Risk of anaphylaxis in complementary and alternative medicine.

Purpose of review: Complementary and alternative medicine (CAM) use is widespread across the world. Patients with asthma and allergy regularly use CAM therapies. Allergic and anaphylactic reactions to CAM have been reported. Recent findings: Recent attempts to regulate and monitor adverse reaction to these therapies have given us further insight into potential causes of severe allergic reactions. Several culprits identified including Andrographis paniculata, Echinacea species, bee products, Ginkgo biloba and Ginseng are discussed here. Summary: Knowing the factors that increase the risk of anaphylaxis allows reactions to be recognized, reported and further investigated. Research to identify key causative allergens is necessary in the future. Collaboration between the allergy community and CAM practitioners can allow better understanding of allergy to these therapies. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2uScvWs

Three-dimensional volumetric changes in the upper airway after maxillomandibular advancement in obstructive sleep apnoea patients and the impact on quality of life

Publication date: Available online 20 July 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): B. Veys, L. Pottel, W. Mollemans, J. Abeloos, G. Swennen, N. Neyt
Obstructive sleep apnoea (OSA) is a sleep-related breathing disorder, characterized by repetitive airway obstructions, causing disruptive snoring and daytime sleepiness. Maxillomandibular advancement (MMA), which enlarges the upper airway, is a therapeutic surgical approach. However, no study has performed an upper airway sub-region analysis using validated three-dimensional (3D) anatomical and technical limits on cone beam computed tomography (CBCT). Hence, this prospective, observational trial was performed to evaluate 3D volumetric changes in the upper airway according to validated 3D cephalometric landmarks, before and after MMA, for all patients with a polysomnography diagnosis of OSA (apnoea–hypopnoea index (AHI) ≥5). The secondary objective was to evaluate the impact of MMA on the AHI and in a subjective manner with the Epworth Sleepiness Scale (ESS) and OSA questionnaire. Eleven consecutive OSA patients were included. A significant volume increase in the oropharynx (P=0.002) and hypopharynx (P=0.02) was observed, in contrast to a non-significant volume reduction in the nasopharynx (P >0.05). The median AHI (P=0.03) and ESS score (P=0.004) decreased significantly as a result of surgery. In conclusion, MMA significantly enlarges the airway volume of the oropharynx and hypopharynx and is associated with improved quality of life.



http://ift.tt/2ulg0BH

Central nervous system anomalies in craniofacial microsomia: a systematic review

Publication date: Available online 20 July 2017
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): R.W. Renkema, C.J.J.M. Caron, E.B. Wolvius, D.J. Dunaway, C.R. Forrest, B.L. Padwa, M.J. Koudstaal
Extracraniofacial anomalies, including central nervous system (CNS) anomalies, may occur in craniofacial microsomia (CFM). This systematic review was performed to provide an overview of the literature on the prevalence and types of CNS anomalies and developmental disorders in CFM, in order to improve the recognition and possible treatment of these anomalies. A systematic search was conducted and data on the number of patients, patient characteristics, type and prevalence of CNS anomalies or developmental delay, and correlations between CFM and CNS anomalies were extracted. Sixteen papers were included; 11 of these described developmental disorders. The most common reported anomalies were neural tube defects, corpus callosum agenesis or hypoplasia, intracranial lipoma, Arnold–Chiari malformations, hydrocephaly, ventriculomegaly, and cerebral hypoplasia. The prevalence of CNS anomalies in CFM varied from 2% to 69%. The prevalence of developmental disorders, such as intellectual disability, language or speech developmental delay, and neuropsychomotor delay, varied from 8% to 73%. This study suggests that CNS anomalies and developmental disorders are seen in a substantial proportion of patients with CFM. Further research should focus on determining which features of CFM are correlated with CNS anomalies to allow adequate screening and timely care.



http://ift.tt/2uJaUBu

Floor of Mouth Haematoma following Dental Implant Placement: Systematic Review and Case Presentation

Publication date: Available online 21 July 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Catherine Law, Peyman Alam, Farzad Borumandi
PurposeThe authors aim to give a structured review of the reported cases of floor of mouth haematoma during or following dental implantation, the frequent causes and management; with the presentation of a related case.MethodsAn online search of the medical literature was conducted from the year 1990 to 2016. The following search terms were used: floor of mouth haematoma, sublingual haematoma, dental implant haematoma, implant in mandible and complication of dental implant. Abstracts were screened for relevance to the aims of the review. Relevant reports in the English language were included and referenced. The articles were reviewed for patient demographics, implant location, coagulopathy, pre- or postoperative imaging, airway management, treatment of the haematoma and management of the offending implant.ResultsThe literature search identified 25 reported cases. Haemorrhage was caused by perforation of the lingual cortex in 84% of cases (n=21). Airway obstruction resulted in emergency intubation or tracheostomy in 68% of patients (n=17). The majority of cases (n=18, 72%) required surgical management in the hospital setting. The management of the offending implant was reported inconsistently. Out of 17 reported cases, 5 implants had to be removed, 9 remained in situ and in 3 cases the implant placement was abandoned. Only one case performed preoperative three-dimensional imaging prior to implant insertion. We report an additional case with significant floor of mouth haematoma, which required immediate surgical evacuation and haemostasis.ConclusionSerious complications such as floor of mouth haematoma after dental implant insertion may occur which can be potentially life-threatening. Pre-operative 3D imaging helps to visualize the individual mandibular shape which may reduce the incidence of serious complications. If injury to vessels of the floor of the mouth cannot be confidently excluded, further assessment and treatment is recommended before the patient is being discharged.



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Surgical management of an aggressive multifocal squamous odontogenic tumor

Publication date: Available online 21 July 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Pieter-Jan Verhelst, Laury Grosjean, Eman Shaheen, Constantinus Politis
Squamous odontogenic tumor is a rare benign epithelial odontogenic tumor of the jaw. Most are solitary lesions, although rare multifocal lesions have been described. Maxillary lesions have more aggressive behavior. Because of their benign character, these lesions are usually treated using a conservative surgical approach with curettage and surgical enucleation. Here we present a case of a 29-year-old woman with multifocal lesions who was initially treated with conservative surgical therapy. Early recurrence 6-months post-surgery prompted more aggressive resection. The case is discussed in the context of current evidence related to the epidemiology, etiology, diagnosis, and therapy of squamous odontogenic tumors.



http://ift.tt/2gRSJ7e

Surgical Safety Checklists are Under Utilized in Ambulatory Oral and Maxillofacial Surgery

Publication date: Available online 21 July 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Archana Viswanath, Andras Balint, Robert E. Johnson, Morton B. Rosenberg, Daniel Oreadi
PurposeThe objective of this study was to determine the attitudes towards and the prevalence of surgical safety checklist in ambulatory oral and maxillofacial surgery (OMS) practice.MethodsThe investigators designed and implemented a cross-sectional study and enrolled a random sample of oral-maxillofacial surgeons. The predictor variable was years removed from residency. The primary outcome was the prevalence of surgical safety checklist usage in ambulatory OMS practice. The secondary outcome was to determine whether surgeons whom do not currently use a checklist would be willing to do so if provided with one. Other demographic variables included age, gender, location of practice, type of practice, and number of ambulatory procedures performed per week. Appropriate uni- and bivariate statistics were computed and the levels of significance set at 0.05; 95% confidence intervals were also calculated.ResultsThe study sample was composed of 120 clinicians. 42% of respondents reported that they were not using a surgical safety checklist for ambulatory surgery. 93% of those respondents not currently using a checklist reported they would consider implementing a surgical safety checklist in their practice if provided with one. 45.3% of surgeons performing more than 30 procedures a week reported not using a surgical safety checklist. The majority (67.9%) of respondents whom had completed OMS training greater than 20 years ago reported not using a checklist in their practice.ConclusionAccording to our survey, the majority of practicing oral-maxillofacial surgeons do not currently use surgical safety checklists. Although the response rate was only 12%, the survey does reflect a clear lack of use of checklists among practicing oral-maxillofacial surgeons despite the widespread acceptance in the medical community.



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Comparative metabolic analysis in head and neck cancer and the normal gingiva

Abstract

Objectives

Chronic accumulation of lactate in malignant tumor tissue is associated with increased malignancy and radioresistance. For this study, biopsies of primary head and neck squamous cell carcinoma (HNSCC) and of the normal gingiva of the same patient were compared via metabolic profiling to the healthy gingiva from cancer-free patients.

Materials and methods

Cryobiopsies of 140 HNSCC patients were used to determine ATP, lactate, and glucose concentrations of the tumor and normal gingiva via induced metabolic bioluminescence imaging (imBI). Additionally, these metabolites were quantified in a collective of 79 healthy (non-tumor-bearing) patients. Furthermore, tumor samples were analyzed via immunofluorescence imaging and quantitative real-time PCR for the expression of lactate and glucose transporters.

Results

There were significant differences in ATP concentrations detectable between the tumor, normal gingiva of tumor patients, and gingiva from healthy patients. Lactate concentrations were significantly increased in tumor tissue compared to the normal gingiva of tumor patients as well as the gingiva from healthy patients. Concerning glucose, there was a significant decrease in glucose concentrations detectable in the tumor biopsies compared to the normal gingiva of tumor patients. On the other hand, tumor samples from patients revealed significantly elevated relative expression levels of monocarboxylate transporters (MCT-1 and MCT-4), as well as glucose transporters (GLUT-1 and GLUT-3) compared to the corresponding normal gingiva of each patient.

Conclusions

We could demonstrate that the lactate concentration in HNSCC correlates with primary tumor (T) stage.

Clinical relevance

The aim of this study was to identify metabolic parameters to improve early cancer diagnosis, allow predictions on the degree of malignancy, and contribute to a personalized tumor therapy.

http://ift.tt/2ukFi2K

Approximal morphology as predictor of approximal caries in primary molar teeth

Abstract

Objective

To evaluate the predictive power of the morphology of the distal surface on 1st and mesial surface on 2nd primary molar teeth on caries development in young children.

Sample and methods

Out of 101 3-to 4-year-old children from an on-going study, 62 children, for whom parents' informed consent was given, participated. Upper and lower molar teeth of one randomly selected side received a 2-day temporarily separation. Bitewing radiographs and silicone impressions of interproximal area (IPA) were obtained. One-year procedures were repeated in 52 children (84%). The morphology of the distal surfaces of the first molar teeth and the mesial surfaces on the second molar teeth (n=208) was scored from the occlusal aspect on images from the baseline resin models resulting in four IPA variants: concave-concave; concave-convex; convex-concave, and convex-convex. Approximal caries on the surface in question was radiographically assessed as absent/present.

