of recent bleed. These were determined to be the source of the mediastinal bleeding and patientâ™s initial presentation. The patient was managed medically after obtaining multiple expert opinions from various institutions.

http://ift.tt/2vBTLa0

Severe destructive nasopharyngeal granulomatosis with polyangiitis with superimposed skull base Pseudomonas aeruginosa osteomyelitis

Skull base osteomyelitis in the setting of granulomatosis with polyangiitis (GPA) is rare and entails significant diagnostic challenges. We present a case of a 65-year-old Caucasian man with a history of rheumatoid arthritis, off immunosuppression for 18 months, who presented with 2 years of chronic headaches, severe fatigue, saddle nose deformity and 20-kilogram unintentional weight loss. Maxillofacial CT revealed an extensive destructive sinonasal and erosive skull base process. Laboratory evaluation showed equivocal elevation of antiproteinase 3 antibodies with negative antineutrophil cytoplasmic antibody panel. Biopsy of the skull base/clivus revealed necrotising granulomatous inflammation with focal vasculitis consistent with GPA, and multiple bone cultures were positive for Pseudomonas aeruginosa. This patient was diagnosed concurrently with GPA and P. aeruginosa skull base osteomyelitis. He was started on a 6-week course of cefepime intravenously and oral prednisone, with the plan to initiate rituximab infusion 2 weeks after initiation of antibiotic therapy.

http://ift.tt/2uCsbvV

Cystometrography of meningitis-retention syndrome

Although the combination of acute urinary retention and aseptic meningitis has not been well recognised, this combination can be referred to as meningitis-retention syndrome (MRS). We report a case of MRS with urodynamic follow-up. A 29-year-old man developed fever and headache, and after 7 days, he developed sudden urinary retention. Neurological examination indicated stiff neck, hyper-reflexes of the lower extremities. Cerebrospinal fluid examination showed mononuclear leucocytosis, increased protein level. Myelin basic protein was absent. MRI of the brain and spinal cord were normal. Cystometrography revealed an atonic bladder. The diagnosis was MRS. After 11 days of hospital day, his symptoms reduced rapidly, and on the 12th day, cystometrography revealed normal pattern. In mild cases, the symptoms reduced and the urodynamic examination improved rapidly. Although MRS is a rare symptom, its urodynamic assessment is important.

http://ift.tt/2vBWdNu

Consumptive hypothyroidism in solitary cutaneous haemangioma

Description

A 21/2-year-old boy had been diagnosed with primary hypothyroidism and was referred for persistently elevated thyroid stimulating hormone (TSH) despite regular supervised administration of a high dose of L-thyroxine (15 µg/kg/day) for preceding 3 months. His developmental milestones (sitting with support at 6 months of age) were normal initially. His parents then noticed progressive lethargy, sleepiness, poor feeding, constipation, hoarse cry and delayed milestones that prompted a medical consultation. Thyroid function tests done a week after his birth for unconjugated hyperbilirubinaemia were normal. When the test was repeated at about 1.5 years of age, TSH came out to be 76 µIU/mL.

Clinical examination revealed short stature, facial puffiness, macroglossia with dry and coarse skin and a small umbilical hernia (figure 1). Thyroid was palpable at eutopic location. A cutaneous haemangioma (12 cmx10 cm) was present over the left suprascapular area (figure 2). The parents stated that the...

http://ift.tt/2uCgl52

Hypertensive encephalopathy mimicking cerebral vasculitis with pontine oedema, cerebellar white matter lesions and multiple cerebral infarctions

A 47-year-old man with poorly controlled hypertension presented with headaches, right-sided weakness and dysarthria. CT and MRI scans of the brain showed widespread abnormalities including significant pontine oedema, basal ganglia and corona radiata infarctions and cerebellar white matter high signal. Imaging of the intracerebral vasculature also demonstrated wall irregularities. Initially a central nervous system inflammatory disorder was thought to be the most likely diagnosis, possibly acute demyelinating encephalomyelitis or cerebral vasculitis, and the patient was treated with high-dose intravenous steroids. The diagnosis of hypertensive encephalopathy was made because (1) the patient was hypertensive and (2) the patients MRI findings resolved with antihypertensive treatment.

