Purpose: To report our findings in 2 patients who developed a central retinal vein occlusion (CRVO) and were chronic users of antipsychotic medications. Case Presentation: Case 1 was a 62-year-old woman who had a sudden reduction of vision in her right eye to 20/2,000. Her fundus showed signs of an impending CRVO with marked macular edema. She had been taking antipsychotic drugs (quetiapine fumarate and risperidone) for about 2 years. She refused anti-VEGF therapy for her macular edema but selected systemic kallidinogenase. Two days later, the macular edema was significantly reduced but the number of cotton wool spots (CWS) was increased. Ten days later, the macular edema was resolved and her BCVA improved to 20/60. The CWS gradually disappeared, and her BCVA improved to 20/20. Case 2 was a 43-year-old man who presented with vision reduction in his right eye of 1 week's duration. His BCVA was 20/50 and his fundus showed signs of a CRVO-related macular edema with CWS in the peripapillary area. He had been taking sulpiride (DogmatylTM) for depression for 1 year, and his blood test showed an increase in red blood cells and hematocrit. Anti-VEGF therapy was performed, and the macular edema was resolved with vision improving to 20/20. There has been no recurrence to date in both cases. Conclusions: These results indicate that a CRVO can be a complication of chronic use of antipsychotic medications. However, early treatment can lead to good outcomes. Clinicians should question patients who develop a sudden CRVO whether they are using antipsychotic medications.
Case Rep Ophthalmol 2017;8:410–415
http://ift.tt/2eMi4yR
Τρίτη 25 Ιουλίου 2017
Fundus Findings in Wernicke Encephalopathy
Wernicke encephalopathy (WE) is an acute neuropsychiatric syndrome resulting from thiamine (vitamin B1) deficiency, classically characterized by the triad of ophthalmoplegia, confusion, and ataxia. While commonly associated with chronic alcoholism, WE may also occur in the setting of poor nutrition or absorption. We present a 37-year-old woman who underwent laparoscopic sleeve gastrectomy and presented with visual disturbance with bilateral horizontal nystagmus, confusion, and postural imbalance. Fundus examination revealed bilateral optic disc edema with a retinal hemorrhage in the left eye. Metabolic workup demonstrated thiamine deficiency. Her symptoms resolved after thiamine treatment. This case raises the awareness of the possibility of posterior segment findings in WE, which are underreported in WE.
Case Rep Ophthalmol 2017;8:406–409
http://ift.tt/2h2fKUO
Masthead
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 8
http://ift.tt/2h28sAq
Editorial Board Page
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 8
http://ift.tt/2eMJMeA
Table of Contents
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 8
http://ift.tt/2h1G41u
AAOMS Author Disclosure forms
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 8
http://ift.tt/2eMptOq
Making Research One of Our Key Priorities
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 8
Author(s): James R. Hupp
http://ift.tt/2h1O6aM
Can Preoperative Intramuscular Single-Dose Dexamethasone Improve Patient-Centered Outcomes Following Third Molar Surgery?
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 8
Author(s): Mahmoud Al-Dajani
PurposeBecause of increased attention focused on administering dexamethasone to treat third molar surgical complications, this study investigated the efficacy of single-dose dexamethasone in managing postoperative complications after impacted third molar surgery. Pain intensity and analgesic intake, patients' discomfort, limitation of oral function, and limitation of daily activities were assessed.Materials and MethodsThis triple-blinded split-mouth randomized controlled clinical trial included patients 18 to 30 years old who underwent randomized bilateral extractions of impacted mandibular third molars during 2 consecutive sessions. Each patient was given a single-dose intramuscular injection of dexamethasone (0.1 mg/kg) preoperatively in 1 session and a placebo in the other session. Data were collected daily for 7 postoperative days, and 14 patient-centered outcomes were interpreted. A 2-tailed P value less than .05 was considered significant.ResultsAll 32 patients (100%) enrolled completed the study. When administered dexamethasone, patients reported less pain (P ≤ .007), took fewer analgesics (P ≤ .002), reported less swelling (P ≤ .007), had less difficulty in eating (P ≤ .024), had less difficulty in enjoying food (P ≤ .005), had less difficulty in speech (P = .043), had less trismus (P = .005), were absent less from school or work (P ≤ .016), and had less disruption of daily activity (P ≤ .042). The differences between the 2 conditions in bleeding, malaise, and sleep disturbance were not significant (P > .05).ConclusionProphylactic dexamethasone administered intramuscularly before third molar surgery should be recommended as a safe and effective strategy for decreasing pain and discomfort and enhancing oral functions and daily activities, unless contraindicated.
http://ift.tt/2eN73gF
Influence of Lateral-Medial Sinus Width on No-Grafting Inlay Osteotome Sinus Augmentation Outcomes
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 8
Author(s): Xiaohui Cheng, Xiucheng Hu, Shuangquan Wan, Xiachen Li, Yiming Li, Feilong Deng
PurposeIntrasinus new bone formation (BF) has been observed after no-grafting osteotome sinus augmentation, and it is hypothesized to be influenced by the dimensions of the maxillary sinus. The aim of this clinical trial is to evaluate the influence of lateral-medial sinus width (SW) on no-grafting osteotome sinus augmentation outcomes using cone-beam computed tomography.Patients and MethodsAll patients recruited for this prospective study were treated with no-grafting osteotome sinus augmentation with simultaneous implant placement. Cone-beam computed tomography was obtained before, immediately after, and 6 months after the surgical procedure to use for measurements. Descriptive statistics were calculated and univariate, bivariate, and multivariate analysis were conducted to evaluate the influence of average SW and other relevant factors on procedure outcomes, including new BF, residual bone resorption (BR), and change of peri-implant bone height (CPBH).ResultsA total of 48 implants placed in 32 elevated sinuses of 29 patients were included. The average SW was 11.3 ± 1.8 mm. Intrasinus BF measured 1.7 ± 0.9 mm at 6 months after surgery. The amount of BR was 0.3 ± 0.9 mm, and CPBH was calculated as 1.3 ± 1.3 mm. Multivariate analysis showed a negative correlation between SW and BF (r = –0.469, P = .001), as well as between SW and CPBH (r = –0.562, P = .001). A positive correlation was discovered between SW and BR (r = 0.311, P = .027) in general.ConclusionsThe lateral-medial SW was observed to have a negative correlation with new BF and CPBH after no-grafting osteotome sinus augmentation.
http://ift.tt/2h1vuI0
Surgical Uprighting Is a Successful Procedure for Management of Impacted Mandibular Second Molars
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 8
Author(s): Bonnie L. Padwa, Rushil R. Dang, Cory M. Resnick
PurposeImpacted mandibular second molars can cause caries and root resorption on adjacent molars and can lengthen orthodontic treatment. Surgical uprighting is one management option. The purposes of this study were to 1) evaluate radiographic outcomes for surgical uprighting of impacted mandibular second molars and 2) propose an etiology for impaction.Materials and MethodsThis was a retrospective cohort study of patients who had surgical uprighting of mandibular second molars and had preoperative and at least 12-month postoperative panoramic images and an age- and gender-matched control group of patients undergoing routine orthodontic treatment. Predictor variables included age, gender, impaction type, preoperative angle of impaction, preoperative periodontal bone level distal to an adjacent first molar, posterior eruption space, pathology, and concomitant extraction of the adjacent third molar. Outcome variables were change in impaction type, postoperative periodontal bone levels around the first and second molars, postoperative tooth angle and posterior eruption space, periapical radiolucency, pulpal obliteration, root resorption, and need for extraction. Descriptive statistics were calculated.ResultsThe sample and control groups each had 16 patients. The mean ages at the first radiographs were 13 ± 1.1 and 13.19 ± 0.61 years for the treatment and control groups, respectively, and the mean follow-up radiographs were obtained 2.4 ± 1.4 and 2.3 ± 0.82 years later. No preoperative images showed pathologic lesions obstructing eruption. Postoperatively, all uprighted molars were Pell and Gregory type IA. The mean change in the angles of the uprighted teeth was 23.5 ± 16.1° (P < .001). The mean distal bone levels of the adjacent first molar were 3.41 ± 1.52 mm preoperatively and 1.45 ± 0.54 mm postoperatively (improvement, 42.5%; P < .001). The preoperative posterior eruption space was 53.6% longer in the control than in the treatment group (P < .001), and the increase in this distance postoperatively was greater for the treatment group than for the control group (P < .001). Pulpal obliteration (n = 6; 31.5%), periapical radiolucency (n = 2; 10.5%), and root resorption (n = 1; 5.3%) were seen on postoperative radiographs. There were 2 failures (10.5%).ConclusionsSurgical uprighting of mandibular second molars is a useful procedure with a low failure rate. Insufficient space for eruption is the likely primary etiology for impaction.
http://ift.tt/2eNfR6i
Oculocardiac Reflex in an Orbital Fracture Without Entrapment
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 8
Author(s): Timothy C. Woernley, Thomas L. Wright, Duc N. Lam, Jonathon S. Jundt
Large orbital fractures in older patients are infrequently associated with an exaggerated oculocardiac reflex. This report describes the case of a patient in his 40s with a large right orbital floor and medial wall fracture without radiographic evidence of extraocular muscle compression or entrapment who developed severe nausea and bradycardia with movement of his affected eye. The patient exhibited bradycardia to 17 beats per minute during the initial examination and was taken urgently to the operating room for reconstruction of the right orbital floor and medial wall. Additional episodes of bradycardia intraoperatively were responsive to glycopyrrolate. After the procedure, the patient's pain was decreased, a normal range of motion was restored, and the bradycardia and nausea resolved. An explanation for induction of the oculocardiac reflex is considered in the absence of clinical or radiologic entrapment because large orbital fractures are not often considered to induce this reflex.
http://ift.tt/2h28oka
A Review of In-Office Dynamic Image Navigation for Extraction of Complex Mandibular Third Molars
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 8
Author(s): Robert W. Emery, Oxana Korj, Ravi Agarwal
PurposeWe performed a retrospective review of in-office removal of complex mandibular third molars with a dynamic image navigation system (DINS).Materials and MethodsA retrospective review was conducted of cases completed from 2010 to 2014 by a single oral and maxillofacial surgeon. The average age of the patients was 47 years (range, 27 to 72 years). Extraction complexity was classified with Juodzbalys and Daugela's classification system. The included study cases had complexity scores of 9 or greater. Each patient received custom intraoral splints to secure the tracking array and underwent cone beam computed tomography image acquisition. All surgical procedures were performed with a precalibrated tracking straight handpiece under dynamic navigation.ResultsAll 25 cases were treated successfully with the use of the DINS. Twelve of these cases were associated with pathologic lesions. Three patients were noted to have inferior alveolar nerve paresthesia. One patient sustained a pathologic fracture at week 2. Postoperative infections were noted in 7 cases, 2 of which had a pre-existing infection. One patient reported temporary limitation of mouth opening. A coronectomy was performed in 1 case.ConclusionsWe present results using a new technology, the DINS, for removal of complex mandibular third molars. Potential advantages are 1) improved visualization and localization of anatomic structures such as the inferior alveolar nerve, lingual cortical plate, and adjacent roots; 2) improved control during osteotomy; 3) decreased surgical access requirements and reduction in overall bone removal; 4) ability to perform complex procedures successfully in an in-office setting; 5) decreased surgical time resulting from improved visualization; and 6) potential use as a teaching tool. Possible limitations of the use of an in-office DINS include increased cost, increased time attributed to presurgical planning, initial learning curve, and optical array interference by the surgeon or assistants during surgery.