Results

Of the 52 children examined at follow-up, 31 children (60%) had 1–4 concave surfaces. In total 53 (25%) of the 208 surfaces were concave. A total of 22 children (43%) had 1–4 approximal lesions adding up to 59 lesions. Multiple logistic regression analyses disclosed that gender, surface morphology on one of the approximal surfaces (focus-surface), and adjacent-surface morphology were significantly related to caries development (p values ≤ 0.03). The odds ratio for developing caries in the focus-surface/adjacent-surface in the four IPA variants were convex-convex, 1.0; convex-concave, 5.5 (CI 2.0–14.7); concave-convex, 12.9 (CI 4.1–40.3); and concave-concave, 15.7 (CI 5.1–48.3).

Conclusion

Morphology of approximal surfaces in primary molar teeth, in particular both surfaces being concave, significantly influences the risk of developing caries.

Clinical relevance

The concave morphology of approximal surfaces can predict future caries lesions supporting specific home-care and in-office preventive strategies.

http://ift.tt/2uSoaEH

Risk of anaphylaxis in complementary and alternative medicine.

Purpose of review: Complementary and alternative medicine (CAM) use is widespread across the world. Patients with asthma and allergy regularly use CAM therapies. Allergic and anaphylactic reactions to CAM have been reported. Recent findings: Recent attempts to regulate and monitor adverse reaction to these therapies have given us further insight into potential causes of severe allergic reactions. Several culprits identified including Andrographis paniculata, Echinacea species, bee products, Ginkgo biloba and Ginseng are discussed here. Summary: Knowing the factors that increase the risk of anaphylaxis allows reactions to be recognized, reported and further investigated. Research to identify key causative allergens is necessary in the future. Collaboration between the allergy community and CAM practitioners can allow better understanding of allergy to these therapies. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2uScvWs

A Single 10 mg Oral Dose of Biotin Interferes with Thyroid Function Tests

Thyroid , Vol. 0, No. 0.


http://ift.tt/2uSaCZQ

Large facial lymphatic malformation treatment using sclerosing agent followed by surgical resection: clinical and pathology report

Abstract

Lymphatic malformations are rare slow-flow vascular malformations, with high tendency to appear in the head and neck region. The treatment of these lesions ranges from follow-up to sclerosing agent injection to surgical excision. The authors present a case of a new born with large extensive lingual and submandibular lymphatic malformation, for which the patient underwent tracheostomy and gastrostomy insertion. He was then treated successfully with sclerosing agent injections followed by surgical excision, with 7 years follow-up. The second case presented is a two and a half baby with large lingual lymphatic malformation, treated successfully with doxycycline injections followed by intraoral excision of the lesion. Pathology of the excised lesion is then demonstrated, which shows for the first time the different layers affected by the sclerosing agent.

http://ift.tt/2tozDHE

Endoscopic transcanal myringoplasty for tympanic perforations: An outpatient minimally invasive procedure

Since the 1950s, microscopic myringoplasty has been the standard surgery for repairing a perforated tympanic membrane. In addition to conventional microscopic myringoplasty, endoscopic myringoplasty has been an emerging technique since the late 1990s. This study evaluated the efficacy of endoscopic transcanal myringoplasty for repairing tympanic perforations and examined the minimally invasive feature of this technique (no postauricular incision, no canalplasty).

http://ift.tt/2uS5pBl

The treatment and outcome analysis of primary squamous cell carcinoma of the thyroid

Primary squamous cell carcinoma (SCC) of the thyroid is a rare disease. It usually presents with locally advanced disease and has an overall poor prognosis. In this study, we investigated the characteristics and outcomes of patients with SCC of the thyroid, and reported our experience with chemotherapy with lenvatinib in the treatment of SCC of the thyroid.

http://ift.tt/2vKx6bE

MicroRNA-27b inhibits cell proliferation in oral squamous cell carcinoma by targeting FZD7 and Wnt signaling pathway

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Bingyao Liu, Wei Chen, Gang Cao, Zhen Dong, Jinke Xu, Tingyuan Luo, Senlin Zhang
This study intended to investigate the role of microRNA-27b (miR-27b) in proliferation of oral squamous cell carcinoma (OSCC) cells and to explore the potential molecular mechanism. Cell proliferation was detected by MTT assay. The expression levels of miR-27b, Frizzled7 (FZD7), cyclin D1 and c-myc were detected by quantitative real time polymerase chain reaction (qRT-PCR). The protein expression level of FZD7 was detected by western blot analysis. The relationship between miR-27b and FZD7, and the activity of Wnt signaling pathway were determined using luciferase reporter assay. The miR-27b expression in OSCC cell lines was significantly decreased compared with control. Overexpression of miR-27b remarkably inhibited OSCC cell proliferation. Additionally, miR-27b could target and inhibit FZD7 expression and decrease the activity of Wnt signaling pathway.miR-27b could inhibit OSCC cell proliferation through inhibiting FZD7 and FZD7-mediated Wnt signaling pathway.



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Determinants of Infection Outcome in HCV-Genotype 4

Viral Immunology , Vol. 0, No. 0.


http://ift.tt/2ukxmhV

MicroRNA-27b inhibits cell proliferation in oral squamous cell carcinoma by targeting FZD7 and Wnt signaling pathway

Publication date: November 2017
Source:Archives of Oral Biology, Volume 83
Author(s): Bingyao Liu, Wei Chen, Gang Cao, Zhen Dong, Jinke Xu, Tingyuan Luo, Senlin Zhang
This study intended to investigate the role of microRNA-27b (miR-27b) in proliferation of oral squamous cell carcinoma (OSCC) cells and to explore the potential molecular mechanism. Cell proliferation was detected by MTT assay. The expression levels of miR-27b, Frizzled7 (FZD7), cyclin D1 and c-myc were detected by quantitative real time polymerase chain reaction (qRT-PCR). The protein expression level of FZD7 was detected by western blot analysis. The relationship between miR-27b and FZD7, and the activity of Wnt signaling pathway were determined using luciferase reporter assay. The miR-27b expression in OSCC cell lines was significantly decreased compared with control. Overexpression of miR-27b remarkably inhibited OSCC cell proliferation. Additionally, miR-27b could target and inhibit FZD7 expression and decrease the activity of Wnt signaling pathway.miR-27b could inhibit OSCC cell proliferation through inhibiting FZD7 and FZD7-mediated Wnt signaling pathway.



http://ift.tt/2uJb2Ba

Perforator based rectus free tissue transfer for head and neck reconstruction: New reconstructive advantages from an old friend

Many donor sites are used for autogenous transplantation to reconstruct soft tissue defects in the head and neck [1]. The ideal soft tissue donor site would have a long vascular pedicle, be accompanied by adipose tissue that is highly moldable so that the volume of adipose within the transplant can be customized, and would not contain muscle, so that the volume of the transplant is not affected by muscle atrophy.

http://ift.tt/2gRiVip

A review study to evaluate holmium:YAG laser lithotripsy with flexible ureteroscopy in patients on ongoing oral anticoagulant therapy

Abstract

The objective of this study was to evaluate the safety and efficacy of flexible ureteroscopy (FURS) and holmium:YAG laser lithotripsy for the treatment of upper urinary tract stones in patients on active oral anticoagulants. The records of 1081 patients who underwent flexible ureteroscopic holmium:YAG (Ho:YAG) laser lithotripsy for upper ureteral and renal calculi from 1999 to 2015 were retrospectively reviewed. A total of 84 patients on continuous oral anticoagulation or antiplatelet therapy (warfarin, aspirin, or clopidogrel) were identified. Of these patients, 40 were on warfarin, 25 on aspirin, 11 on clopidogrel, and 8 on both aspirin and clopidogrel. The drugs were not discontinued. The baseline characteristics, indications for anticoagulation therapy, perioperative data, stone-free rate, and complications were documented. Evaluation of outcomes was assessed at 1-, 3-, and 6-month follow-up postoperatively. Mean stone size was 19.7 ± 9.4 (range 8 to 31 mm). Twenty patients had upper ureteral and 64 patients had intrarenal calculi. Two patients had bilateral renal calculi. Mean operation time was 78.2 ± 23.8 min (range 17 to 144 min). Two procedures (2.3%) in warfarin group were terminated due to persistent bleeding causing visual impairment. No transfusions were required. The mean serum hemoglobin levels did not change significantly (12.9 ± 3.7 to 12.2 ± 3.3 g/dL). No thromboembolic or cardiac adverse events were observed perioperatively. The double-j (DJ) ureteral catheterization time was 29.6 ± 9.3 days (range 14 to 68 days) and the hospital stay was 1.6 ± 0.6 days (range 1 to 4). The stone-free rate was 95.2% (80 patients) at 6 months. Flexible ureteroscopic Ho:YAG laser lithotripsy in patients requiring long-term anticoagulation therapy seems to be a safe and effective procedure and should be considered as a first-line treatment option in such patients for the surgical management of upper urinary tract stones.

http://ift.tt/2gRNsMG

Intraosseous spindle cell lipoma of the mandible: case report

Publication date: Available online 21 July 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): T.J. Cooper, T. Lincoln, D.T. James, S. Borgna
We describe what is to our knowledge the first reported intraosseous spindle cell lipoma of the mandible. It is the first spindle cell lipoma we have seen that shows dental resorption, and the largest that we have seen published (60×30×20mm).



http://ift.tt/2ujpCOJ

Use of cyanoacrylate tissue adhesive to orientate histopathological specimens

Publication date: Available online 21 July 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): W. Rodgers, K. Mitsimponas, K. Shakib




http://ift.tt/2vtTuqp

Traction with bilateral reverse eyelets: a simple technique for management of sagittal palatal fractures

Publication date: Available online 21 July 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A. Jain, S. Sharma




http://ift.tt/2uj3OCU

Severe distortion of an orbital titanium mesh implant after recurrent facial trauma: a potential threat to the orbital contents?

