Human Remains and Funerary Rites in the Phoenician Necropolis of Motya (Sicily)

Abstract

The aim of this paper is to examine the fresh evidence retrieved in the early cemetery or 'archaic necropolis' (8^th-6^th century BC) on the island of Motya, one of the main Phoenician colonies in the Mediterranean. Because of its integrity and the large number of finds, the cemetery has been considered one of the most relevant sites for the study of early burial customs in the West.

The absence of anthropological data, completely neglected in the past, was a major shortcoming of previous research. This failing is now being rectified by a new project of fieldwork and excavation undertaken on the island by a team from Palermo University.

This report provides a close examination of the human remains from a group of 32 graves discovered during three seasons (2013-2015) in a combined archaeological and taphonomic perspective, and contributes to shed light on the funerary practices of the Phoenicians in Sicily.

http://ift.tt/2uJuJFP

Xerostomia Pilot Fudan: Acupuncture for Prevention of Radiation-Induced Xerostomia

Conditions:   Head and Neck Cancer;   Xerostomia
Intervention:   Other: Acupuncture
Sponsor:   M.D. Anderson Cancer Center
Recruiting - verified August 2017

http://ift.tt/2uWWlX7

A matched-guise study on L2, heritage, and native Spanish speakers’ attitudes to Spanish in the State of Washington

By means of a matched-guise study, this paper examines the attitudes of L2, heritage, and native Spanish speakers in the state of Washington toward Mexican-accented and English-accented Spanish. We interpret our findings in the wake of previous research on language attitudes and ideologies related to Spanish in the United States which shows that Spanish and those who speak it as a first or heritage language are thought to have a lower socioeconomic status than English and Anglophones. 97 Spanish-speaking participants residing in Washington (N=95) and the Pacific Northwest (N=2) rated 4 voices along six-point semantic differential scales falling into the dimensions of superiority, solidarity, language competence, and physical characteristics. We submitted mean scores to a linear mixed-effects model. Contrary to our expectations, all groups rated the Mexican-accented guises higher than the English-accented guises in the dimension of superiority. Also unforeseen, the L2 speakers rated the Mexican-accented voices higher in the dimension of solidarity. We consider the high level of education of the respondents and, for the L2 subjects, their experience as advanced Spanish language speakers, as likely explanations for the observed attenuation of well-documented prevailing stereotypes directed at Latinos from the monolingual community at large.

http://ift.tt/2i19Tjk

Welsh English intonation and social identity

This paper is a sociophonetic study concerned with state-of-the-art description of Welsh English (WE) pitch patterns which may serve as WE regional and social markers. WE pitch patterns in authentic spontaneous conversations are correlated with social factors of regional and cultural background (North Wales, South Wales, Cardiff), generation of speakers (young, middle-aged, old), gender (men, women) and social class (middle, working). The data are compared to Received Pronunciation (RP) tone nomenclature (Crystal, 1969) in search of systemic (i.e. concerned with the total repertoire of tones in each variety), distributional and realisational differences. Within the identical tone systems a considerable difference in the distribution of certain WE pitch configurations is interpreted as the impact of the Welsh language. The data are further specified to the dominant pattern frequency in each region, age, gender and social class. Special reference is made to the acoustic structure of rise-falls in North Wales, which is a new subject of research.

http://ift.tt/2fGazcU

Langues de France et Charte européenne des langues régionales ou minoritaires: inventaire critique des arguments anti-ratification (2014-2015) [Languages of France and the European Charter for Regional or Minority Languages]

The deliberations in France surrounding the potential ratification of the European Charter for Regional or Minority Languages (from January 2014 to October 2015) resulted in a national debate unheard of since 1999, providing new insight into resistance towards promoting these languages in the public space. Despite a recent survey claiming that 'the ideological barriers on this issue have now almost disappeared', the virulent arguments opposing ratification eventually triumphed in the Senate. Basing ourselves on comments published in the media by a range of opponents to ratification of the Charter, we review here the various ideological strategies used to preserve the linguistic status quo in France and to maintain the supremacy of French.

http://ift.tt/2i1AzR2

Ideology and language choice: Catalan-speaking university students

The article analyses the relationship between the ideological factors of university students from the cities of Barcelona, Valencia and Palma de Mallorca, and their language behavior. Apart from the traditional right-left scale, the self-defining ideology focuses on the national-regional identity, which resulted as the main ideological variable in the last studies on language choice in the Catalan language area. The data were gathered through a sociolinguistic questionnaire to approximately 600 respondents. The results highlight the importance of identity in the three different regions but also the impact it has on the use of Catalan. The comparative analysis from the main Catalan-speaking cities and society in general is crucial to show the interaction between different perceptions of ideological factors and language choice, being Valencia the only city where the use of Catalan correlates with an ideological position: the left.

http://ift.tt/2fHoaRg

Enoncés de type OV et positionnements sociaux dans l’espagnol parlé par les Quichuas équatoriens à Cali (Colombie) [OV constructions and stance in the Spanish spoken by Ecuadorian Quichuas in Cali (Columbia)]

Members of the indigenous Quichuan minority population living in Cali within an asymmetrical contact setting usually make use of linguistic marked elements from two varieties of Spanish which they speak: Andean Spanish and Spanish from Cali. One of these marked linguistic elements is OV syntactic constructions, highly frequent in Andean Spanish. A sequential conversation analysis shows that when Quichuas in Cali interact with someone outside the group, they may express differentiation through the use of OV constructions. Construed as a social positioning, this differentiation takes place in an act of stance (Du Bois 2002, 2007; Jaffe 2009; Johnstone 2009; Kiesling 2011) which arises with an evaluation of a referent in the discourse situation by a speaker, then triggers a social positioning that finally leads to a disalignment vis-à-vis another speaker. This article discusses the social effects of linguistic marked forms such as OV constructions in an understudied area (Cali, Colombia) within a field of research (Spanish-Quichua contact) that usually focuses on contact issues from a typological perspective.