http://ift.tt/2eMEhg5
Horizontal changes of the proximal mandibular segment after mandibular setback surgery using 3D CT data
Publication date: Available online 25 July 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Bo-Ram Yeo, Jeong-Joon Han, Seunggon Jung, Hong-Ju Park, Hee-Kyun Oh, Min-Suk Kook
Objectives.To evaluate horizontal changes of the proximal mandibular segment after mandibular setback surgery using three-dimensional computed tomography (3D CT).Study Design.This study included 66 patients who underwent bilateral sagittal split ramus osteotomy (BSSRO) for correction of mandibular prognathism Using 3D CT data obtained preoperatively (T1), immediately postoperatively (T2), and 6 months postoperatively (T3), horizontal changes of the proximal mandibular segment including intercondylar width (ICW), intergonial width (IGW), and frontal-ramal inclination (FRI) were evaluated.Results.The value of right-FRI was 11.43 ± 1.36° at T1, 11.91 ± 1.96° at T2, and 10.7 ± 1.5° at T3. The values of left-FRI were 6.10 ± 1.03° at T1, 8.17 ± 1.66° at T2, and 7.66 ± 1.65° at T3. The values of IGW were 99.67 ± 1.67 mm at T1, 98.24 ± 1.72 mm at T2, and 97.08 ± 1.71 mm at T3. IGW was significantly decreased at T3 compared with T1 (p < 0.001). The values of ICW were 123.51 ± 1.66 mm at T1, 123.9 ± 1.66 mm at T2, and 122.88 ± 1.58 mm at T3.Conclusion.Lower facial width at mandibular angle region decreased immediately after mandibular setback surgery and showed further decreases during the postoperative period.
http://ift.tt/2tYj6cU
The influence of food consistency on chewing rate and muscular work
Source:Archives of Oral Biology, Volume 83
Author(s): A. van der Bilt, J.H. Abbink
Food properties influence the parameters of the masticatory process, such as jaw movement, muscle activity and chewing rate. Firm foods will require more muscle activity than softer foods. However, the influence of food hardness on chewing rate is ambiguous as both slower and higher chewing rates have been reported for harder foods. Rheological characteristics of the food, such as plasticity and elasticity, may help to explain differences in chewing rate. The aim of our study was to determine the influence of food properties on chewing rate and muscular work in five phases of a chewing sequence. Eighty-four participants chewed on five foods, which strongly differed in consistency. Chewing gum was used as a reference food. The phase in the chewing sequence had a large significant effect on cycle duration for the five foods. A significant decrease in cycle duration at the beginning of chewing was followed by an increase in later phases, leading to U-shaped curves. Food type had a small effect on the average cycle duration. However, large significant differences in cycle duration were observed between the foods at the beginning of a chewing sequence. In that phase, the firm foods were chewed much slower than the soft foods. Muscular work was significantly influenced by both chewing phase and food type.
http://ift.tt/2h1pRcJ
The influence of food consistency on chewing rate and muscular work
Source:Archives of Oral Biology, Volume 83
Author(s): A. van der Bilt, J.H. Abbink
Food properties influence the parameters of the masticatory process, such as jaw movement, muscle activity and chewing rate. Firm foods will require more muscle activity than softer foods. However, the influence of food hardness on chewing rate is ambiguous as both slower and higher chewing rates have been reported for harder foods. Rheological characteristics of the food, such as plasticity and elasticity, may help to explain differences in chewing rate. The aim of our study was to determine the influence of food properties on chewing rate and muscular work in five phases of a chewing sequence. Eighty-four participants chewed on five foods, which strongly differed in consistency. Chewing gum was used as a reference food. The phase in the chewing sequence had a large significant effect on cycle duration for the five foods. A significant decrease in cycle duration at the beginning of chewing was followed by an increase in later phases, leading to U-shaped curves. Food type had a small effect on the average cycle duration. However, large significant differences in cycle duration were observed between the foods at the beginning of a chewing sequence. In that phase, the firm foods were chewed much slower than the soft foods. Muscular work was significantly influenced by both chewing phase and food type.
http://ift.tt/2h1pRcJ
Histopathological and clinical evaluation of chronic spontaneous urticaria patients with neutrophilic and non-neutrophilic cutaneous infiltrate
Publication date: Available online 25 July 2017
Source:Allergology International
Author(s): Cíntia Freitas Martins, Karina Lopes Morais, Pamela Figueroa, Natasha Favoretto Dias, Neusa Sakai Valente, Celina Wakisaba Maruta, Paulo Ricardo Criado
BackgroundChronic urticaria has an expressive prevalence in general population, especially in adults, and is defined by the presence of intermittent hives for six weeks or longer. Our study aims to characterize the histological patterns of chronic spontaneous urticaria, based on the inflammatory cell infiltrate, and correlate them to laboratory exams.MethodsIt was performed a retrospective analysis of laboratory, histopathology and direct immunofluorescence data of 93 patients with chronic urticaria. For histopathological analysis, cell count was performed in four fields at high magnification (×400) for each specimen. The resulting cell count medians were submitted to statistical analysis and, then, were correlated to laboratorial findings.ResultsWe found a female predominance (76.34%) of chronic urticaria cases, and an average age of 42.5 years (SD ± 15). Two histological groups were distinctive: 1) chronic urticaria with predominance of neutrophils or eosinophils – N (%) = 39 (42.4%) – and 2) chronic urticaria with predominance of lymphocytes – N (%) = 53 (57.6%). There was not significant correlation between histological groups and laboratorial tests. Moreover, direct immunofluorescence was positive in 21 (33,87%) from 62 patients.ConclusionsThere is not enough scientific evidence to support neutrophilic urticaria as a solid, separate entity.
http://ift.tt/2vHWYp5
Learning curve of tonsillectomy
To determine the time required to sufficiently educate a well-trained surgeon to perform tonsillectomy.
http://ift.tt/2uw2oVN
A single-institution assessment of superficial spreading melanoma (SSM) in the pediatric population: Molecular and histopathologic features compared with adult SSM
The epidemiology of pediatric melanoma is distinct from that seen in adults. This is more distinguishable when pediatric patients are separated into prepubertal and adolescent groups.
http://ift.tt/2uvHJ43
Anaphylaxis and intimate behaviour.
Purpose of review: Intimate behaviours may represent an unusual way of exposure to a culprit allergen, or the frame for sex-related allergies due to triggers typically linked to that situation. The present review aims at summarizing the state of the art about the topic, in order to spread the awareness and the basic know-how in the field of sexual-related allergies. Recent findings: Kiss-related IgE-mediated reactions are caused in sensitized partners mainly by the passive transport of allergenic molecules through saliva, skin or oral mucosa. It has also been recently suggested that kissing may act as an epicutaneous way for induction of allergic sensitization. Among food and drugs, not only but mostly, peanuts and beta-lactams, respectively, are the usual trigger. Although controversial, 1-hour wait before kissing and a proper mouth cleaning have been suggested as prevention strategies. Sexual intercourse related local or systemic symptoms can be caused by seminal plasma hypersensitivity, an IgE-mediated/type IV reaction due to prostate-specific antigen, which carries high homology to the canine prostatic kallikrein (Can f 5). Although applied to few patients, successful desensitization and immunotherapy protocols have been proposed. Summary: Intimate behaviours are possible modalities of contact with the allergen. The exact prevalence of such hypersensitivity reactions is not known, but for its implications on Quality of Life and reproductive wishes, the possible link between sex and allergy should become part of the personal culture of clinical allergists and every clinician, in order to extend and improve the diagnosis of unusual or unexplained conditions. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2vYrIBH
http://ift.tt/2vYrIBH
Vermeidung unbeabsichtigter perioperativer Hypothermie: ein Leitfaden
Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 554-562
DOI: 10.1055/s-0041-103653
Die unbeabsichtigte perioperative Hypothermie (Körperkerntemperatur < 36 °C) ist ein potenziell komplikationsträchtiges, schwerwiegendes Ereignis: Sie führt zu einer erhöhten Inzidenz an Wundinfektionen und vermehrten Blutverlusten/Transfusionsbedarf. Dieser Beitrag thematisiert die praktische Umsetzung der AWMF-S3-Leitlinie „Vermeidung von perioperativer Hypothermie" von 2014 1. Er soll als Leitfaden für die tägliche klinische Arbeit dienen.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2uXdkfQ
Einfluss der Kardioanästhesie auf das Patientenoutcome
Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 498-511
DOI: 10.1055/s-0042-118830
Die Kardioanästhesie ist ein hoch technisierter, subspezialisierter Bereich der Anästhesiologie. Die Verbesserung des Patientenoutcomes wurde untersucht für hämodynamisches Management durch zielgerichtete Therapie, Nierenprotektion durch ischämische Fernpräkonditionierung, Myokardprotektion durch pharmakologische Präkonditionierung mittels volatiler Anästhetika, Neuroprotektion durch Nahinfrarotspektrometrie und perioperative Echokardiografie.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2uXgEaJ
Assoziation genetischer Polymorphismen mit chronischem postoperativem Schmerz
Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 476-478
DOI: 10.1055/s-0043-109232
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2tAMXc5
Anästhesie und Outcome
Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 484-485
DOI: 10.1055/s-0043-113905
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2tAMWF3
Normokarbie nach Reanimation scheint mit besseren Outcomes verbunden
Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 478-480
DOI: 10.1055/s-0043-109606
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2tAU2tc
Anästhesie und Outcome: Einfluss der perioperativen Prozesse
Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 525-541
DOI: 10.1055/s-0042-118828