Publication date: Available online 21 July 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): J.M. Foletti, P. Scolozzi
Titanium mesh implants have proved their effectiveness in the reconstruction of fractures of the orbital wall, and their compromise between stiffness and elasticity allows for optimal support of the orbital contents. However, after recurrent orbital trauma, these implants (even when properly positioned) can become a potential "penetrating object" that threatens the critical adjacent anatomical structures. We report the case of a patient with recurrent facial trauma whose orbit had previously been reconstructed with a titanium implant, and which resulted in severe deformation.



http://ift.tt/2vua0GU

Re: Endoscopically-assisted extracapsular dissection of pleomorphic adenoma of the parotid gland through a postauricular sulcus approach in young patients

Publication date: Available online 21 July 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): S.S. Bakshi




http://ift.tt/2ujEgFM

Free flap reconstruction for patients aged 85 years and over with head and neck cancer: clinical considerations for comprehensive care

Publication date: Available online 21 July 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): X.F. Chen, Y.M. Chen, S. Gokavarapu, Q.C. Shen, T. Ji
We aimed to identify and evaluate the clinical challenges involved in microvascular flap reconstructions of defects caused by resection of head and neck cancer among patients aged 85 and over. We designed a retrospective study of patients who were treated in the head and neck department of a tertiary referral centre from 2005 to 2015, and all patients aged 85 years and over who had reconstructions with microvascular flaps for head and neck cancer were entered into the study. A total of 24 patients fulfilled the criteria, of whom 15 were men and nine were women. The median (range) duration of stay in hospital was 23 (14-59) days. Eighteen patients had an American Society of Anesthesiologists (ASA) score grade II and six patients grade III. The median (range) operating time was 420 (310-705)minutes, and operative blood loss 550 (200-1500)ml. Sixteen patients had prophylactic tracheostomies, nine of whom developed postoperative surgical complications, seven associated with the tracheostomy (p=0.005). Resections of head and neck cancer and microvascular reconstructions in patients aged 85 and over are associated with a high incidence of postoperative complications. Medical complications tend to be associated with the tracheostomy while surgical complications are potentially associated with the ASA score. Although the morbidity is high, complex resections and microvascular reconstructions are successful with optimum recovery, and age did not seem to influence the outcome. However, it is necessary to avoid prophylactic tracheostomy if possible in these patients.



http://ift.tt/2vtZEGY

Minimally-invasive removal of a screw in the mandibular condyle using computer-assisted navigation

Publication date: Available online 21 July 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): D.-D. Xu, J.-H. Dai, Z.-B. Li, Z. Li




http://ift.tt/2ujudAJ

Management of upper and lower molars that are displaced into the neighbouring spaces

Publication date: Available online 21 July 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): P. Bozkurt, E. Erdem
Our aim was to describe our experience of retrieval of accidental displacements of upper and lower molars into neighbouring anatomical spaces. Thirteen patients were evaluated retrospectively in terms of age, sex, affected side, jaw (mandible or maxilla), surgeon's experience, whether the extracted teeth had erupted, which portion of the tooth or teeth was displaced, the anatomical space into which the fragment was displaced, postoperative complaints, timing of the retrieval, type of anaesthesia, and surgical approach. There were no significant differences in sex, affected side, which part of the tooth was displaced, whether the extracted teeth had erupted, type of anaesthesia, or timing of retrieval. We conclude that this condition should be treated, although follow-up alone may be an option. The intraoral lingual pouch approach for complications of mandibular third molars and the intraoral Caldwell-Luc operation for those in the maxilla could be successful options for retrieval.



http://ift.tt/2vucbdB

Hepatitis transmission risk in kidney transplantation (the HINT study): a cross-sectional survey of transplant clinicians in Australian and New Zealand.

Background: Interpreting hepatitis serology and virus transmission risk in transplantation can be challenging. Decisions must balance opportunity to transplant against potential infection transmission. We aimed to survey understanding among the Australian and New Zealand medical transplant workforce of hepatitis risk in kidney donors and recipients. Methods: An anonymous, self-completed, cross-sectional survey was distributed via electronic mailing lists to Australian and New Zealand clinicians involved in kidney transplantation (2014-2015). We compared interpretation of clinical scenarios with paired donor and recipient hepatitis B and C (HBV, HBC) serology to recommendations in clinical practice guidelines. We used logistic regression modelling to investigate characteristics associated with decisions on transplant suitability in scenarios with poor (

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Monoclonal Gammopathy of Undetermined Significance after Kidney Transplantation: single-center experience.

Background: Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic premalignant plasma cell disorder. Prevalence and clinical outcomes of MGUS in kidney transplant (KT) recipients have been previously reported in few studies with conflicting results. Methods: We conducted a retrospective study in a population of 548 KT recipients transplanted between 1998 and 2015. Results: Thirty-nine subjects (8.1%) developed MGUS after KT. At diagnosis of MGUS, the average age was 52+/-9.2 years and 23% of patients were younger than 50 years. Occurrence of MGUS was not influenced by age and sex. After a mean follow-up of 7.8 years, only 1 patient (2.5%) progressed to multiple myeloma. We found no differences in the incidence of solid and hematological malignancies, serious infections, graft failure and mortality between KT patients with MGUS and a matched cohort of KT recipients without MGUS. The MGUS group had a significantly higher prevalence of Monoclonal B cell Lymphocytosis (MBL), premalignant condition poorly described in KT recipients. Prior history of glomerulonephritis or interstitial nephritis, as cause of renal failure, represented the only predictive factor for MGUS development. Conclusions: MGUS is a premalignant disorder frequently encountered in KT recipients; we found no differences in clinical outcomes between MGUS patients and KT controls. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2uJVkVZ

Validation of the Prognostic Kidney Donor Risk Index (KDRI) Scoring System of Deceased Donors for Renal Transplantation in the Netherlands.

Background: The prognostic Kidney Donor Risk Index (KDRI)-developed and internally validated in the US-is a widely-used tool to predict transplant outcome of a deceased donor kidney. The KDRI is currently used for longevity matching between donors and recipients in the US. Methods: We aimed to externally validate the KDRI as proposed by Rao et al, (2009) containing 10 donor factors (KDRIdonor-only) and 1 with 4 additional transplant factors (KDRIfull), with stratification on recipient age and diabetes. We used the Dutch Organ Transplantation Registry to include 3201 adult recipients transplanted from 2002 to 2012. Results: The median Dutch KDRI was 1.21, and comparable with the year 2012 in the US (median of 1.24). The calibration-slope was 0.98 and 0.96 for the KDRIfull and KDRIdonor-only, respectively, indicating that predictions of graft failure were on average similar. The discriminative ability (Harrell's C) of the KDRIfull and the KDRIdonor-only at 5 years was 0.63 (95%CI 0.62-0.64), and 0.62 (95%CI 0.61-0.63), respectively. We found misspecification of 3 KDRI factors: age (p=.002), weight (p=.017), and cold ischemia time (p24h vs 12h, p=.059) could improve predictive ability. Conclusions: The KDRI performs equal in the Dutch population. Discriminative ability of the KDRI indicates limited clinical use for adequate individualized decisions. An updated KDRI may contribute to a standardized policy meeting the growing demand of donor kidneys in the Eurotransplant region. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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C1-inhibitor Treatment Decreases Renal Injury in an Established Brain-dead Rat Model.

Background: Kidneys derived from brain-dead (BD) donors have lower graft survival rates compared to kidneys from living donors. Complement activation plays an important role in brain death. The aim of our study was therefore to investigate the effect of C1-inhibitor (C1-INH) on BD-induced renal injury. Methods: Brain death was induced in rats by inflating a subdurally placed balloon catheter. Thirty minutes after BD, rats were treated with saline, low-dose or high-dose C1-INH. Sham-operated rats served as controls. After 4 hours of brain death, renal function, injury, inflammation and complement activation was assessed. Results: High-dose C1-INH treatment of BD donors resulted in significantly lower renal gene expression and serum levels of IL-6. Treatment with C1-INH also improved renal function and reduced renal injury, reflected by the significantly lower KIM-1 gene expression and lower serum levels of LDH and creatinine. Furthermore, C1-INH effectively reduced complement activation by brain death and significantly increased functional levels. However, C1-INH treatment did not prevent renal cellular influx. Conclusions: Targeting complement activation after the induction of brain death reduced renal inflammation and improved renal function, before transplantation. Therefore, strategies targeting complement activation in human BD donors might clinically improve donor organ viability and renal allograft survival. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2uKfYp1

Oral nucleos(t)ide Analogs Alone After Liver Transplantation in Chronic Hepatitis B with Preexisting rt204 Mutation.

Background: There is currently limited data regarding the use of oral antiviral therapy alone without HBIG for CHB patients with preexisting LAM-resistance (LAM-R) undergoing liver transplantation. Methods: This is a cohort study determining the effectiveness and long-term outcome in this group of patients. Results: Fifty-seven consecutive CHB patients with preexisting rt204 LAM-R mutations or virological load refractory to LAM undergoing liver transplantation were included, with a median follow-up of 73 months. Fifty-five (96.5%) patients received a regimen that included the use of nucleotide analogs. The cumulative rate of HBsAg seroclearance at 1, 5, and 10 years was 82%, 88%, and 91% respectively. At the time of transplantation, 39 (72%) patients had detectable HBV DNA, with a median of 4.5 log copies/mL. The cumulative rate of HBV undetectability was 91% at 1 year, increasing to 100% by 5 years. After 1 year of liver transplantation, over 90% of patients had undetectable HBV DNA, and from 8 years onwards, 100% had undetectable HBV DNA. The overall long-term survival was excellent, with a 12-year survival of 87%. There was no HBV-related graft loss, and no retransplantation or deaths due to HBV reactivation. Conclusion: Oral antiviral therapy alone without HBIG is highly effective in preventing HBV reactivation and graft loss from recurrent hepatitis B after liver transplantation in patients with preexisting lamivudine resistance HBV. The long-term outcome was excellent, with survival of 87% at 12 years after transplantation, without any mortality related to HBV reactivation. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2tosl6w

Prognostic Factors in Lung Transplantation after Hematopoietic Stem Cell Transplantation.

Background: Lung transplantation is the final life-saving option for patients with pulmonary complications after hematopoietic stem cell transplantation (HSCT). Patients undergoing HSCT for hematologic diseases are thought to be high-risk candidates for lung transplantation; therefore, few lung transplants are performed for these patients, and few studies have been reported. This study aimed to describe the characteristics and outcomes of lung transplantation in patients with pulmonary complications after HSCT. Methods: We retrospectively investigated 62 patients who underwent lung transplantation after HSCT. All data were collected from 6 lung transplant centers in Japan. Results: Seventeen patients underwent cadaveric lung transplantation, whereas 45 underwent living-donor lobar lung transplantation (LDLLT). In the LDLLT group, 18 patients underwent LDLLT after HSCT in which 1 of the donors had also served as a donor for HSCT. Seven patients underwent single LDLLT for which the donor was the same as the patient from whom stem cells were obtained for HSCT. Preoperative hypercapnia was observed in 52 patients (84%). Thirteen patients (21%) required mechanical ventilation preoperatively. Fifty-five patients underwent HSCT for hematologic malignancies, and 4 (7%) relapsed after lung transplantation. The 5-year survival rate was 64.2%. In a multivariable analysis, patients younger than 45 years and those with the same donor for both procedures exhibited significantly better survival (p = 0.012 and 0.041, respectively). Conclusions: Lung transplantation for pulmonary complications after HSCT was performed safely and yielded better survival, especially in younger recipients for whom both lung transplantation and HSCT involved the same donor. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2uKrxwj

Trichodysplasia Spinulosa.

No abstract available

http://ift.tt/2toaJIh

New answers to old conundrums: what antibodies, exosomes and inflammasomes bring to the conversation. Canadian National Transplant Research Program international summit report.