http://ift.tt/2i08M3l

La pluralización de haber presentacional en el español peninsular: datos de Twitter [The pluralization of presentational haber in Peninsular Spanish: Data from Twitter]

In this paper we explore whether Twitter data can be used in dialectological studies of morphosyntactic alternations in Peninsular Spanish. Specifically, drawing on a corpus of tweets we evaluate the hypothesis that in Peninsular Spanish, as in Caribbean Spanish, the pluralization of presentational haber (e.g., había(n) fiestas 'there were parties') is constrained by two domain-general cognitive constraints on language production: markedness of coding and statistical preemption. Then, we analyze the geographic distribution of haber pluralization in Peninsular Spanish. The results show that haber is pluralized in 11% (N= 611/5,500) of the cases. The mixed-effects logistic regression analysis supports that nouns which can easily be imagined as starting points of a series of events, the absence of negation, and verb tenses other than the preterit favor pluralization. To explore the geographic distribution of haber pluralization in Peninsular Spanish, we use a generalized additive mixed model, which generates a line that runs approximately from Lérida in the north of Spain to Almería in the south, crossing Teruel and Albacete. East of that line, the pluralized variant has a higher probability of occurrence, but it is not absent from other areas of the Peninsula. We conclude that (i) haber pluralization in Peninsular Spanish is constrained by domain-general cognitive constraints on language production and that (ii) tweets constitute a viable alternative to spoken language data in dialectological studies of morphosyntactic variation.

http://ift.tt/2fHo9Nc

Common language in the workplace: An approach devoid of social perspective?

This paper puts under scrutiny a contemporary management tool called "common language". This concept derives both from the idea of "freedom" of speech in the workplace, as set up by the Auroux Act, and from the "participative" management approach that emerged in the early 1980s. "Common language" has been developed as part of corporate culture consisting in creating a common culture in which workers can identify themselves; the aim being to coordinate the workers' actions so they contribute to corporate success. We analyze "common language" as a theoretical construct within a corpus of corporate communication manuals. This study is multidisciplinary: it is mainly based on sociology, sociolinguistics and discourse analysis. We postulate that "common language" is a vision devoid of social perspective, based on an endemic culture where linguistic, cultural, historical and thus social questions are minimized. This interpretation leads us to question whether freedom of speech in the workplace is real or not. Indeed, in the corporate communication manuals studied, language at work is limited to a "theoretical reason". Ultimately, the rationalization of language in the workplace suggests a technological rationality close to classical management.

http://ift.tt/2i0wUTA

Prescriptivism, nation, and style: The role of nonclassical elements in the stylistic stratification of Modern Hebrew

Modern Hebrew (MH) presents an interesting case of a national language whose crystallisation involved not only intensive planning, but also unplanned processes of stratification, which has resulted in a continuous reevaluation and reallocation of existing features. The role of nonclassical inherited elements in this progression is revealing, as they emblematise popular 'authentic' usage on the one hand and diasporic (i.e. nonnative) premodern being on the other, thus exposing the tension between standard and nonstandard language. This study examines the stylistic status of two such elements, be'im 'if' and bixde 'for', 'in order', in two major phases in the short history of MH, in order to characterise the prescriptive discourse of MH and its national undertones.

http://ift.tt/2fHAcuh

Haitian Creole. Structure, Variation, Status, Origin. Albert Valdman (2015) Sheffield and Bristol, CT, Equinox ISBN 978-1845533885. Pp. 494

http://ift.tt/2i04NDU

Doing Sociolinguistics: A practical guide to data collection and analysis, Miriam Meyerhoff, Erik Schleef, and Laurel MacKenzie (2015) New York: Routledge ISBN: 9780415698207 (pbk). Pp. xxii + 190

http://ift.tt/2fHo7oy

Imprisoned in English: The Hazards of English as a Default Language, Anna Wierzbicka (2014) Oxford: Oxford University Press ISBN 978-0199321506 (pbk). Pp. xii + 287

http://ift.tt/2i0ZeF9

Pernambuco index: predictability of the complexity of surgery for impacted lower third molars

This study aimed to develop and validate an index of surgical difficulty for the removal of impacted lower third molars. The study was performed in two steps. The first was a cross-sectional analysis of clinical, demographic, and radiographic variables collected from patients undergoing the removal of an impacted lower third molar between 2008 and 2012. The second step was a prospective cohort study involving the same surgical procedures to validate the index; this was performed between 2013 and 2016.

http://ift.tt/2fH4LQy

L2 Pragmatic Development in Study Abroad Contexts, Wei Ren (2015) Bern: Peter Lang; ISBN 1424-8689 (pbk). Pp. 256

http://ift.tt/2fHA9i5

The expression of endogenous hydrogen sulfide signal during distraction osteogenesis in a rabbit model

The hydrogen sulfide (H2S) signal system plays an important role in bone metabolism. However, the role of endogenous H2S during distraction osteogenesis (DO) remains unclear. Sixty-two male New Zealand White rabbits were subjected to right mandibular DO. Before distraction, the animals were divided randomly into two groups: group A, 0.5mm twice/day for 10 days; group B, 1.25mm twice/day for 4 days. Plasma and distraction gap tissue were harvested to determine the H2S signal. The osteogenesis effect was also evaluated.