In den letzten Jahren hat sich die Rolle des Anästhesisten vom „Narkosearzt" zum perioperativen Mediziner und Risikospezialisten enorm gewandelt. Die Patienten sind älter, multimorbide und werden zu immer umfangreicheren Eingriffen und Interventionen aufgeboten. Sozioökonomische Aspekte haben an Bedeutung zugenommen. Der Anästhesist ist als Wegbereiter eines guten Outcomes in nahezu alle perioperativen Prozesse involviert: präoperative Evaluation, Festlegung und Optimierung der prä- und intraoperativen Bedingungen, moderne intraoperative Anästhesieführung sowie eine postoperative, medizinisch indizierte, effektive und effiziente Behandlung der teilweise hochkomplexen Patienten. Die einzelnen perioperativen Prozessschritte auf diesem Weg werden in Anlehnung an etablierte Leitlinien und die Zunahme der gegenwärtigen Anforderungen beleuchtet. Schließlich wird ein besonderer Akzent auf die Erkenntnis gelegt, dass der perioperative Prozess nicht mit dem Operationsende abgeschlossen ist – postoperatives Outcome ist nicht zuletzt von postoperativen Komplikationen auf der Normalstation negativ beeinflusst. Das Risiko für Todesfälle nach Komplikationen, „Failure to rescue", sollte frühzeitig erkannt und umgehend behandelt werden.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2uXsstp
Retrograde Kanülierung peripherer Venen bei Intensivpatienten von Vorteil
Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 478-478
DOI: 10.1055/s-0043-112731
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2tAC7mk
Über 1700 hilfreiche Antworten
Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 482-482
DOI: 10.1055/s-0043-100004
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2tB3ug5
Kryoablation peripherer Nerven zur Therapie von Phantomschmerz
Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 480-481
DOI: 10.1055/s-0043-105640
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2tBjmz0
Entwicklung der anästhesieassoziierten Letalität und Einfluss auf das Outcome
Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 486-497
DOI: 10.1055/s-0042-118827
Die anästhesieassoziierte Letalität konnte in den letzten Jahrzehnten deutlich gesenkt werden. Dies ermöglicht neben einer zuverlässigen Monitoringtechnik gut ausgebildetes Personal, das die patienten- und eingriffsspezifischen Risiken in das intraoperative Management mit einbezieht. Die richtige postoperative Betreuung von Patienten in Aufwachraum, PACU und Intensivstation ist ein weiterer zentraler Punkt für ein verbessertes Patienten-Outcome.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2tAynkF
Thrombozytentransfusion assoziiert mit Risiko für nosokomiale Infektionen
Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 480-480
DOI: 10.1055/s-0043-114311
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2tB1zrP
Anästhesie und Outcome: Einfluss bei Kindern
Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 513-523
DOI: 10.1055/s-0042-118829
Die operative Versorgung von Kindern birgt ein erhöhtes Risiko schwerer perioperativer Komplikationen und stellt hohe Anforderungen an die beteiligten Berufsgruppen. Um das perioperative Outcome von Kindern vonseiten der Anästhesie positiv zu beeinflussen, sind neben der Optimierung institutioneller Faktoren individuelle Möglichkeiten innerhalb der intraoperativen Phase der Narkoseeinleitung und -aufrechterhaltung bedeutend, insbesondere die Einstellung des adäquaten Blutdrucks.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2tB14Ov
Der Faktenturbo für die Kitteltasche
Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 482-482
DOI: 10.1055/s-0042-120981
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2tAC75O
Remifentanil up2date – Teil 1
Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 543-553
DOI: 10.1055/s-0042-122041
Remifentanil ist ein kurzwirksames, potentes Opioid mit guter Steuerbarkeit – und vor allem in der ambulanten Anästhesiologie nahezu unverzichtbar. Umso härter trifft uns die seit 2016 eingeschränkte Verfügbarkeit und Kontingentierung. Dieser Beitrag liefert einen Überblick über die Substanz, ihre Geschichte und pharmakologischen Eigenschaften.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2tAG0rk
Alarm-Fatigue – wieviel Alarm verträgt der Mensch?
Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 564-570
DOI: 10.1055/s-0042-118618
Durch zunehmende Technisierung in der Anästhesiologie und Intensivmedizin steigen sowohl Anzahl der Geräte als auch deren visuelle und akustische Alarme. Die meisten aller Alarme sind jedoch Fehlalarme, was bei den Mitarbeitern zu Frustration, Aggression und Fehlverhalten führt. Dieser Übersichtsartikel fasst die Risikofaktoren für die Entstehung von „Alarm-Fatigue" zusammen und gibt einen Ausblick auf mögliche Lösungsstrategien.
[...]
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2uX4yya
Welche Atemunterstützung bei akuter viraler Bronchiolitis im Säuglingsalter?
Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52: 476-476
DOI: 10.1055/s-0043-105624
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
http://ift.tt/2tAFZDM
Learning curve of tonsillectomy
Source:Auris Nasus Larynx
Author(s): Pei-Yin Wei, Chia-Huei Chu, Mao-Che Wang
ObjectiveTo determine the time required to sufficiently educate a well-trained surgeon to perform tonsillectomy.Material and methodsFrom July 1, 2000 to June 30, 2008, we analyzed 110 patients who underwent bilateral tonsillectomy. All the procedures were performed by 16 ENT surgeons trained in the same tertiary referral medical center during their residency. This training included a 4-year training program before 2002, and a 5-year training program thereafter. We stratified the patients into groups according to each surgeon's residency year at the time the operations were performed. Operation time, estimated blood loss and length of hospital stay of these patients were compared by the surgeon's residency year and by different training program of residency.ResultsThere was a trend of decreased operation time in the senior year of residency, especially for 5th year surgeons, without reaching statistical significance. When comparing different training program, the operation time was statistically shorter in the 5-year training program than in the 4-year training program. However, no difference was noted in estimated blood loss and hospital stay length.ConclusionThe operation time of residents in the 5-year training program was shorter than that of residents in the 4-year training program, which implies that extending the training program by one year may improve the quality of training.
http://ift.tt/2vGRGtX
Morphometric Analysis of Temporomandibular Joint Elements
To study the morphology of temporomandibular joint (TMJ) elements and examine the feasibility of a novel biofidelic articular disc casting technique.
http://ift.tt/2uvzyVi
Accuracy and reproducibility of the DAVID SLS-2 scanner in three-dimensional facial imaging
A prospective study was performed to test the accuracy and reproducibility of the DAVID-SLS-2 scanner (SLS-2) [DAVID Vision Systems GmbH], compared to the validated 3dMDtrio scanner (3dMD) [3dMD, LLC, Atlanta, GA, USA].
http://ift.tt/2vH6Pf2
MAGEA4 expression in bone and soft tissue tumors: its utility as a target for immunotherapy and diagnostic marker combined with NY-ESO-1
Abstract
Cancer-testis (CT) antigens have promise as targets for immunotherapy, because of their restricted expression in tumor or testis tissue. MAGEA4 is both a MAGE family member and a CT antigen, and has attracted attention as a potential immunotherapeutic target. We investigated MAGEA4 expression by immunohistochemistry in bone and soft tissue tumor specimens that consisted of 35 malignant or intermediate and 24 benign histological subtypes, in order to evaluate its possible utility as an immunotherapy target and its potential use as a diagnostic marker when combined with another CT antigen, NY-ESO-1. Among these tumors, MAGEA4 was detected in 82.2% of synovial sarcomas, 67.7% of myxoid liposarcomas, 43.8% of osteosarcomas, 41.4% of angiosarcomas, 24.6% of malignant peripheral nerve sheath tumors (MPNSTs), and 21.4% of chondrosarcomas. NY-ESO-1 expression was found in 88.2% of myxoid liposarcomas, 61.1% of synovial sarcomas, 31.3% of osteosarcomas, 21.4% of pleomorphic liposarcomas, 16.7% of desmoplastic small round cell tumors, and 14.3% of chondrosarcomas. Benign tumors and non-tumorous tissue, except for testis tissue, did not express MAGEA4 or NY-ESO-1. Combined use of MAGEA4 and NY-ESO-1 increased the sensitivity, specificity, positive predictive values, and negative predictive values for distinguishing synovial sarcoma from spindle cell tumors and other mimicking tumors, compared to individual use of MAGEA4 or NY-ESO-1. Our results support the immunotherapy targeting MAGEA4 or NY-ESO-1 can be an ancillary therapy in the above-mentioned tumors, and the potential utility of MAGEA4 as an ancillary diagnostic marker for synovial sarcoma combined with NY-ESO-1.
http://ift.tt/2uvr298
A review of chitosan's effect on oral biofilms: Perspectives from the tube to the mouth
Source:Journal of Oral Biosciences
Author(s): Eduardo Manuel Costa, Sara Silva, Mariana Veiga, Freni Kekhasharú Tavaria, Maria Manuela Pintado
BackgroundThe oral cavity is a propitious environment for bacteria with different tissue tropisms to colonize and grow due to its diverse surfaces. For bacterial survival in the oral cavity, where tissues are continuously bathed in fluids, biofilm formation is necessary. Dental biofilm, i.e. dental plaque, is notoriously hard to inhibit and traditional oral care solutions are either ineffective at managing oral biofilms or cause secondary effects, such as teeth staining, that make them unattractive.HighlightChitosan has high biocompatibility and antimicrobial activity that is heralded by the pharmaceutical industry for its applicability in biofabrication. Therefore, this material is a potential substitute for the antimicrobials traditionally used in oral care.ConclusionCurrently, the body of work on chitosan and the oral cavity ranges from planktonic studies in vitro to biofilm control/removal studies in vivo. With a wide range of topics available for analysis, this review provides a working understanding of chitosan's role in the control and management of oral biofilms.
http://ift.tt/2tXkJr8
A Comparative Evaluation of Closed and Open Treatment in the Management of Unilateral Displaced Mandibular Subcondylar Fractures: A Prospective Randomized Study
Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1603499
The aim of the study is to evaluate closed and open treatment in the management of unilateral displaced mandibular subcondylar fractures. Twenty patients with unilateral subcondylar fractures of the mandible were evaluated with degree of displacement of more than 20 degrees and ramal height shortening of more than 10 mm. They were informed of the need for 6-month follow-up. Patients were thoroughly informed, explaining the possible advantages and disadvantages of the open and closed treatment options. Radiographic parameters included the level of fracture, deviation of fragment, and ramal height shortening. Correct anatomical reduction is achieved by open treatment as compared with closed treatment. Regarding pain, mouth opening, and lateral excursion movement, statistically significant difference was found in both groups (p < 0.01). In radiographic assessment of ramal height shortening and fracture displacement, statistically significant difference was found (p < 0.01). And no significant complication is found in both treatment groups. The results of this study favor the open treatment for the management of displaced subcondylar fractures. However, the treatment results are also acceptable for closed group.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2tBhBC2
Anaphylaxis and intimate behaviour.