Antibody-mediated injury is a major cause of allograft dysfunction and loss. Antibodies to ABH(O) blood group antigens are classical mediators of ABO-incompatible (ABOi) graft rejection, while donor-specific anti-HLA antibodies and, more recently, autoantibodies are appreciated as important contributors to allograft inflammation and dysfunction. In August 2016, the International Summit of the Canadian National Transplant Research Program focused on recent advances in the field of antibody-mediated rejection. Here, we describe work presented and discussed at the meeting, with a focus on 3 major themes: the importance of 1- Natural antibodies and autoantibodies, 2- tissue injury derived exosomes and autoimmunity, 3- inflammasome activation and innate immune responses in regulating allograft inflammation and dysfunction. Finally, we explore novel areas of therapeutic intervention that have recently emerged from these 3 major and overlapping fields of transplantation research. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2uKiv2y

Seasonal variability precipitating hand transplant rejection?.

No abstract available

http://ift.tt/2tosdE4

Expanding the Toolkit for the Study of Allo-specific B and T Cell Responses.

No abstract available

http://ift.tt/2uK74ba

Terasaki epitope mismatch burden predicts the development of de novo DQ donor specific antibodies and are associated with adverse allograft outcomes.

Background: De novo DQ DSA are associated with antibody-mediated rejection and allograft loss. Given the lack of effective treatment of de novo DQ DSA, their prevention is vital if there is to be an improvement of long term allograft survival. Using the HLA Matchmaker programme, DQ epitope matching has been shown to be superior to HLA antigen mismatching in predicting de novo DQ DSA development. Whether DQ epitopes determined by Terasaki may more accurately predict de novo DQ development over HLA antigen matching is not known. Methods: We retrospectively analysed the immunogenicity of the different HLA antigens, DQB1 alleles and DQB1 Teraskai epitopes (TerEp) in a large cohort of renal transplant recipients, by comparing patient mismatches with de novo DSA development. Results: Patients mismatched at a DQB1 allele were at significantly higher risk of developing de novo DSA compared with other mismatched HLA antigens. Patients mismatched at the DQ7 allele appear to be at specific risk. For patients mismatched at a single DQB1 allele, the risk of de novo DQ DSA development increases with the number of TerEp mismatches. However, the immunogenicity of the different DQ TerEps, do not appear to be equal. Patients who develop antibodies against TerEps are at increased risk of adverse allograft outcomes, specifically antibody-mediated rejection. Conclusion: Epitope mismatch burden, determined by TerEps, helps predict risk of de novo DQ DSA development, and offers an alternative approach to predict an alloimmune response. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2tobxN4

Endoscopic transcanal myringoplasty for tympanic perforations: An outpatient minimally invasive procedure

Publication date: Available online 21 July 2017
Source:Auris Nasus Larynx
Author(s): Chih-Chieh Tseng, Ming-Tang Lai, Chia-Che Wu, Sheng-Po Yuan, Yi-Fang Ding
ObjectiveSince the 1950s, microscopic myringoplasty has been the standard surgery for repairing a perforated tympanic membrane. In addition to conventional microscopic myringoplasty, endoscopic myringoplasty has been an emerging technique since the late 1990s. This study evaluated the efficacy of endoscopic transcanal myringoplasty for repairing tympanic perforations and examined the minimally invasive feature of this technique (no postauricular incision, no canalplasty).MethodsWe retrospectively reviewed the medical records of patients who underwent endoscopic transcanal myringoplasty for perforations of the tympanic membrane. The main outcome was the overall rate of graft success of endoscopic transcanal myringoplasty.ResultsA total of 181 patients were included in the analysis. The overall graft success was determined in 163 of 181 patients (92.8%). The mean preoperative and postoperative air-bone gaps were 19.3dB and 7.8dB, respectively, revealing a significant improvement of 11.5dB (Cohen's d, 1.27; 95% CI, 1.03–1.50; P<0.05; paired t test) in the air-bone gap. The rate of graft success with partial visualization of the perforation margin was comparable to that with complete visualization of the perforation margin. Larger sizes of perforations were significantly associated with lower rates of graft success (P<0.01).ConclusionOur study revealed that the rate of graft success and hearing results of endoscopic transcanal myringoplasty and microscopic myringoplasty are comparable for repairing perforations of the tympanic membrane. Visualization of the perforation margin by otoscopy did not affect the rate of graft success. However, endoscopic transcanal myringoplasty is less invasive because this technique does not require postauricular incision, canalplasty, and general anesthesia.



http://ift.tt/2toGhO2

Neuraxial drug delivery for the management of cancer pain: cost, updates, and society guidelines.

Purpose of review: The present study discusses the utilization of neuraxial drug delivery (NDD) for the management of cancer pain, based on recent trials, reviews, and guidelines with a focus on cost analysis. Recent findings: Almost all recent publications suggest that more stringent research is needed to improve evidence on NDD, particularly as conflicting reports exist regarding cost effectiveness of drug delivery systems. The combination of local anesthetics and opioids, with or without clonidine, continues to be reported as beneficial with the utilization of patient controlled systems providing an advantage over continuous ones. Interestingly, the use of opioids as an adjunct to local anesthetics may not enhance analgesia but the addition of dexamethasone is useful for incident cancer-related bone pain. Ziconitide remains supported as first-line therapy in districts where it is available - United States and Europe. Although new targeted drugs are being designed for cancer pain management, none have seen human clinical trials in the last year. Summary: The ability to demonstrate cost effectiveness of NDD is variable from region to region. Less expensive externalized systems may pose a viable alternative. With the exception of dexamethasone, no new drugs have been shown to provide any benefit to conventional medications. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2ujgEky

Management of complex spine surgery.

Purpose of review: The main objective of this article is to present the updated data regarding the perioperative management of patients undergoing major spine surgery in an era where the surgical techniques are changing and there is a high demand for these surgeries in older and high-risk patients. Recent findings: Preoperative assessment and stabilization is now more structured protocol and it is based on a multidisciplinary approach to the patient. The Enhanced Recovery After Surgery (ERAS) programs and the Perioperative Surgical Home on major spine surgery are not yet fully evidence based but it seems that the use of a perioperative optimization of patients and use of a drugs' bundle is more effective than using single drugs or interventions on the postoperative pain reduction and faster recovery from surgery. Fluid and pain-control protocols combined with an accurate blood management represent the key to success. Summary: A tailored approach to patients undergoing major spine surgeries seems to be effective improving the outcome and quality of life of patients. Future studies should aim to understand which elements of the ERAS can be improved to allow the patient to have a long-term good outcome. Video abstract: http://ift.tt/2vtcsgP Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2ujeGRp

Dog-Bite–Related Craniofacial Fractures among Pediatric Patients: A Case Series and Review of Literature

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1604073

Dog bites in the pediatric population commonly cause injuries to the head and can be associated with fractures, often leading to prolonged hospital stays, multiple surgical interventions, and long-term complications. Our goal was to evaluate our experience with dog-bite–related craniofacial fractures, understand frequency and demographics of these fractures, identify common fracture patterns, and provide recommendations based on management and complications encountered. The institution's electronic medical record was reviewed. A review of the English literature for the past 20 years was also conducted. A retrospective chart review was conducted using ICD-9 codes to include all patients with head and neck dog bites and craniofacial fractures. Fractures resulting from canine bites to the face and scalp were rare, occurring in our study in less than 1% of total facial dog bites (1,069 cases) and 1.5% of pediatric facial dog bites (462 cases). Ages ranged from 5 months to 9 years at the time of presentation. A total of seven patients, all pediatric, were documented. All seven patients required operative intervention for their wounds, and five patients required at least two operative interventions. Midface and skull fractures were the most commonly encountered fracture sites. Dog bite injuries to the face in young children, especially when severe, should raise suspicion for fracture of underlying bone. Management of these injuries should include a multidisciplinary approach and focus on repair of soft tissue and skeletal deformities. Furthermore, it is prudent to follow up patients who require operative management after injury to monitor for long-term complications, given the significant proportion of complications and operative takebacks in this study.
[...]

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

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

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Contralateral Islanded Facial Artery Myomucosal Flap for the Reconstruction of Floor of the Mouth Defect

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1604071

Reconstruction of floor of the mouth and ventral surface of the tongue defects can be challenging because inadequate correction can lead to mobility restriction of the tongue and resultant impairment of speech and swallowing. Ideal flap should be pliable, provide adequate bulk, be easy to harvest, and cosmetically acceptable. Commonly used ipsilateral facial artery–based myomucosal flaps may not be ideal if facial vessels need resection. We share our experience in a case of simultaneous primary mucoepidermoid carcinoma of right submandibular and sublingual glands, with a postsurgical defect involving floor of the mouth and ventral surface of the tongue, reconstructed with islanded facial artery myomucosal flap raised from left buccal mucosa and tunneled into the right floor of the mouth defect medial to mandible. The case is being reported to share the method of reconstruction as well as for the rare presentation of simultaneous primary mucoepidermoid carcinoma of multiple major salivary glands.
[...]

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

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

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The Use of Virtual Surgical Planning in Total Facial Skeletal Reconstruction of Treacher Collins Syndrome: A Case Report

Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1604424

Facial skeletal reconstruction of patients with severe Treacher Collins syndrome (TCS) requires correction of both midface and mandibular deficiencies. Implementing virtual surgical planning can provide an accurate three-dimensional analysis of craniofacial abnormalities, creating calvarial donors that match the anatomy of the desired malar augmentation and facilitating bimaxillary movements, positioning, and fixation in orthognathic surgery. We present a case of an 18-year-old patient with TCS, who underwent staged zygomaticomaxillary reconstruction and double-jaw osteotomy with sliding genioplasty, using computer-assisted surgical planning. Following these operations, the patient achieved not only improved facial harmony but also class I occlusion.
[...]

