Risk factors of pediatric tinnitus: Systematic review and meta-analysis

Objectives/Hypothesis

Medications for pediatric tinnitus are not widely used due to a lack of evidence-based information. The modification of risk factors is essential in pediatric tinnitus; however, there is a lack of systematic reviews despite several reports on risk factors. This study performed a systematic review and meta-analysis of available literature to evaluate risk factors of pediatric tinnitus.

Methods

Studies reporting the risk factors of pediatric tinnitus were systematically reviewed by searching the MEDLINE, PubMed, and Embase databases for studies published from database inception to 2016. The selected articles included clinical or epidemiological studies conducted with at least 50 subjects and at least one risk factor, including age, gender, hearing loss, noise exposure, or smoking.

Results

Eleven studies involving a total of 28,358 individuals were identified. Increased age was not a significant risk factor with a standardized median difference of 0.16 (95% confidence interval [CI]: −0.01 to 0.33). However, there was a significant correlation between increased age and tinnitus in the adolescent population. The odds ratio (OR) was 1.37 for female gender (95% CI: 1.17 to 1.60), 2.39 for hearing loss (95% CI: 1.48 to 3.87), and 11.35 for noise exposure (95% CI: 1.87 to 68.77). Two studies in adolescents showed statistical significance for smoking as a risk factor in developing tinnitus (OR: 6.05, 95% CI: 1.81 to 20.21).

Conclusions

Older-aged adolescents, as well as those who are females and those with hearing loss may have a higher risk of tinnitus. Noise exposure in the general pediatric population and smoking in adolescents may represent especially important risk factors in pediatric tinnitus. Laryngoscope, 2017

http://ift.tt/2ymZ56Q

Adult normative data for phonatory aerodynamics in connected speech

Objectives/Hypothesis

To establish normative values for phonatory aerodynamic measurements in connected speech across adult ages and gender.

Study Design

Prospective data collection across group design.

Methods

One hundred fifty adults aged >18 years without voice complaints were stratified into three equal-age groups (group 1 [ages 18–39 years]; group 2 [ages 40–59 years], and group 3 [ages 60 + years]) and two equal-gender groups (male and female) resulting in 25 participants in each category. Participants read the first four sentences of the Rainbow Passage at comfortable pitch and loudness to obtain a connected speech sample. The following dependent variables were analyzed: breath number, reading passage duration, mean phonatory airflow, inspiratory airflow duration, and expiratory airflow duration.

Results

A gender effect was found for mean phonatory airflow, with males showing significantly greater phonatory airflow than females during connected speech (P < .001). Number of breaths was significantly greater for group 3 than group 2 (P < .001) and group 1 (P < .001). Duration, and inspiratory and expiratory airflow durations were all significantly greater for group 3 (P < .001) than group 2 (P < .001) than group 1 (P < .001).

Conclusions

This study provides normative data for phonatory aerodynamics in adult connected speech. Significant age and gender effects were observed. Laryngoscope, 2017

http://ift.tt/2lFDikN

Geographic Disparity in Liver Allocation: Time to Act or Have Others Act for us

No abstract available

http://ift.tt/2xOUDcz

International Data Base Populated by Anonymous Social Networking to Study Transplant Tourism

No abstract available

http://ift.tt/2A9jOrS

Management of pediatric psoriasis with acitretin: A review

Abstract

Psoriasis is a chronic inflammatory disease of the skin which can occur at any age-group. Psoriasis in childhood is not uncommon and has genetic susceptibility but usually, an environmental trigger such as infection is thought to initiate the disease process. Pediatric psoriasis has profound effects on both physical and psychosocial health of the patient. Treatment of mild psoriasis can be done with topical therapies but those which do not respond to topical therapies can be treated with phototherapy and systemic therapies. The use of systemic therapies in childhood is mainly based on the published data, case series, expert opinion and the experience as there is the lack of controlled trials in the age group. Based on the experience retinoids are probably the second line drugs for the treatment of pediatric psoriasis which do not respond to topical therapies and phototherapy. Using acitretin in a low dose and with proper physical examinations and laboratory investigations will reduce the hazard of potential serious adverse events. This article gives the review of the use of acitretin in pediatric psoriasis.

http://ift.tt/2iTw8IX

Interleukin-33 promotes the inflammatory reaction in chronic rhinosinusitis with nasal polyps by NF-κB signaling pathway

OBJECTIVE: Interleukin (IL)-33 promotes T helper (Th2) immune response and may be involved in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP). Using murine and human specimens, we evaluated the role of IL-33 in CRSwNP.