http://ift.tt/2i0YIqF

Speak English or What? Codeswitching and Interpreter Use in New York City Courts. Philipp Sebastian Angermeyer (2015) [Oxford Studies in Language and Law] Oxford and New York: Oxford University Press ISBN 978-0-19-933756-9. Pp 248

http://ift.tt/2i0jwi4

The Handbook of Conversation Analysis, Jack Sidnell and Tanya Stivers (eds) (2013) Chichester, West Sussex, UK: Blackwell ISBN 978-1-4443-3208-7 (Hardback) Pp. 825

http://ift.tt/2w5vwFu

The Oxford Handbook of Sociolinguistics, Robert Bayley, Richard Cameron, and Ceil Lucas (eds) (2015), New York: Oxford University Press ISBN 9780190233747 Pp. 194

http://ift.tt/2vWBhoc

Trapezoidal mandibular osteotomy for augmentation of the airway in sleep apnoea

Trapezoidal osteotomy is indicated for patients with severe obstructive sleep apnoea for whom it is necessary to advance the genial muscles without altering the facial profile. The use of prototyped surgical guides ensures precision by limiting the size of the osteotomy to avoid damage to anatomical structures. They provide a better prognosis, more predictable outcomes, lower morbidity, and shorter operating time.1–5

http://ift.tt/2wKO1Mr

Use of buccal cortex as interpositional graft in mandibular setbacks

The most commonly used options for mandibular fixation after sagittal split ramus osteotomy (SSRO) are monocortical plates and bicortical screws, which have comparable stability.1 We have recently changed our practice to the routine use of bicortical screws where possible, particularly for mandibular setbacks. They are faster to place and need to be removed less often than miniplates.2

http://ift.tt/2vyp0Fw

Cancer risks and survival in patients with multiple primary melanomas: Association with family history of melanoma and germline CDKN2A mutation status

Worse outcomes have been noted in patients with multiple primary melanomas (MPMs) than in patients with single primary melanomas.

http://ift.tt/2uIBZlc

Correction

Connolly KL, Nehal KS, Dusza SW, et al. Assessment of intraoperative pain during Mohs micrographic surgery (MMS): An opportunity for improved patient care. J Am Acad Dermatol. 2016;75(3):590-594.

http://ift.tt/2uJ18wg

Variations in risk of asthma and seasonal allergies between early- and late-onset pediatric atopic dermatitis: A cohort study

Atopic dermatitis is associated with other allergic conditions, but variations in this "atopic march" are poorly understood.

http://ift.tt/2w8zcFr

Use of the Hemangioma Severity Scale to facilitate treatment decisions for infantile hemangiomas

The Hemangioma Severity Scale (HSS) assesses the severity of an infantile hemangioma (IH).

http://ift.tt/2w8zLz4

Lessons from CTLA-4 deficiency and checkpoint inhibition

Bernice Lo | Ussama M Abdel-Motal

http://ift.tt/2i0kkUb

Cancer vaccines in the era of checkpoint blockade: the magic is in the adjuvant

Willem W Overwijk

http://ift.tt/2fHrRXv

Barbed snore surgery for concentric at the velum collapse: the Alianza technique

Recently, new conservative and non-resective surgical techniques, including palatopharyngeal surgical lifting and suspension (the 'Roman blinds technique') and modular barbed snore surgery (MBSS), have been successfully introduced for the treatment of obstructive sleep apnea syndrome (OSAS). This pilot longitudinal study describes our preliminary experience with the 'Alianza technique' (the simultaneous use of Roman blinds and MBSS) in mild to moderate OSAS patients with concentric pharyngeal collapse at the velum, previously documented by means of drug-induced sleep endoscopy.

http://ift.tt/2uInkqp

How novel structures inform understanding of complement function

Abstract

During the last decade, the complement field has experienced outstanding advancements in the mechanistic understanding of how complement activators are recognized, what C3 activation means, how protein complexes like the C3 convertases and the membrane attack complex are assembled, and how positive and negative complement regulators perform their function. All of this has been made possible mostly because of the contributions of structural biology to the study of the complement components. The wealth of novel structural data has frequently provided support to previously held knowledge, but often has added alternative and unexpected insights into complement function. Here, we will review some of these findings focusing in the alternative and terminal complement pathways.

http://ift.tt/2wYCt7w

Presidential Health: Secrets, Surprises, and Controversies

How much do you know about the history of presidential health?
Medscape Family Medicine

http://ift.tt/2fFjkE4

Omalizumab Benefits Patients With Chronic Inducible Urticaria

The recombinant anti-immunoglobulin E (IgE) monoclonal antibody omalizumab has 'substantial benefits' in treating various forms of chronic inducible urticaria (CIndU), according to a new systematic review.
Reuters Health Information

http://ift.tt/2uMMKly

Monoclonal Antibody 5F11G11

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy Aug 2017, Vol. 36, No. 4: 196-197.


http://ift.tt/2vCVJIa

Monoclonal Antibody 1C11 Mouse Monoclonal Antibody Against Mortalin

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy Aug 2017, Vol. 36, No. 4: 192-193.


http://ift.tt/2vWngHi

Expression, Purification, and Refolding of Human Lipocalin 6 and Production of a Monoclonal Antibody Against This Protein

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy Aug 2017, Vol. 36, No. 4: 185-191.


http://ift.tt/2vDp9pQ

Chicken HMGB1 Monoclonal Antibody

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy Aug 2017, Vol. 36, No. 4: 194-195.


http://ift.tt/2vVJSre

Establishment of a Monoclonal Antibody Against chGILZ

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy Aug 2017, Vol. 36, No. 4: 176-180.


http://ift.tt/2vCLhR5

Anterior superior alveolar nerve injury after extended endoscopic medial maxillectomy: a preclinical study to predict neurological morbidity

Background

Endoscopic medial maxillectomies (EMMs) are used to optimize exposure of the maxillary sinus and retromaxillary areas. Although in type D EMM (Sturmann-Canfield procedure) the anterior superior alveolar nerve (ASAN) is always at risk of injury, only 29% of patients complained of alveolar process and dental anesthesia. The purpose of this anatomical study is to assess the neural anastomotic network of the ASAN (ASAN-NAN) and describe different extensions of type D EMMs in a preclinical setting.