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

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

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Promising approaches for treatment and prevention of viral respiratory illnesses

Publication date: Available online 21 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Nikolaos G. Papadopoulos, Spyridon Megremis, Nikolaos A. Kitsioulis, Olympia Vangelatou, Peter West, Paraskevi Xepapadaki
Viral respiratory infections are the most common human ailments, leading to enormous health and economic burden. Hundreds of virus species and subtypes have been associated with these conditions, with influenza viruses (IFV), respiratory syncytial virus (RSV) and the rhinoviruses (RV) being the most frequent and with the highest burden. When considering prevention or treatment of viral respiratory infections, potential targets include the causative pathogens themselves but also the immune response, disease transmission or even just the symptoms. Strategies targeting all these aspects are concurrently developing and several novel and promising approaches are emerging. In this perspective, we overview the entire range of options and highlight some of the most promising approaches, including new antivirals, symptomatic or immunomodulatory drugs, the re-emergence of natural remedies, as well as vaccines and public health policies towards prevention. Wide scale prevention through immunisation appears to be within reach for RSV and promising for IFV, while additional effort is needed in regard to RV, as well as other respiratory viruses.



http://ift.tt/2txD4jf

Effect of home exposure to Staphylococcus aureus on asthma in adolescents

Publication date: Available online 21 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Meghan F. Davis
This is the first study to find that environmental Staphylococcus aureus and staphylococcal enterotoxins in a national population of inner-city adolescents with asthma are common and have the potential to drive asthma symptoms.



http://ift.tt/2vtUPNU

Genetic and epigenetic regulation of YKL-40 in childhood

Publication date: Available online 21 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Stefano Guerra, Erik Melén, Jordi Sunyer, Cheng-Jian Xu, Iris Lavi, Marta Benet, Mariona Bustamante, Anne-Elie Carsin, Carlota Dobaño, Mònica Guxens, Christina Tischer, Martine Vrijheid, Inger Kull, Anna Bergström, Ashish Kumar, Cilla Söderhäll, Ulrike Gehring, Dorieke J. Dijkstra, Pieter van der Vlies, Magnus Wickman, Jean Bousquet, Dirkje S. Postma, Josep M. Anto, Gerard H. Koppelman
BackgroundCirculating levels of the chitinase-like protein YKL-40 are influenced by genetic variation in its encoding gene (CHI3L1) and are increased in several diseases, including asthma. Epigenetic regulation of circulating YKL-40 early in life is unknown.ObjectiveTo determine (1) whether methylation levels at CHI3L1 CpG sites mediate the association of CHI3L1 single nucleotide polymorphisms (SNPs) with YKL-40 levels in the blood; and (2) whether these biomarkers (CHI3L1 SNPs, methylation profiles, and YKL-40 levels) are associated with asthma in early childhood.MethodsWe used data from up to 2405 participants from the INMA, BAMSE, and PIAMA birth cohorts. Associations between 68 CHI3L1 SNPs, methylation levels at 14 CHI3L1 CpG sites in whole blood DNA, and circulating YKL-40 levels at 4 years of age were tested using correlation analysis, multivariable regression, and mediation analysis. Each of these biomarkers was also tested for association with asthma at 4 years of age using multivariable logistic regression.ResultsYKL-40 levels were significantly associated with seven SNPs and with methylation at five CpG sites. Consistent associations between these seven SNPs (particularly rs10399931 and rs4950928) and five CpG sites were observed. Alleles linked to lower YKL-40 levels were associated with higher methylation levels. Participants with high YKL-40 levels (defined as the highest YKL-40 tertile) had increased odds for asthma as compared with subjects with low YKL-40 levels [meta-analyzed adjusted odds ratio (adjOR): 1.90, 1.08-3.36]. In contrast, neither SNPs nor methylation levels at CpG sites in CHI3L1 were associated with asthma.ConclusionsThe effects of CHI3L1 genetic variation on circulating YKL-40 are partly mediated by methylation profiles. In our study, YKL-40 levels, but not CHI3L1 SNPs or methylation levels, were associated with childhood asthma.

Teaser

Circulating YKL-40 and variation in its encoding gene CHI3L1 have been associated with asthma. We found that methylation levels at CHI3L1 CpG sites partly mediated CHI3L1 genetic effects on circulating YKL-40, although they were not associated with childhood asthma.


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Thoracic paravertebral block for postoperative pain management after renal surgery: A randomised controlled trial.

BACKGROUND: Thoracic paravertebral block (ThPVB) combined with general anaesthesia is used in thoracic and general surgery. It provides effective analgesia, reduces surgical stress response and the incidence of chronic postoperative pain. OBJECTIVE: To assess the efficacy of ThPVB in reducing opioid requirements and decreasing the intensity of pain after renal surgery. DESIGN: A prospective, randomised, open label study. SETTING: A single university hospital. Study conducted from August 2013 to February 2014. PARTICIPANTS: In total, 68 patients scheduled for elective renal surgery (open nephrectomy or open nephron-sparing surgery). INTERVENTIONS: Preoperative ThPVB with 0.5% bupivacaine combined with general anaesthesia, followed by postoperative oxycodone combined with nonopioid analgesics as rescue drugs. Follow-up period: 48 h. MAIN OUTCOME MEASURES: Total dose of postoperative oxycodone required, pain intensity, occurrence of opioid related adverse events, ThPVB-related adverse events and patient satisfaction. RESULTS: A total of 68 patients were randomised into two groups and, of these, 10 were subsequently excluded from analysis. Patients in group paravertebral block (PVB; n = 27) had general anaesthesia and ThPVB, and those in group general (anaesthesia) (GEN) (n = 31) formed a control group receiving general anaesthesia only. Compared with patients in group GEN, patients who received ThPVB required 39% less i.v. oxycodone over the first 48 h and had less pain at rest (P

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Clinical trial registry use in anaesthesiology systematic reviews: A cross-sectional study of systematic reviews published in anaesthesiology journals and the Cochrane Library.

BACKGROUND: Publication bias within systematic reviews may result in incorrect conclusions leading to inappropriate clinical decisions and a decreased quality of patient care. Searching clinical trial registries for unpublished studies is one possible solution to minimise publication bias. OBJECTIVES: To examine rates of clinical trial registry searches in systematic reviews published in respected anaesthesiology journals and whether these searches found trials (or data) eligible for inclusion; to compare rates of registry searches between published reviews and similar reviews within the Cochrane Anaesthesia, Critical and Emergency Care Group; to conduct trial registry searches for a subset of reviews, determining whether eligible studies were overlooked; to investigate whether reporting of results in completed anaesthesia trials on ClinicalTrials.gov followed guidelines. DESIGN: A cross-sectional study of systematic reviews published in 10 anaesthesiology journals and the Cochrane Library. SETTING AND PARTICIPANTS: PubMed and the Cochrane Library were searched for systematic reviews or meta-analyses. MAIN OUTCOME MEASURES: The primary outcome was the number of systematic reviews that searched clinical trial registries for unpublished trials. Secondary outcomes included the number of registered trials in the ClinicalTrial.gov registry and the number of trials reporting trial results which were available on the ClinicalTrials.gov database and which should have been considered in a systematic review. RESULTS: The PubMed search yielded 507 records, and 415 remained after exclusions. Of these, 49 (11.8%) included a search of clinical trial registries. In total, 12 systematic reviews reported finding unpublished data but only five incorporated the data into their analyses. Of the Cochrane reviews, 58.9% (43/73) reported registry searches. Among a sample of 30 systematic reviews that omitted registry searches, we found many studies within the registries that were probably eligible to be included in the systematic reviews. For completed trials within the ClinicalTrials.gov database, only 15.4% reported results. CONCLUSION: The majority of systematic reviews in anaesthesiology did not include data from clinical trial registries. Exclusion of statistically nonsignificant data may lead to a biased interpretation of the data and hence inappropriate clinical interventions. TRIAL REGISTRATION: Registered in University hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000021932). (C) 2017 European Society of Anaesthesiology

http://ift.tt/2uJYdX2

History of anaesthesia: the ketamine story - past, present and future.

: Ketamine's history begins in the 1950s in Detroit, Michigan, at Parke-Davis Laboratories. On 26 March 1956, Harold V. Maddox synthesised phencyclidine or PCP. Domino studied PCP effects in animals and in 1958, Greifenstein made the first trials of PCP in humans under the name of Sernyl. Sernyl did not cause depression of cardiovascular and respiratory functions, but elicited severe excitation with a very prolonged postoperative recovery. Because of its psychedelic effects, it became a street drug under the name of 'angel dust' and was placed on schedule II of Federal Controlled Substance Act (CSA) in 1978. Eticyclidine or PCE had no medical career. The chemist Calvin Stevens, consultant to Parke-Davis, synthesised ketamine in 1962. The drug was studied in humans in 1964, by Domino and Corssen. These authors described the so-called 'dissociative anaesthesia'. Ketamine was patented in 1966 under the name of Ketalar for human use and was administered to soldiers during the Vietnam war. Because of abuse, ketamine was placed among the class III substances of CSA in 1999. The psychedelic effects and the arrival of propofol prompted the shelving of ketamine. However, the discovery of the NMDA-receptor and its noncompetitive inhibition by ketamine revolutionized the pathophysiology of hyperalgesia and mental functioning. In early 1990s, the arrival of remifentanil preceded the discovery of opioid-induced hyperalgesia, eliciting a paradigm shift in the management of pain, and a comeback of ketamine, as and antihyperalgesic drug. Ketamine is nowadays under the spotlight in the field of treatment-resistant depression and has been proposed as a potential fast antidepressant in patients with high suicidal risk. In a near future, we may observe new practices like increased S-(+)-ketamine availability, new ultra-short-acting ketamine analogues or the development antagonists. (C) 2017 European Society of Anaesthesiology

http://ift.tt/2toeHAs

Injectate spread following anterior sub-costal and posterior approaches to the quadratus lumborum block: A comparative cadaveric study.

BACKGROUND: The dermatomal level of analgesia achieved with quadratus lumborum blocks varies according to the location of injection. The most commonly used approaches are either at the postero-lateral aspect or anterior to the quadratus lumborum muscle. The aim of the study was to determine whether the site of injection of contrast dye around the quadratus lumborum muscle of cadavers affects the extent and mechanism of dye spread. METHODS: Six fresh human cadavers received either a posterior quadratus lumborum block or an anterior sub-costal quadratus lumborum block on each side. Cadavers were then dissected to determine the extent of dye spread. RESULTS: The posterior quadratus lumborum block approach revealed consistently deep staining of the iliohypogastric, ilioinguinal, subcostal nerve, T11 to 12 and L1 nerve roots. In addition, staining of the middle thoracolumbar fascia was seen in all specimens but only variable staining of T10 nerve roots. The anterior subcostal quadratus lumborum block approach in all specimens demonstrated predictable deep staining of the iliohypogastric and ilioinguinal nerves, subcostal nerves, T11 to 12 and L1 nerve roots, and in addition traversing the arcuate ligaments to involve T9 to 12 nerve roots with variable staining of higher thoracic nerve roots. CONCLUSION: Our cadaveric study demonstrates that injection of dye on the posterior aspect of quadratus lumborum muscle led to injectate spread through the lateral and posterior abdominal wall but with limited cranial spread, whereas the anterior approach produced broader coverage of the lower to mid-thoracic region. Clinical translation of these findings to determine the practical significance is warranted. (C) 2017 European Society of Anaesthesiology

http://ift.tt/2uJT5lD

Serious game versus online course for pretraining medical students before a simulation-based mastery learning course on cardiopulmonary resuscitation: A randomised controlled study.

