Determination of ochratoxin A in fruit juice by high-performance liquid chromatography after vortex-assisted emulsification microextraction based on solidification of floating organic drop

Abstract

A rapid, simple, and green vortex-assisted emulsification microextraction method based on solidification of floating organic drop was developed for the extraction and determination of ochratoxin A (OTA) with high-performance liquid chromatography. Some factors influencing the extraction efficiency of OTA such as the type and volume of extraction solvent, sample pH, salt concentration, vortex time, and sample volume were optimized. Under optimized conditions, the calibration curve exhibited linearity in the range of 50.0–500 ng L⁻¹ with a coefficient of determination higher than 0.999. The limit of detection was 15.0 ng L⁻¹. The inter- and intra-assays relative standard deviations were in a range of 4.7–8.7%. The accuracy of the developed method was investigated through recovery experiments, and it was successfully used for the quantification of OTA in 40 samples of fruit juice.

http://ift.tt/2gTIpbr

Transcatheter aortic valve-in-valve implantation of a CoreValve in a JenaValve prosthesis: a case report

Transcatheter aortic valve implantation has become an accepted treatment modality for inoperable or high-risk surgical patients with symptomatic severe aortic stenosis.

http://ift.tt/2gTzbvS

Unusual Superolateral Dislocation of Bilateral Mandibular Condyles

Abstract

We describe a case of maxillofacial trauma in a paediatric patient in which the left mandibular condyle was superolaterally displaced into the temporal fossa, medial to the zygomatic arch which was intact and the right condyle was also displaced similarly but the zygomatic arch was also fractured on this side. Also, there was an associated mandibular symphyseal fracture.

http://ift.tt/2gUziv3

Guidelines for autopsy investigation of sudden cardiac death: 2017 update from the Association for European Cardiovascular Pathology

Abstract

Although sudden cardiac death (SCD) is one of the most important modes of death in Western countries, pathologists and public health physicians have not given this problem the attention it deserves. New methods of preventing potentially fatal arrhythmias have been developed and the accurate diagnosis of the causes of SCD is now of particular importance. Pathologists are responsible for determining the precise cause and mechanism of sudden death but there is still considerable variation in the way in which they approach this increasingly complex task. The Association for European Cardiovascular Pathology has developed these guidelines, which represent the minimum standard that is required in the routine autopsy practice for the adequate investigation of SCD. The present version is an update of our original article, published 10 years ago. This is necessary because of our increased understanding of the genetics of cardiovascular diseases, the availability of new diagnostic methods, and the experience we have gained from the routine use of the original guidelines. The updated guidelines include a detailed protocol for the examination of the heart and recommendations for the selection of histological blocks and appropriate material for toxicology, microbiology, biochemistry, and molecular investigation. Our recommendations apply to university medical centers, regionals hospitals, and all healthcare professionals practicing pathology and forensic medicine. We believe that their adoption throughout Europe will improve the standards of autopsy practice, allow meaningful comparisons between different communities and regions, and permit the identification of emerging patterns of diseases causing SCD. Finally, we recommend the development of regional multidisciplinary networks of cardiologists, geneticists, and pathologists. Their role will be to facilitate the identification of index cases with a genetic basis, to screen appropriate family members, and ensure that appropriate preventive strategies are implemented.

http://ift.tt/2jdosAX

Status of Otorhinolaryngology as Specialty of Choice Among Female Medical Graduates

Abstract

Specialty choices among medical graduates have undergone changes over time. We aimed to analyze status of otorhinolaryngology as specialty of choice among female medical graduates and factors affecting it. A total of 123 female medical graduates were surveyed during their internship over a period of 1 year in a tertiary-care hospital. Each intern was assessed using a questionnaire at the end of otorhinolaryngology rotation. The survey included nine questions about future career choices with special focus on ENT as a choice for specialization. Questions on choice of specialty, reason for choice, quality of undergraduate teaching and clinical postings were included. The post graduation specialty choices in descending order are Medicine, Pediatrics, Surgery, Obstetrics and Gynecology, Dermatology, Ophthalmology, Radiology, ENT, Anesthesia, Psychiatry followed by Physiology, Anatomy and Biochemistry. Among surgical branches most popular choice was General Surgery followed by Obstetrics and Gynecology, Ophthalmology, ENT and Orthopedics in descending order. Reason for the choice included advice from family and friends. Forty two interns (34.2%) followed advice of senior colleagues, 42 (34.2%) followed advice of relatives in the medical field, 25 (20.3%) took advice of non-medico parents while 14 (11.3%) followed their peer group. Regarding the opinion on the quality of undergraduate teaching and clinical postings, both were rated good by the majority. Otorhinolaryngology is less preferred than other general surgery, Obstetrics and Gynecology and ophthalmology by female medical graduates among surgical disciplines. Possible reasons and ways to improve status of Otorhinolaryngology are discussed.

http://ift.tt/2xl9nUj

Status of Otorhinolaryngology as Specialty of Choice Among Female Medical Graduates

Abstract

Specialty choices among medical graduates have undergone changes over time. We aimed to analyze status of otorhinolaryngology as specialty of choice among female medical graduates and factors affecting it. A total of 123 female medical graduates were surveyed during their internship over a period of 1 year in a tertiary-care hospital. Each intern was assessed using a questionnaire at the end of otorhinolaryngology rotation. The survey included nine questions about future career choices with special focus on ENT as a choice for specialization. Questions on choice of specialty, reason for choice, quality of undergraduate teaching and clinical postings were included. The post graduation specialty choices in descending order are Medicine, Pediatrics, Surgery, Obstetrics and Gynecology, Dermatology, Ophthalmology, Radiology, ENT, Anesthesia, Psychiatry followed by Physiology, Anatomy and Biochemistry. Among surgical branches most popular choice was General Surgery followed by Obstetrics and Gynecology, Ophthalmology, ENT and Orthopedics in descending order. Reason for the choice included advice from family and friends. Forty two interns (34.2%) followed advice of senior colleagues, 42 (34.2%) followed advice of relatives in the medical field, 25 (20.3%) took advice of non-medico parents while 14 (11.3%) followed their peer group. Regarding the opinion on the quality of undergraduate teaching and clinical postings, both were rated good by the majority. Otorhinolaryngology is less preferred than other general surgery, Obstetrics and Gynecology and ophthalmology by female medical graduates among surgical disciplines. Possible reasons and ways to improve status of Otorhinolaryngology are discussed.

http://ift.tt/2xl9nUj

Mutilating Lesions of Face

Abstract

The destructive lesions affect midline facial areas causing extensive destruction. These lesions are challenging till date due to peculiarity in presentation and non availability of any single objective test. An attempt has been done to evaluate these different clinical presentations of lesions presenting at a single centre and the challenges faced by us at a tertiary government setup. Prospective study done on 15 patients presenting in department during period of 2006–2016. After a detailed history, hematological and biochemical markers, ESR, radiographical tests, pus culture, C ANCA, CECT PNS and histopathogical evaluation were done. 12 out of 15 patients were male; Most common age group was above 45 years of age. All cases had ulceration of nose, 9 had cartilaginous destruction and 3 had osseocartilaginous destruction. 5 cases of mucormycosis had hyperglycemia with 2 having ketonuria and 4 had nerve palsies. All patients needed multiple biopsies. 3 cases of wegners and 4 cases were suspected of IMDD and immunohistochemistry was advised. C ANCA was negative in wegners cases as they were in limited form. Mutilating diseases of face usually present at an advanced stage with diverse etiology, are slowly progressive and require detailed evaluation. Due to lack of availability of IHC markers and C-ANCA at every centre it is difficult to diagnose them. The treatment is challenging due to incomplete response and frequent relapses. These cases require proper work up plan and perseverance leads to a final diagnosis.

http://ift.tt/2wgubap

Mutilating Lesions of Face

Abstract

The destructive lesions affect midline facial areas causing extensive destruction. These lesions are challenging till date due to peculiarity in presentation and non availability of any single objective test. An attempt has been done to evaluate these different clinical presentations of lesions presenting at a single centre and the challenges faced by us at a tertiary government setup. Prospective study done on 15 patients presenting in department during period of 2006–2016. After a detailed history, hematological and biochemical markers, ESR, radiographical tests, pus culture, C ANCA, CECT PNS and histopathogical evaluation were done. 12 out of 15 patients were male; Most common age group was above 45 years of age. All cases had ulceration of nose, 9 had cartilaginous destruction and 3 had osseocartilaginous destruction. 5 cases of mucormycosis had hyperglycemia with 2 having ketonuria and 4 had nerve palsies. All patients needed multiple biopsies. 3 cases of wegners and 4 cases were suspected of IMDD and immunohistochemistry was advised. C ANCA was negative in wegners cases as they were in limited form. Mutilating diseases of face usually present at an advanced stage with diverse etiology, are slowly progressive and require detailed evaluation. Due to lack of availability of IHC markers and C-ANCA at every centre it is difficult to diagnose them. The treatment is challenging due to incomplete response and frequent relapses. These cases require proper work up plan and perseverance leads to a final diagnosis.

http://ift.tt/2wgubap

Patient-oriented toxicity endpoints after head and neck reirradiation with intensity modulated radiation therapy

Publication date: October 2017
Source:Oral Oncology, Volume 73
Author(s): Danielle N. Margalit, Jonathan D. Schoenfeld, Bhupendra Rawal, Robert I. Haddad, Paul J. Catalano, Laura A. Goguen, Nicole G. Chau, Guilherme Rabinowits, Jochen H. Lorch, Donald J. Annino, Roy B. Tishler
ObjectivesTo characterize specific serious toxicities of reRT with intensity modulated radiation therapy (IMRT) for squamous cell carcinoma of the head and neck (SCCHN) and identify treatment-related predictors of toxicity for patient counseling and decision-making.Materials/Methods75 consecutive patients with recurrent or 2nd primary SCCHN received reRT from 8/2004-02/2013. All patients had prior definitive or postoperative RT. Objective endpoints of "serious toxicity" were defined as: hospitalization during reRT, tracheotomy after reRT, hemorrhage, soft tissue complication requiring operative intervention, or other CTCAE grade ≥4 toxicity.ResultsPatients received definitive (n=41,55%) or postoperative (n=34,45%) reRT (median dose 60Gy, range 59.4–70Gy). Most patients (88%) had concurrent chemotherapy. With a median follow-up of 1.4years, 39 (52%) patients had at least one serious toxicity: hospitalization during reRT (24%), surgically-managed soft tissue complication (19%), and/or urgent tracheotomy (18%). There were no grade 5 acute toxicities but there were 4 fatal hemorrhages (median 8.3months) including 2 attributed to local-regional recurrence (LRR). Most patients (69%) had a percutaneous endoscopic gastrostomy (PEG) tube at last follow-up; those with a LRR had higher PEG tube-dependence rates (86% vs. 53%, p=0.001). LRR, site of reRT, and laryngeal RT dose, were marginally associated with toxicity-risk.ConclusionsPatients considering reRT should be counseled on the high rate of PEG tube-dependence, and events of urgent tracheotomy, hospitalization, hemorrhage, and operative intervention, which typically occur months after reRT completion. Further study of baseline patient function and cumulative radiation dose to the larynx and other organs-at-risk may improve estimates of serious toxicity-risk after reRT.