Purpose of review: Intimate behaviours may represent an unusual way of exposure to a culprit allergen, or the frame for sex-related allergies due to triggers typically linked to that situation. The present review aims at summarizing the state of the art about the topic, in order to spread the awareness and the basic know-how in the field of sexual-related allergies. Recent findings: Kiss-related IgE-mediated reactions are caused in sensitized partners mainly by the passive transport of allergenic molecules through saliva, skin or oral mucosa. It has also been recently suggested that kissing may act as an epicutaneous way for induction of allergic sensitization. Among food and drugs, not only but mostly, peanuts and beta-lactams, respectively, are the usual trigger. Although controversial, 1-hour wait before kissing and a proper mouth cleaning have been suggested as prevention strategies. Sexual intercourse related local or systemic symptoms can be caused by seminal plasma hypersensitivity, an IgE-mediated/type IV reaction due to prostate-specific antigen, which carries high homology to the canine prostatic kallikrein (Can f 5). Although applied to few patients, successful desensitization and immunotherapy protocols have been proposed. Summary: Intimate behaviours are possible modalities of contact with the allergen. The exact prevalence of such hypersensitivity reactions is not known, but for its implications on Quality of Life and reproductive wishes, the possible link between sex and allergy should become part of the personal culture of clinical allergists and every clinician, in order to extend and improve the diagnosis of unusual or unexplained conditions. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2vYrIBH
http://ift.tt/2vYrIBH
Omalizumab Treatment in Chronic Inducible Urticaria: A Systematic Review of Published Evidence
Publication date: Available online 24 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Marcus Maurer, Martin Metz, Randolf Brehler, Uwe Hillen, Thilo Jakob, Vera Mahler, Claudia Pföhler, Petra Staubach, Regina Treudler, Bettina Wedi, Markus Magerl
BackgroundOmalizumab, a recombinant anti-IgE antibody, effectively treats chronic spontaneous urticaria. Evidence is lacking in chronic inducible urticarias (CIndUs), which are frequently H1-antihistamine resistant.ObjectiveWe aimed to determine, from the current published literature, the strength of evidence for omalizumab efficacy and safety in the treatment of CIndUs.MethodsWe performed a PubMed® search to identify evidence on omalizumab use in the following nine CIndU subtypes: symptomatic dermographism, cold urticaria, delayed pressure urticaria, solar urticaria, heat urticaria, vibratory angioedema, cholinergic urticaria, contact urticaria and aquagenic urticaria.Results43 trials, case studies, case reports and analyses were identified. Our review indicates that omalizumab has substantial benefits in various CIndUs. The evidence is strongest for symptomatic dermographism, cold urticaria and solar urticaria. Little/no evidence was available on vibratory angioedema, aquagenic and contact urticaria. Our review supports the rapid onset of action, demonstrated through early symptom control in most cases, sometimes within 24 hours. Many patients gained complete/partial symptom relief and substantially improved quality of life. Adverse events were generally low with omalizumab being well tolerated by most patients including children.ConclusionsA strong body of evidence supports the use of omalizumab in the treatment of patients with therapy-refractory CIndU. More data from randomised controlled studies are warranted.
http://ift.tt/2tHYt9q
Sputum autoantibodies in severe eosinophilic asthma
Publication date: Available online 24 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Manali Mukherjee, David C. Bulir, Katherine Radford, Melanie Kjarsgaard, Chynna Margaret Huang, Elizabeth A. Jacobsen, Sergei I. Ochkur, Ana Catuneanu, Hanah Lamothe-Kipnes, James Mahony, James J. Lee, Paige Lacy, Parameswaran K. Nair
BackgroundThe persistence of eosinophils in sputum despite high doses of corticosteroids indicates disease severity in asthma. Chronic inflamed airways over time may lose tolerance to immunogenic entities released upon frequent eosinophil degranulation, which further contributes to disease severity and necessitates increase in maintenance corticosteroids.ObjectivesTo investigate the possibility of a polyclonal autoimmune event in asthmatic airways, and identify associated clinical and molecular characteristics.MethodsPresence of autoantibodies against eosinophil peroxidase (EPX) and anti-nuclear antibodies (ANAs) was investigated in eosinophilic asthmatics maintained on high dose corticosteroids and/or prednisone. The ability of sputum immunoglobulins to induce eosinophil degranulation in vitro was assessed. In addition, the associated inflammatory micro-environment in patients with detectable autoantibodies was examined.ResultsWe report a "polyclonal" autoimmune event occurring in the airways of prednisone-dependent asthmatics with increased eosinophil activity and/or recurrent pulmonary infections, evident by the concomitant presence of sputum anti-EPX and ANAs of the IgG subtype. Extensive cytokine profiling of the sputum revealed a Th2-dominated micro-environment (eotaxin-2, IL-5, IL-18, IL-13), and increased signalling molecules that support the formation of ectopic lymphoid structures (B-cell activating factor, B-cell attracting chemokine-1). Immunoprecipitated sputum immunoglobulins from patients with increased autoantibodies triggered eosinophil degranulation in vitro, with release of extensive histone-rich extracellular-traps; an event unsuppressed by dexamethasone possibly contributing to the steroid-unresponsive nature of these eosinophilic patients.ConclusionThis study identifies an "autoimmune" endotype of severe asthma that can be identified by the presence of sputum autoantibodies against EPX and autologous cellular components.
Teaser
We report a novel concept of an autoimmune inflammation localised to the airways of severe eosinophilic asthmatics. This is possibly steroid-insensitive, contributing to disease severity, and necessitates identification of these patients for appropriate therapeutic strategies. (35 words)http://ift.tt/2tX873t
Inflammatory Mediators Mediate Airway Smooth Muscle Contraction through a GPCR-TMEM16A-VDCC Axis and Contribute to Bronchial Hyperresponsiveness in Asthma
Publication date: Available online 25 July 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Pei Wang, Wei Zhao, Jie Sun, Tao Tao, Xin Chen, Yan-Yan Zheng, Cheng-Hai Zhang, Zhong Chen, Yun-Qian Gao, Fan She, Ye-Qiong Li, Li-Sha Wei, Ping Lu, Cai-Ping Chen, Ji Zhou, Da-Quan Wang, Liang Chen, Xiao-Hao Shi, Linhong Deng, Ronghua ZhuGe, Hua-Qun Chen, Min-Sheng Zhu
BackgroundAllergic inflammation has long been implicated in asthmatic hyperresponsiveness of airway smooth muscle (ASM), but its mechanism underlying remains incompletely understood. Serving as GPCR agonists, several inflammatory mediators can induce membrane depolarization, contract ASM and augment cholinergic contractile response. We hypothesized that the signal cascade integrating on membrane depolarization by the mediators might involve asthmatic hyperresponsiveness.ObjectiveWe sought to investigate the signalling transduction of inflammatory mediators in ASM contraction and assess its contribution in the genesis of hyperresponsiveness.MethodsWe assessed the capacity of inflammatory mediators to induce depolarization currents by electrophysiological analysis. We analysed the phenotypes of TMEM16A knockout mice, applied pharmacological reagents and measured the Ca2+ signal during ASM contraction. To study the role of the depolarization signalling in asthmatic hyperresponsiveness, we measured the synergistic contraction by acetylcholine and inflammatory mediators both ex vivo and in OVA-induced mouse modelResultsInflammatory mediators, such as 5-HT, histamine, U46619 and LTD4, are capable of inducing ClCa currents in ASM cells, and these currents are mediated by TMEM16A. A combination of multiple analysis revealed that a GPCR-TMEM16A-VDCC signalling axis was required for ASM contraction induced by inflammatory mediators. Block of TMEM16A activity may significantly inhibit the synergistic contraction of acetylcholine and the mediators, and hence reduces hypersensitivity.ConclusionsA GPCR-TMEM16A-VDCC axis contributes to inflammatory mediator-induced ASM contraction, and synergistically activating TMEM16A by allergic inflammatory mediators with cholinergic stimuli.
Graphical abstract
Teaser
The GPCR-TMEM16A-VDCC signalling axis plays important role in inflammatory mediator-induced ASM contraction and hypersensitivity. TMEM16A may be a prospective drug target of asthma.http://ift.tt/2tIfi47
National clinical practice guidelines for food allergy and anaphylaxis: an international assessment
Clinical practice guidelines are important tools to promote evidence-based clinical care, but not all countries have the capacity or infrastructure to develop these in-house. The European Academy of Allergy an...
http://ift.tt/2uyMzfb
Role of the Perioperative Surgical Home in Optimizing the Perioperative Use of Opioids.
Several federal agencies have recently noted that the United States is in the midst of an unprecedented "opioid epidemic," with an increasing number of opioid-related overdoses and deaths. Providers currently face 3 population-level, public health challenges in providing optimal perioperative pain care: (1) the continued lack of overall improvement in the excessive incidence of inadequately treated postoperative pain, (2) minimizing or preventing postoperative opioid-related side effects, and (3) addressing current opioid prescribing patterns, and the accompanying problematic surge in prescription opioid diversion, misuse, abuse, addiction, and overdose. In the Perioperative Surgical Home model, anesthesiologists and other pain medicine specialists are uniquely qualified and positioned to develop, implement, and coordinate a comprehensive perioperative analgesic plan, which begins with the formal preoperative patient assessment and continues throughout the postdischarge, convalescence period. The scope and practice of pain management within the Perioperative Surgical Home should thus (a) expand to include routine preoperative patient-level pain-risk stratification (including the chronic use of opioid and nonopioid analgesics), (b) address the multitude of biopsychosocial factors that contribute to interpatient pain variability, and (c) extend and be well coordinated across all 4 phases of the surgical pain experience (preoperative, intraoperative, postoperative, and postdischarge). Specifically, safe and effective perioperative pain management should include a plan of care that is tailored to the individual patient's underlying disease(s), presence of a chronic pain condition and preoperative use of opioids, and the specific surgical procedure- with evidence-based, multimodal analgesic regimens being applied in the vast majority of cases. An iteratively evolutionary component of an existing institutional Perioperative Surgical Home program can be an integrated Transitional Pain Service, which is modeled directly after the wellestablished prototype at the Toronto General Hospital in Ontario, Canada. This multidisciplinary, perioperative Transitional Pain Service seeks to modify the pain trajectories of patients who are at increased risk of (a) long-term, increasing, excessive opioid consumption and/or (b) developing chronic postsurgical pain. Like the Perioperative Surgical Home program in which it can be logically integrated, such a Transitional Pain Service can serve as the needed but missing linkage to improve the continuum of care and perioperative pain management for elective, urgent, and emergent surgery. Even if successfully and cost-efficiently embedded within an existing Perioperative Surgical Home, a new perioperative Transitional Pain Service will require additional resources. (C) 2017 International Anesthesia Research Society
http://ift.tt/2v5HA95
http://ift.tt/2v5HA95
Perioperative Amino Acid Infusion for Preventing Hypothermia and Improving Clinical Outcomes During Surgery Under General Anesthesia: A Systematic Review and Meta-analysis.