Methods

The ASAN and its medial anastomotic branches (MABs) and lateral anastomotic branches (LABs) were evaluated by cone-beam computerized tomography (CBCT). Five different extensions of type D (D1 to D5) EMMs were identified and nerves at risk of injury in each type were assessed by CBCT. Moreover, quantification of surgical corridors was performed on cadaver heads with a neuronavigation system.

Results

Fifty-seven CBCT scans were analyzed. The ASAN would be spared in 16.3% of cases with a type D1 EMM, while it would be injured in the majority of type D2 to D5 resections. At least 1 nerve of the ASAN-NAN was spared in 96.6%, 93%, 74.6%, 0%, and 65.8% of type D1 to D5 EMMs, respectively. Two cadaver heads were dissected and the incremental volume and number of maxillary subsites exposed was assessed in type D1 to D5 EMMs.

Conclusion

ASAN function impairment is probably compensated by LABs and MABs. If this hypothesis will be validated in a prospective study on patients, preoperative CBCT evaluation could predict neurological morbidity after type D EMM, and allow tailoring the procedure to minimize impairment of the ASAN-NAN.

http://ift.tt/2fFug4B

The innate immune system and beyond

http://ift.tt/2i03ll5

Efficacy of endoscopic sinus surgery for chronic rhinosinusitis following primary radiotherapy and concurrent chemotherapy for nasopharyngeal carcinoma

Background

Chronic rhinosinusitis (CRS) is a downstream complication following radiotherapy or chemoradiation for nasopharyngeal carcinoma (NPC). Endoscopic sinus surgery (ESS) is an accepted therapy for medically refractory CRS, but its efficacy in addressing CRS symptoms in patients with previously irradiated NPC is unclear.

Methods

All patients at the Stanford Sinus Center with a history of radiation therapy or chemoradiation for NPC between 2006 and 2015 were reviewed. Patients without antecedent CRS prior to NPC treatment (n = 26) were retrospectively divided into 2 cohorts based on whether they developed postirradiation CRS and underwent ESS (surgical group, n = 13) or did not develop CRS (control, n = 13). Demographic and clinical characteristics were collected, and temporal changes in 22-item Sino-Nasal Outcome Test (SNOT-22) score were compared.

Results

The median time following primary irradiation to initial presentation was 6.8 and 6.5 years in the surgical and control groups, respectively. The surgical cohort had statistically greater baseline SNOT-22 scores than the control group (45 vs 14, p = 0.0198). At 6 to 12 months postoperatively, the surgical group demonstrated statistically significant and clinically meaningful improvements in SNOT-22 scores when compared to controls (15-point decrease vs 0, p = 0.0040), ultimately resulting in similar SNOT-22 scores for both groups (28 vs 18, p = 0.3687). The rhinologic, extranasal, and ear/face subdomain scores of the surgical group were significantly greater than those of the control group preoperatively (rhinologic: p = 0.0010; extranasal: p = 0.0179; ear/face: p = 0.0068), but these disparities resolved postoperatively (rhinologic: p = 0.1461; extranasal: p = 0.3131; ear/face: p = 0.3401).

Conclusion

ESS appears to effectively manage recalcitrant CRS symptoms in patients previously treated with radiation therapy and concurrent chemotherapy for NPC.

http://ift.tt/2fFp0xX

Defining Radioiodine-Refractory Differentiated Thyroid Cancer: Efficacy and Safety of Lenvatinib by Radioiodine-Refractory Criteria in the SELECT Trial

Thyroid , Vol. 0, No. 0.


http://ift.tt/2uCYpbI

An Exploratory Study of Fatigue and Physical Activity in Canadian Thyroid Cancer Patients

Thyroid , Vol. 0, No. 0.


http://ift.tt/2uV68wQ

Sinnbasierte Interventionen bei fortgeschritten erkrankten Patienten

Zusammenfassung

Menschen mit fortgeschrittener Tumorerkrankung zeigen häufig schwere psychosoziale Beeinträchtigungen, die einem umfassenden existenziellen Leiden entsprechen können. Im besonderen Fall des CUP-Syndroms (CUP Cancer of Unknown Primary) sind entsprechende empirische Daten rar. Allerdings wurden in den letzten Jahren eine Reihe psychoonkologischer Interventionsansätze vorgestellt, die insbesondere für Patienten mit infauster Prognose und schwerer psychischer Belastung entwickelt wurden. Diese Ansätze zeichnen sich durch ihre Adaptivität im onkologischen und palliativmedizinischen Setting aus. Ferner sind sie in randomisierten kontrollierten Studien auf ihre Effektivität überprüft worden. Ein wirksamer einzeltherapeutischer Ansatz ist CALM (Managing Cancer and Living Meaningfully), der Belastungen im Umgang mit Unsicherheit und einer verkürzten Lebenserwartung reduziert. Die Autoren stellen ein kurzes Therapiebeispiel vor.

http://ift.tt/2vV46l2

Versorgungsforschung in der Radioonkologie am Beispiel der Körperstereotaxie

Zusammenfassung

Hintergrund

Die körperstereotaktische Bestrahlung (SBRT) ist eine noch junge Methode der Radioonkologie, die durch eine präzise und intensive Bestrahlung in wenigen Behandlungssitzungen charakterisiert ist und dadurch eine hohe lokale Tumorkontrolle bei gleichzeitig guter Verträglichkeit erreicht. Aufgrund der raschen technischen und klinischen Weiterentwicklung der SBRT sind viele Details der klinischen Praxis nicht standardisiert, was eine breite und sichere Anwendung der SBRT potenziell gefährdet.