BACKGROUND: Although both recorded lectures and serious games have been used to pretrain health professionals before simulation training on cardiopulmonary resuscitation, they have never been compared. OBJECTIVE: The aim of this study was to compare an online course and a serious game for pretraining medical students before simulation-based mastery learning on the management of sudden cardiac arrest. DESIGN: A randomised controlled trial. Participants were pretrained using the online course or the serious game on day 1 and day 7. On day 8, each participant was evaluated repeatedly on a scenario of cardiac arrest until reaching a minimum passing score. SETTING: Department of Simulation in Healthcare in a French medical faculty. PARTICIPANTS: Eighty-two volunteer second-year medical students participated between June and October 2016 and 79 were assessed for primary outcome. INTERVENTIONS: The serious game used was Staying Alive, which involved a 3D realistic environment, and the online course involved a PowerPoint lecture. MAIN OUTCOME MEASURES: The median total training time needed for students to reach the minimum passing score on day 8. This same outcome was also assessed 4 months later. RESULTS: The median training time (interquartile range) necessary for students to reach the minimum passing score was similar between the two groups: 20.5 (15.8 to 30.3) minutes in the serious game group versus 23 (15 to 32) minutes in the online course group, P = 0.51. Achieving an appropriate degree of chest compression was the most difficult requirement to fulfil for students in both groups. Four months later, the median training time decreased significantly in both groups, but no correlation was found at an individual level with the training times observed on day 8. CONCLUSION: The serious game used in this study was not superior to an online course to pretrain medical students in the management of a cardiac arrest. The absence of any correlation between the performances of students evaluated during two training sessions separated by 4 months suggests that elements such as chest compression can only be learned by simulation-based training. TRIAL REGISTRATION: ClinicalTrials.gov-NCT02758119. (C) 2017 European Society of Anaesthesiology

http://ift.tt/2toexca

EU Panel Recommends Dupilumab (Dupixent) for Eczema

A committee of the European Medicines Agency has recommended marketing authorization for dupilumab (Dupixent) for the treatment of moderate to severe atopic dermatitis in adults who are candidates for systemic therapy.
International Approvals

http://ift.tt/2uiCg0q

6 Active Immunization

Publication date: 2018
Source:Principles and Practice of Pediatric Infectious Diseases
Author(s): Raymond A. Strikas, Alison C. Mawle, Larry K. Pickering, Walter A. Orenstein




http://ift.tt/2vsVijj

Rhinoorbitocerebral Mucormycosis with Maggots in a Neglected Diabetic Patient

Abstract

Mucormycosis is a rare opportunistic fungal infection in immunocompromised patients, Rhizopus species are most common, sometimes mucormycosis can be life threatening we report a case of rhinoorbitocerebral mucormycosis a patient with diabetic ketoacidosis secondarily infected by maggots with altered consciousness and metabolic decompensation.

http://ift.tt/2uj973K

Vocoder Simulations Explain Complex Pitch Perception Limitations Experienced by Cochlear Implant Users

Abstract

Pitch plays a crucial role in speech and music, but is highly degraded for people with cochlear implants, leading to severe communication challenges in noisy environments. Pitch is determined primarily by the first few spectrally resolved harmonics of a tone. In implants, access to this pitch is limited by poor spectral resolution, due to the limited number of channels and interactions between adjacent channels. Here we used noise-vocoder simulations to explore how many channels, and how little channel interaction, are required to elicit pitch. Results suggest that two to four times the number of channels are needed, along with interactions reduced by an order of magnitude, than available in current devices. These new constraints not only provide insights into the basic mechanisms of pitch coding in normal hearing but also suggest that spectrally based complex pitch is unlikely to be generated in implant users without significant changes in the method or site of stimulation.

http://ift.tt/2gQtMJ8

Rhinoorbitocerebral Mucormycosis with Maggots in a Neglected Diabetic Patient

Abstract

Mucormycosis is a rare opportunistic fungal infection in immunocompromised patients, Rhizopus species are most common, sometimes mucormycosis can be life threatening we report a case of rhinoorbitocerebral mucormycosis a patient with diabetic ketoacidosis secondarily infected by maggots with altered consciousness and metabolic decompensation.

http://ift.tt/2uj973K

Expression of Concern

This Expression of Concern alerts readers to potential questions about research results published in a report of a trial in this journal in 2015 and announces the beginning of deeper investigation into the quality of this research.

http://ift.tt/2vspnzw

An Australian Mohs external quality assurance program

http://ift.tt/2uHjHEc

Biomarkers as a treatment guide in rheumatoid arthritis

Publication date: Available online 20 July 2017
Source:Clinical Immunology
Author(s): Tsutomu Takeuchi
It is anticipated that biomarkers support rheumatologists to judge a group of patients that can improve the diagnosis and prognosis, and further facilitate appropriate and precise treatment with targeted therapy. In particular, biomarkers for predicting and monitoring response to biological disease modifying anti-rheumatic drugs (DMARDs) are demanding. Given the mechanism action of biological DMARDs is much more simple than the conventional synthetic DMARDs, a variety of approaches to find such biomarkers has been taken recent years. In this article, I will summarize the background for biomarker research and introduce recent topics in the research and the possible clinical applications of biomarkers to guide treatment in rheumatoid arthritis (RA).



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B-cells as therapeutic targets in neuro-inflammatory diseases

Publication date: Available online 21 July 2017
Source:Clinical Immunology
Author(s): Reinhard Hohlfeld
B cells are an emerging therapeutic target in neuroinflammatory diseases. The anti-CD20 monoclonal antibody ocrelizumab was recently approved in the US as the first B-cell targeting immunomodulatory treatment for relapsing-remitting MS and primary progressive MS. In autoantibody-associated demyelinating syndromes such as neuromyelitis optica (NMO) and in myelin-oligodendrocyte-glycoprotein-(MOG)-autoantibody-associated encephalomyelitis, B-cells are a logical target based on the pathogenesis of these antibody-mediated disorders. Furthermore, B cells and autoantibodies are promising targets in a variety of autoantibody-associated encephalitis syndromes such as N-methyl-d-aspartate receptor (NMDAR)-antibody encephalitis.



http://ift.tt/2vsiJcE

Efficacy paradox and proportional contextual effect (PCE)

Publication date: Available online 20 July 2017
Source:Clinical Immunology
Author(s): Weiya Zhang, Michael Doherty
The "efficacy paradox" is when the effect of a treatment tested in an RCT, or evidence-based guideline advice, differs markedly from treatment benefits observed in clinical practice. This arises because in RCT reporting and guideline development treatment efficacy is judged by the separation of the treatment group from the placebo group (the specific treatment effect) whereas in clinical practice it is the overall treatment effect, which includes both specific and contextual responses, that patients experience. This paradox causes a disconnect between guidelines and clinical practice and ignores the importance of contextual response in clinical care. This article fully explains and discusses these issues and presents a possible way to reduce the paradox through an alteration in RCT reporting that shifts the focus to overall treatment benefit and the proportion ("proportional contextual effect") that is explained by placebo and contextual effects.



http://ift.tt/2uQocNj

Oral treatment with foralumab, a fully human anti-CD3 monoclonal antibody, prevents skin xenograft rejection in humanized mice

Publication date: Available online 21 July 2017
Source:Clinical Immunology
Author(s): Mineko Ogura, Songyan Deng, Paula Preston-Hurlburt, Hideki Ogura, Kunwar Shailubhai, Chantal Kuhn, Howard L. Weiner, Kevan C. Herold
Oral administration of biologics may be a feasible approach for immune therapy that improves drug safety and potentiates mechanisms of tolerance at mucosal barriers. We tested the ability of a fully human non-FcR binding anti-CD3 mAb, foralumab, to prevent skin xenograft rejection in mice with human immune systems. At an intragastric dose of 15μg, the drug could transit through the small bowel. Serum absorption and binding of lymphoid cells was seen and proliferative responses of splenic CD8+ T cells to mitogen were reduced. Five consecutive daily doses, then weekly dosing led to indefinite graft acceptance without depletion of peripheral T cells. Proliferative and cytokine responses to activation of splenocytes with PHA were reduced. The serum levels of IL-10 but not TNF were increased 6days after application of the skin graft. Oral treatment with anti-CD3 mAb may represent a feasible approach for immune modulation.



http://ift.tt/2vs7aBY

Solving the pathogenesis of ankylosing spondylitis

Publication date: Available online 20 July 2017
Source:Clinical Immunology
Author(s): Matthew A. Brown




http://ift.tt/2uQtKXU

Dendritic cells activation is associated with sustained virological response to telaprevir treatment of HCV-infected patients

Publication date: Available online 20 July 2017
Source:Clinical Immunology
Author(s): Sacchi Alessandra, Tumino Nicola, Turchi Federica, Refolo Giulia, Fimia GianMaria, Ciccosanti Fabiola, Montalbano Marzia, Lionetti Raffaella, Taibi Chiara, D'Offizi Gianpiero, Casetti Rita, Bordoni Veronica, Cimini Eleonora, Martini Federico, Agrati Chiara
First anti-HCV treatments, that include protease inhibitors in conjunction with IFN-α and Ribavirin, increase the sustained virological response (SVR) up to 80% in patients infected with HCV genotype 1. The effects of triple therapies on dendritic cell (DC) compartment have not been investigated. In this study we evaluated the effect of telaprevir-based triple therapy on DC phenotype and function, and their possible association with treatment outcome.HCV+ patients eligible for telaprevir-based therapy were enrolled, and circulating DC frequency, phenotype, and function were evaluated by flow-cytometry. The antiviral activity of plasmacytoid DC was also tested.In SVR patients, myeloid DC frequency transiently decreased, and returned to baseline level when telaprevir was stopped. Moreover, an up-regulation of CD80 and CD86 on mDC was observed in SVR patients as well as an improvement of IFN-α production by plasmacytoid DC, able to inhibit in vitro HCV replication.



http://ift.tt/2vsezBo

Rheumatic paraneoplastic syndromes – A clinical link between malignancy and autoimmunity

Publication date: Available online 21 July 2017
Source:Clinical Immunology
Author(s): Bernhard Manger, Georg Schett
Paraneoplastic syndromes are rare but can have enormous clinical impact on diagnosis and outcome of neoplastic diseases. The rheumatologist should be familiar with a few typical musculoskeletal manifestations of malignancies to be able to diagnose them early for a timely initiation of anti-tumour therapies. This review describes the characteristic features of various paraneoplastic arthritides and vasculitides, cancer-associated myositis, hypertrophic osteoarthropathy, and tumour-induced osteomalacia. In addition, the current knowledge about underlying pathomechanisms of these syndromes is discussed.



http://ift.tt/2uQhKWu

miRNA meets plasma cells “How tiny RNAs control antibody responses”

Publication date: Available online 21 July 2017
Source:Clinical Immunology
Author(s): Julia Meinzinger, Hans-Martin Jäck, Katharina Pracht
We review the importance of small non-coding microRNAs for the generation of germinal center B cells and their differentiation in antibody-secreting plasma cells. In the last part, we briefly elucidate the role of microRNAs in some plasma cell disorders.



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B cells and their cytokine activities implications in human diseases

Publication date: Available online 21 July 2017
Source:Clinical Immunology
Author(s): Simon Fillatreau
B cells are the only cell type that can give rise to antibody-producing cells, and the only cell type whose selective depletion can, today, lead to an improvement of a wide range of immune-mediated inflammatory diseases, including disorders not primarily driven by autoantibodies. Here, I discuss this paradoxical observation, and propose that the capacity of B cells to act as cytokine-producing cells explains how they can control monocyte activity and subsequently disease pathogenesis. Together with current data on the effect of anti-CD20 B cell-depleting reagents in the clinic, this novel knowledge on B cell heterogeneity opens the way for novel safer and more efficient strategies to target B cells. The forthcoming identification of disease-relevant B cell subsets is awaited to permit their monitoring and specific targeting in a personalized medicine approach.