http://ift.tt/2eUK7N3

Beyond availability: the importance of routine videolaryngoscopy and institution-based rescue methods of difficult videolaryngoscopy

Editor—We appreciate the fabulous work of Cook and Kelly on the national survey of videolaryngoscopy (VL) in the UK.¹ According to the Difficult Airway Society's 2015 guidelines² videolaryngoscopes should be immediately available at all times and all anaesthetists should be trained and skilled in their use. We are glad to see the main finding that VL is available in >90% of UK hospital, though only one in seven hospitals have VL available in all relevant clinical areas. Beyond the availability of videolaryngoscopes, whether to be skilled in VL remains an important issue.

http://ift.tt/2wfZylu

Lack of benefit of near-infrared spectroscopy monitoring for improving patient outcomes. Case closed?

Near-infrared spectroscopy (NIRS) monitoring of regional cerebral oxygen saturation (rSco2) during cardiac surgery has been available to clinicians for more than three decades.¹² This monitoring is attractive because it is non-invasive, requires minimal user technical expertise, provides an intuitively important end point (oxygenation of the superficial cerebral cortex), and has a continuous output. As a result of these features, NIRS monitoring overcomes many of the limitations of existing monitors for judging adequacy of cerebral perfusion during surgery [(particularly, throughout cardiopulmonary bypass (CPB)], such as electroencephalography, transcranial Doppler monitoring, and jugular bulb venous oxygen saturation. Early reports showing the value of bilateral rSco2 monitoring for early detection of CPB oxygenator malfunction, arterial or venous cannula malposition, and occult aortic dissection, in addition to utility during aortic arch surgery, fuelled enthusiasm for its adoption in cardiac surgery.² This enthusiasm was broadened with publication of non-randomized, observational studies showing a link between reduction from baseline rSco2 (i.e. 'desaturations') during CPB and a variety of neurological end points, including postoperative cognition dysfunction (POCD) and stroke.² Interpretation of these data, however, are confounded by many methodological limitations.

http://ift.tt/2wPI3M7

Response to: Go/no-go decision in anaesthesia: wide variation in risk tolerance amongst anaesthetists

Editor—The work by Greig and colleagues¹ brings to light conflicting organizational and management practices for the operating theatre. A majority of the confusion and tension in this high-pressure environment can be traced back to the fundamental misunderstanding of high-reliability organizations (HRO) and ultra-safe systems (USS). In fact, the authors state that "health care providers aspire to become high-reliability organizations, but this practice contrasts with existing high-reliability organizations, such as aviation, where decision-making aids and standardized operating procedures are widely used."¹ However, the aviation industry is predominantly an ultra-safe system, not a high-reliability organization.

http://ift.tt/2wgLGr1

Can predicting transfusion in cardiac surgery help patients?

In this issue of the British Journal of Anaesthesia, Klein and colleagues¹ describe the ACTA-PORT, a new score for predicting the risk of one or more red blood cell transfusions in patients undergoing cardiac surgery. The authors' desire to provide a simple, accurate tool to help predict the risk of transfusion in patients undergoing cardiac surgery is commendable, but does it help our patients?

http://ift.tt/2wgh1tP

Influence of deep neuromuscular block on the surgeonś assessment of surgical conditions during laparotomy: a randomized controlled double blinded trial with rocuronium and sugammadex

Abstract

Background. During laparotomy, surgeons may experience difficult surgical conditions if the patient's abdominal wall or diaphragm is tense. Deep neuromuscular block (NMB), defined as a post-tetanic-count (PTC) between 0-1, paralyses the abdominal wall muscles and the diaphragm. We hypothesized that deep NMB (PTC 0-1) would improve subjective ratings of surgical conditions during upper laparotomy as compared with standard NMB.Methods. This was a double blinded, randomized study. A total of 128 patients undergoing elective upper laparotomy were randomized to either continuous deep NMB (infusion of rocuronium 2 mg ml⁻¹) or standard NMB (bolus of rocuronium 10 mg or increased depth of anaesthesia). Surgical conditions were evaluated using a 5-point subjective rating scale (1: extremely poor, 5: optimal) every 30 min. Primary outcome was the average of scores for a patient's surgical conditions. Other outcomes were surgical rating score during fascial closure, episodes of a need to optimize surgical conditions, occurrence of wound dehiscence, and wound infection.Results. Deep compared with standard NMB resulted in better ratings of surgical conditions; median 4.75 (range 3–5) compared with 4.00 (range 1–5) (P<0.001), respectively. Deep compared with standard NMB resulted in better ratings of surgical conditions during fascial closure (P<0.001), fewer episodes of need to optimize surgical conditions (P<0.001), and fewer incidents with sudden movements (P<0.001). No differences in operating time, occurrence of wound infection, and wound dehiscence were found.Conclusions. Deep NMB compared with standard NMB resulted in better subjective ratings of surgical conditions during laparotomy.Clinical trial registration: NCT02140593.

http://ift.tt/2wQrFev

Viscoelastometric testing, fibrinogen and transfusion during post-partum haemorrhage

Editor—Many readers will recognize the pleasure of a new pair of glasses (Fig. 1). They are perfectly tailored to our own visual defect, and wearing them gives one a feeling of clarity and brightness that is comparable with opening the curtains after a good night's sleep. In an era of evidence-based medicine, should we question the evidence base for eyeglasses? Might this be unnecessary when there is a palpable association between a specific intervention and an intended outcome such that we are easily convinced of the causal nature of that association? There will certainly be an effect of using viscoelastometric testing on plasma transfusion if practice changes from giving plasma 'blindly' to giving plasma based on the coagulation testing. The real question is whether this change in practice will lead to better outcomes. In this issue of the BritishJournalof Anaesthesia, Collins and colleagues¹² provide new information on monitoring and managing haemostasis in patients with post-partum haemorrhage.

http://ift.tt/2wgh1dj

Videolaryngoscopy and obstetric anaesthesia

Editor—We congratulate Professor Cook and Dr Kelly on their important national survey of videolaryngoscopy in the UK.¹ They highlighted that while videolaryngoscopes (VLs) are widely available in main operating theatres, availability in other areas where tracheal intubation is undertaken is much lower, being around only 50% of intensive care units and obstetric theatres. We would suggest that this figure is a particular concern to obstetric anaesthesia, where the risk of failed intubation is greater than the general population. In 2011, we conducted a national Obstetric Anaesthetists' Association approved survey of the availability of VLs in UK obstetric units. This survey (response rate 72%) found that only 42% of obstetric units had a dedicated VL with widespread variation in the type of device available.²

http://ift.tt/2wgrPYY

Theseus, the Labyrinth, and the Minotaur of anaesthetic-induced developmental neurotoxicity

When Theseus set sail to slay the mighty Minotaur, he likely spared a thought for the difficulty in navigating the Labyrinth that surrounded his foe. The search for therapies for anaesthetic-induced developmental neurotoxicity shares a similar mythical context. In our version of these events, Prince Theseus is the cure (potentially played by dexmedetomidine), the Minotaur is sevoflurane-induced neurotoxicity and the Labyrinth (a maze of confounding factors) is represented by physiological aberrations. In this issue of the British Journal of Anaesthesia, two reports¹² appear to arrive at contradictory conclusions regarding the success of dexmedetomidine in combating sevoflurane-induced developmental neurotoxicity in neonatal rat pups. The two research teams are to be congratulated for reporting the results in a manner that enables the reader to appreciate the entire gamut from protection against organ toxicity to toxicity to the entire organism because of the clarity and detail in their reports. However, the physiological derangements observed in these studies, and their contradictory findings, lead to labyrinthine interpretation. Readers should also refer to the accompanying editorial on the same studies by Vutskits and Sall³ when considering these issues.

http://ift.tt/2wQl0kq

In the September BJA…

This issue of the BJA contains a special section on anaesthetic neurotoxicity and neuroplasticity following a call for papers associated with the Second BJA Seminar on Neurotoxicity and Neuroplasticity held in June 2016 at Churchill House in London. The main issue includes a number of articles relevant to bleeding, transfusion and coagulation in cardiac surgery, postpartum haemorrhage, and liver transplantation, as well as important contributions on airway management.

http://ift.tt/2wQCTjg

Anaesthesia-induced developmental neurotoxicity: reality or fiction?