Blood pressure treatment was instigated from admission, and the patients symptoms improved with resolution of the radiological abnormalities.

http://ift.tt/2vBIIgQ

Focused assessment with sonography for trauma (FAST) identifies liver injury following cardiopulmonary resuscitation

Liver trauma is a recognised rare complication of cardiopulmonary resuscitation (CPR) and may be difficult to detect. We report a case of intraperitoneal haemorrhage due to liver injury following CPR in a 50-year-old man admitted to the intensive care unit. The haemorrhage was diagnosed with focused assessment with sonography for trauma (FAST). FAST can rapidly and easily diagnose liver injury. FAST is recommended for excluding haemoperitoneum in patients who are haemodynamically unstable after resuscitation.

http://ift.tt/2uCtLxP

Patterns of fractionation for patients with T2N0M0 glottic larynx cancer undergoing definitive radiotherapy in the United States

Publication date: September 2017
Source:Oral Oncology, Volume 72
Author(s): William A. Stokes, Priscilla K. Stumpf, Bernard L. Jones, Patrick J. Blatchford, Sana D. Karam, Ryan M. Lanning, David Raben
ObjectivesAmong patients with T2N0M0 glottic larynx cancer undergoing definitive radiotherapy, recent retrospective and prospective data have suggested improved outcomes with altered fractionation over conventional fractionation (CFxn). We sought to characterize national fractionation patterns and to compare outcomes among them.Materials and MethodsWe queried the National Cancer Database for T2N0M0 squamous cell carcinomas of the glottis diagnosed from 2004–2014 and managed with definitive radiotherapy. Dose-per-fraction and duration of radiotherapy were used to define cohorts undergoing CFxn, hypofractionation (HypoFxn), and hyperfractionation (HyperFxn). Logistic regression was performed to identify predictors of receiving altered fractionation. Cox regression and propensity-score matching (PSM) analyses were used to compare survival between schedules.ResultsWe abstracted 2 006 CFxn patients, 1 166 HypoFxn patients, and 161 HyperFxn patients. Fractionation patterns changed significantly from 2004 to 2014, with use of HyperFxn decreasing from 6.3% to 1.8% and use of HypoFxn increasing from 23.9% to 54.1% (p<0.001). Receipt of altered fractionation was independently associated with later year of diagnosis and higher facility volume. On Cox regression, both HypoFxn (hazard ratio [HR] for mortality 0.84, 95% confidence interval [95%CI] 0.73–0.97) and HyperFxn (HR 0.74, 95%CI 0.56–0.99) were associated with improved survival over CFxn. The survival advantage of each altered fractionation schedule over CFxn was redemonstrated on comparison of PSM groups.ConclusionIncreasing utilization of HypoFxn for T2N0M0 glottic cancer is driving national practice patterns away from CFxn. Our findings support the use of altered fractionation, particularly HypoFxn, for patients undergoing definitive radiotherapy, although HyperFxn remains understudied in a prospective fashion.



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

Publication date: Available online 18 July 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): A. Rozeboom, L. Dubois, R. Bos, R. Spijker, J. de Lange
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. A total of seventy studies were selected for detailed analysis. Most studies reported good results with regard to the outcome measures of open treatment. Surgical complications including hematoma, wound infection, weakness of the facial nerve, sialocele, salivary fistula, sensory disturbance of the great auricular nerve, unsatisfactory scarring, and fixation failure were reported in the studies. This review suggests that because of the high level of methodological variance in the relevant studies published to date, among other factors, there are currently no evidence-based conclusions or guidelines that can be formulated with regard to the most appropriate open treatment. Establishment of such standards could potentially improve treatment outcomes.