Amino acid (AA) infusion is sometimes selected to avoid hypothermia during general anesthesia. However, the widespread clinical use of AA infusion therapy has not been established. This study aimed to clarify the evidence that AA infusion can increase patient body temperature and improve clinical outcomes using the Grading of Recommendations Assessment, Development, and Evaluation system. We searched MEDLINE (PubMed), Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi (Japana Centra Revuo Medicina) in November 2015. Studies were reviewed by 2 independent assessors to identify randomized controlled trials (RCTs) involving AA infusion compared with placebos during surgery under general or combined general/epidural anesthesia. Study quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation system and the Cochrane methodology. The primary outcome was difference in body temperature before and after perioperative AA infusion. Shivering frequency, blood loss volume, postoperative intubation time, and hospitalization period were also assessed as clinical outcomes. We analyzed the outcome data using a random effect model. From 298 screened titles, 14 RCTs met our inclusion criteria, including 626 patients (327 in AA and 299 in placebo groups). In 626 participants from 14 RCTs, AA infusion increased body temperature by a mean difference (MD) of 0.46[degrees]C (95% confidence interval [CI], 0.31-0.62, low-quality evidence). Regarding other outcomes, AA infusion decreased shivering frequency by a risk ratio of 0.34 (95% CI, 0.12-0.94; 7 RCTs, 248 participants, very low-quality evidence), shortened postoperative intubation time by MD of -125 minutes (95% CI, -210 to -38.8; 2 RCTs, 158 participants, moderate-quality evidence), and shortened the hospitalization period by MD of -1.81 days (95% CI, -2.07 to -1.55; 3 RCTs, 230 participants, low-quality evidence) compared with placebo. There was no significant difference in the volume of blood loss between the 2 groups (standardized MD, -0.20, 95% CI, -0.44 to 0.04; low-quality evidence). There was no publication bias. AA infusion in the perioperative period increased patient body temperature and improved clinical outcomes compared with placebo. However, the evidence to support the use of AA infusion is limited, and further large-scale RCTs are required. (C) 2017 International Anesthesia Research Society
http://ift.tt/2vYdQr8
http://ift.tt/2vYdQr8
Medication Errors in Pediatric Anesthesia: A Report From the Wake Up Safe Quality Improvement Initiative.
BACKGROUND: Wake Up Safe is a quality improvement initiative of the Society for Pediatric Anesthesia that contains a deidentified registry of serious adverse events occurring in pediatric anesthesia. The aim of this study was to describe and characterize reported medication errors to find common patterns amenable to preventative strategies. METHODS: In September 2016, we analyzed approximately 6 years' worth of medication error events reported to Wake Up Safe. Medication errors were classified by: (1) medication category; (2) error type by phase of administration: prescribing, preparation, or administration; (3) bolus or infusion error; (4) provider type and level of training; (5) harm as defined by the National Coordinating Council for Medication Error Reporting and Prevention; and (6) perceived preventability. RESULTS: From 2010 to the time of our data analysis in September 2016, 32 institutions had joined and submitted data on 2087 adverse events during 2,316,635 anesthetics. These reports contained details of 276 medication errors, which comprised the third highest category of events behind cardiac and respiratory related events. Medication errors most commonly involved opioids and sedative/hypnotics. When categorized by phase of handling, 30 events occurred during preparation, 67 during prescribing, and 179 during administration. The most common error type was accidental administration of the wrong dose (N = 84), followed by syringe swap (accidental administration of the wrong syringe, N = 49). Fifty-seven (21%) reported medication errors involved medications prepared as infusions as opposed to 1 time bolus administrations. Medication errors were committed by all types of anesthesia providers, most commonly by attendings. Over 80% of reported medication errors reached the patient and more than half of these events caused patient harm. Fifteen events (5%) required a life sustaining intervention. Nearly all cases (97%) were judged to be either likely or certainly preventable. CONCLUSIONS: Our findings characterize the most common types of medication errors in pediatric anesthesia practice and provide guidance on future preventative strategies. Many of these errors will be almost entirely preventable with the use of prefilled medication syringes to avoid accidental ampule swap, bar-coding at the point of medication administration to prevent syringe swap and to confirm the proper dose, and 2-person checking of medication infusions for accuracy. (C) 2017 International Anesthesia Research Society
http://ift.tt/2v5IRNz
http://ift.tt/2v5IRNz
Improving Adherence to Intraoperative Lung-Protective Ventilation Strategies at a University Medical Center.
BACKGROUND: Intraoperative lung-protective ventilation (ILPV) is defined as tidal volumes 65 kg. Surveyed providers demonstrated stronger agreement to having knowledge and practice consistent with ILPV after interventions. CONCLUSIONS: Our interventions improved anesthesia provider adherence to low tidal volume ILPV. IBW was found to be an important factor related to provider adherence to ILPV. Provider attitudes about their knowledge and practice consistent with ILPV also changed with our interventions. (C) 2017 International Anesthesia Research Society
http://ift.tt/2v6fNWb
http://ift.tt/2v6fNWb
Estimation of Stroke Volume and Stroke Volume Changes by Electrical Impedance Tomography.
BACKGROUND: Electrical impedance tomography (EIT) is a noninvasive imaging method that identifies changes in air and blood volume based on thoracic impedance changes. Recently, there has been growing interest in EIT to measure stroke volume (SV). The objectives of this study are as follows: (1) to evaluate the ability of systolic impedance variations ([DELTA]Zsys) to track changes in SV in relation to a baseline condition; (2) to assess the relationship of [DELTA]Zsys and SV in experimental subjects; and (3) to identify the influence of body dimensions on the relationship between [DELTA]Zsys and SV. METHODS: Twelve Agroceres pigs were instrumented with transpulmonary thermodilution catheter and EIT and were mechanically ventilated in a random order using different settings of tidal volume (VT) and positive end-expiratory pressure (PEEP): VT 10 mL[middle dot]kg-1 and PEEP 10 cm H2O, VT 10 mL[middle dot]kg-1 and PEEP 5 cm H2O, VT 6 mL[middle dot]kg-1 and PEEP 10 cm H2O, and VT 6 mL[middle dot]kg-1 and PEEP 5 cm H2O. After baseline data collection, subjects were submitted to hemorrhagic shock and successive fluid challenges. RESULTS: A total of 204 paired measurements of SV and [DELTA]Zsys were obtained. The 4-quadrant plot showed acceptable trending ability with a concordance rate of 91.2%. Changes in [DELTA]Zsys after fluid challenges presented an area under the curve of 0.83 (95% confidence interval, 0.74-0.92) to evaluate SV changes. Conversely, the linear association between [DELTA]Zsys and SV was poor, with R2 from linear mixed model of 0.35. Adding information on body dimensions improved the linear association between [DELTA]Zsys and SV up to R2 from linear mixed model of 0.85. CONCLUSIONS: EIT showed good trending ability and is a promising hemodynamic monitoring tool. Measurements of absolute SV require that body dimensions be taken into account. (C) 2017 International Anesthesia Research Society
http://ift.tt/2vYlodd
http://ift.tt/2vYlodd
Venovenous Bypass Is Associated With a Lower Incidence of Acute Kidney Injury After Liver Transplantation in Patients With Compromised Pretransplant Renal Function.
BACKGROUND: Although the hemodynamic benefits of venovenous bypass (VVB) during liver transplantation (LT) are well appreciated, the impact of VVB on posttransplant renal function is uncertain. The aim of this study was to determine if VVB was associated with a lower incidence of posttransplant acute kidney injury (AKI). METHODS: Medical records of adult (>=18 years) patients who underwent primary LT between 2004 and 2014 at a tertiary hospital were reviewed. Patients who required pretransplant renal replacement therapy and intraoperative piggyback technique were excluded. Patients were divided into 2 groups, VVB and non-VVB. AKI, determined by the Acute Kidney Injury Network criteria, was compared between the 2 groups. Propensity match was used to control selection bias that occurred before VVB and multivariable logistic regression was used to control confounding factors during and after VVB. RESULTS: Of 1037 adult patients who met the study inclusion criteria, 247 (23.8%) received VVB. A total of 442 patients (221 patients in each group) were matched. Aftermatch patients were further divided according to a predicted probability AKI model using preoperative creatinine (Cr), VVB, and intraoperative variables into 2 subgroups: normal and compromised pretransplant renal functions. In patients with compromised pretransplant renal function (Cr >=1.2 mg/dL), the incidence of AKI was significantly lower in the VVB group compared with the non-VVB group (37.2% vs 50.8%; P = .033). VVB was an independent risk factor negatively associated with AKI (odds ratio, 0.1; 95% confidence interval, 0.1-0.4; P = .001). Renal replacement in 30 days and 1-year recipient mortality were not significantly different between the 2 groups. The incidence of posttransplant AKI was not significantly different between the 2 groups in patients with normal pretransplant renal function (Cr
http://ift.tt/2v5FO7O
http://ift.tt/2v5FO7O
Lack of Association Between the Use of Nerve Blockade and the Risk of Persistent Opioid Use Among Patients Undergoing Shoulder Arthroplasty: Evidence From the Marketscan Database.
BACKGROUND: Persistent opioid use following surgery has received increasing attention from policymakers, researchers, and clinicians. Perioperative nerve blockade has been hypothesized to decrease the risk of persistent opioid use. We examined whether nerve blockade was associated with a decreased risk of persistent opioid use among patients undergoing shoulder arthroplasty, a procedure with high rates of persistent postoperative pain. METHODS: Using health care claims data, we constructed a sample of 6695 patients undergoing shoulder arthroplasty between 2002 and 2012 and used billing data to identify the utilization of nerve blockade. We then used a multivariable logistic regression to estimate the association between nerve blockade and 2 measures of opioid use: having filled at least 1 prescription for an opioid between postoperative days (PODs) 0 and 90, and between POD 91 and 365. This regression adjusted for a variety of potential confounders, such as preoperative opioid use and medical history. RESULTS: There was no association between nerve blockade and our 2 measures of persistent opioid use: adjusted odds ratio, 1.12 (97.5% confidence interval, 0.939-1.34; P = .15) for opioid use between POD 0 and 90, and adjusted odds ratio, 0.997 (97.5% confidence interval, 0.875-1.14; P = .95) for opioid use between POD 91 and 365. CONCLUSIONS: Although the use of perioperative nerve blockade may offer short-term benefits, in this study, it was not associated with a reduction in the risk of persistent opioid use for patients undergoing shoulder arthroplasty. (C) 2017 International Anesthesia Research Society
http://ift.tt/2vYmXrS
http://ift.tt/2vYmXrS
A Novel Method of Evaluating Key Factors for Success in a Multifaceted Critical Care Fellowship Using Data Envelopment Analysis.