As animal evidence continues to mount, we face a real dilemma regarding the clinical relevance of anaesthesia-induced developmental neurotoxicity. In December 2016, the US Food and Drug Administration (FDA) issued an announcement stating that commonly used general anaesthetics could potentially be detrimental to very young and rapidly developing brains. This announcement was based on an extensive body of animal research.^1–24 Now we must grapple with the FDA's official recommendation that potential risks should be balanced with the benefits of appropriate anaesthesia in young children. More importantly, as we deal with the official expectation that potential risks should be discussed with families and heath-care providers, we are reminded how crucial it is to deepen our understanding of the pertinent mechanisms and potential long-lasting behavioural outcomes relating to the exposure of the young brain to anaesthesia.

http://ift.tt/2wgvAhi

Effects of propofol and surgery on neuropathology and cognition in the 3xTgAD Alzheimer transgenic mouse model

Abstract

Background. Previous work suggests that anaesthesia and surgery amplify the pathology and cognitive impairment of animals made vulnerable via age or specific transgenes. We hypothesized that surgery under propofol anaesthesia, a widely used i.v. general anaesthetic, has minimal delayed cognitive and neuroinflammatory sequelae in a vulnerable mouse transgenic model.Methods. We conducted caecal ligation and excision surgery in cognitively presymptomatic (11-month-old) 3xTgAD mice under i.p. propofol anaesthesia. Age-matched 3xTgAD control mice received vehicle or propofol without surgery. Morris water maze testing was conducted 3 and 15 weeks later. Brains were examined with quantitative immunohistochemistry for amyloid β plaques, tau pathology, and microglial activation. Acute changes in neuroinflammatory cytokines were assessed in separate cohorts at 6 h.Results. We detected no significant differences between groups in escape latencies at either 3 or 15 weeks, but detected a significant effect of surgery in the probe test at both 3 and 15 weeks. Spatial working memory was unaffected at 16 weeks in any group. No effects of either propofol alone or propofol with surgery were detected on plaque formation, tau aggregates, or neuroinflammation. Acute biochemical assays detected no effects in brain interleukin-10 or interleukin-6 concentrations.Conclusions. Surgery in a vulnerable transgenic mouse under propofol anaesthesia was associated with minimal to no changes in short- and long-term behaviour and no changes in neuropathology. This suggests that propofol anaesthesia is associated with better cognitive outcomes in the aged, vulnerable brain compared with inhalation anaesthesia.

http://ift.tt/2wgKfZG

Perioperative goal-directed therapy with uncalibrated pulse contour methods: impact on fluid management and postoperative outcome

Editor—The conclusions of the very recent meta-analysis by Michard and colleagues¹ in the British Journal of Anaesthesia is that the use of perioperative goal-directed therapy (GDT) with uncalibrated pulse contour (uPC) techniques is associated with a decrease in postoperative morbidity, but not associated with an increase in total fluid administration. An accompanying editorial has analysed in detail some methodological issues related to this and other systematic reviews, but has not challenged its conclusions.² In fact, the editorial expanded these conclusions claiming that this systematic review provides us with the best currently available evidence on this topic. Although these conclusions seem logical, and may even be true, a more careful examination of this meta-analysis leads me to believe that its conclusions should be very different.

http://ift.tt/2wQtIzm

Causes of sudden death of young anesthesiologists in China Response to Zhang and colleagues: Rising sudden death among anaethesiologists in China.

Editor—We read with great interest the survey results of Chinese anaesthesiologists by Zhang and colleagues.¹ The authors claimed that anaesthesiologists in China are currently suffering from work overload, and sudden death is increasing dramatically. More than 10 anaesthesiologists aged 30–45 yr had a cardiac arrest as a result of a heavy workload in China from 2013 to 2014.² The cause of death attributed to cardiac arrest is overly inclusive as one can make the argument that all demise can be eventually attributed to cardiopulmonary arrest. The causal relationship between relative 'work overload' and sudden death is lacking in pathophysiological explanation.

http://ift.tt/2wgLY13

Response to: Routine use of viscoelastic blood tests for diagnosis and treatment of coagulopathic bleeding in cardiac surgery: updated systematic review and meta-analysis

Editor—With great interest we read the systematic review and meta-analysis on the routine use of viscoelastic haemostatic assays (VHA) for diagnosis and treatment of coagulopathic bleeding in cardiac surgery published by Serraino and Murphy.¹ Significant reductions in red blood cell transfusion requirements by the use of VHA have been confirmed by previous Cochrane reviews.²³ Reducing the exposure to allogeneic blood products is a clear perioperative management goal improving patient outcome and recommended by evidence-based bleeding guidelines.⁴ Moreover, Serraino and Murphy report significant reductions in platelet transfusion and plasma transfusion (RR 0.78, 95% CI 0.66–0.93; P=0.004), which is also clinically highly relevant considering specific transfusion-associated risks. Most importantly, the authors also report a significant reduction in acute renal failure (RR 0.42, 95% CI 0.20–0.86; P=0.02). Causality cannot be identified by meta-analyses, but acute renal failure has been shown to be associated with a significant increase in long-term mortality in cardiac and noncardiac surgery.^5–8

http://ift.tt/2wQrCPR

Reply to Lucas and Vaughan: videolaryngoscopy and obstetric anaesthesia?

Editor—We thank Lucas and Vaughan for their comments on our paper.¹ Their survey correlates with our survey in 2015² in finding that approximately half of UK obstetric units have a dedicated videolaryngoscope (VL): 42% in the survey of Noblet and colleagues in 2011³ and 55% in our survey in 2013.² A survey by Hales and colleagues, also in 2014, reported that 90% of UK obstetric units have a VL, but this has yet to be published in full.⁴

http://ift.tt/2wQu7Sl

Optimal patient blood management in cardiac surgery using viscoelastic point-of-care testing Response to: Routine use of viscoelastic blood tests for diagnosis and treatment of coagulopathic bleeding in cardiac surgery: updated systematic review and meta-analysis

Editor—We read with interest the study of Serraino and Murphy¹ on routine use of point-of-care (POC) testing for diagnosis and treatment of coagulopathy in cardiac surgery patients. During cardiac surgery major blood loss is common. There is general agreement that less bleeding and optimal patient blood management are essential determinants of postoperative outcome.² The conclusion of Serraino and Murphy that POC viscoelastic testing lacks clinical effectiveness is an important negative finding, but should not disparage the significance of efficiently reducing the rate of unnecessary transfusions.

http://ift.tt/2wg9wTV

Reply to Chang: After availability, training and experience are needed

Editor—We thank Dr Chang for his kind comments.¹ It is becoming increasingly common for videolaryngoscopy to be included in guidelines for the management of difficulty during intubation, and the evidence supports this.²³ With this in mind it is a concern that one of the findings of our survey was that, although videolaryngoscopy is available in the vast majority of hospitals, it generally appears to be much less available in areas where intubation fails more frequently (obstetrics, intensive care, emergency department). We hope that this has been addressed since the time the survey was completed, but if this is not the case then we hope that the guidelines and other literature, such as our survey, may stimulate change.

http://ift.tt/2wQtKY0

Safety assessments in the avoidance of preoperative α-receptor blockade in phaeochromocytoma surgery: the pitfalls of a zero numerator

Editor—The recent observational case series reported by Groeben and colleagues¹ addressing the avoidance of preoperative α-receptor blockade in patients undergoing phaeochromocytoma surgery clearly challenges conventional thought. Their study showed that the maximal intraoperative blood pressure in non-α-blocked patients was no different than in those having received preoperative phenoxybenzamine or doxazosin therapy (185 mm Hg vs 178 mm Hg, respectively; P=0.25). In addition, there were no major complications reported – notably an absence of myocardial infarction (MI) – making this practice, at least according to the authors, seemingly "safe". Unfortunately, because of the present study's scope (i.e. an eight yr period of patient accrual) and subject matter, it is unlikely that a confirmatory study will ever be undertaken, so we are left having to rely on the authors' conclusions that "phaeochromocytoma surgery without medical pre-treatment is feasible and safe".

http://ift.tt/2wQjeQm

Viscoelastometry guided fresh frozen plasma infusion for postpartum haemorrhage: OBS2, an observational study

Abstract

Background. Postpartum haemorrhage (PPH) can be exacerbated by haemostatic failure. Based on data from trauma studies, empirical infusions of fresh frozen plasma (FFP) are often given during severe PPH if coagulation tests are unavailable. This study observed a cohort of women with moderate/severe PPH in whom FFP infusion was guided by the use of viscoelastometric point-of-care testing (VE-POCT) and clinical assessment.Methods. Women were enrolled into this observational study when blood loss was measured or suspected to be about 1000 mL. If Fibtem A5 determined by Rotem^® thromboelastometry remained >15 mm, or bleeding stopped, FFP was withheld. If Fibtem A5 was ≤15 mm and bleeding ongoing, women were randomized into an interventional study as previously reported. Clinical and laboratory outcomes were recorded.Results. The study recruited 605 women and 98% had FFP withheld. The median (25^th–75^th centile) total blood loss was 1500 (1300–2000) mL with 300 (50–545) mL occurring after enrolment. Total blood loss was >2500 mL in 40/605 (6.6%) women. RBCs were transfused in 141/605 (23.3%) patients and 11 (1.8%) received ≥4 units. At least one invasive procedure was performed in 283/605 (46.8%) women. Level 3 care was required for 10/605 (1.7%) women. No women developed clinically significant haemostatic impairment.Conclusions. Restrictive use of FFP guided by clinical assessment of bleeding and VE-POCT is feasible and did not result in clinically significant haemostatic impairment. Studies should compare the clinical and cost effectiveness of empirical FFP infusions, according to current guidelines, with targeted use of FFP based on VE-POCT.Clinical trial registration: ISRCTN46295339 (http://ift.tt/2uIJ5tt) (accessed July 24, 2017), EudraCT 2012-005511-11 (http://ift.tt/2wgwjip) (accessed July 24, 2017).

http://ift.tt/2wQYjwB

Author’s reply to Grocott: Risk of cardiac ischaemia in patients without α-receptor blockade for phaeochromocytoma surgery

Editor—We thank Prof Grocott for his comments.¹ The author questions whether the incidence of perioperative myocardial infarction in patients with phaeochromocytoma without perioperative α-receptor blockade is truly zero, without taking serial troponin measurements.

http://ift.tt/2wgLBUf

Dentoalveolar Effects of Early Orthodontic Treatment in Patients With Cleft Lip and Palate.

No agreement exists on the most appropriate timing of orthodontic treatment in patients with cleft lip and palate. The aim of this study is to investigate the effect of early orthodontic treatment on development of the dental arches and alveolar bone. A dental casts analysis was performed on 28 children with cleft lip and palate before orthodontic treatment (T0; mean age, 6.5 +/- 1.7) and at the end of active treatment (T1; mean age, 9.2 +/- 2.1 years). The considered variables were: intercanine and intermolar distances; dental arch relationships, evaluated according to the modified Huddart/Bodenham system. The study group was divided into 2 samples according to the age at T0: Group A (age = 6 years). A statistical comparison of the treatment effects between the 2 samples was performed. Patients in Group A exhibited a greater increase of intercanine distance (8 mm versus 2.7 mm; P

http://ift.tt/2eNfhC4

Large-Scale Study of Long-Term Anteroposterior Stability in a Surgery-First Orthognathic Approach Without Presurgical Orthodontic Treatment.