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Changes in IL-17A, macrophage-derived chemokine and adiponectin following treatment of psoriasis with calcipotriol plus betamethasone dipropionate aerosol foam: results from the PSO-ABLE study

Abstract

Psoriasis vulgaris is an immune-mediated disease characterized by skin and systemic inflammation that is associated with an increased risk of comorbidities such as cardiovascular disease. Although typically associated with moderate-to-severe psoriasis, recent data suggests that increased vascular inflammation may occur in patients with milder psoriasis. It has been shown that systemic treatment of psoriasis leads to an improvement in cardiovascular-associated biomarkers, eg adiponectin levels.

This article is protected by copyright. All rights reserved.

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Primary Small Cell Carcinoma of the Hypopharynx: A Report of Two Cases and Review of Nine Additional Cases

Objective. Two patients with primary small cell carcinoma (SmCC) of the hypopharynx, an extremely rare site for the occurrence of SmCC, are reported and nine additional well-documented cases are reviewed. Methods. Case report and review of the literature concerning primary SmCC of the hypopharynx. Results. On the final analysis, we reviewed eleven cases of primary SmCC of the hypopharynx. The tumors contained mixed elements of SmCC and squamous cell carcinoma (SCC) in six (55%) of eleven patients. Out of eleven patients, two patients had distant metastasis at the initial presentation. Even though nine patients presented with locoregional disease, development of distant metastasis after treatment was seen in five patients (56%), whereas there was no report of treatment failure on the primary site. To achieve more than two-year survival, patients should have received more than 4 cycles of chemotherapy. Conclusion. We report two cases of primary SmCC of the hypopharynx with a review of the literature. In more than half of the cases, combined carcinomas with SCC are seen. Because this tumor has a strong propensity for distant metastasis even in patients with clinically localized tumor, new powerful systemic agents should be explored.

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Reporting of outcomes in randomised controlled trials on nail psoriasis; a Systematic Review

Summary

Harmonization of outcome measures is needed to increase the value of clinical trials on nail psoriasis. To provide the first step in core outcome set (COS) development, a systematic review was conducted to identify outcome domains and instruments reported in (ongoing) randomised controlled trials (RCTs) on nail psoriasis.

Identified outcome domains included clinical signs, quality of life, symptoms and delivery of care. A NAPSI was most commonly used to assess clinical signs (73.8% of studies). Other outcome instruments used included the NAS, composite fingernail score, a physician global assessment, individual nail features or a combination of these. Heterogeneity in type and reporting (e.g. NAPSI 50, NAPSI 75) of outcome instruments was high and characteristics were often insufficient reported. 43.1% of studies assessed quality of life, with 3.1% of studies using a nail psoriasis specific tool. Assessment of symptoms and delivery of care was limited.

In conclusion, heterogeneity in type and reporting of nail psoriasis outcome instruments needs to be addressed in the process towards COS development. Sufficient reporting of instrument characteristics should be encouraged. As nail psoriasis is generally assessed secondary to psoriasis of the skin or joints, collaboration between different research groups in COS development is needed.

This article is protected by copyright. All rights reserved.

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Risk of Cancer in Patients with Psoriasis on Biologic Therapies: A Systematic Review

Summary

Biologic therapies are highly effective in psoriasis, but have profound effects on innate and adaptive immune pathways that may negatively impact on cancer immunosurveillance mechanisms. To investigate the risk of cancer in psoriasis patients treated with biologic therapy we searched Medline, Embase, and the Cochrane Library (up to August 2016) for randomized control trials, prospective cohort studies and systematic reviews that reported cancer incidence in people exposed to biologic therapy for psoriasis compared to a control population. Eight prospective cohort studies met our inclusion criteria. All the evidence reviewed related to tumour necrosis factor inhibitors (TNFi) with the exception of one study on ustekinumab. An increased risk of non-melanoma skin cancer (NMSC), particularly squamous cell carcinoma, was reported with TNFi compared to both a general United States population and a rheumatoid arthritis population treated with TNFi. No evidence for increased risk of cancers (reported as all cancers, lymphoma, melanoma, prostate, colorectal and breast cancer) other than NMSC was identified. There were important limitations to the studies identified including choice of comparator arms, inadequate adjustment for confounding factors and failure to account for latency periods of cancer. There remains a need for ongoing pharmacovigilance in relation to cancer risk and biologic therapy; to determine whether the NMSC signal is specifically attributable to TNFi, further investigation is required using prospectively-collected data with adjustment for known NMSC risk factors. Systematic review registration number: PROSPERO; 2015:CRD42015017538.