BACKGROUND: The current system of summative multi-rater evaluations and standardized tests to determine readiness to graduate from critical care fellowships has limitations. We sought to pilot the use of data envelopment analysis (DEA) to assess what aspects of the fellowship program contribute the most to an individual fellow's success. DEA is a nonparametric, operations research technique that uses linear programming to determine the technical efficiency of an entity based on its relative usage of resources in producing the outcome. DESIGN: Retrospective cohort study. SUBJECTS AND SETTING: Critical care fellows (n = 15) in an Accreditation Council for Graduate Medical Education (ACGME) accredited fellowship at a major academic medical center in the United States. METHODS: After obtaining institutional review board approval for this retrospective study, we analyzed the data of 15 anesthesiology critical care fellows from academic years 2013-2015. The input-oriented DEA model develops a composite score for each fellow based on multiple inputs and outputs. The inputs included the didactic sessions attended, the ratio of clinical duty works hours to the procedures performed (work intensity index), and the outputs were the Multidisciplinary Critical Care Knowledge Assessment Program (MCCKAP) score and summative evaluations of fellows. RESULTS: A DEA efficiency score that ranged from 0 to 1 was generated for each of the fellows. Five fellows were rated as DEA efficient, and 10 fellows were characterized in the DEA inefficient group. The model was able to forecast the level of effort needed for each inefficient fellow, to achieve similar outputs as their best performing peers. The model also identified the work intensity index as the key element that characterized the best performers in our fellowship. CONCLUSIONS: DEA is a feasible method of objectively evaluating peer performance in a critical care fellowship beyond summative evaluations alone and can potentially be a powerful tool to guide individual performance during the fellowship. (C) 2017 International Anesthesia Research Society
http://ift.tt/2vYlTEg
http://ift.tt/2vYlTEg
End-Expiratory Occlusion Test Predicts Fluid Responsiveness in Patients With Protective Ventilation in the Operating Room.
BACKGROUND: End-expiratory occlusion test (EEOT) has been proposed to predict fluid responsiveness in mechanically ventilated intensive care unit patients. The utility of this test during low-tidal-volume ventilation remains uncertain. This study aimed to determine whether hemodynamic variations induced by EEOT could predict the effect of volume expansion in patients with protective ventilation in the operating room. METHODS: Forty-one patients undergoing neurosurgery were included. Stroke volume and pulse pressure variations were continuously recorded using pulse contour analysis before and immediately after a 30-second EEOT and after volume expansion (250 mL saline 0.9% given over 10 minutes). Patients with an increase in stroke volume >= 10% after volume expansion were defined as responders. RESULTS: Twenty patients were responders to fluid administration. EEOT induced a significant increase in stroke volume, which was correlated with the stroke volume changes induced by volume expansion (r2 = 0.55, P
http://ift.tt/2vYdNeW
http://ift.tt/2vYdNeW
DaMab-2: Anti-Human DGKα Monoclonal Antibody for Immunocytochemistry
Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.
http://ift.tt/2eLGbgQ
Intravenous Immunoglobulin as Adjunct Therapy for Refractory Pyoderma Gangrenosum: Systematic Review of Cases and Case Series
Summary
Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis. Treatment regimens for refractory cases are non-standardized. Intravenous immunoglobulin (IVIG) is an emerging treatment with reported success, but the efficacy of IVIG for PG is unknown. In this systematic review of cases and case series, we assessed the efficacy of IVIG for treatment of PG, as observed at our institution and reported in the literature. A retrospective chart review at two tertiary care hospitals between 2000-2015, and literature searches in PubMed/MEDLINE, EMBASE, and Web of Science from all years were conducted. There were 49 total patients, including 43 patients from 26 articles and 6 institutional cases. There was complete or partial response in 43 (87.8%) patients and complete response in 26 (53.1%) patients. The mean time to initial response to treatment and treatment length were 3.5 (3.3) weeks and 5.9 (7.8) months, respectively. On average, 2.6 treatments had been trialed before IVIG initiation. IVIG was administered with systemic steroids in 43 (87.8%) cases. Mild adverse events, especially nausea and headache, were reported in 12 (24.5%) patients. Our systematic review suggests a potential role for IVIG as adjuvant therapy for refractory PG. Prospective clinical trials testing the efficacy of IVIG for refractory PG are needed to validate these findings.
This article is protected by copyright. All rights reserved.
http://ift.tt/2v5qXKS
A rare manifestation of burns after lightning strike in rural Ghana: a case report
Lightning is a natural phenomenon that mostly affects countries in the tropical and subtropical regions of the globe, including Ghana. Lightning strikes pose a global public health issue. Although strikes to h...
http://ift.tt/2v4QYK5
Morphometric Analysis of Temporomandibular Joint Elements
Publication date: Available online 25 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Audrey E. Paglio, Aaron P. Bradley, R. Shane Tubbs, Marios Loukas, Piotr B. Kozlowski, Anthony C. Dilandro, Yujiro Sakamoto, Joe Iwanaga, Cameron Schmidt, Anthony V. D'Antoni
PurposeTo study the morphology of temporomandibular joint (TMJ) elements and examine the feasibility of a novel biofidelic articular disc casting technique.Methods8 formalin-fixed cadavers (77.8% female, 22.2% male) with mean (SD) death age of 71.9 (13.7) years were used for this study. In each specimen the masseter muscle, mandibular ramus, and articular disc were dissected bilaterally and measured for length, width, and thickness. All anatomic measurements were made using a digital slide caliper (Hawk Inc., Cleveland, OH). Further, a novel method for the creation of biofidelic articular disc models was established through trial and error. Models were measured for accuracy against their biological counterparts.ResultsLeft articular disc length and thickness were inversely correlated (r = −0.58, p < 0.049). Direct correlations existed between right disc and ramus thickness (r = 0.56, p < 0.039), masseter length and thickness (r = 0.59, p < 0.009), and masseter width and thickness (r = 0.66, p < 0.003). Comparison of the model measurements with their biological counterparts found no significant differences.DiscussionThese observed correlations between elements of the TMJ hold relevance for oral-maxillofacial surgeons and researchers examining disorders of the TMJ. Additionally, our casting technique proved accurate in modeling human articular discs.
http://ift.tt/2v56VQq
Accuracy and reproducibility of the DAVID SLS-2 scanner in three-dimensional facial imaging
Publication date: Available online 25 July 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Jesper Jared Secher, Tron Andre Darvann, Else Marie Pinholt
PurposeA prospective study was performed to test the accuracy and reproducibility of the DAVID-SLS-2 scanner (SLS-2) [DAVID Vision Systems GmbH], compared to the validated 3dMDtrio scanner (3dMD) [3dMD, LLC, Atlanta, GA, USA].Materials and MethodsThe accuracy of the SLS-2 was determined through multiple scans of a mannequin face model using both scanners. The reproducibility of a protocol for achieving consistent three-dimensional (3D) face scans in live subjects was carried out using the SLS-2. A precision of <1 mm was considered clinically significant.ResultsThe mannequin face model was reproduced with no significant errors in the SLS-2 compared to the 3dMDtrio, with normally distributed data (mean = 0.002 mm; SD = 0.01 mm). In live subjects, the forehead, midface, chin and general face region showed mean errors and SD < 0.24 mm and < 1 mm, respectively. In the neck area, the data were not found to be normally distributed (mean = −1.6 mm; SD = 2.1 mm).ConclusionStructured light scanning may be used for acquiring 3D face scans in live subjects in a radiation-free and reproducible manner, provided that the head of the subject is positioned in the same posture for each scan. Special care is recommended in positioning the head in the sagittal plane during scanning.
http://ift.tt/2vG090w
New Therapies in the Spotlight at AAD Summer Meeting
Agents that target interleukin-23 for atopic dermatitis and psoriasis will be among the hot topics presented at the upcoming American Academy of Dermatology (AAD) Summer Meeting.
Medscape Medical News
http://ift.tt/2vTJ3vF
The clinical characteristics and audiogram in 103 meniere disease patients with and without vestibular migraine
Abstract
1 There was a close relationship between MD and VM. 48 MD patients(46.6%) had VM, 18 MD patients (17.5%)were probable to have VM.
2 MD patients with VM have better hearing than those without VM at 500 Hz, 1000Hz, and 2000Hz.
3 Among MD patients with VM, the mean monthly frequency of vertigo attack was 7.1,which can differ significantly from those among MD patients with probable VM and those without VM.(P<0.01).
4 The female MD patients were 7.92 times to have VM than male MD patients(95% CI, 2.97 to 21.08; P=0.001).
5 A close pathophysiologic relation remained between MD and VM; the monthly frequency of vertigo attacks could be a diagnosis indicator to screen the MD patients with or without VM.
This article is protected by copyright. All rights reserved.
http://ift.tt/2uuiuPH
A Comparison of the Diagnostic Efficiency of Guided Fine Needle Aspiration Cytology Versus Conventional Fine Needle Aspiration Cytology of the Thyroid
Abstract
Fine needle aspiration cytology (FNAC) is possibly the most useful investigation for the thyroid. However, conventional FNAC (C-FNAC) is limited by a high rate of inadequate samples. Ultrasound guided FNAC (US-FNAC) has been proposed as an alternative. This study aims to estimate the measures of diagnostic accuracy of FNAC as well as to compare US-FNAC against C-FNAC. Patients who underwent FNAC at our for a period of 5 years were selected. This comprised of 237 C-FNAC cases and 173 US-FNAC cases. Out of these 410 cases, 129 cases had cyto-histological correlation. The proportion of inadequate samples, malignant cases as well as indeterminate cases were compared between US-FNAC and C-FNAC. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios for positive and negative results and odds ratio were estimated for overall FNAC as well as US-FNAC and C-FNAC patients. US-FNAC has a significantly lower proportion of inadequate samples (0.58 vs. 15.19%), as well as a lower proportion of indeterminate samples (1.7 vs. 7.6%) and a higher proportion of malignant cases (6.4 vs. 2.1%). When the inadequate samples were excluded, the results for tests of diagnostic effectiveness for overall FNAC, US-FNAC and C-FNAC respectively ranged between 66.67 and 80% for sensitivity, between 86.05 and 100% for specificity, between 45.45 and 100% for PPV and between 97.37 and 98.7% for NPV. FNAC is a useful test for differentiating malignant from benign lesions. When inadequate samples are excluded, both US-FNAC and C-FNAC are accurate diagnostic tests. However, US-FNAC is a more useful test since it results in a lower number of inadequate samples. Also, US-FNAC results in a greater yield of malignancy and a lower percentage of indeterminates, possibly due to additional information received from ultrasound examination.