MATERIALS AND METHODS: To establish CRSwNP, Balb/c mice were sensitized with house dust mite, followed up by intranasal exposure to Staphylococcus aureus to stimulate the inflammatory response of nasal mucosa. The hematoxylin-eosin staining and total serum IgE were used to the successful construction of CRSwNP model. For mechanistic studies, we blocked mice with IL-33 and the Th2 cells counts in tissue were detected. Th2 cytokine expression of IL-4, IL-5, IL-13, IL-22, CCL-11, and CCL-24 in control group, CRSwNP group and IL-33 blockade group at 12 weeks after CRSwNP model establishment, were analyzed by qRT-PCR. Meanwhile, the relative mRNA and protein expression levels of NF-κB, MyD88 and TLR7 were detected after IL-33 blockade. To document the inflammatory response in patients with CRSwNP, The relative mRNA expression of IL-4, IL-5, IL-13, IL-22, CCL-11, and CCL-24 in control individuals and patients with CRSwNP (chronic rhinosinusitis with nasal polyps) were analyzed by qRT-PCR.

RESULTS: The CRSwNP model was successfully constructed. After IL-33 blocked, the relative expression of IL-33 and Th2 cells counts were reduced significantly. CRSwNP mice showed overproduction of IL-4, IL-5, IL-13, IL-22, CCL-11, and CCL-24 and IL-33 blockade inhibited the expression of IL-4, IL-5, IL-13, IL-22, CCL-11, and CCL-24. Furthermore, IL-33 blockade decreased the mRNA levels of NF-κB, MyD88 and TLR7, and also restrained the protein expression of them. On the other hand, patients' specimens with CRSwNP showed high levels of Th2 cytokines including IL-33, IL-4, IL-5, IL-13, IL-22, CCL-11, and CCL-24.

CONCLUSIONS: CRSwNP is associated with overexpression of IL-33, with subsequent activation of Th2 immune response by NF-κB signaling pathway.

L'articolo Interleukin-33 promotes the inflammatory reaction in chronic rhinosinusitis with nasal polyps by NF-κB signaling pathway sembra essere il primo su European Review.

http://ift.tt/2huItQ1

Anterior palatoplasty in the treatment of obstructive sleep apnoea - a systemic review.

Related Articles

Anterior palatoplasty in the treatment of obstructive sleep apnoea - a systemic review.

Acta Otorhinolaryngol Ital. 2017 Oct 31;:

Authors: Pang KP, Pang EB, Pang KA, Rotenberg B

Abstract
This study seeks to determine the objective and subjective success rates of anterior palatoplasty and its variants for the treatment of obstructive sleep apnoea (OSA). A systematic review with two independent searches of Medline, PubMed, Cochrane Library and Evidence Based Medicine Reviews was performed to identify publications relevant to OSA and anterior palatoplasty. All relevant studies published before 30 June 2015 were included. Six studies were included in the systematic review. The numbers of patients in each paper ranged from 13 to 77 (total=240), and mean age ranged from 21 to 51 years. Substantial and consistent improvement in polysomnography (PSG) outcomes were observed in patients after the anterior palatoplasty, with or without multilevel surgery. The results showed that the anterior palatoplasty technique provides significantly improvement in the post-operative AHI. The mean pre-operative AHI (in the 6 papers) improved from 16.3 to 7.1, the snore visual analogue scale improved from 7.5 to 3.1 and the Epworth score reduced from 11.3 to 7.3 post-operatively. The overall pro-rated pooled success rate for all the patients was 72.5%, with a mean follow-up of 17.3 months. Anterior palatoplasty is an effective option in the management of patients with mild to moderate OSA.