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Wet work exposure and hand eczema among healthcare workers - a cross-sectional study

Summary

Background

Hand eczema is more common in healthcare workers compared to the general population. The hands are subject to changing occupational exposures due to mandatory hygiene regulations for health care workers.

Objectives

To describe the exposure due to hygiene procedures and investigate the associations between occupational hand washing, use of non-sterile gloves, and hand disinfectant and self-reported hand eczema.

Methods

Cross-sectional study with an electronic questionnaire distributed to 28 762 hospital employees in southern Sweden. Respondents working as nurses, assistant nurses or physicians constituted the group of healthcare workers analysed. Adjustments were made for gender, age, wet work at home, life-style factors and atopic dermatitis.

Results

12 288 (43%) responded including 9051 healthcare workers. In this group the 1-year prevalence of self-reported hand eczema was 21%. On a daily basis, 30% reported hand washing with soap >20 times at work, 45% used hand disinfectants >50 times, and 54% used non-sterile gloves > 2 hours. After adjustment for confounding factors, a dose-dependent association with self-reported hand eczema was found for the daily number of hand washes with soap at work and time working with disposable gloves, but not for alcoholic disinfectant use. Hand washing outside work was not associated with self-reported hand eczema in the adjusted multivariate analysis.

Conclusions

In this study, we found a higher 1-year prevalence of self-reported hand eczema among Swedish healthcare workers than reported in the general population. Hand washing with soap and use of disposable gloves were associated with the occurrence of self-reported hand eczema in a dose-dependent way. Use of hand disinfectant was not associated with self-reported hand eczema.

This article is protected by copyright. All rights reserved.

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Melasma: an Up-to-Date Comprehensive Review

Abstract

Melasma is a common acquired condition of symmetric hyperpigmentation, typically occurring on the face, with higher prevalence in females and darker skin types. Multiple etiologies, including light exposure, hormonal influences, and family history, have been implicated in the pathogenesis of this disorder. Overall prevalence ranges widely at 1–50%, since values are typically calculated within a specific ethnic population within a geographic region. Histologically, melasma can display increased epidermal and/or dermal pigmentation, enlarged melanocytes, increased melanosomes, solar elastosis, dermal blood vessels, and, occasionally, perivascular lymphohistiocytic infiltrates. Various topical, oral, and procedural therapies have been successfully used to treat melasma. Traditional topical therapies including hydroquinone, tretinoin, corticosteroids, and triple combination creams; however, other synthetic and natural topical compounds have also shown varying efficacies. Promising oral therapies for melasma include tranexamic acid, Polypodium leucotomos, and glutathione. Procedures, including chemical peels, microneedling, radiofrequency, and lasers, are also often used as primary or adjunctive treatments for melasma. Notably, combination therapies within or across treatment modalities generally result in better efficacies than monotherapies. This review serves as a comprehensive update on the current understanding of the epidemiology, pathogenesis, clinical and histologic features of melasma, as well as treatments for this common, yet therapeutically challenging, condition.

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Bilateral multiple pulmonary artery aneurysms associated with cavitary pulmonary tuberculosis: a case report

Pulmonary artery aneurysms constitute 50%) of cases, however, pulmonary artery aneurysm is a rar...

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Potential emerging treatment in vitiligo using Er:YAG in combination with 5FU and clobetasol

Summary

Background

Vitiligo is a pigmentary disorder of skin affecting at least 1% of the world population of all races in both sexes. Its importance is mainly due to subsequent social and psychological problems rather than clinical complications. Various treatment choices are available for vitiligo; however, laser-based courses have shown to give more acceptable results.