http://ift.tt/2eKZsPs
A Comparison of the Diagnostic Efficiency of Guided Fine Needle Aspiration Cytology Versus Conventional Fine Needle Aspiration Cytology of the Thyroid
Abstract
Fine needle aspiration cytology (FNAC) is possibly the most useful investigation for the thyroid. However, conventional FNAC (C-FNAC) is limited by a high rate of inadequate samples. Ultrasound guided FNAC (US-FNAC) has been proposed as an alternative. This study aims to estimate the measures of diagnostic accuracy of FNAC as well as to compare US-FNAC against C-FNAC. Patients who underwent FNAC at our for a period of 5 years were selected. This comprised of 237 C-FNAC cases and 173 US-FNAC cases. Out of these 410 cases, 129 cases had cyto-histological correlation. The proportion of inadequate samples, malignant cases as well as indeterminate cases were compared between US-FNAC and C-FNAC. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios for positive and negative results and odds ratio were estimated for overall FNAC as well as US-FNAC and C-FNAC patients. US-FNAC has a significantly lower proportion of inadequate samples (0.58 vs. 15.19%), as well as a lower proportion of indeterminate samples (1.7 vs. 7.6%) and a higher proportion of malignant cases (6.4 vs. 2.1%). When the inadequate samples were excluded, the results for tests of diagnostic effectiveness for overall FNAC, US-FNAC and C-FNAC respectively ranged between 66.67 and 80% for sensitivity, between 86.05 and 100% for specificity, between 45.45 and 100% for PPV and between 97.37 and 98.7% for NPV. FNAC is a useful test for differentiating malignant from benign lesions. When inadequate samples are excluded, both US-FNAC and C-FNAC are accurate diagnostic tests. However, US-FNAC is a more useful test since it results in a lower number of inadequate samples. Also, US-FNAC results in a greater yield of malignancy and a lower percentage of indeterminates, possibly due to additional information received from ultrasound examination.
http://ift.tt/2eKZsPs
Trigriluzole With Nivolumab and Pembrolizumab in Treating Patients With Metastatic or Unresectable Solid Malignancies or Lymphoma
Conditions: Lymphoma; Metastatic Malignant Solid Neoplasm; Metastatic Melanoma; Metastatic Renal Cell Cancer; Recurrent Bladder Carcinoma; Recurrent Classical Hodgkin Lymphoma; Recurrent Head and Neck Squamous Cell Carcinoma; Recurrent Lymphoma; Recurrent Malignant Solid Neoplasm; Recurrent Renal Cell Carcinoma; Stage III Bladder Cancer; Stage III Lymphoma; Stage III Non-Small Cell Lung Cancer AJCC v7; Stage III Renal Cell Cancer; Stage III Skin Melanoma; Stage IIIA Non-Small Cell Lung Cancer AJCC v7; Stage IIIA Skin Melanoma; Stage IIIB Non-Small Cell Lung Cancer AJCC v7; Stage IIIB Skin Melanoma; Stage IIIC Skin Melanoma; Stage IV Bladder Cancer; Stage IV Lymphoma; Stage IV Non-Small Cell Lung Cancer AJCC v7; Stage IV Renal Cell Cancer; Stage IV Skin Melanoma; Stage IVA Bladder Cancer; Stage IVB Bladder Cancer; Unresectable Head and Neck Squamous Cell Carcinoma; Unresectable Solid Neoplasm
Interventions: Drug: Enzyme Inhibitor Therapy; Other: Laboratory Biomarker Analysis; Biological: Nivolumab; Biological: Pembrolizumab
Sponsors: Rutgers, The State University of New Jersey; National Cancer Institute (NCI)
Not yet recruiting - verified July 2017
http://ift.tt/2gZFTUs
Interventions: Drug: Enzyme Inhibitor Therapy; Other: Laboratory Biomarker Analysis; Biological: Nivolumab; Biological: Pembrolizumab
Sponsors: Rutgers, The State University of New Jersey; National Cancer Institute (NCI)
Not yet recruiting - verified July 2017
http://ift.tt/2gZFTUs
Pseudomonas Scleritis following Pterygium Excision
Purpose: The aim of this case report was to describe a patient who presented with Pseudomonas scleritis after pterygium excision. The study was conducted at the Department of Ophthalmology, Faculty of Medicine, Chiang Mai University in Chiang Mai, Thailand. Methods: The record of a patient who was diagnosed as Pseudomonas scleritis after pterygium excision was retrospectively reviewed for history, clinical characteristics, laboratory findings, treatments, and outcomes. Results: We described a 66-year-old male patient with a history of pterygium excision in his right eye 10 years ago, he presented with infectious scleritis. Scleral thinning, tissue necrosis, and overlying calcified plaque were found. The culture of scleral scraping revealed Pseudomonas aeruginosa. Topical fortified amikacin (20 mg/mL) and intravenous ceftazidime were started. Urgent surgical debridement of scleral infiltrates and irrigation of necrotic sclera and surrounding conjunctiva with fortified amikacin (20 mg/mL) were performed. After 2 weeks of treatment, scleral thinning and inflammation decreased, and the best-corrected visual acuity improved from 6/24 to 6/9. Fortified amikacin eye drops (20 mg/mL) were continued until the fourth week, with no scleral thinning seen. Conclusions: P. aeruginosa is a virulent organism that causes infectious scleritis complicated by melting and necrotizing of the sclera. This report emphasized that early recognition, intensive antimicrobial treatment, and surgical debridement can prevent morbidity related to this Pseudomonas infection.
Case Rep Ophthalmol 2017;8:401–405
http://ift.tt/2tGN5ea
Case Rep Ophthalmol 2017;8:401–405
http://ift.tt/2tGN5ea
Role of tissue eosinophils in chronic rhinosinusitis–associated olfactory loss
Background
Olfactory dysfunction is 1 of the hallmark symptoms of chronic rhinosinusitis (CRS). Eosinophilic inflammation has been implicated as a potential causative factor. However, prior studies have been limited by retrospective study designs, concomitant use of systemic corticosteroids, and other confounding factors.
Methods
CRS and healthy non-CRS control subjects undergoing endoscopic sinus or skull-base surgery were prospectively enrolled and completed olfactory testing utilizing the 40-item Smell Identification Test (SIT) immediately prior to surgery. Histopathological evaluation of tissue excised from the ethmoid bulla was performed by a pathologist in a blinded fashion. Disease severity and patient-reported outcomes were measured via the Lund-Mackay computed tomography (CT) grading system and 22-item Sino-Nasal Outcome Test (SNOT-22), respectively. The associations between olfactory function, tissue eosinophilia, and disease severity were analyzed using Spearman rank order correlation and multiple linear regression.
Results
Twenty-seven (27) subjects with CRS without nasal polyps (CRSsNP), 32 subjects with CRS with nasal polyps (CRSwNP), and 10 healthy non-CRS controls were enrolled. CRSwNP was associated with higher mean tissue eosinophil counts (71.6 vs 28.1 eosinophils/high-power field [HPF], p < 0.05) and lower age/sex-adjusted SIT scores (−17.4 vs −6.2, p < 0.001) when compared to CRSsNP. SIT scores were strongly negatively correlated with tissue eosinophil counts in CRSwNP (r = −0.60, p = 0.0003), but not CRSsNP (r = 0.16, p = 0.42). The correlation between olfactory function and tissue eosinophilia in CRSwNP persisted after adjusting for disease severity.
Conclusion
Tissue eosinophilia is associated with olfactory loss in CRSwNP, independent of disease severity. These results suggest a possible role for eosinophils or eosinophil-associated cytokines in CRS-associated olfactory loss.
http://ift.tt/2vG7hKC
Aggressive Posterior Retinopathy of Prematurity in a Premature Male Infant
A premature male infant was born at 30 weeks' gestation with a birth weight of 1,700 g in a rural hospital. He was diagnosed with respiratory distress syndrome and received continuous positive airway pressure treatment for 26 days. At 26 days after birth, the patient was transferred to our hospital for further evaluation and management. A comprehensive eye examination revealed a stage 3 retinopathy of prematurity (ROP) involving zone 2 in both eyes. The patient was recommended to a provincial-level eye hospital for emergency laser therapy. Five months after birth, the feedback from the eye hospital showed that the patient had a high risk of blindness in both eyes. Our case report shows that delaying first screening examination increases the possibility of developing aggressive posterior ROP in infants with ROP. Doctors in rural hospitals should be aware of this possibility and trained for early screening and treatment in high-risk infants.
Case Rep Ophthalmol 2017;8:396–400
http://ift.tt/2tzE7el
Die OncoBox Research als Instrument für Versorgungsforschung
Zusammenfassung
Hintergrund
Eines der Ziele der Zertifizierung von Organkrebszentren ist die ständige Verbesserung der Versorgungsqualität. Dies geschieht über die Erfüllung und Weiterentwicklung der Anforderungen, den Vergleich der eigenen Kennzahlenergebnisse mit denen der anderen Zentren und das Lernen voneinander. Bislang werden die Kennzahlen aggregiert auf Zentrumsebene dokumentiert.
Ziel
Um zukünftig Auswertungen zu ermöglichen, die die unterschiedliche Verteilung von Patientenmerkmalen (Casemix) zwischen den Zentren berücksichtigen, wird derzeit die OncoBox Research (OBR) entwickelt. Der Beitrag gibt einen kurzen Überblick über den derzeitigen Stand von Versorgungsforschung und Dokumentation in zertifizierten Zentren, zeigt anhand von Beispielen die Grenzen der bisherigen Auswertungen auf und skizziert Möglichkeiten der OBR.
Material und Methoden
Die OBR ist eine Weiterentwicklung der OncoBox, die bereits von Brust‑, Darm- und Prostatakrebszentren genutzt wird, um die Daten zwischen den Zentren vergleichbar zu machen und den Zentren eine Qualitätssicherung während der Datenerfassung erlaubt. Die OBR soll die Nutzung dieser Daten zu Forschungszwecken ermöglichen. Wesentliche Anwendungsfelder sind Casemix-adjustierte Zentrumsvergleiche und die Beantwortung kennzahlenspezifischer Fragestellungen. Beispielsweise können solche kennzahlenspezifischen Fragestellungen betrachten, wie stark und aufgrund welcher Merkmale die Leitlinienadhärenz zwischen Patientengruppen und Zentren variiert.
Ergebnisse und Diskussion
Die OBR befindet sich derzeit in der Entwicklung. Ihr Potenzial besteht in der Kombination einer technischen, datenanalytischen mit einer sozialen, forschungskooperativen Innovation. Ihr Erfolg ist wesentlich vom Interesse der leistungserbringenden Zentren abhängig.
http://ift.tt/2tz2BVc
A review of available laser and intense light source home devices: A dermatologist's perspective
Summary
Background
Home optical devices are becoming an increasingly popular treatment modality sought out by patients for dermatologic pathologies such as acne, hair removal and anti-aging, as these devices are a low-cost and convenient therapy choice.
Methods
An Internet search using PubMed.gov was completed with search terms, "home device dermatology," "home device acne," "home device hair" or "hair removal," and "home device aging."
Results
Currently, there are multiple home optical devices available on the market. These devices have been approved for the treatment of acne, scars, hair removal, and wrinkles using intense pulsed light, light-emitting diode, heat, infrared, low-level light therapy, and laser. Although studies on home devices are limited, current dermatologic literature shows that these devices are promising with significant post-treatment results as well as a high level of safety.