Presurgical orthodontic treatment has long been known as a prerequisite in the traditional orthognathic approach. However, achieving ideal decompensation is very difficult even in the presurgical orthodontic period. For minimization of this problem, the surgery-first orthognathic concept has been introduced. The authors hypothesized that this treatment modality will be feasible for skeletal class III dentofacial deformity patients. In this study, the authors tried to compare the traditional and surgery-first approaches regarding long-term outcomes in terms of stability, based on large-scale data. The patients included in this study had skeletal class III dentofacial deformities, and all underwent, and completed, orthognathic surgery between December 2007 and December 2015. The inclusion criteria were based on presurgical simulation on the dental model, and the authors predicted the potential of the surgery-first approach by this preoperative simulation model. Patients with cleft-related syndromes, those who underwent orthognathic surgeries due to facial asymmetry or class II deformity were excluded from the study. In total, 104 class III patients were enrolled in the surgery-first group and 51 class III patients in the traditional orthodontic-first group. Satisfactory results were achieved in all 155 patients with dentofacial deformity in this study. Overall, the analysis revealed that anteroposterior skeletal long-term stability in the surgery-first approach was not different, statistically or otherwise, from that in the orthodontic-first approach. Anteroposterior skeletal stability was maintained well in the surgery-first approach. In conclusion, surgery-first approach without presurgical orthodontic treatment can achieve similar results of long-term anteroposterior stability in correcting dentofacial deformities as the orthodontic treatment-first approach. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2xcTT3F

Examination of Nasolacrimal Duct Morphometry Using Cone Beam Computed Tomography in Patients With Unilateral Cleft Lip/Palate.

Objective: The cleft lip/palate (CLP) deformity negatively affects the anatomy of the nasal cavity and maxilla. The effects of this deformity on the lacrimal system have been unidentified yet. This study aimed to evaluate the morphometric changes in the nasolacrimal duct using cone-beam computed tomography (CBCT) in patients with unilateral CLP. Materials and Methods: Retrospective bilateral measurements of the narrowest transversal diameters and the lengths of the nasolacrimal ducts were made for the affected and unaffected sides of 28 patients with CLP and 28 control patients, using the CBCT images. The measurements were statistically compared. Results: The mean narrowest transversal diameter of the nasolacrimal duct for the affected side of the patients with unilateral CLP was statistically significantly narrower than the unaffected side (P = 0.01). There were no statistically significant differences between the control group and the affected and unaffected sides of patient group with unilateral CLP regarding the nasolacrimal duct diameter. The differences were not statistically significant among all groups regarding the mean nasolacrimal duct length. Conclusion: The diameter of the nasolacrimal duct at the affected side of unilateral CLP was narrower than the unaffected side. According to this result, the CLP deformity can have an effect on the nasolacrimal duct diameter. However, CLP might not affect the nasolacrimal duct length. (C) 2017 by Mutaz B. Habal, MD.

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Simultaneous Reconstruction of Both Facial Paralysis and Temporomandibular Joint Ankylosis With a Composite Flap From Dorsum of Foot.

Free extensor digitorum brevis muscle flap in facial paralysis, and the second metatarsophalangeal joint flap is used at the temporomandibular joint reconstruction for a long time. Anatomically, these flaps can be harvested through even the same pedicle flap even on the same regions. Literature is available of their usage along with the use of hand and upper extremity reconstruction. Unlike this example, the authors have used these flaps in maxillofacial region where facial paralysis and temporomandibular joint reconstruction will be performed together. In this study, clinical report and surgical details of this flap have been shared. (C) 2017 by Mutaz B. Habal, MD.

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Vascular Anomalies of Posterior Fossa and Their Implications.

Posterior fossa houses very vital and sensitive structures namely midbrain, pons, medulla, and cerebellum. These structures are irrigated by vertebral, posterior inferior cerebellar, anterior inferior cerebellar, and superior cerebellar arteries. Parts of brain located in posterior fossa control important parts of body so any variation pertaining to stenosis, atresia, hypoplasia, fenestration, agenesis, and duplication in the arteries supplying these parts alter the irrigation pattern culminating into various morbid and mortal neurologic disorders. Therefore, a sound understanding and thorough knowledge of posterior circulation vascular variant anatomy builds the foundation for the accurate diagnosis and appropriate management of neurovascular ischemic and hemorrhagic diseases of posterior fossa. To aid in addressing these complex neurologic disorders and neurosurgical treatment to be carried out successfully, updating and consolidating the knowledge of all the variations/insults of these arteries becomes essential. Therefore, review study has been carried out. Literature search was carried out using databases, including Scielo, Scopmed, Medline, PubMed, and Wiley online library. Papers containing original data were selected and secondary references retrieved from bibliographies. Search terms used were posterior fossa, anomalies of vertebral, posterior inferior cerebellar, anterior inferior cerebellar, and superior cerebellar arteries. The study will be of paramount importance to angiographers in interpreting angiographs, neurologists in diagnosis and treatment of neurologic disorders, and neurosurgeons in performing surgery in posterior fossa and craniovertebral region particularly dealing with tumors and vascular malformations. (C) 2017 by Mutaz B. Habal, MD.

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Maxillary Hypoplasia: Differential Diagnosis of Nasal Obstruction in Infants.

Maxillary hypoplasia (MH) is a rare cause of respiratory dysfunction in infants and may occur in association with genetic abnormalities or as an isolated condition. It is included in the differential diagnosis of congenital nasal obstruction. This paper seeks to report a case series of infants with MH, discuss methods for its diagnosis, and compare computed tomography (CT) measurements of nasal cavities of infants with MH and without craniomaxillofacial abnormalities. The therapeutic approach in each patient is also described. All infants with MH admitted to a tertiary hospital between 2012 and 2015 were included. Baseline nasal endoscopy was performed at bedside. The width of the infants' nasal cavities was measured by a radiologist with experience in CT scanning of facial bones. Control patients were infants of matched sex and similar age who underwent head CT scanning for various reasons. Overall, 8 infants with MH and 8 controls were assessed. All nasal cavity dimensions of infants with MH were significantly smaller than those of control subjects. The authors conclude that the diagnosis of MH should be considered in infants with nasal obstruction and nasal cavity narrowing at nasal endoscopy. (C) 2017 by Mutaz B. Habal, MD.

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Does a Premaxillary Setback and Lip Adhesion Have a Negative Impact on Lip Outcome in Bilateral Cleft Patients?.

Background: The early premaxillary setback and lip adhesion remains as a controversial maneuver in the treatment of bilateral cleft lip and palate patients. This study aimed to assess extent of preoperative deformity and lip outcomes during the first year after surgery in bilateral cleft patients who underwent premaxillary setback and lip adhesion and to compare to those with primary lip repair. Methods: A retrospective observational study was conducted of 16 nonsyndromic consecutive bilateral complete cleft lip patients (with and without Simonart band), who underwent primary cleft lip repair. Patients were allocated in group 1 without premaxillary setback and group 2 with premaxillary setback and lip adhesion. Preoperative and postoperative linear measurements were used for intergroup and intragroup comparisons. Results: Cutaneous lip height of patients in group 2 significantly (P 0.05) differences in intragroup 1 comparisons, and in intergroup comparisons. Conclusion: Bilateral cleft patients with a protruded and deviated premaxilla over 10 mm discrepancy of the lateral maxillary achieved noninferior lip symmetry 1 year postoperatively compared with patients with less severe original deformity. (C) 2017 by Mutaz B. Habal, MD.

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Use of a Balloon Catheter With Intraoperative C-Arm Fluoroscan for Reduction of Zygomatic Arch Fractures.

Background and Objectives: The purpose of this study was to evaluate the usefulness of C-arm fluoroscan with a balloon catheter in patients undergoing closed reduction of zygomatic arch fractures. Subjects and Methods: All patients who had zygomatic arch reduction surgery between 2006 and 2015 were identified and classified into 2 groups. Group A included those patients who underwent closed reduction of zygomatic arch fractures. Group B included those who underwent zygomatic arch reduction surgery with a C-arm fluoroscan and supporting balloon. A balloon catheter was used to stabilize the zygomatic bone after reduction. Results were scored from 1 (poor) to 3 (good) to assess surgical outcomes based on 3 criteria: alignment of the zygomatic arch on a postoperative computed tomography scan, facial asymmetry in photography, and the patient's subjective satisfaction. Results: The authors enrolled 32 patients with zygomatic arch fractures. 18 patients underwent closed reduction for zygomatic arch fractures (group A), while 14 patients underwent closed reduction with C-arm fluoroscan and balloon support (group B). The average score for group A was 2.00 for alignment, 2.56 for facial asymmetry, and 2.67 for subjective satisfaction compared with 2.64 for alignment, 2.86 for facial asymmetry, and 2.79 for subjective satisfaction in group B. There were statistically significant differences in the alignment and facial asymmetry scores between the 2 groups. Conclusion: The authors suggest that C-arm fluoroscan with balloon support is a useful modality for reduction of zygomatic arch fractures that provides better surgical outcomes than conventional closed reduction surgery. (C) 2017 by Mutaz B. Habal, MD.

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Postoperative Changes After Closed Reduction of Nasal Fracture.

Nasal bone fracture is the most common facial fracture; however, surgery does not guarantee reduction and complications, such as undercorrection, overcorrection, and deviation, may occur. By analyzing findings of computed tomography (CT) immediately and at 3 months postoperatively, we evaluated the accuracy of reduction and long-term changes to the nasal bone. Patients with pure nasal bone fracture were evaluated from January 1, 2010 to December 31, 2011. First, we categorized fracture types according to the Stranc-Robertson classification system, using preoperative CT findings (ie, F1, F2, L1, and L2). We categorized each result of reduction by immediate postoperative CT scan findings as "Excellent," "Good," "Fair," and "Poor," with "Excellent" and "Good" ratings being considered a "Success." We evaluated changes to the nasal bone at 3 months after reduction, using the same grade. A total of 128 patients were analyzed. The results of patients in the F1 group were better than those of other patients immediately postoperatively, whereas those of the L2 group were worse. The overall success rate was 49.2% (58/118). At 3 months postoperatively, 33 cases exhibited an improvement to a higher grade, whereas 25 cases improved from an unacceptable outcome to a successful outcome, with the overall success rate being 70.3% (83/118). Immediately postoperative CT scans can be helpful for surgeons in determining whether a secondary adjustment is necessary. Incompletely reduced nasal bone showed spontaneous improvement in bony arrangement according to our study, so simple observation could be a choice. (C) 2017 by Mutaz B. Habal, MD.

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Nasal Deviation in Patients With Asymmetric Mandibular Prognathism.