PMID: 29087404 [PubMed - as supplied by publisher]

http://ift.tt/2zm57EJ

Nerve and vein preserving neck dissections for oral cancers: a prospective evaluation of spinal accessory nerve function and internal jugular vein patency following treatment.

Related Articles

Nerve and vein preserving neck dissections for oral cancers: a prospective evaluation of spinal accessory nerve function and internal jugular vein patency following treatment.

Acta Otorhinolaryngol Ital. 2017 Oct 31;:

Authors: Kumar Reddy GR, Hulikal N, Lakshmi AY, Vengamma B

Abstract
Nerve and vein preserving modification of the radical neck dissection is commonly used in the management of oral squamous cell cancers. There is limited literature addressing nerve function and vein patency following treatment. We prospectively analysed 65 patients with nerve conduction study using surface electromyography at baseline, 1 month and 6 months post-surgery and colour Doppler of the internal jugular vein at baseline and 1 month post-surgery. We also studied functional outcomes of nerve sparing with arm abduction test and Neck Dissection Quality of Life questionnaire. There was a statistically significant increase in mean latency of motor action potential and decrease in the mean amplitude of the motor action potential following surgery, suggesting nerve dysfunction. Following surgery, there was a significant decrease in the diameter of the vein as well as an increase in the velocity of blood flow; there was partial thrombus in 5% of individuals. In conclusion, even though nerve dysfunction compromised shoulder abduction, vein dysfunction rarely resulted in any significant clinical impact.

PMID: 29087403 [PubMed - as supplied by publisher]

http://ift.tt/2z6ngUd

Modification of growth, immunologic and feeding parameters in children with OSAS after adenotonsillectomy.

Related Articles

Modification of growth, immunologic and feeding parameters in children with OSAS after adenotonsillectomy.

Acta Otorhinolaryngol Ital. 2017 Oct 31;:

Authors: Cassano M, Russo G, Granieri C, Ciavarella D

Abstract
Obstructive sleep apnoea syndrome can cause growth delay in children. Adeno-tonsillectomy can resolve the syndrome in most cases. The aim of our study is to examine modifications in clinical and laboratory growth and immunological parameters and food intake changes in OSAS children after surgery. Twenty-eight children with severe OSAS associated with adeno-tonsillar hypertrophy were submitted to paediatric evaluation to calculate auxologic parameters (weight, height, BMI and standard deviation scores), a blood draw to evaluate growth (GH; IGF-1) and immunological parameters (IgG; IgA; IgM) and a dietitian evaluation to calculate caloric intake before and after 3 months following adeno-tonsillectomy. Mean height and weight values in the study group were slightly inferior to same-age children mean according to the percentile values. After surgery, both height and BMI increased significantly at 3-months follow-up: mean height increased 2.93 cm (p = 0.0001); BMI values greatly increased by 0.72 kg/m2 (p = 0.009). Standard deviation scores increased significantly for height (p = 0.03), weight (p = 0.001) and BMI (p = 0.001). These values significantly increased, despite almost unchanged caloric intake between the pre- and post-surgery period (90 ± 24 vs 91 ± 27 kcal/kg/day; p > 0.05). In all children, age-related GH values were normal and did not show any significant increase, while IGF-1 values significantly increased during the study period (p = 0.01). Regarding immunological parameters, only IgA levels decreased after surgery and maintained a value that was higher than normal (> 70 mg/dL). In conclusion, children affected by adenotonsillar hypertrophy and OSAS do not show significant growth delay, but they do experience a slowdown in growth rate. After adeno-tonsillectomy, the speed of growth soon increases, as weight and growth increase notwithstanding an unchanged food intake. Moreover, surgery does not cause reduction in the efficiency of the immune system.

PMID: 29087402 [PubMed - as supplied by publisher]

http://ift.tt/2iR2yn4

From CT scanning to 3D printing technology: a new method for the preoperative planning of a transcutaneous bone-conduction hearing device.

Related Articles

From CT scanning to 3D printing technology: a new method for the preoperative planning of a transcutaneous bone-conduction hearing device.