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Novel insights into the pathogenesis of psoriasis

Publication date: Available online 21 July 2017
Source:Clinical Immunology
Author(s): T.A. Luger, K. Loser

Graphical abstract

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The serine/threonine protein phosphatase 2A controls autoimmunity

Publication date: Available online 21 July 2017
Source:Clinical Immunology
Author(s): Amir Sharabi, Isaac R. Kasper, George C. Tsokos
Protein phosphatase 2A (PP2A) is the first Ser/Thr phosphatase recognized to contribute to human and murine lupus immunopathology. PP2A expression in SLE is controlled both epigenetically and genetically, and it is increased in patients with SLE, which contributes to decreased IL-2 production, decreased CD3ζ and increased FcRγ expression on the surface of T cells, increased CREMα expression, hypomethylation of genes associated with SLE pathogenesis, and increased IL-17 production. B regulatory subunit of PP2A regulates IL-2 deprivation-induced T cell death and is decreased in SLE patients. A mouse overexpressing PP2Ac in T cells displays peripheral granulocytosis, elevated IL-17 production, and develops glomerulonephritis when challenged. A mouse which lacks PP2Ac only in regulatory T cells develops severe autoimmunity and multiorgan inflammation because of loss of restraint on mTORC1 and inability of Foxp3+ cells to regulate conventional T cells. Targeting PP2A in T cell subsets may be therapeutic for SLE and other autoimmune diseases.



http://ift.tt/2vsDmVR

Paediatric hepatocellular carcinoma in tight junction protein 2 (TJP2) deficiency

http://ift.tt/2gQjYim

Crescentic glomerular nephritis associated with rheumatoid arthritis: a case report

Rheumatoid arthritis is a systemic disorder where clinically significant renal involvement is relatively common. However, crescentic glomerular nephritis is a rarely described entity among the rheumatoid nephr...

http://ift.tt/2tmWoLS

Vocoder Simulations Explain Complex Pitch Perception Limitations Experienced by Cochlear Implant Users

Abstract

Pitch plays a crucial role in speech and music, but is highly degraded for people with cochlear implants, leading to severe communication challenges in noisy environments. Pitch is determined primarily by the first few spectrally resolved harmonics of a tone. In implants, access to this pitch is limited by poor spectral resolution, due to the limited number of channels and interactions between adjacent channels. Here we used noise-vocoder simulations to explore how many channels, and how little channel interaction, are required to elicit pitch. Results suggest that two to four times the number of channels are needed, along with interactions reduced by an order of magnitude, than available in current devices. These new constraints not only provide insights into the basic mechanisms of pitch coding in normal hearing but also suggest that spectrally based complex pitch is unlikely to be generated in implant users without significant changes in the method or site of stimulation.

http://ift.tt/2gQtMJ8

Hearing Loss and the Effects of Statin Drugs in People With Head and Neck Squamous Cell Carcinoma Treated With Cisplatin Chemoradiation

Conditions:   Head and Neck Cancer;   Hearing Disorder;   Hyperlipidemia
Intervention:  
Sponsor:   National Institute on Deafness and Other Communication Disorders (NIDCD)
Recruiting - verified July 18, 2017

http://ift.tt/2uQ3NYC

Metabolomic and BH3 Profiling of Esophageal Cancers: Identification of Novel Assessment Methods of Treatment Response for Precision Therapy

Conditions:   Esophageal Cancer;   Esophageal Adenocarcinoma;   Esophageal Squamous Cell Cancer;   Esophageal Neoplasms;   Squamous Cell Carcinoma
Interventions:   Other: Chemoradiotherapy;   Procedure: Esophagectomy
Sponsor:   National Cancer Institute (NCI)
Not yet recruiting - verified July 17, 2017

http://ift.tt/2vIpw10

M3541 in Combination With Radiotherapy in Subjects With Solid Tumors

Condition:   Solid Tumors
Interventions:   Drug: M3541;   Radiation: Palliative Radiotherapy (RT)
Sponsors:   EMD Serono Research & Development Institute, Inc.;   Merck KGaA
Not yet recruiting - verified July 2017

http://ift.tt/2uQjmj9

PET-Directed Therapy With Pembrolizumab and Combination Chemotherapy in Treating Patients With Previously Untreated Classical Hodgkin Lymphoma

Conditions:   Classical Hodgkin Lymphoma;   Lymphocyte-Depleted Classical Hodgkin Lymphoma;   Lymphocyte-Rich Classical Hodgkin Lymphoma;   Mixed Cellularity Classical Hodgkin Lymphoma;   Nodular Sclerosis Classical Hodgkin Lymphoma
Interventions:   Procedure: Computed Tomography;   Drug: Dacarbazine;   Drug: Doxorubicin Hydrochloride;   Radiation: Fludeoxyglucose F-18;   Other: Laboratory Biomarker Analysis;   Biological: Pembrolizumab;   Procedure: Positron Emission Tomography;   Drug: Vinblastine Sulfate
Sponsors:   Northwestern University;   National Cancer Institute (NCI)
Not yet recruiting - verified July 2017

http://ift.tt/2vIBxU9

Apatinib Combined With Chemotherapy for Esophageal Squamous Cell Cancer After the Failure of Standard Treatment

Condition:   Esophageal Squamous Cell Carcinoma
Interventions:   Drug: Apatinib;   Drug: fluorouracil and platinum
Sponsor:   The First Affiliated Hospital of Anhui Medical University
Recruiting - verified June 2017

http://ift.tt/2uQci63

Study of Targeted Therapy Using Transcription Activator-like Effector Nucleases in Cervical Precancerous Lesions

Condition:   Human Papillomavirus-Related Malignant Neoplasm
Interventions:   Biological: T27;   Biological: T512
Sponsor:   Huazhong University of Science and Technology
Not yet recruiting - verified July 2017

http://ift.tt/2uQfGxA

Trial of Magnetic Resonance Imaging Guided Radiotherapy Dose Adaptation in Human Papilloma Virus Positive Oropharyngeal Cancer

Conditions:   Malignant Neoplasms of Lip Oral Cavity and Pharynx;   Oropharyngeal Cancer
Interventions:   Procedure: Modified Barium Swallow (MBS);   Behavioral: Swallowing Questionnaire;   Behavioral: Symptom Questionnaire;   Procedure: Video-Strobe Procedure;   Procedure: MRI Guided Intensity Modulated Radiotherapy (IMRT) Planning;   Procedure: Standard-of-Care Intensity Modulated Radiotherapy (IMRT) Planning;   Radiation: Intensity Modulated Radiotherapy (IMRT)
Sponsors:   M.D. Anderson Cancer Center;   National Cancer Institute (NCI)
Not yet recruiting - verified July 2017

http://ift.tt/2tNuRTg

Pancreatoduodenectomy With Mesopancreas Dissection.A Prospective Study Comparing Artery-first Approach Versus Standard Approach

Condition:   Periampullary Carcinoma Resectable
Interventions:   Procedure: Artery-first Approach;   Procedure: Standard Approach
Sponsor:   Assiut University
Not yet recruiting - verified May 2017

http://ift.tt/2uPUDLE

Laryngocele: A Rare Case Report and Review of Literature

Abstract

Laryngocele is an abnormal cystic dilatation of the saccule of the larynx. It communicates with the laryngeal lumen and contains air. Laryngocele can be classified as internal (within the larynx), external (outside the larynx) and mixed (both). It is a rare entity. Hereby, we are reporting a case of laryngocele, which presented to us with a diagnostic quandary. After confirming the diagnosis by radiology, patient was operated upon by external approach. In the following article, we also discuss the establishment of the diagnosis and review different surgical modalities for the management of various types of laryngocele.

http://ift.tt/2uhFsJF

Participation of osteoclastogenic factors in immunopathogenesis of human chronic periapical lesions

Abstract

Background

Chronic periapical lesions (CPLs) are common lesions of the oral cavity and are the result of caries, tooth fracture, iatrogenic causes or factors causing contamination and pulp necrosis. Inflammatory cells participate in the expansion of CPLs by releasing factors that stimulate or inhibit osteolytic activity. The objective of this study was to investigate the participation of RANKL, TNF-α, cathepsin K, IL-33 and OPG in the development of radicular cysts (RCs) and periapical granulomas (PGs).

Methods

Paraffin-embedded sections of 30 RCs and 22 PGs were submitted to immunohistochemistry.

Results

Immunoexpression of the proteins studied was observed in the epithelium and capsule of RCs, as well as in connective tissue of PGs. The expression of the osteoclastogenic factors studied differed significantly in RCs and PGs (p<0.001), with lower expression of OPG in RCs. In PGs, the lowest expression was observed for cathepsin K. Comparison of the two lesions showed a similar participation of RANKL and IL33, while a significant difference was observed for OPG (p<0.001), TNF-α (p=0.002) and cathepsin K (p=0.016). No association of proteins expression with lesions size was observed.

Conclusions

This study demonstrated the participation of RANKL, TNF-α, IL-33, cathepsin K and OPG in the development of RCs and PGs, with emphasis on the highest immunoreactivity of cathepsin in RCs and TNF-α and OPG in PGs. OPG possibly determines the slower growth of PGs compared to RCs.

This article is protected by copyright. All rights reserved.

http://ift.tt/2twI87z

Lichenified papules: An unusual cutaneous presentation of metastatic breast cancer

http://ift.tt/2vIjEox

Chronic cheilitis: Faecal calprotectin test a way to diagnose oral Crohn's disease

http://ift.tt/2uhL6vr

Folliculotropic mycosis fungoides associated with atopic dermatitis

http://ift.tt/2vInbD7

Tinea corporis presenting as disseminated verrucous plaques caused by Arthroderma incurvatum in a young Indian boy

http://ift.tt/2ui2oIG

Adult morphea en coup de sabre with accompanying regional polymyositis: A separate entity?

http://ift.tt/2vIjttt

A case of disfiguring primary cutaneous squamous cell carcinoma of the nasal tip

http://ift.tt/2uhN1jJ

Laryngocele: A Rare Case Report and Review of Literature

Abstract

Laryngocele is an abnormal cystic dilatation of the saccule of the larynx. It communicates with the laryngeal lumen and contains air. Laryngocele can be classified as internal (within the larynx), external (outside the larynx) and mixed (both). It is a rare entity. Hereby, we are reporting a case of laryngocele, which presented to us with a diagnostic quandary. After confirming the diagnosis by radiology, patient was operated upon by external approach. In the following article, we also discuss the establishment of the diagnosis and review different surgical modalities for the management of various types of laryngocele.

http://ift.tt/2uhFsJF

Erratum

Case Rep Ophthalmol 2017;8:389

http://ift.tt/2tmxUme

Meta-analysis of quality-of-life improvement after cochlear implantation and associations with speech recognition abilities

Objectives

Determine the impact of cochlear implantation on quality of life (QOL) and determine the correlation between QOL and speech recognition ability.