Methoden

Innerhalb der Deutschen Gesellschaft für Radioonkologie (DEGRO) wird seit 2010 die Methode der SBRT durch eine dedizierte Arbeitsgruppe evaluiert und erforscht: die Aktivitäten in Patterns-of-Care Analysen sowie Entwicklung von Leitlinien wird hier zusammengefasst. Zusätzlich erfolgte eine Recherche und Analyse aktueller Literatur.

Ergebnisse und Schlussfolgerungen

Innerhalb der DEGRO AG Stereotaxie wurden Registerstudien zur SBRT beim nichtkleinzelligen Lungenkarzinom sowie von Lungenmetastasen etabliert, welche die weltweit größten Patientenkollektive bildeten. Diese Datenbanken ermöglichten die Analyse von komplexen Zusammenhänge zwischen lokaler Effektivität, Bestrahlungsdosis, technologischer Ausführung der SBRT, Erfahrung des behandelnden Zentrums sowie Überleben der Patienten. Dies resultierte in einer Standardisierung sowie Weiterentwicklung der SBRT auf höchstem internationalem Qualitätsniveau.

http://ift.tt/2vBI589

Onkologische Bewegungsmedizin

Zusammenfassung

Die klinisch relevanten Effekte bewegungstherapeutischer Interventionen wurden über alle Phasen der onkologischen Behandlung in zahlreichen „high quality trials", systematischen Übersichtsartikeln und Metaanalysen belegt. Neben den positiven Einflüssen auf behandlungsspezifische Nebenwirkungen können Bewegungsmangelsymptome verhindert und die gesundheitsspezifische Lebensqualität verbessert werden. Auch die Chemotherapieadhärenz lässt sich positiv beeinflussen, sodass die optimale medizinische Therapie besser toleriert wird. Neueste Daten erhärten zunehmend den Verdacht, dass die krebsspezifische Mortalität bei Mamma- und Kolonkarzinom durch regelmäßige körperliche Bewegung gesenkt werden kann. Auf dem Weg zur Standardsäule in der onkologischen Behandlung fehlen neben der Klärung der optimalen Trainingssteuerung sowie des bewegungstherapeutischen Einsatzes bei fortgeschrittenen Erkrankungen flächendeckende und qualitätsgesicherte therapeutische Versorgungsstrukturen in Deutschland.

http://ift.tt/2vV9KU7

Versorgungsforschung in der onkologischen Pankreaschirurgie

Zusammenfassung

Hintergrund

Eine Vielzahl an Studien hat die Fallzahlmenge pro Krankenhaus als eine signifikante unabhängige Variable für die Mortalität nach komplexen Operationen identifiziert. Aufgrund dessen haben viele Länder eine Zentralisierung der Versorgungsstrukturen durch die Einführung von Mindestmengen angestrebt.

Fragestellung

Der derzeitige Stand der Versorgungsforschung in der onkologischen Pankreaschirurgie wird zusammengefasst, und es werden internationale Erfahrungen mit der Zentralisierung der Versorgungsstrukturen dargestellt.

Material und Methode

Auf Basis einer systematischen Literaturrecherche wurden die wichtigsten Studienergebnisse zur Versorgungsforschung und Erfahrungen mit der Zentralisierung der Versorgungsstrukturen im Bereich der onkologischen Pankreaschirurgie zusammengetragen.

Ergebnisse

Mengen-Ergebnis-Zusammenhänge sind für komplexe Pankreasoperationen auf nationaler und internationaler Ebene vielfach nachgewiesen. International konnten bereits beeindruckende Ergebnisse durch eine relevante Zentralisierung der Pankreaschirurgie erreicht werden. In Deutschland werden die geltenden Mindestmengen jedoch nur mangelhaft umgesetzt, was im Laufe der letzten Jahre eine Reduzierung der Mortalität auf Bundesebene verhindert hat.

Schlussfolgerungen

Mit Blick auf die beeindruckenden Ergebnisse anderer Länder scheint eine erfolgreiche Konzentration der Versorgungsstrukturen der Schlüssel zu einer Verbesserung der Ergebnisqualität in der Pankreaschirurgie zu sein.

http://ift.tt/2vBNJaE

Issue Information

http://ift.tt/2uV7uYw

Fragility of epidermis: acne and post-procedure lesional skin

Abstract

'Fragile skin', or skin with lower resistance to aggressors, can be broadly classified into four causal categories: constitutional (age-dependent or associated with specific vulnerable locations on the body, e.g. eyelids), pathological (related to disease), circumstantial (related to environmental or internal factors, e.g. stress) and iatrogenic (caused by medical interventions or treatments). In this supplement, we focus on the fourth category, the iatrogenic origin of fragile skin and the role that dermo-cosmetics can have in restoring the natural protective function of the skin following treatments for skin diseases and medical interventions. We present epidemiological data on the prevalence of fragile skin in three different geographical regions, and the results of two randomized controlled studies investigating the efficacy and tolerability of dermo-cosmetics in combination with topical acne treatment and following physical skin damage. Overall, we found that prevalence across the three regions (23% in Germany, 41% in UAE, 56% in Taiwan) reflected previous global estimates (24–53%) across skin types, with significant associations found with environmental and lifestyle factors, such as stress, humidity and pollution. The iatrogenic effects of topical acne treatments can result in poor compliance or use of over-the-counter moisturizers, which may reduce treatment efficacy. Dermo-cosmetics were found to aid in restoration of fragile skin caused by the acne topical retinoid treatment adapalene 0.1% gel, by reducing transepidermal water loss and improving skin hydration, as well as reducing the side-effects such as skin irritation that are frequently associated with topical retinoids. Additionally, dermo-cosmetic products were found to accelerate wound closure following skin damage in a laser ablation model and reduced the duration of post-procedural side-effects such as itching and burning.

http://ift.tt/2uCRtet

Nongenetically modified Lactococcus lactis-adjuvanted vaccination enhanced innate immunity against Helicobacter pylori

Abstract

Background

Gram-positive enhancer matrix particles (GEM) produced by Lactococcus lactis can enhance vaccine-induced immune response. However, the mechanism under which this adjuvant mounts the efficacy of orally administered vaccines remains unexplored.