Acta Otorhinolaryngol Ital. 2017 Oct 31;:

Authors: Canzi P, Marconi S, Manfrin M, Magnetto M, Carelli C, Simoncelli AM, Fresa D, Beltrame M, Auricchio F, Benazzo M

Abstract
The aim of the present study was to assess the feasibility and utility of 3D printing technology in surgical planning of a transcutaneous boneconduction hearing device (Bonebridge®) (BB), focusing on the identification of the proper location and placement of the transducer. 3D printed (3DP) models of three human cadaveric temporal bones, previously submitted to CT scan, were created with the representation of a topographic bone thickness map and the sinus pathway on the outer surface. The 3DP model was used to detect the most suitable location for the BB. A 3DP transparent mask that faithfully reproduced the surface of both the temporal bone and the 3DP model was also developed to correctly transfer the designated BB area. The accuracy of the procedure was verified by CT scan: a radiological marker was used to evaluate the degree of correspondence of the transducer site between the 3DP model and the human temporal bone. The BB positioning was successfully performed on all human temporal bones, with no difficulties in finding the proper location of the transducer. A mean error of 0.13 mm was found when the transducer site of the 3DP model was compared to that of the human temporal bone. The employment of 3D printing technology in surgical planning of BB positioning showed feasible results. Further studies will be required to evaluate its clinical applicability.

PMID: 29087401 [PubMed - as supplied by publisher]

http://ift.tt/2iSX77h

Rescue therapy with bismuth quadruple regimen in patients with Helicobacter pylori -resistant strains

Abstract

Background

Bismuth quadruple therapy (BQT) is the recommended rescue therapy for Helicobacter pylori (H. pylori) infection. This study aimed to assess the efficacy and safety of a 10-day BQT regimen in patients who failed previous therapies and were infected with multiresistant H. pylori strains

Materials and methods

Helicobacter pylori-infected patients underwent endoscopy, culture, and susceptibility test for clarithromycin, metronidazole, and levofloxacin. Treatment with three-in-one capsule (Pylera®) four times daily and esomeprazole 20 mg twice daily for 10 days was administered. Treatment-emergent adverse events (TEAEs) were registered.

Results

A total of 116 patients with persistent H. pylori infection following at least one eradication therapy attempt were treated. Overall, resistance toward clarithromycin was detected in 80% of strains, toward metronidazole in 70%, and levofloxacin in 47.5%, with dual or triple resistance in 72.5% of cases. An eradication rate of 81.0% (95% CI: 73.0-87.1) and 87.0% (95% CI: 79.4-92.1) at ITT and PP analyses, respectively, was achieved. The cure rate remained high until it was used as fourth-line regimen, while it dropped to low values (<67%) in those patients with more than 4 therapy failures. A total of 65.7% (95% CI: 56.4-74.0) patients complained of TEAEs.

Conclusions

Our data found that bismuth-based quadruple regimen is effective as rescue therapy for curing patients infected with multiresistant H. pylori strains.

http://ift.tt/2A1xjsK

Shear Wave Elastography in Thyroid Nodules with Indeterminate Cytology: Results of a Prospective Bicentric Study

Thyroid Nov 2017, Vol. 27, No. 11: 1441-1449.


http://ift.tt/2lGfFsu

Low Malignancy Rates in Fine-Needle Aspiration Cytologies in a Primary Care Setting in Germany

Thyroid Nov 2017, Vol. 27, No. 11: 1385-1392.


http://ift.tt/2ylLlsZ

The 2017 Bethesda System for Reporting Thyroid Cytopathology

Thyroid Nov 2017, Vol. 27, No. 11: 1341-1346.


http://ift.tt/2lGaQzh

Future Meetings

Thyroid Nov 2017, Vol. 27, No. 11: 1461-1461.


http://ift.tt/2ymVpBY

Contribution of 3D printing to mandibular reconstruction after cancer

Publication date: Available online 1 November 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): A. Dupret-Bories, S. Vergez, T. Meresse, F. Brouillet, G. Bertrand
Three-dimensional (3D) printing is booming in the medical field. This technology increases the possibilities of personalized treatment for patients, while lowering manufacturing costs. To facilitate mandibular reconstruction with fibula free flap, some companies propose cutting guides obtained by CT-guided moulding. However, these guides are prohibitively expensive (€2,000 to €6,000). Based on a partnership with the CNRS, engineering students and a biomedical company, the authors have developed cutting guides and 3D-printed mandible templates, deliverable in 7days and at a lower cost. The novelty of this project is the speed of product development at a significantly lower price. In this technical note, the authors describe the logistic chain of production of mandible templates and cutting guides, as well as the results obtained. The goal is to allow access to this technology to all patients in the near future.