Study Design

Two authors independently searched PubMed, Medline, Scopus, and the Cumulative Index to Nursing and Allied Health Literature to identify studies reporting hearing-specific or cochlear implant (CI)–specific QOL outcomes before and after cochlear implantation, and studies reporting correlations between QOL and speech recognition after cochlear implantation. Data from the included articles were obtained independently by two authors. Standardized mean difference (SMD) for each measure and pooled effects were determined to assess improvement in QOL before and after cochlear implantation.

Results

From 14 articles with 679 CI patients who met the inclusion criteria, pooled analyses of all hearing-specific QOL measures revealed a very strong improvement in QOL after cochlear implantation (SMD = 1.77). Subset analysis of CI-specific QOL measures also showed very strong improvement (SMD = 1.69). Thirteen articles with 715 patients met the criteria to evaluate associations between QOL and speech recognition. Pooled analyses showed a low positive correlation between hearing-specific QOL and word recognition in quiet (r = 0.213), sentence recognition in quiet (r = 0.241), and sentence recognition in noise (r = 0.238). Subset analysis of CI-specific QOL showed similarly low positive correlations with word recognition in quiet (r = 0.213), word recognition in noise (r = 0.241), and sentence recognition in noise (r = 0.255).

Conclusions

Using hearing-specific and CI-specific measures of QOL, patients report significantly improved QOL after cochlear implantation. However, widely used clinical measures of speech recognition are poor predictors of patient-reported QOL with CIs. Laryngoscope, 2017

http://ift.tt/2uIBtGS

Diagnostic accuracy of nasal cannula versus microphone for detection of snoring

Objective

Snoring is a common reason for referral to a sleep unit. Although there are several instruments to measure snoring, there is no gold standard for this purpose. In this study, we determine the diagnostic accuracy of the cannula as compared with the microphone, which are the two most commonly used tools.

Study Design

We performed a cross-sectional study of 75 patients who underwent baseline home sleep apnea testing for any reason.

Methods

Snore intensity and percentage were assessed during Home sleep-apnea testing via nasal cannula and microphone in all patients. We performed a complete diagnostic accuracy analysis, assuming the microphone to be the reference instrument use in order to compare it with the cannula.

Results

The intra-class correlation coefficient between the cannula and microphone for the percentage of snoring was 0.25. The Bland Bland-Altman analysis to determine the agreement regarding the percentage of snoring showed a lower limit of −57.73 and an upper limit of 20.30. A linear regression analysis of the differences produced a negative slope of −0.86. The receiver operating characteristic curve for severe snoring using the cannula produced an area under the curve of 0.67 (P = 0.019). The cannula showed a sensitivity of 57.89 and a specificity of 73.21.

Conclusion

The nasal cannula showed poor reliability and accuracy for measuring snoring.

Level of Evidence

2b. Laryngoscope, 2017

http://ift.tt/2uhZwKx

The effect of frailty on short-term outcomes after head and neck cancer surgery

Objective

To determine the relationship between frailty and comorbidity, in-hospital mortality, postoperative complications, length of hospital stay (LOS), and costs in head and neck cancer (HNCA) surgery.

Study Design

Cross-sectional analysis.

Methods

Discharge data from the Nationwide Inpatient Sample for 159,301 patients who underwent ablative surgery for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2001 to 2010 was analyzed using cross-tabulations and multivariate regression modeling. Frailty was defined based on frailty-defining diagnosis clusters from the Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator.

Results

Frailty was identified in 7.4% of patients and was significantly associated with advanced comorbidity (odds ratio [OR] = 1.5[1.3–1.8]), Medicaid (OR = 1.5[1.3–1.8]), major procedures (OR = 1.6[1.4–1.8]), flap reconstruction (OR = 1.7[1.3–2.1]), high-volume hospitals (OR = 0.7[0.5–1.0]), discharge to a short-term facility (OR = 4.4[2.9–6.7]), or other facility (OR = 5.4[4.5–6.6]). Frailty was a significant predictor of in-hospital death (OR = 1.6[1.1–2.4]), postoperative surgical complications (OR = 2.0[1.7–2.3]), acute medical complications (OR = 3.9[3.2–4.9]), increased LOS (mean, 4.9 days), and increased mean incremental costs ($11,839), and was associated with higher odds of surgical complications and increased costs than advanced comorbidity. There was a significant interaction between frailty and comorbidity for acute medical complications and length of hospitalization, with a synergistic effect on the odds of medical complications and LOS in patients with comorbidity who were also frail.

Conclusion

Frailty is an independent predictor of postoperative morbidity, mortality, LOS, and costs in HNCA surgery patients, and has a synergistic interaction with comorbidity that is associated with an increased likelihood of medical complications and greater LOS in patients with comorbidity who are also frail.

Level of Evidence

2c. Laryngoscope, 2017

http://ift.tt/2uIEpTX

Association between systemic antibiotic and corticosteroid use for chronic rhinosinusitis and quality of life

Objective

We sought to establish the significance of querying chronic rhinosinusitis (CRS) patients about their past CRS-related oral antibiotic and corticosteroid usage by determining the association between these metrics and patients' quality of life (QoL).

Study Design

Cross-sectional study.

Methods

A total of 157 patients with CRS were prospectively recruited. CRS-specific QoL was measured using the 22-item Sinonasal Outcome Test (SNOT-22). General health-related QoL was measured using the EuroQoL five-dimensional questionnaire visual analog scale. Associations were sought between these measures of QoL and frequency of CRS-related oral antibiotic and corticosteroid usage reported by the participants in the prior 3 and 12 months.

Results

More frequent antibiotic and corticosteroid use was significantly associated with worse CRS-specific and general health-related QoL, whether querying medication use over the prior 3 months or over the prior 12 months (P < 0.001 in all cases). The effect size of CRS-related antibiotic use during the prior 3 months on CRS-specific QoL (SNOT-22 score) was significantly greater than for use during the prior 12 months. However, there was no other statistically significant difference in effect size for association between QoL and CRS-related antibiotic or corticosteroid use in the prior 3 months versus prior 12 months. These results were independent of the presence or absence of polyps.

Conclusion

More frequent past CRS-related oral antibiotic and corticosteroid use, regardless of time period queried (3 months or 12 months) is associated with significant decrease in CRS-specific and general health-related QoL. CRS-related systemic medication use is an important indicator of CRS patients' QOL that easily can be queried and utilized in both clinical and research settings.

Level of Evidence

2c. Laryngoscope, 2017

http://ift.tt/2ui02b8

Editor's Choice

http://ift.tt/2uIJ0VX

Plain language summaries in Simplified Chinese

Linked Comment: Wu et al. Br J Dermatol 2017; 177:72–83

Linked Comment: Tashiro et al. Br J Dermatol 2017; 177:158–167

Linked Comment: Senet et al. Br J Dermatol 2017; 177:206–211

Linked Comment: Gambichler et al. Br J Dermatol 2017; 177:238–244

Linked Comment: Saunte et al. Br J Dermatol 2017; 177:47–62

Linked Comment: Andersen et al. Br J Dermatol 2017; 177:107–116

Linked Comment: Su et al. Br J Dermatol 2017; 177:125–133

Linked Comment: Cañueto et al. Br J Dermatol 2017; 177:168–178

Linked Comment: Gilbert et al. Br J Dermatol 2017; 177:117–124

Linked Comment: Chasset et al. Br J Dermatol 2017; 177:188–196

Linked Comment: Karimkhani et al. Br J Dermatol 2017; 177:134–140

Linked Comment: Hagforsen et al. Br J Dermatol 2017; 177:179–187

Linked Comment: Reich et al. Br J Dermatol 2017; 177:197–205

http://ift.tt/2vrz1lS

Percutaneous absorption risks in atopic dermatitis

Linked Article: Halling-Overgaard et al. Br J Dermatol 2017; 177:84–106.

http://ift.tt/2uIj6BE

Prognostic factors of patients with linear IgA bullous dermatosis

Linked Article: Gottlieb et al. Br J Dermatol 2017; 177:212–222.

http://ift.tt/2vqUlrR

New technology discloses the tumour margin of extramammary Paget disease?

Linked Article: Murata et al. Br J Dermatol 2017; 177:229–237

http://ift.tt/2vrfZfy

Biologics for psoriasis: more drugs, new patient categories, but fresh challenges for clinical dermatologists

http://ift.tt/2vrnvXI

Antimalarials in cutaneous lupus erythematous subtypes

Linked Article: Chasset et al. Br J Dermatol 2017; 177:188–196.

http://ift.tt/2uINVGo

Cover image: Intralymphatic histiocytosis with giant blanching violaceous plaques

http://ift.tt/2vrgvKi

Pathogenesis of morphoea: knowledge gaps in subtypes and comparisons to systemic sclerosis

Linked Article: Saracino et al. Br J Dermatol 2017; 177:34–46.

http://ift.tt/2uIJ2Nz

Clinical significance of immunoglobulin E in bullous pemphigoid

Linked Article: Hashimoto et al. Br J Dermatol 2017; 177:141–151.

http://ift.tt/2uIyWfz

Positive about negative: no need for a pink cloud of fluff and justifications

http://ift.tt/2uIe7kA

Folliculotropic mycosis fungoides is a heterogenous group

Linked Article: van Santen et al. Br J Dermatol 2017; 177:223–228.

http://ift.tt/2vrNbDt

Image Gallery: Congenital onychodysplasia of the toenails

http://ift.tt/2vrsvM8

Plain language summaries

Linked Comment: Wu et al. Br J Dermatol 2017; 177:72–83

Linked Comment: Tashiro et al. Br J Dermatol 2017; 177:158–167

Linked Comment: Senet et al. Br J Dermatol 2017; 177:206–211

Linked Comment: Gambichler et al. Br J Dermatol 2017; 177:238–244

Linked Comment: Saunte et al. Br J Dermatol 2017; 177:47–62

Linked Comment: Andersen et al. Br J Dermatol 2017; 177:107–116

Linked Comment: Su et al. Br J Dermatol 2017; 177:125–133

Linked Comment: Cañueto et al. Br J Dermatol 2017; 177:168–178

Linked Comment: Gilbert et al. Br J Dermatol 2017; 177:117–124

Linked Comment: Chasset et al. Br J Dermatol 2017; 177:188–196

Linked Comment: Karimkhani et al. Br J Dermatol 2017; 177:134–140

Linked Comment: Hagforsen et al. Br J Dermatol 2017; 177:179–187

Linked Comment: Reich et al. Br J Dermatol 2017; 177:197–205

http://ift.tt/2uIO1xE