Materials and Methods

We used a prophylactic mice model to investigate the mechanism of GEM-adjuvanted vaccination. Helicobacter pylori urease-specific antibody response was monitored and detected in murine serum by ELISA. Urease-specific splenic cytokine profile was examined. Gastric inflammatory responses were measured on day 43 or 71 by quantitative real-time PCR, flow cytometry and histology.

Results

We found that GEM enhanced the efficiency of oral H. pylori vaccine by promoting innate immunity. The vaccine CUE-GEM composed of GEM particles and recombinant antigen CTB-UE provided protection of immunized mice against H. pylori insult. The protective response was associated with induction of postimmunization gastritis and local Th1/Th17 cell-medicated immune response. We showed that innate inflammatory responses including neutrophil chemokines CXCL1-2, neutrophils, and antimicrobial proteins S100A8 and MUC1 were significantly elevated. Within all infected mice, S100A8 and MUC1 levels were negatively correlated with H. pylori burden. Strikingly, mice receiving GEM also show reduction of colonization, possibly through natural host response pathways to recruit CD4⁺ T cells and promote S100A8 expression.

Conclusions

These findings suggest that GEM-based vaccine may impact Th1/Th17 immunity to orchestrate innate immune response against H. pylori infection.

http://ift.tt/2uHdULE

Neoadjuvant Immunoradiotherapy in Head & Neck Cancer

Conditions:   Head and Neck Cancer;   Head and Neck Squamous Cell Carcinoma
Interventions:   Drug: Nivolumab;   Procedure: Surgical Resection;   Radiation: Radiation
Sponsors:   Providence Health & Services;   Providence Cancer Center, Earle A. Chiles Research Institute
Not yet recruiting - verified August 2017

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Palliative end ileostomy and gastrojejunostomy for a metastatic distal transverse colonic malignancy complicated by a proximal duodenocolic fistula: a case report

Fistulae between the colon and upper gastrointestinal tract are distressing and uncommon complications of malignancies involving this region. We report a case of a middle-aged man with a locally advanced and m...

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Cryoablation of cardiophrenic angle lymph node metastases: a case report

Cardiophrenic angle lymph node metastases are relatively rare. Surgical resection is the main treatment for cardiophrenic angle lymph node metastasis, but it is not always possible.

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Treatment of notalgia paraesthetica with manipulative physiotherapy

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Participation of extracellular signal-regulated kinases 1/2 in osteoblast and adipocyte differentiation of mesenchymal stem cells grown on titanium surfaces

Osteoblasts and adipocytes coexist in the implantation site and affect the process of titanium (Ti) osseointegration. As extracellular signal-regulated kinases 1/2 (ERK1/2) are involved in osteogenesis and adipogenesis, the aim of our study was to investigate if the effects of Ti surface topography on osteoblast and adipocyte differentiation are modulated by ERK1/2. The experiments were conducted based on the effect of the ERK1/2 inhibitor, PD98059, on mesenchymal stem cells (MSCs) grown under osteogenic and adipogenic conditions on Ti with nanotopography (Ti-Nano) or on machined Ti (Ti-Machined). The results showed that, in general, ERK1/2 inhibition favored osteoblast and adipocyte differentiation of MSCs grown on Ti-Machined. In MSCs grown on Ti-Nano, ERK1/2 inhibition upregulated the expression of alkaline phosphatase and osteocalcin and reduced extracellular matrix mineralization. In terms of adipocyte differentiation, ERK1/2 inhibition elicited similar MSC responses to Ti-Nano and Ti-Machined, upregulating gene expression of adipocyte markers without affecting lipid accumulation. Our results indicate that, under osteogenic and adipogenic conditions, the responses of MSCs to Ti surface topography in terms of osteogenesis and adipogenesis are dependent on ERK1/2. Thus, a precise modulation of ERK1/2 expression and activity induced by surface topography could be a good strategy to drive the process of implant osseointegration.

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A survey on monopolar radiofrequency treatment

Abstract

This questionnaire-based study was aimed to measure the level of appreciation, awareness of the special tips, and practice patterns of monopolar radiofrequency among Korean dermatologists practicing a specific monopolar radiofrequency device (Thermage® Inc., Hayward, CA). A total of 82 surveys were analyzed to show that the majority of participants (78.8%) were highly satisfied with the outcomes of monopolar radiofrequency treatment. All respondents were aware of the Eye Tip 0.25 cm², and the majority knew the difference between the Face tip (blue) and the Total tip (orange). Most (86.3%) agreed to the statement that 900 shots were appropriate for facial tightening in those between the ages of 35 and 65 years. 66.2% of participants reported to have perform monopolar radiofrequency to extra-facial sites within the past year. As for the tips, the Total tip was most popular for all body sties and the Big tip was favored for the abdomen, thighs and buttock. We hope our data allow dermatologists to better utilize monopolar radiofrequency.

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Anaesthesia for head and neck cancer surgery

1C012A013A02

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Principles of resource allocation in critical care

1I022C073J02

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25 Jahre Vereinigung Mitteldeutscher Hals-Nasen-Ohren-Ärzte (MDHNO)

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First Evaluation of the Behavioral Addiction Indoor Tanning Screener (BAITS) in a nationwide representative sample

Abstract

Background

Evidence suggests that indoor tanning (IT) may have addictive properties. However, many instruments for measuring IT addiction show poor validity and reliability. Recently, a new instrument, the Behavioral Addiction Indoor Tanning Screener (BAITS), has been developed.