Objective

The aim of this trial was to evaluate the efficacy of Er:YAG laser as a supplementary medicine to topical 5FU and clobetasol in vitiligo patients.

Methods

Two comparable vitiligo patches from 38 eligible patients were randomized to receive topical 5FU and clobetasol in control group and additional Er:YAG laser in intervention group. Major outcomes of interest were the size of patch and pigmentation score at randomization and 2 and 4 months after therapy.

Results

Final sample included 18 (47%) male patients and age of 35.66±8.04. The performance Er:YAG group was superior in all sites. Reduction in the size of patches was greater in Er:YAG group (p-value=.004). Also, this group showed a higher pigmentation scores in the trial period than control group (p-value<.001).

Conclusions

Greater reduction in the size and increase in pigmentation score was seen in Er:YAG group especially for short periods after therapy and repeating laser sessions may help improving final outcomes. Er:AYG could help in reducing complications of long-term topical treatments, achieving faster response, and improving patient adherence.

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In vitro evaluation of chitosan-coated liposome containing both coenzyme Q10 and alpha-lipoic acid: Cytotoxicity, antioxidant activity, and antimicrobial activity

Summary

Background

Chitosan-coated liposome containing both coenzyme Q10 and alpha-lipoic acid (CCAL) was a novel multifunctional nano delivery system exhibited long-term stability at room temperature and high encapsulation efficiency. Which containing two kinds of antioxidants (coenzyme Q10 and alpha-lipoic acid) and two antibacterial agents (chitosan and alpha-lipoic acid). However, the further biocompatibility, such as cytotoxicity and antioxidant activity, and antimicrobial activity of CCAL, has not been systematically evaluated.

Objectives

This study aims to evaluate the cytotoxicity, antioxidant activity and antimicrobial activity of CCAL.

Methods

This article evaluated the in vitro cytotoxicity and antioxidant activity of CCAL by CCK8 assay, and antimicrobial activity on Staphylococcus aureus and Escherichia coli was investigated.

Results

For antioxidant activity study, CCAL displayed significant antioxidant effect when compared with control group (P<.01). Finally, CCAL also exhibited antimicrobial activity, and CCAL showed stronger bactericidal effect with Gram-positive bacteria than Gram-negative bacteria.

Conclusions

CCAL could be a potential antioxidant delivery system for cosmetics or pharmaceuticals without cytotoxicity and artificial preservatives free.

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Bone involvement: Histopathological evidence for endoscopic management of sinonasal inverted papilloma

Objective

The aim of this study is to provide histopathological evidence for a better understanding of the excision of bone underlying tumor.

Study Design

Retrospective study.

Methods

Thirty patients with histopathological diagnosis of sinonasal inverted papilloma (SIP) were enrolled. All patients underwent preoperative radiography to define the tumor location. The primary tumor and underlying bone, removed during endoscopic surgery, were examined under microscope.

Results

Twenty-five of 30 specimens exhibited bony hyperostosis on computed tomography (CT) images, and 12 of 30 specimens showed evidence of bony lamellar erosion. Both coexisted in 11 cases. Half of the relapse cases (8 of 16) presented bone discontinuity on CT, which indicates a higher propensity for bone involvement when compared with primary SIP. On histopathology, 26 cases presented hyperostosis and 11 cases showed bone invasion. In total, 90% of cases covered both. Sixteen cases showed a growing tendency of inflammatory cells infiltration.

Conclusion

Histopathological evidence of bone involvement indicates the importance of removal of the underlying bone at the time of endoscopic tumor resection. We hypothesized that bone involvement including bone invasion and osteogenesis may be induced by the tumor, and any microscopic lesion in the bony crevices probably indicates recurrence of SIP. Furthermore, infiltration of inflammatory cells may facilitate bone involvement and cause recurrence.