Purpose: This study was aimed to evaluate the nasal deviation in patients with asymmetric mandibular prognathism. Materials and Methods: Thirty-five patients with skeletal class III malocclusion were included in the study. Significant mandibular asymmetry of >4 mm menton deviation in three-dimensional (3D) reformatted cone beam computed tomography images was defined as asymmetry group (n = 20). Patients without mandibular asymmetry served as control group (n = 15). The mandibular asymmetry was evaluated pre- and postoperatively. Results: Nasal tip was significantly shifted to the deviated side of the mandible (short side) in the asymmetry group, as compared to the control group (1.5 +/- 0.9 degree, P

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The Effectiveness of Oxidized Regenerated Cellulose as a Graft Material in Transalveolar Osteotome Sinus Lift Procedure.

The posterior maxilla is challenged with postextraction alveolar bone resorption and pneumatization drive of the Schneiderian membrane that reduces the subantral distance. To overcome such anatomic obstacle a sinus augmentation procedure was introduced either via lateral or crestal approach depending on residual ridge height. The current study evaluated oxidized regenerated cellulose (ORC) as a grafting material versus osteon II by measuring bone gain and graft density, 24 weeks postoperatively. Twenty consecutive patients (24 cases) aged from 20 to 65 years were considered eligible after clinical and radiographic evaluation. These patients were allocated in 2 groups (study and control) that underwent transcrestal osteotome antral membrane balloon elevation and surgical void augmentation with ORC in the study group, while the control group grafted with collagen membrane and osteon II with simultaneous dental implant placement in both groups and were followed up for 1 year. Cone beam computed tomography was taken for all patients preoperatively and postoperatively to verify neoformed bone and density in Hounsfield units (HU). The mean gained height of the bone was 6.48 mm (5.94 mm in the study and 7.02 mm in the control). The mean density of graft above implant apex was 497.99 HU (434.23 HU in the study and 561.75 HU in the control). Apart from Schneider membrane thickening in 2 patients from the control group, there were no serious complications reported throughout the study. These results demonstrate that ORC is a reasonable grafting material with comparable outcomes when compared to osteon II with less postoperative complications. (C) 2017 by Mutaz B. Habal, MD.

http://ift.tt/2eNW2si

A Patient Information Leaflet Reduces Parental Anxiety Before Their Child's First Craniofacial Multidisciplinary Outpatient Appointment.

Introduction: It is expected that a child's first outpatient appointment with a craniofacial multidisciplinary team (MDT) instills anxiety in parents. Limited data exist on the aspects of the appointment that parents are most concerned about and what information they desire. The effect of written information provision on this cohort is unstudied. Methods: Parents attending their child's first outpatient appointment with the Birmingham Children's Hospital Craniofacial MDT between September and December 2012 completed a questionnaire to identify concerns they had relating to the appointment. A patient information leaflet was subsequently developed and distributed. From September 2015 to January 2016, questionnaires completed by parents assessed the usefulness of the leaflet and whether it reduced parental anxiety. Results: Twenty-six initial questionnaires were returned. Seventeen respondents (65%) reported that they were concerned about some aspect of their child's appointment. Twenty-two (86%) expressed a desire for more information surrounding their child's appointment. Thirteen (50%) requested for this information to be provided using a patient information leaflet. After the introduction of the leaflet, 30 questionnaires were returned. All 30 (100.0%) found the leaflet easy to understand. Twenty-nine (96.7%) felt the leaflet provided helpful information. Eighteen (60.0%) felt less worried about the appointment after reading the leaflet. Conclusions: The majority of parents of children referred to a craniofacial MDT appointment displayed concerns that related to the appointment itself. Specific information relating to the appointment process itself was desired. A purpose-built leaflet successfully provided parents with desired information and lowered anxiety among the majority of attendees. (C) 2017 by Mutaz B. Habal, MD.

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Reviews of "The Future of Basic Science in Academic Surgery: Identifying Barriers to Success for Surgeon-Scientists" by Keswani S, Moles CM, Morowitz M, Zeh H, Kuo JS, Levine MH, Cheng LS, Hackam DJ, Ahuja N, Goldestein AM, Basic Science Committee of the Society of University Surgeons in Ann Surg 265:1053-1059, 2017 and "The Extinction of the Surgeon Scientist" by Kibbe MR, Velazquez OC in Ann Surg 265:1060-1061, 2017.

No abstract available

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Sudden hearing loss: an effectivity comparison of intratympanic and systemic steroid treatments

Abstract

Corticosteroid treatment has been considered the most effective treatment modality for sudden sensorineural hearing loss so far. Application route of corticosteroids may vary. We have designed a prospective randomized case-controlled clinical trial to evaluate the effectivenesses of the different application routes of steroids in the treatment of SSHL. Thirty-five patients were distributed randomly to two groups which were treated with either 'oral' or 'intratympanic' corticosteroids. Intratympanic steroid administration was performed three times every other day transtympanically. At the end of third month, recovery rate in the 'intratympanic' group was 84.2%, whereas in the 'oral' group, it was 87.5%. The difference between the recovery rates was not statistically significant. There were no major complications related to transtympanic steroid administration. These findings support that intratympanic steroid therapy is an alternative to systemic steroid therapy in the initial treatment of sudden hearing loss. In addition, transtympanic technique is an easy to perform and safe method for delivering steroids into the inner ear.

http://ift.tt/2eVfZB7

Videoendoscopy worsens swallowing function: a videofluoroscopic study. A randomized controlled trial

Abstract

Aspiration pneumonia is a cause of mortality in the elderly. Evaluating swallowing function is important. Videofluoroscopy and flexible endoscopic evaluation of swallowing are comparable; however, observing all swallowing dynamics is impossible using the latter approach. We examined the significance of flexible endoscopic evaluation of swallowing using videofluoroscopy. Thirty-seven patients with dysphagia [70.0 ± 8.9 (range 49–84) years] were included. In random order, patients underwent videofluoroscopy with 10 cc contrast material, once without, and once with an endoscope inserted. Laryngeal elevation delay time, Penetration–Aspiration Scale score, and Pharyngeal Residue Severity Rating Scale score were evaluated. Laryngeal elevation delay time without or with endoscope insertion was similar (0.35 ± 0.16 s vs. 0.36 ± 0.16 s, P = 0.29). The Penetration–Aspiration Scale (3.59 ± 2.71 vs. 4.41 ± 2.85; P < 0.001) and Pharyngeal Residue Severity Rating Scale (0.97 ± 0.93 vs. 1.46 ± 1.10; P < 0.001) scores differed significantly. The cases that showed no aspiration without endoscope insertion showed greater aspiration with endoscope insertion, and the cases that did not show aspiration with an endoscope inserted also showed no aspiration without an endoscope. Flexible endoscopic insertion resulted in more severe aspiration and residue than non-insertion, as assessed using videofluoroscopy.

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The impact of cumulative dose of cisplatin on outcome of patients with head and neck squamous cell carcinoma

Abstract

Despite the wide use of cisplatin-based concomitant chemoradiotherapy (CCRT) for head and neck squamous cell carcinoma (HNSCC), data on the optimal regimen and cumulative dose are scarce and frequently conflicting. We aimed to evaluate the compliance and the impact of the cumulative dose of cisplatin on overall survival (OS), disease-free survival (DFS), loco-regional control (LRC), and distant-metastasis-free survival (DMFS) in a retrospective study. Between 2008 and 2015, 279 patients with HNSCC scheduled for CCRT (three courses of 3-week 100 mg/m² cisplatin) were identified. Of the whole group, 14% did not receive any cisplatin and 26% received daily cisplatin. In patients planned for three courses (n = 167), 56% received 3, 20% received 2, and 24% received one course. After median follow-up of 31.6 months, the actuarial OS, DFS, LRC, and DMFS rates at 3 years for patients received cumulative dose of ≥200 mg/m² were significantly better compared to those received <200 mg/m²; 74 vs. 51% for OS, 73 vs. 49% for DFS, 80 vs. 58% for LRC (p < 0.001), and 85 vs. 76% for DMFS (p = 0.034). At multivariate analysis, the cumulative cisplatin dose (≥200 vs. <200 mg/m²) was significantly predictive for OS (HR 2.05; 95% CI 1.35–3.13, p = <0.001). Borderline GFR (60–70 mL/min) at baseline predicts compliance for ≥two courses (p = 0.003). In conclusion, considerable proportion of patients did not receive all pre-planned courses of cisplatin. Patients receiving cumulative cisplatin dose ≥200 mg/m² had significantly better outcome than those receiving <200 mg/m² and cumulative dose <200 mg/m² might even be detrimental. These findings increased the bulk of slowly growing evidence on the optimal cumulative dose of cisplatin. Baseline GFR might predict compliance.

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Letter to the Editor regarding “Revision adenoidectomy in children: a population-based cohort study in Taiwan”

http://ift.tt/2gS3vdW

Long-term functional outcomes after resection of tongue cancer: determining the optimal reconstruction method

Abstract

The appropriate tongue reconstruction method is critical for better functional outcomes. The aim of this study was to determine the optimal reconstructive method for restoring postoperative function based on the extent of resection. We retrospectively reviewed 43 patients with lateral oral tongue cancer who underwent glossectomy between January 2010 and October 2014. Tongue mobility, articulation, verbal diadochokinesis, speech intelligibility and swallowing outcomes were assessed 2–3 years postoperative and were analyzed according to resected tongue volume and the method of reconstruction. In partial glossectomy cases, the secondary intention group had better function in tongue mobility, articulation, and speech intelligibility (p < 0.001 for all) than the free flap reconstruction group. In contrast, in hemi-glossectomy cases, the free flap reconstruction group had better tongue mobility, articulation, verbal diadochokinesis and speech intelligibility (p < 0.05 for all) than the secondary intention group. There was no significant difference in swallowing outcome between the secondary intention and flap reconstruction groups in both partial glossectomy and hemi-glossectomy cases. In conclusion, secondary intention appears to be the most appropriate option after partial glossectomy. However, flap reconstruction is necessary to restore tongue volume and function in patients who undergo a resection of more than half of the tongue volume.