Objectives

Our aim was to test validity and reliability of the BAITS by using a multi-method approach.

Methods

We used data of the first wave of the National Cancer Aid Monitoring on Sunbed Use (NCAM), which includes a cognitive pretest (08/2015) and a Germany-wide representative survey (10-12/2015). In the cognitive pretest 10 participants were interviewed, while 3,000 individuals aged 14 to 45 years were included in the representative survey. Potential symptoms of IT addiction were measured via the BAITS, a brief screening survey including seven items (answer categories: yes vs. no). Criterion validity was assessed by comparing the results of BAITS with usage parameters. Additionally, we tested internal consistency and construct validity.

Results

19.7% of current and 1.8% of former IT users were screened positive for symptoms of a potential IT addiction. We found significant associations between usage parameters and the BAITS (criterion validity). Internal consistency (reliability) was good (Kuder-Richardson-20=0.854). The BAITS was shown to be a homogenous construct (construct validity).

Conclusions

Compared to other short instruments measuring symptoms of a potential IT addiction, the BAITS seems to be a valid and reliable tool. With its short lengths and the binary items the BAITS is easy to use in large surveys.

This article is protected by copyright. All rights reserved.

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Popliteal Artery Entrapment or Chronic Exertional Compartment Syndrome?

Diagnosis of lower limb pain in an athlete can be a challenging task due to the variety of potential etiologies and ambiguity of presenting symptoms. Five of the most commonly encountered causes of limb pain in athletes are chronic exertional compartment syndrome (CECS), medial tibial stress syndrome (MTSS), tibial stress fractures, soleal sling syndrome, and popliteal artery entrapment syndrome (PAES). Of these, the least frequent but potentially most serious of the pathologies is PAES. With an incidence of less than 1% seen in living subject studies, the condition is rare. However, a missed diagnosis will likely lead to progression of the disease and potential for unnecessary invasive procedures (McAree et al. 2008). In this paper, we present a young athlete misdiagnosed and treated for chronic exertional compartment syndrome. In both descriptive and a quick-reference table format, we review current literature and discuss how best to distinguish functional PAES from other causes of activity-related leg pain.

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Lane's Disease (Erythema Palmare Hereditarium): A Report of Five Cases and a Review of the Literature

Abstract

Background

Erythema palmare hereditarium (EPH), also known as Lane's disease, is a rare, benign condition presenting as persistent erythema involving the palms. EPH can appear at birth or later in life and usually in at least two members of the same family, although a sporadic case has been reported.

Methods

We report five cases of EPH and offer a review of the current literature. The first and second cases are twin boys presenting with erythema mainly on the thenar and hypothenar eminences and on the phalanges that appeared 8 months after birth. The third case is a girl with congenital palmar erythema and two other capillary malformations. The fourth case is a 58-year-old woman with palmar erythema that appeared after pregnancy. Her 32-year-old daughter had presented with the same palm redness since birth.

Results

A review of the literature shows that women are affected almost three times more than men. Dermoscopic evaluation showed red structureless areas with arborizing vessels, mainly running parallel along follicular openings.

Conclusion

EPH should be considered in all patients presenting with palmar erythema, especially in familial long-lasting forms. It can be congenital or acquired, but the pathogenetic mechanism is unclear. To the best of our knowledge, this is the first dermatoscopic study of EPH and the largest case series reported in the literature, involving two families and one sporadic case.

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Study of Cognitive Function in Children Treated with Propranolol for Infantile Hemangioma

Abstract

Background

Oral propranolol is considered the first choice for the treatment of infantile hemangiomas (IHs). There is a concern that administering propranolol in newborns and infants could induce adverse effects in learning and memory processes in the long term. The purpose of this study was to assess cognitive and memory functions in children who had been treated with propranolol for IH during their infancy.

Methods

A total of 23 children between 5 and 7.5 years of age who had been treated with oral propranolol for IH during infancy were tested for cognitive functions with the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) test and for memory functions with the Test of Memory and Learning (TOMAL).

Results

Comparison of our sample with a normal distribution by a Shapiro-Wilk W test showed no significant difference for any of the composite scores in the WPPSI-IV and TOMAL tests except for positive asymmetry and concentration of scores around average (p = 0.01) in the WPPSI-IV composite score (mean intelligence), due to one atypically high score.

Conclusions

The distribution of scores for intelligence and memory scales in our study population was similar to that in the reference general population. These results fail to support any significant disturbance in intelligence and memory development in children treated during infancy with propranolol for IH.

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Flagellate Dermatitis in a Child Most Likely Secondary to Doxorubicin

Abstract

Flagellate dermatitis, a cutaneous eruption in which the patient appears to have been whipped, has been described with antineoplastic agents and shiitake mushroom ingestion. A 15-year-old girl with metastatic Ewing sarcoma developed pruritic erythematous linear lesions on her trunk that became hyperpigmented over time during her first cycle of chemotherapy with doxorubicin, vincristine, cyclophosphamide, and ganitumab. Flagellate dermatitis was diagnosed based on clinical and histologic findings. Flagellate dermatitis (FD) is a rare cutaneous eruption named for its appearance, in which the patient appears to have been whipped. It has been associated with chemotherapeutic agents such as bleomycin . We report FD in a child that occurred during chemotherapy treatment that included doxorubicin.