Level of Evidence

3b. Laryngoscope, 2017

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Rapidly growing cystic vestibular schwannoma with sudden onset facial palsy, ten years after subtotal excision

An elderly male patient diagnosed with a right-sided cystic vestibular schwannoma (CVS) at our center underwent a translabyrinthine approach with a subtotal excision to preserve the facial nerve (FN). The tumor grew slowly for the first 9 years but in the subsequent 2 years grew rapidly, with the patient developing a FN paralysis. Using the previous approach, a second surgery was done and the tumor was excised, leaving behind a sheath of tumor on the facial and lower cranial nerves. This case demonstrates that CVSs show unpredictable growth patterns and need to be followed up for a longer period of time. Laryngoscope, 2017

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In response to In reference to laboratory assessment of sudden sensorineural hearing loss: A case-control study

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Medical residents' circadian preferences across specialties

Objective

Circadian preference refers to the tendency of individuals to be more alert and effective in the morning (larks) or the evening (owls). Given the rigors of medical residency training and perceived lifestyle differences among specialties, circadian preference may play a role in choice of medical specialty and subsequent job satisfaction during training. This study aimed to determine the circadian preferences of residents across specialties and correlations with specialty choice and job satisfaction.

Study Design

Single-institution, cross-sectional survey.

Methods

The Horne-Ostberg Morningness-Eveningness questionnaire, the standard to identify circadian preference, was modified to include demographic and job satisfaction variables and administered to residents at our tertiary care hospital in 2014. Independent t tests were used to correlate circadian preference and specialty choice, and Spearman's correlations were used to correlate circadian preference and job satisfaction.

Results

A total of 160 residents from postgraduate years 1 through 7 and 10 specialties responded. The mean chronotype scores from all specialties met the category of "neither" morning nor evening type. A significant difference occurred between emergency medicine residents and residents from anesthesiology (P = 0.0007), surgery (P < 0.0001), and medicine (P = 0.0005). Residents in the surgical specialties trended toward the morning chronotype, whereas emergency medicine trended toward evening chronotype. There was no significant correlation between chronotype and job satisfaction.

Conclusion

Although preliminary because of the low response rate, this study points to the potential of considering circadian preference in choice of specialty training and for designing resident on-call schedules.

Level of Evidence

NA. Laryngoscope, 2017

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Immune Checkpoint Inhibitors in Organ Transplant Patients.

Modulation of T-cell activity through blockade of coinhibitory molecules has revolutionized the treatment of various malignancies. Several immune checkpoint inhibitors are currently Food and Drug Administration approved which target various coinhibitory pathways including cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed death 1 receptor (PD-1), and programmed cell death ligand-1. Clinical trials that lead to the Food and Drug Administration approval of these agents often excluded patients with an organ transplant. Excluding these patients was deliberate due to concern that immune checkpoint inhibitor therapy could lead to graft rejection. The PD-1 and CTLA-4 pathways are essential to downregulate our immune system in the setting of T-cell activation to prevent autoimmunity. Furthermore, both pathways are implicated in transplanted organ tolerance and modulation of the pathways may inadvertently lead to peripheral transplant rejection. Currently, there are no guidelines for the treatment of patients with immune checkpoint inhibitors in the setting of a prior organ transplant. Thus far, there are only 10 reported cases of patients in the literature who were treated in this setting. Two additional cases are reported herein, including 1 patient with a prior cardiac transplant receiving nivolumab for non-small cell lung cancer. Of the 12 cases, 4 patients experienced organ rejection. From these observations, the authors hypothesize factors that affect safety and of this treatment modality in this patient population. These factors include the integral role of the PD-1 pathway compared with the CTLA-4 pathway in organ acceptance, sequential implementation of different immune checkpoint inhibitor classes, length of time with a transplant before therapy, strength of immunosuppressive agents to prevent organ transplant rejection, and immunogenicity of the particular organ grafted. Although limited cases have been reported, there are circumstances in which immune checkpoint inhibitors have been used in the setting of organ transplantation without resulting in organ rejection. A thorough discussion with the patient of the potential risks, including graft rejection, and benefits of this therapy is necessary before beginning this treatment. More research is needed to explore the safety and efficacy of immune checkpoint inhibitors in the setting of organ transplantation. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved

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