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Role of imaging in the follow-up of T2–T3 glottic cancer treated by transoral laser microsurgery

Abstract

An unblinded retrospective analysis of prospectively collected data was carried out on 138 patients affected by glottic pT2 and selected pT3 squamous cell carcinomas (SCC) treated by transoral laser microsurgery (TLM). The entire cohort was divided into two groups: Group A included 78 "high-risk" patients (pT2 with impaired vocal cord mobility, pT3 for anterior paraglottic and/or pre-epiglottic space invasion, presence of angioembolization, perineural spread, and positive lymph nodes in the neck) who underwent postoperative surveillance by endoscopy and imaging (CT or MR), while Group B included 60 "low-risk" patients (pT2 with absence of the above-mentioned features) who underwent endoscopic follow-up alone. Aim of the present study was to assess the diagnostic gain in performing combined endoscopic and radiologic surveillance in the "high-risk" group compared to endoscopy alone in the "low-risk" one. There was no significant difference in terms of overall and disease-specific survivals between the two follow-up policies in spite of their different risk profiles. The same was true for organ preservation rate, which was 81% in the "high-risk" and 89% in the "low-risk" group. In contrast, the cumulative probability of disease-free survival was 54% for Group A and 65% for Group B (p = 0.0023). Therefore, our combined endoscopy and imaging surveillance protocol allowed increasing the submucosal recurrence detection rate in "high-risk" pT2–pT3 glottic SCC to 43%. An earlier detection of submucosal recurrences made salvage surgery by TLM feasible in at least half of cases, thus closing the gap between oncologic outcomes obtained in "high-"- vs. "low-risk" patients and leading to organ preservation rates that are favorably comparable to those obtained with open-neck partial laryngectomies and non-surgical organ preservation protocols.

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In response to Letter regarding “Revision adenoidectomy in children: a population-based cohort study in Taiwan”

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Hybrid cochlear implantation: quality of life, quality of hearing, and working performance compared to patients with conventional unilateral or bilateral cochlear implantation

Abstract

The objective of the present study is to evaluate the effect of hybrid cochlear implantation (hCI) on quality of life (QoL), quality of hearing (QoH), and working performance in adult patients, and to compare the long-term results of patients with hCI to those of patients with conventional unilateral cochlear implantation (CI), bilateral CI, and single-sided deafness (SSD) with CI. Sound localization accuracy and speech-in-noise test were also compared between these groups. Eight patients with high-frequency sensorineural hearing loss of unknown etiology were selected in the study. Patients with hCI had better long-term speech perception in noise than uni- or bilateral CI patients, but the difference was not statistically significant. The sound localization accuracy was equal in the hCI, bilateral CI, and SSD patients. QoH was statistically significantly better in bilateral CI patients than in the others. In hCI patients, residual hearing was preserved in all patients after the surgery. During the 3.6-year follow-up, the mean hearing threshold at 125–500 Hz decreased on average by 15 dB HL in the implanted ear. QoL and working performance improved significantly in all CI patients. Hearing outcomes with hCI are comparable to the results of bilateral CI or CI with SSD, but hearing in noise and sound localization are statistically significantly better than with unilateral CI. Interestingly, the impact of CI on QoL, QoH, and working performance was similar in all groups.

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Prophylactic etanercept treatment in cisplatin ototoxicity

Abstract

The aim of our study was to evaluate the audiological protective effects of etanercept using distortion product otoacoustic emission (DPOAE) in rats with hearing loss due to cisplatin ototoxicity. The study began with 36 healthy female albino rats; 31 rats had good measurements in DPOAE and were included in the study. On day 0, a single dose of etanercept was given by intraperitoneal administration to 15 rats (etanercept group). No medication was given to the control group. After 24 h, 16 mg/kg cisplatin was given to all rats. DPOAE measurements were performed on the 3rd, 7th, and 21st day. After the DPOAE test on the 21st day, the animals were killed by decapitation. Between-group and intra-group comparisons were made using the data of the two groups. A statistically significant difference was observed on the 3rd day at 4921 Hz and higher frequencies, on the 7th day at 6064 Hz and higher frequencies, and on the 21st day at 6494 Hz and higher frequencies (p < 0.05). We observed 10% ototoxicity in the etanercept group and 56% ototoxicity in the control group. A single dose of etanercept 1 day before cisplatin administration decreases cisplatin ototoxicity in the early period. This effect comes to the fore especially over 4500 Hz frequencies at 65 dB and higher.

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uDISE model: a universal drug-induced sedation endoscopy classification system—part 1

Abstract

Drug-induced sedation endoscopy (DISE) classification systems play a significant role in clinical analysis based on DISE findings, treatment decision process, treatment planning process and fundamentally in treatment outcomes. However, there is a major problem: there is no universally agreed DISE classification system. Hence, for the same DISE examination different DISE classification systems can be used to: assess anatomic findings, decide and plan different treatments. Hence, this leads to different treatment outcomes. The key objective of this study is to propose uDISE model: universal drug-induced sedation endoscopy (DISE) classification system. Set theory and relational mapping was used to develop a DISE classification system based on anatomical structures/level; degree of severity; and configuration of obstruction and its relationship with existing DISE classification systems. uDISE model consists of seven anatomical sites (nose, velum, tonsils, lateral pharyngeal wall/oropharynx, tongue base, epiglottis and larynx), three degrees of obstructive severity (none, partial and complete), three configurations of obstruction (anteroposterior, lateral and circumferential) and a severity index. uDISE model was mapped to four existing DISE classification systems: Pringle and Croft grading system, VOTE, NOHL and P-T-L-Tb-E. uDISE model provides a methodology for mapping different DISE findings based on different classification systems into one common DISE assessments format. This provides a framework for comparing different DISE assessments, treatment plan and treatment outcome irrespective of DISE classification system used. Further research is required to establish a complete relational mapping between uDISE model and other existing DISE classification systems.

http://ift.tt/2wPdMxK

Whole-exome sequencing to identify the cause of congenital sensorineural hearing loss in carriers of a heterozygous GJB2 mutation

Abstract

Bi-allelic variations in the gap junction protein beta-2 (GJB2) gene cause up to 50% of cases of newborn hearing loss. Heterozygous pathogenic GJB2 variations are also fivefold overrepresented in idiopathic patient groups compared to the normal-hearing population. Whether hearing loss in this group is due to unidentified additional variations within GJB2 or variations in other deafness genes is unknown in most cases. Whole-exome sequencing offers an effective approach in the search for causative variations in patients with Mendelian diseases. In this prospective genetic cohort study, we initially investigated a family of Turkish origin suffering from congenital autosomal recessive hearing loss. An index patient and his normal-hearing father, both bearing a single heterozygous pathogenic c.262G>T (p.Ala88Ser) GJB2 transversion as well as the normal-hearing mother were investigated by means of whole-exome sequencing. Subsequently the genetic screening was extended to a hearing-impaired cohort of 24 families of Turkish origin. A homozygous missense c.5492G>T transversion (p.Gly1831Val) in the Myosin 15a gene, previously linked to deafness, was identified as causative in the index family. This very rare variant is not listed in any population in the Genome Aggregation Database. Subsequent screening of index patients from additional families of Turkish origin with recessive hearing loss identified the c.5492G>T variation in an additional family. Whole-exome sequencing may effectively identify the causes of idiopathic hearing loss in patients bearing heterozygous GJB2 variations.

http://ift.tt/2f9SUaz

Sensitivity and specificity of the abbreviated profile of hearing aid benefit (APHAB)

Abstract

Subjective hearing loss in hearing-impaired patients can be assessed by inventory questionnaires. The abbreviated profile of hearing aid benefit (APHAB) measures subjective hearing loss in four typical hearing situations (subscales). It is used to fit hearing aids in patients with statutory insurance in Germany. In addition, the unaided APHAB (APHAB_u) can be used as a primary diagnostic instrument in audiology. There are no published data regarding the sensitivity and specificity of the unaided APHAB_u. Therefore, we investigated these parameters for detecting hearing loss of at least 25 dB at any frequency between 0.5 and 8.0 kHz. We used the APHAB_u to determine hearing loss in 245 subjects aged 50 years and older without any reported disease of the ears. Due to incomplete answering of the APHAB form, 55 subjects have been excluded. We also measured the pure-tone thresholds by air conduction for all octave frequencies between 0.5 and 8 kHz. Receiver operating characteristic (ROC) curves and the Youden Index were used to determine the diagnostic value of the APHAB_u, particularly sensitivity and specificity, in three different ways: (1) separately for ease of communication (EC_u), background noise (BN_u), and hearing with reverberation (RV_u) subscales; (2) with the mean value of EC_u, BN_u, and RV_u; and (3) with a logistic regression model. The area under the ROC curve was lower for BN only (0.83) and nearly equal for all other methods (0.87–0.89). Depending on how we performed the analyses, the sensitivity of the APHAB_u was 0.70–0.84 (single subscales), 0.76 (mean value of EC_u, BN_u, and RV_u), or 0.85 (logistic regression model). The specificity was 0.79–0.95. The use of single APHAB_u subscales for determining the sensitivity and specificity of the APHAB_u due to confusing results. In comparison, the use of the mean value of EC_u, BN_u, and RV_u and the use of the logistic regression model due to equal values in the ROC curves but a higher sensitivity in the logistic regression model. Therefore, we would recommend the last method for determining the sensitivity and specificity of the APHAB_u.

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Water penetration of grommets: an in vitro study

Abstract

The insertion of grommets has been one of the most common procedures carried out by ENT surgeons for patients with persistent middle ear fluid. There has always been apprehension at the use of grommets by patients undertaking swimming or other water sports due to concerns of grommet penetration by water into the middle ear. Despite this, no common consensus exists amongst otolaryngologists regarding post-operative advice following grommet insertion. Most studies focus on surface swimming and do not consider other activities such as diving that patients may undertake. This study aimed to determine the hydrostatic head required for water to pass through a grommet using different water-based solutions. These were selected to simulate conditions such as swimming and showering or bathing. An improved model of a grommeted middle ear (based on previous work by Ricks et al.) was constructed using two 5-ml plastic syringes, latex (from a surgical glove), two rubber neoprene membranes and a Shah Ventilation Tube (1.14 mm). Different water solutions were added to the system and the hydrostatic head measured using digital calipers. The results revealed that the hydrostatic head required to penetrate a grommet is lowest using soapy water and highest with distilled water. The differences between chlorinated water and 3% saline were not significant. We hope that this study can be used in conjunction with previous work to better prepare the ENT surgeon in giving suitable post-operative advice following grommet insertion.

http://ift.tt/2fahqZh

Clinical outcomes after local anesthesia with monitored anesthesia care during thyroidectomy and selective neck dissection: a randomized study

Abstract

Although thyroidectomy under local anesthesia with monitored anesthesia care (LA-MAC) has been reported, reports of neck dissections beyond level VI under LA-MAC in patients with thyroid cancer are rare. We aimed to analyze clinical data and patient satisfaction levels during thyroidectomy and selective neck dissection by comparing LA-MAC and general anesthesia (GA) in adult patients undergoing these surgeries for thyroid cancer. The 60 enrolled patients comprised 50 patients that underwent thyroidectomy and 10 that underwent selective neck dissection; 30 underwent thyroidectomy (n = 25) or selective neck dissection (n = 5) under LA-MAC and 30 (matched patients) underwent thyroidectomy (n = 25) or selective neck dissection (n = 5) under GA. Complaints of postoperative nausea, vomiting, throat discomfort, and voice changes were significantly fewer in the LA-MAC group than in the GA group. Postoperative pain, odynophagia, dyspnea, and patient satisfaction levels were not significantly different between groups. In the thyroidectomy group, postoperative nausea, vomiting, throat discomfort, and voice changes were less common with LA-MAC, whereas postoperative pain, odynophagia, dyspnea, and patient satisfaction levels were similar for both anesthesia methods. The selective neck dissection group showed no differences between the two anesthesia methods. No postoperative complications were reported in all patients. Our results suggest that LA-MAC can be routinely used for select cases of thyroidectomy and is feasible for selective neck dissection beyond level VI with regard to postoperative discomfort, patient satisfaction levels, and safety. However, further investigations are necessary to clarify these findings.