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Hypopigmented Mycosis Fungoides with Large Cell Transformation in a Child

Abstract

Hypopigmented mycosis fungoides (HMF) is the most common variant of mycosis fungoides (MF) in children. Large-cell transformation in HMF has never been reported. Herein we report a case of HMF in an 8-year-old boy who presented with a 6-year history of hypopigmented patches on the bilateral arms, lower back, buttocks, posterior thighs, and lower legs. Biopsy revealed an abnormal CD8⁺ epidermotropic T-cell infiltrate consistent with the diagnosis of MF. The T-cell clonality study was positive. The patient was started on narrowband ultraviolet B (NBUVB) phototherapy and topical steroids. He had a 50% reduction in his patches after 10 months of treatment, after which he developed a single annular plaque on his left thigh. The biopsy specimen demonstrated large cells that were diffusely CD8⁺ and CD30⁻. Clobetasol propionate ointment was prescribed, which led to complete resolution of the plaque within 2 weeks. NBUVB phototherapy was continued and the patient had a complete response within the following 5 months. The case is an example of exceptionally rare large-cell transformation in pediatric MF and stresses the importance of regular follow-up of these patients.

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Spontaneous Regression of a Nail Matrix Melanocytic Nevus in a Child

Abstract

A 14-year-old Hispanic boy presented with a 0.25-mm wide, sharply demarcated, dark brown band of longitudinal melanonychia of the left thumbnail. A clinical diagnosis of nail matrix nevus was made and the boy was scheduled for follow-up. The band showed proximal fading after 6 months and had completely faded after 11 months, with the proximal nail fold showing small dark brown dots on dermoscopy. We documented the spontaneous regression of melanonychia over 11 months.

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Clinical Outcome and Prognosis of Young Patients with Mycosis Fungoides

Abstract

Background/Objectives

Mycosis fungoides (MF) in young patients is rare and may have atypical presentations. There are limited data in these patients. The objective was to determine the clinical outcome and prognosis of young patients with MF.

Methods

A search of our institutional cancer registry database was conducted for patients diagnosed with MF at younger than 30 years of age.

Results

Our study included 74 patients (median age at diagnosis 25.5 yrs). Sixty-five (88%) presented with early stage disease and variants of MF (n = 44 [59%]), leading to a median delay in diagnosis of 2.5 years. Hypopigmented MF (n = 27 [36.5%]) was the most common variant, affecting predominantly African American (44.4% vs 19%; p = 0.02) and younger (20 vs 26 yrs; p < 0.001) patients. All patients with hypopigmented MF presented with early stage disease and were less likely to develop progressive disease (PD) than those with other variants (11% vs 34%; p = 0.03). Nineteen patients (26%) developed PD during a median follow-up of 3.5 years, which was associated with advanced-stage disease (89% vs 17%; p < 0.001), older age (>20 yrs) (31% vs 13%; p = 0.08), African American race (52.6% vs 20%; p = 0.009), and poikilodermatous presentation (p < 0.01). Overall survival was good (97.2% at 5 yrs, 95.9% at 10 yrs) despite the delay in diagnosis and atypical presentation.

Conclusions

Progressive disease is associated with older age, African American race, the poikilodermatous variant, and advanced-stage disease. The hypopigmented variant is a common presentation in young patients and has an indolent disease course. Our study confirms an overall favorable prognosis in young patients with MF.

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An omental fibroma resembling a testicular tumour but presented as an irreducible inguinal hernia

Abstract

We present a case of omental fibroma, which posed a surgical diagnostic dilemma. Primary tumours of the omentum are uncommon, and omental fibromas account for 2% of these. The rarity of omental fibroma and paucity of available information hamper an accurate diagnosis. In this particular case, the diagnostic process was misleading. The history was classical of an irreducible inguinal hernia, but the physical examination and imaging studies were suggestive of a testicular tumour. However, intraoperatively, an omental tumour and a normal testicle were found in the scrotum. Histopathological examination proved the tumour to be a fibroma. The presentation of an omental fibroma in an inguinal hernia sac had never been reported in literature. Due to the rarity of such cases, a thorough history, detailed examination, and objective investigation are the pillars to attain the correct diagnosis.

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Gallbladder bleeding associated with microscopic polyangiitis: a case report

Abstract

A 71-year-old male who had a 6 years history of microscopic polyangiitis (MPA) was admitted to our hospital with a chief complaint of upper abdominal pain and nausea. Abdominal contrast-enhanced CT revealed extravasation of contrast medium in the gallbladder, and the patient was diagnosed with gallbladder bleeding. Although we started conservative treatment, anemia, hypotension and tachycardia had progressed gradually. Therefore, we performed emergent laparoscopic cholecystectomy on the following day. Intraoperative findings showed a remarkably distended gallbladder due to interior clots; however, the cholecystitis itself was not significant. Histopathological findings showed infiltrations of inflammatory cells around the blood vessels and vascular rupture. The postoperative course was uneventful. MPA is a type of ANCA-associated vasculitis. To the best of our knowledge, this is the first report of gallbladder bleeding associated with MPA. Spontaneous hemostasis cannot be expected, instead, surgical treatment must be performed promptly.

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Missed diagnosis of a large, right-sided diaphragmatic rupture with herniated liver and concomitant liver laceration after blunt trauma: consequences for delayed surgical repair

Abstract

Diaphragmatic injuries are relatively rare and as such frequently missed, particularly if they occur as a rare event on the right-sided dome. Even if detected in the early phase, the concomitant injury of other organs may delay the time to repair. The delay in surgical correction may aggravate additional adherences between thoracic and abdominal organs and cause the diaphragmatic muscle to retract, causing a larger tissue defect that may prevent primary suture repair. This should be taken into consideration when choosing access to repair (thoracic, abdominal or both cavities), mode (open or laparoscopic) and type of repair (primary suture or use of mesh material to close the defect). Here we present a case of delayed right-sided, blunt diaphragmatic injury with herniation of liver. Repair was performed in a delayed manner with an initial laparoscopic exploration converted to open abdominal repair with closing of defect with Gore-tex mesh material.

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