Conclusions
Home optical devices are mostly used without medical practitioner supervision. As home devices usually deliver less energy per session than with professional treatments, it is important that consumers are given realistic expectations of post-treatment outcomes. Patients may use home devices without disclosure to their physician and it is important as healthcare professionals to be aware of the existence of these devices, how to use the devices properly (including what diseases can be treated and which skin types are considered safe for use), as well as any adverse effects that may occur. New research endeavors are being completed to explore the used of home devices for the treatment of chronic inflammatory diseases such as psoriasis.
http://ift.tt/2uVKTyJ
Clinical outcomes after local field conformal reirradiation of patients with retropharyngeal nodal metastasis
Abstract
Background
The purpose of this study was to present our experience with retropharyngeal node reirradiation using highly conformal radiotherapy (RT).
Methods
A retrospective screen of 2504 consecutively irradiated patients with head and neck malignancies between 2005 and 2015 identified 19 patients who underwent reirradiation for retropharyngeal node metastasis. Clinical and toxicity outcomes were assessed in these patients.
Results
Thirteen patients (68%) had squamous cell carcinoma. Eleven patients (58%) received conventionally fractionated intensity-modulated radiotherapy (IMRT) or proton therapy, and 8 patients (42%) received single-fractionated or hypofractionated stereotactic RT. Fourteen patients (74%) received chemotherapy. Median follow-up was 14.7 months. The 1-year local control, locoregional control, overall survival, and progression-free survival rates were 100%, 94%, 92%, and 92%, respectively. Three patients (16%) experienced acute grade 3 toxicity and occurred in those treated with IMRT. There was no late grade ≥3 toxicity.
Conclusion
Retropharyngeal node reirradiation with conformal therapy is well tolerated and associated with excellent short-term disease control.
http://ift.tt/2vFdSoe
Ectopic parathyroid adenoma in the pyriform sinus
Abstract
Background
Ectopic parathyroid glands may complicate the surgical approach to primary hyperparathyroidism. We describe a rare ectopic parathyroid location, the pyriform sinus.
Methods
Three patients, 2 after prior unsuccessful parathyroid exploration, were found to have ectopic parathyroid adenomas in the pyriform sinus. Two cases were identified by 4D-CT of the neck. The other was localized by a technetium 99m sestamibi single photon emission CT (SPECT). In each case, office endoscopy confirmed the lesions. The patients were treated by either transoral laser or robotic resection of the parathyroid adenoma.
Results
After surgery, the patients had resolution of their hyperparathyroidism.
Conclusion
Ectopic parathyroid adenomas in the pyriform sinus are rare, but should be considered in those patients who have had a failed neck exploration and in those who undergo 4D-CT scanning or SPECT scanning.
http://ift.tt/2utsLLT
Analysis of the incidence and factors predictive of outcome in patients with head and neck cancer with pulmonary nodules
Abstract
Background
The management of pulmonary nodules is challenging; unfortunately, little is known about the incidence and significance of pulmonary nodules in patients with head and neck cancer.
Methods
A review was conducted of 400 consecutive patients with head and neck cancer. Imaging was reviewed to identify the incidence of nodules and patient, tumor, and radiological factors associated with the risk of malignancy.
Results
Nodules were found in 58% of patients, with a malignant rate of 6%. Age was the only predictor of having a nodule and advanced-stage III + IV was a predictor of malignancy (P = .023; odds ratio [OR] 10.64; confidence interval 1.33-84.98).
Conclusion
Patients presenting with head and neck cancer have a higher incidence of pulmonary nodules and a higher risk of malignancy. In contrast to the British Thoracic Society (BTS) guidelines, which use size to guide the need for serial scans, we would recommend follow-up imaging in all patients with head and neck cancer with nodules, irrespective of size.
http://ift.tt/2vF1uom
Polymorphism and peptide-binding specificities of porcine major histocompatibility complex (MHC) class I molecules
Source:Molecular Immunology
Author(s): Shuhua Fan, Yongli Wang, Song Wang, Xian Wang, Yanan Wu, Zibin Li, Nianzhi Zhang, Chun Xia
The swine lymphocyte antigen class I (SLA I) is a highly polymorphic gene superfamily that plays an important role in swine anti-viral immune responses. However, an understanding of the highly variable sites and peptide-binding specificities of SLA I molecule is limited. In this study, a total of 27 SLA I alleles were identified from 3 Tibetan wild boars and 3 Heishan pigs. The phylogenetic relationship between the Tibetan wild boar and other breeds was analyzed using bioinformatics methods, and the highly variable sites were noted in the three dimensional structures of SLA I. Peptides from the porcine reproductive and respiratory syndrome virus (PRRSV) and influenza A virus (IAV) were screened with a bioinformatic method and refolding assay in vitro. The superior SLA I molecules, which have the ability to combine with more peptides, were selected from the Tibetan wild boars and Heishan pigs. The results showed that the SLA I of the Tibetan wild boars was not divergent from other pig breeds and that high-variation sites were mostly located in the peptide binding groove (PBG), suggesting that high variation sites could determines the peptide-binding characteristics and would possibly influences peptide-specific CD8+ T cell recognition. The SLA I allele SLA-1*0302 (known as KY113114) of the Tibetan wild boar formed stable complexes with three PRRSV peptides, and the SLA-3*hs0202 (KJ555032) from Heishan pigs was able to bind with four IAV peptides. The results from this study may benefit vaccine development and may help control IAV and PRRSV in swine.
http://ift.tt/2vVKEkD
Effect of anti-muscarinic autoantibodies on leukocyte function in Sjögren’s syndrome
Source:Molecular Immunology, Volume 90
Author(s): Eun Namkoong, Sang-woo Lee, Nahyun Kim, Youngnim Choi, Kyungpyo Park
Patients with primary Sjögren's syndrome, a systemic autoimmune disease, have been shown to have serum autoantibodies that react with the muscarinic acetylcholine type 3 receptor (M3R).Primary Sjögren's syndrome is a systemic autoimmune disease. Patients with primary Sjögren's syndrome have been shown to have serum autoantibodies that react with the muscarinic acetylcholine type 3 receptor (M3R). Leukopenia has been reported to be significantly more common in primary Sjögren's syndrome patients who have anti-M3R-autoantibodies in their sera. In this study, we investigated whether these anti-M3R autoantibodies have effects on M3R and MHCI expression in Jurkat T cells.Purified IgG antibodies were isolated from the serum of healthy individuals and primary Sjögren's syndrome patients. Jurkat cell line was used to represent T lymphocytes. In situ immunofluorescence confocal microscopy was used to confirm the binding reactivity of primary Sjögren's syndrome IgG antibodies to M3R. Co-immunoprecipitation and immunofluorescence results suggested a direct interaction between M3R and MHC I. Co-internalization of M3R and MHC I was observed when Jurkat cells were exposed to the primary Sjögren's syndrome IgG, but this primary Sjögren's syndrome IgG-induced co-internalization of M3R and MHC I was prevented by the presence of exogenous IFN-γ. Primary Sjögren's syndrome IgG itself did not affect the viability of Jurkat cells, but Jurkat cells exposed to primary Sjögren's syndrome IgG were observed to undergo significant cell death when co-cultured with primary Natural Killer cells.Our results suggest that anti-M3R autoantibodies in primary Sjögren's syndrome induce downregulation of plasma membrane-resident M3R and MHC class I molecules in leukocytes followed by NK cell-mediated cell death. This mechanism may explain the frequency of leukopenia occurrence in patients with primary Sjögren's syndrome.
http://ift.tt/2v3fRpn
Analysis of root surface properties by fluorescence/Raman intensity ratio
Abstract
The aim of this study is to evaluate the existence of residual calculus on root surfaces by determining the fluorescence/Raman intensity ratio. Thirty-two extracted human teeth, partially covered with calculus on the root surface, were evaluated by using a portable Raman spectrophotometer, and a 785-nm, 100-mW laser was applied for fluorescence/Raman excitation. The collected spectra were normalized to the hydroxyapatite Raman band intensity at 960 cm−1. Raman spectra were recorded from the same point after changing the focal distance of the laser and the target radiating angle. In seven teeth, the condition of calculus, cementum, and dentin were evaluated. In 25 teeth, we determined the fluorescence/Raman intensity ratio following three strokes of debridement. Raman spectra collected from the dentin, cementum, and calculus were different. After normalization, spectra values were constant. The fluorescence/Raman intensity ratio of calculus region showed significant differences compared to the cementum and dentin (p < 0.05). The fluorescence/Raman intensity ratio decreased with calculus debridement. For this analysis, the delta value was defined as the difference between the values before and after three strokes, with the final 2 delta values close to zero, indicating a gradual asymptotic curve and the change in intensity ratio approximating that of individual constants. Fluorescence/Raman intensity ratio was effectively used to cancel the angle- and distance-dependent fluctuations of fluorescence collection efficiency during measurement. Changes in the fluorescence/Raman intensity ratio near zero suggested that cementum or dentin was exposed, and calculus removed.
http://ift.tt/2vVpGCo
House dust mites as potential carriers for IgE sensitisation to bacterial antigens
Abstract
Background
IgE-reactivity to antigens from gram-positive and negative bacteria is common in patients suffering from respiratory and skin manifestations of allergy, but the routes and mechanisms of sensitisation are not fully understood. The analysis of the genome, transcriptome and microbiome of house dust mites (HDM) has shown that S. aureus and E. coli species are abundant bacteria within the HDM microbiome. Therefore, our aim was to investigate if HDM are carriers of bacterial antigens leading to IgE sensitisation in patients suffering from atopic dermatitis.
Methods
Plasma samples from AD patients (n=179) were analysed for IgE-reactivity to a comprehensive panel of micro-arrayed HDM allergen molecules and to S. aureus and E. coli by IgE immunoblotting. Antibodies specific for S. aureus and E. coli antigens were tested for reactivity to nitrocellulose-blotted extract from purified HDM bodies and the IgE-reactive antigens were detected by IgE-immunoblot inhibition experiments. IgE antibodies directed to bacterial antigens in HDM were quantified by IgE ImmunoCAP™ inhibition experiments.
Results
IgE-reactivity to bacterial antigens was significantly more frequent in AD patients sensitised to HDM than in AD patients without HDM sensitisation. S. aureus and E. coli antigens were detected in immune-blotted HDM extract and the presence of IgE-reactive antigens in HDM was demonstrated by qualitative and quantitative IgE inhibition experiments.
Conclusion
HDM may serve as carriers of bacteria responsible for the induction of IgE sensitisation to microbial antigens.
This article is protected by copyright. All rights reserved.
http://ift.tt/2tFUf21
Εγγραφή σε:
Αναρτήσεις (Atom)