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Targeting dendritic cells through gold nanoparticles: A review on the cellular uptake and subsequent immunological properties

Publication date: November 2017
Source:Molecular Immunology, Volume 91
Author(s): Suhana Ahmad, Anes Ateqah Zamry, Hern-Tze Tina Tan, Kah Keng Wong, JitKang Lim, Rohimah Mohamud
Gold nanoparticles (NPs) have been proposed as a highly potential tool in immunotherapies due to its advantageous properties including customizable size and shapes, surface functionality and biocompatibility. Dendritic cells (DCs), the sentinels of immune response, have been of interest to be manipulated by using gold NPs for targeted delivery of immunotherapeutic agent. Researches done especially in human DCs showed a variation of gold NPs effects on cellular uptake and internalization, DC maturation and subsequent T cells priming as well as cytotoxicity. In this review, we describe the synthesis and physiochemical properties of gold NPs as well as the importance of gold NPs in immunotherapies through their actions on human DCs.



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Calcitonin gene-related peptide exerts anti-inflammatory property through regulating murine macrophages polarization in vitro

Publication date: November 2017
Source:Molecular Immunology, Volume 91
Author(s): Jia-Xi Duan, Yong Zhou, Ai-Yuan Zhou, Xin-Xin Guan, Tian Liu, Hui-Hui Yang, Hui Xie, Ping Chen
Acute lung injury (ALI) is a condition resulting from direct or indirect lung injury associated with high mortality and morbidity. The phenotype of macrophages in lung contributes to the pathological progress of ALI. Calcitonin gene-related peptide (CGRP) is one of the most abundant neuropeptides in lung, and attenuates lipopolysaccharide (LPS)-induced ALI in rats. However, the exact effect of CGRP on the activation of macrophages remains unknown. Here we investigate the effect of CGRP on the macrophages activation and inflammation in murine macrophages in vitro. We found that LPS increased the expression of CGRP in a LPS-induced ALI murine model and LPS-stimulated murine macrophages. Although CGRP didn't alter the expression of tumor necrosis factor-α (a marker of pro-inflammatory phenotype of macrophages, M1 macrophages) or Arginase 1 (Arg1, a marker of M2 macrophages) in non-differentiated macrophages, CGRP significantly reduced the NLRP3 and pro-IL-1β mRNA expression induced by LPS, as well as NLRP3 protein and IL-1β secretion induced by LPS+ATP in macrophages in vitro. On the other hand, CGRP dramatically enhanced the Arg1 expression and activity induced by IL-4 in the time- and dose-dependent manners. CGRP also promoted the expression of markers of M2 macrophages (IL-10, Fizz1 and Mrc1) induced by IL-4 in murine macrophages. These effects of CGRP were also observed in primary murine peritoneal macrophages. In addition, we found that CGRP regulated macrophages polarization partially through calmodulin, PKC and PKA pathways. Specifically, CGRP could inhibit the degradation of I-κB induced by LPS, and enhance the phosphorylation of STAT6 induced by IL-4 in macrophages. In conclusion, our results indicate that CGRP regulates macrophage polarization and inhibits inflammation in murine macrophages.



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Microsomal glutathione transferase 2 modulates LTC4 synthesis and ROS production in Apostichopus japonicus

Publication date: November 2017
Source:Molecular Immunology, Volume 91
Author(s): Zhen Zhang, Zhimeng Lv, Zhixin Wei, Chenghua Li, Yina Shao, Weiwei Zhang, Xuelin Zhao, Jinbo Xiong
Microsomal glutathione transferase 2 (mGST2) is an integral membrane protein involved in detoxication of xenobiotics, and has also been suggested to catalyze the biosynthesis of pro-inflammatory mediator leukotriene C4 (LTC4) as homologous to LTC4 synthase (LTC4S) in mammals. In the present study, a novel mGST2 homology was identified from Apostichopus japonicus (designated as AjmGST2) by RACE approaches. The full-length cDNA of AjmGST2 was of 1917bp encoding a polypeptide of 161 amino acids residues. Multiple sequences alignment and phylogenetic analysis together supported that AjmGST2 belonged to a new member in invertebrate mGSTs family and close to mammalian LTC4S. Spatial expression analysis revealed that AjmGST2 was ubiquitously expressed in all examined tissues with the larger magnitude in intestine. AjmGST2 transcripts in coelomocytes were slightly induced post 6h challenge of pathogenic Vibrio splendidus and reached the peak expression at 48h. The increased expression profiles of AjmGST2 were also detected in lipopolysaccharide (LPS) exposed primary coelomocytes. Consistently, LTC4 contents were also induced by a 1.56-fold increase in the same condition. Functional assay further revealed that AjmGST2 might be functioned as LTC4S to promote LTC4 synthesis. AjmGST2 knock-down by specific siRNA significantly depressed LTC4 contents with 27.0% decrease at 24h. Meantime, ROS levels were elevated by 40.1% in vitro. All of these results indicated that AjmGST2 performed dual functions roles as LTC4S and ROS eliminator in sea cucumber immune response.



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Solid pseudopapillary neoplasm presenting as a primary ovarian mass in an eighteen-year-old female: report of a case and review of the literature

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What are the real effects of the Mediterranean diet on recurrent colds and their complications?

Publication date: September–October 2017
Source:Allergologia et Immunopathologia, Volume 45, Issue 5
Author(s): J.A. Castro-Rodriguez




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Predictivity of clinical efficacy of sublingual immunotherapy (SLIT) based on sensitisation pattern to molecular allergens in children with allergic rhinoconjunctivitis

Publication date: September–October 2017
Source:Allergologia et Immunopathologia, Volume 45, Issue 5
Author(s): A. di Coste, F. Occasi, G. De Castro, A.M. Zicari, R. Galandrini, A. Giuffrida, L. Indinnimeo, M. Duse
BackgroundThe diagnostic and therapeutic approach to grass pollen allergy is now possible by detecting specific IgE (sIgE) to its allergenic components.AimTo evaluate the correlation between the sensitisation to different molecular Phleum pratense (Phl p) allergens and clinical efficacy of SLIT.MethodsThe pilot study included 36 patients affected by allergic rhinoconjunctivitis, all treated with SLIT actively. We performed serum analysis of sIgE to Phl p 1, 2, 4, 5, 6, 7, 11 and 12. The Average Rhinoconjunctivitis Total Symptom Score (ARTSS) and the Average Combined Score (ACS) were evaluated before and after one year of immunotherapy.ResultsThree different groups of sensitisation were defined based on the range of IgE reactivity to Phleum pratense allergens at baseline: group I (sIgE reactive to 1–3 allergens); group II (sIgE reactive to 4–5 allergens); and group III (sIgE reactive to 6–8 allergens). At T0 ACS was 1.79±0.18 in group I; 1.81±0.23 in group II; and 1.95±0.34 in group III. At T1 ACS was 0.85±0.55 in group I; 1.01±0.31 in group II; and 1.44±0.39 in group III. At T1 there was a significant improvement of ARTSS and ACS for group I (p=0.001).ConclusionsSublingual immunotherapy with a grass pollen is efficacious irrespective of the patients' baseline sensitisation to either single or multiple grass pollen molecular allergens. We found that patients with few sensitisations have a greater improvement in combined symptom and medication score. SLIT improves the clinical course of allergic patients although new sensitisations may appear.



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Molecular diagnosis of allergy to Anisakis simplex and Gymnorhynchus gigas fish parasites

Publication date: September–October 2017
Source:Allergologia et Immunopathologia, Volume 45, Issue 5
Author(s): A. Armentia, J. Santos, Z. Serrano, B. Martín, S. Martín, J. Barrio, S. Fernández, M. González-Sagrado, F. Pineda, R. Palacios
BackgroundThere has been an increase in the prevalence of hypersensitivity to Anisakis simplex. There are fish parasites other than Anisakis simplex whose allergenicity has not yet been studied.ObjectiveTo assess IgE hypersensitivity caused by fish parasite allergens in patients with gastro-allergic symptoms after consumption of fish, shellfish or cephalopods, compared with healthy subjects, pollen allergic individuals and children with digestive symptoms after eating marine food.MethodsWe carried out in vivo tests (skin prick) and in vitro tests (specific IgE determination, Western blot) and component resolved diagnostics (CRD) using microarray analysis in all patients.ResultsCRD better detected sensitisation to allergens from marine parasites than skin prick tests and determination of specific IgE by CAP. Sensitisation to Gymnorhynchus gigas was detected in 26% of patients measured by skin prick tests and 36% measured by IgE.ConclusionsThe prevalence of hypersensitivity to marine parasite allergens other than Anisakis simplex should be studied, and the most appropriate technique for this is CRD.



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CD8+T cells expressing both PD-1 and TIGIT but not CD226 are dysfunctional in acute myeloid leukemia (AML) patients

Publication date: Available online 8 September 2017
Source:Clinical Immunology
Author(s): Mengjie Wang, Jin Bu, Maohua Zhou, Jessica Sido, Yu Lin, Guanfang Liu, Qiwen Lin, Xiuzhang Xu, Jianmei W. Leavenworth, Erxia Shen
Acute myeloid leukemia (AML) is one of the most common types of leukemia among adults with an overall poor prognosis and very limited treatment management. Immune checkpoint blockade of PD-1 alone or combined with other immune checkpoint blockade has gained impressive results in murine AML models by improving anti-leukemia CD8⁺T cell function, which has greatly promoted the strategy to utilize combined immune checkpoint inhibitors to treat AML patients. However, the expression profiles of these inhibitory receptors in T cells from AML patients have not been clearly defined. Here we have defined subsets of CD8⁺ and CD4⁺ T cells in the peripheral blood (PB) from newly diagnosed AML patients and healthy controls (HCs). We have observed increased frequencies of PD-1- and TIGIT expressing CD8⁺ T cells but decreased occurrence of CD226-expressing CD8⁺T cells in AML patients. Further analysis of these CD8⁺ T cells revealed a unique CD8⁺ T cell subset that expressed PD-1 and TIGIT but displayed lower levels of CD226 was associated with failure to achieve remission after induction chemotherapy and FLT3-ITD mutations which predict poor clinical prognosis in AML patients. Importantly, these PD-1⁺TIGIT⁺CD226⁻CD8⁺T cells are dysfunctional with lower expression of intracellular IFN-γ and TNF-α than their counterparts in HCs. Therefore, our studies revealed that an increased frequency of a unique CD8⁺ T cell subset, PD-1⁺TIGIT⁺CD226⁻CD8⁺ T cells, is associated with CD8⁺T cell dysfunction and poor clinical prognosis of AML patients, which may reveal critical diagnostic or prognostic biomarkers and direct more efficient therapeutic strategies.



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Treatment of erythemato-telangiectatic rosacea with brimonidine alone or combined with vascular laser based on preliminary instrumental evaluation of the vascular component

Abstract

The purpose of this study is to evaluate the outcome of a series of patients with erythematotelangiectatic rosacea (ETR) affected by persistent erythema and varying degree of telangiectasias being treated with brimonidine alone or combined with a vascular laser based on the type of vascular components preliminarily evaluated by clinical and instrumental observation. Ten patients affected by ETR were enrolled in a pilot, open study. Instrumental evaluation included erythema-directed digital photography by VISIA-CR™ system and X10 dermoscopy. Those patients showing marked background erythema and minimal telangiectasias (group A) were treated with a single application of brimonidine 0.33% gel, while patients showing both marked background erythema and marked telangiectasias (group B) were treated with a session of Nd:YAG laser and reevaluated 1 month later after a single application of brimonidine. An Investigator Global Assessment (IGA) of treatment outcome was performed at the end of treatment in both groups. In group A, 6 h after brimonidine application, a marked reduction of the background erythema was observed in all patients, and IGA was rated as excellent. In group B, 6 h following the application of brimonidine, a marked reduction of the background erythema was observed in all cases, while telangiectasias remained unchanged. A further treatment with brimonidine 1 month after the Nd:YAG laser session determined complete clearing of facial erythema, and IGA was rated as excellent. In conclusion, a preliminary evaluation of the vascular component by erythema-directed digital photography and dermoscopy in ETR may be helpful to select the most appropriate therapeutic strategy.

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Efficiency of soft tissue incision with a novel 445-nm semiconductor laser

Abstract

Using a 445-nm semiconductor laser for tissue incision, an effective cut is expected due to the special absorption properties of blue laser light in soft tissues. The aim of the present study was the histological evaluation of tissue samples after incision with a 445-nm diode laser. Forty soft tissue specimens were obtained from pork oral mucosa and mounted on a motorized linear translation stage. The handpiece of a high-frequency surgery device, a 970-nm semiconductor laser, and a 445-nm semiconductor laser were connected to the slide, allowing a constant linear movement (2 mm/s) and the same distance of the working tip to the soft tissue's surface. Four incisions were made each: (I) 970-nm laser with conditioned fiber tip, contact mode at 3-W cw; (II–III): 445-nm laser with non-conditioned fiber tip, contact mode at 2-W cw, and non-contact mode (1 mm) at 2 W; and (IV): high-frequency surgery device with straight working tip, 90° angulation, contact mode at 50 W. Histological analysis was performed after H&E staining of the embedded specimens at 35-fold magnification. The comparison of the incision depths showed a significant difference depending on the laser wavelength and the selected laser parameters. The highest incision depth was achieved with the 445-nm laser contact mode (median depth 0.61 mm, min 0.26, max 1.17, interquartile range 0.58) (p < 0.05) with the lowest amount of soft tissue denaturation (p < 0.05). The lowest incision depth was measured for the high-frequency surgical device (median depth 0.36 mm, min 0.12, max 1.12, interquartile range 0.23) (p < 0.05). Using a 445-nm semiconductor laser, a higher cutting efficiency can be expected when compared with a 970-nm diode laser and high-frequency surgery. Even the 445-nm laser application in non-contact mode shows clinically acceptable incision depths without signs of extensive soft tissue denaturation.

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Assessing the potential role of next generation tyrosine kinase inhibitors in the treatment of cancers with acquired kinase domain mutations

Past few decades have seen the gradual replacement of standard cytotoxic therapy with molecular therapeutics, as the former was associated with significant general cell loss. Although molecular targeted therapies had proven to be highly effective, the duration of treatment efficacy is challenged by the growing resistance of cancer cells. The tyrosine kinase receptors are one of the better explored molecular targets in oncology. Cancer-positive for tyrosine kinase fusion genes has been targeted effectively with tyrosine kinase inhibitors (TKI).

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Quality improvement in rhinology

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Oral Ivermectin: Regaining a Drug for the Treatment of Scabies [Free article]

G. Blasco Morente
Actas Dermosifiliogr 2017;108:606

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Variability in Therapeutic Decision Making: Evaluation of the Validity of an Information and Communication Technology Tool [Free article]

F. Rivas Ruiz
Actas Dermosifiliogr 2017;108:607

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Buried Sutures to Facilitate the Closure of Facial Defects [Free article]

G. Romero, P. Cortina
Actas Dermosifiliogr 2017;108:607-8

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Other Faces of Darier Disease [Free article]

E. del Rio
Actas Dermosifiliogr 2017;108:608

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Autoinflammatory Diseases in Pediatric Dermatology-Part 1: Urticaria-like Syndromes, Pustular Syndromes, and Mucocutaneous Ulceration Syndromes [Free article]

S. Hernández-Ostiz, L. Prieto-Torres, G. Xirotagaros, L. Noguera-Morel, Á. Hernández-Martín, A. Torrelo
Actas Dermosifiliogr 2017;108:609-19

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Autoinflammatory Diseases in Pediatric Dermatology–Part 2: Histiocytic, Macrophage Activation, and Vasculitis Syndromes [Free article]

S. Hernández-Ostiz, G. Xirotagaros, L. Prieto-Torres, L. Noguera-Morel, A. Torrelo
Actas Dermosifiliogr 2017;108:620-9

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Diagnostic and Prognostic Relevance of the Cutaneous Manifestations of Neurofibromatosis Type 2 [Free article]

A. Plana-Pla, I. Bielsa-Marsol, C. Carrato-Moñino
Actas Dermosifiliogr 2017;108:630-6

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Impact of Vitiligo on Quality of Life [Free article]

M.A. Morales-Sánchez, M. Vargas-Salinas, M.L. Peralta-Pedrero, M.G. Olguín-García, F. Jurado-Santa Cruz
Actas Dermosifiliogr 2017;108:637-42

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Treatment of Human Scabies with Oral Ivermectin. Eczematous Eruptions as a New Non-Reported Adverse Event [Free article]

J. Sanz-Navarro, C. Feal, E. Dauden
Actas Dermosifiliogr 2017;108:643-9

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Reliability of the MDi Psoriasis Application to Aid Therapeutic Decision-Making in Psoriasis [Free article]

D. Moreno-Ramírez, J.M. Herrerías-Esteban, T. Ojeda-Vila, J.M. Carrascosa, G. Carretero, P. de la Cueva, C. Ferrándiz, M. Galán, R. Rivera, L. Rodríguez-Fernández, R. Ruiz-Villaverde, L. Ferrándiz
Actas Dermosifiliogr 2017;108:650-6

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Guitar-String Suture to Facilitate Closure of a Finger-like Flap for Reconstruction of the Nose [Free article]

E. Querol-Cisneros, P. Redondo
Actas Dermosifiliogr 2017;108:657-64

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Acral Hemorrhagic Darier Disease [Free article]

M.Á. Flores-Terry, M. García-Arpa, M. Llamas-Velasco, C. Mendoza-Chaparro, C. Ramos-Rodríguez
Actas Dermosifiliogr 2017;108:e49-52

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A reddish plaque in the forehead [Free article]

P. Friedman, E. Cohen Sabban, H. Cabo
Actas Dermosifiliogr 2017;108:665-6

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Slow-Growing Keratotic Tumor on the Eyelid [Free article]

F.J. Navarro-Triviño, J. Aneiros-Fernández, A.M. Almodóvar-Real
Actas Dermosifiliogr 2017;108:667-8

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RF-Acral Melanoma and Repetitive Injury to the Sole of the Foot [Free article]

P. Martín-Carrasco, M.T. Monserrat-García, A. Ortiz-Prieto, J. Conejo-Mir
Actas Dermosifiliogr 2017;108:669-70

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Coexistence of Sutton and Meyerson Nevi [Free article]

I. Vázquez-Osorio, M. González-Sabín, E. Rodríguez-Díaz
Actas Dermosifiliogr 2017;108:671

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Isolated Anterior Cervical Hypertrichosis [Free article]

G. Blasco-Morente, I. Sánchez-Carpintero
Actas Dermosifiliogr 2017;108:672

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Edematous Dermatomyositis with Probable Evans Syndrome [Free article]

M.Á. Flores-Terry, M. García-Arpa, J. Anino-Fernández, M.D. Mínguez-Sánchez
Actas Dermosifiliogr 2017;108:673-5

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Reticulate Acropigmentation of Kitamura and Nevus of Ito [Free article]

M. García-Arpa, M. Franco-Muñoz, M.A. Flores-Terry, C. Ramos-Rodríguez
Actas Dermosifiliogr 2017;108:675-7

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Melanomas Arising on Tattoos: A Casual Association with Practical Implications [Free article]

M. Armengot-Carbó, N. Barrado-Solís, C. Martínez-Lahuerta, E. Gimeno-Carpio
Actas Dermosifiliogr 2017;108:678-80

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