http://ift.tt/2iS9mRt

Prognostic factors for parotid metastasis of cutaneous squamous cell carcinoma of the head and neck

Publication date: Available online 1 November 2017
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): C. Bobin, P. Ingrand, B. Dréno, E. Rio, O. Malard, F. Espitalier
BackgroundCutaneous squamous cell carcinoma (CSCC) develops on the head in 80% of cases. Parotid metastasis (PM) is rare, but treatment, which associates surgery and radiation therapy, is heavy and prognosis poor.Material and methodsAll cases of parotidectomy for PM of CSCC of the head and neck between 2005 and 2015 were studied retrospectively. Epidemiologic, oncologic and therapeutic data were analyzed. Overall and specific survival were calculated following Kaplan-Meier. Log-rank and Cox models were used to identify prognostic factors for PM.ObjectivesThe principal study objective was to identify factors for survival in PM from CSCC of the head and neck.ResultsThirty-five patients were included. Mean time to onset of PM was 13months. Overall 1-, 2- and 5-year survival was respectively 70, 66 and 59%. Independent prognostic factors comprised immunodepression, age at treatment, positive CSCC margins, macroscopic facial nerve involvement, and metastatic cervical adenopathies.ConclusionThe study confirmed an association of several independent prognostic factors at the stage of parotid lymph-node metastasis, related to patient, primary CSCC and PM. Complete primary resection is essential to reduce the risk of PM. Intensified radiologic and clinical surveillance should enable early diagnosis.



http://ift.tt/2z7m7vH

Quantitative image analysis of protein expression and colocalization in skin sections

Abstract

Immunofluorescence (IF) and in situ proximity ligation assay (isPLA) are techniques that are used for in situ protein expression and colocalization analysis, respectively. However, an efficient quantitative method to analyze both IF and isPLA staining on skin sections is lacking. Therefore, we developed a new method for semi-automatic quantitative layer-by-layer measurement of protein expression and colocalization in skin sections using the free open-source software CellProfiler. As a proof of principle, IF and isPLA of ichthyosis-related proteins TGm-1 and SDR9C7 were examined. The results indicate that this new method can be used for protein expression and colocalization analysis in skin sections.

This article is protected by copyright. All rights reserved.

http://ift.tt/2zqBNgu

Safety, efficacy, and drug survival of biologics and biosimilars for moderate-to-severe plaque psoriasis

Abstract

Background

Real-life data on newer biologic and biosimilar agents for moderate-to-severe psoriasis are lacking.

Objectives

To examine safety, efficacy, and time to discontinuation (drug survival) of biologics (adalimumab, etanercept, infliximab, secukinumab, and ustekinumab) and compare originators with biosimilars (i.e. Enbrel with Benepali, and Remicade with Remsima).

Methods

The DERMBIO registry contains data on all Danish patients with moderate-to-severe plaque psoriasis treated with biologics. We examined patients treated between January 1^st, 2007 and March 31^st, 2017. We used Kaplan-Meier survival curves and Cox-regression to examine drug survival patterns.

Results

A total of 3495 treatment series (2161 patients) were included (adalimumab n=1332, etanercept n=579, infliximab n=333, ustekinumab n=1055, and secukinumab n=196). Secukinumab had the highest number of PASI100 respondants, but also the lowest drug survival among all biologics. Ustekinumab had the highest drug survival overall. There were no significant differences in discontinuation risk between originator and biosimilar versions of infliximab or etanercept. Treatment with higher-than-approved dosages was frequent for all drugs except for adalimumab and secukinumab. Adverse events (predominantly infections) were most frequent for secukinumab and showed an increased (albeit low) incidence of cardiovascular events compared with the other agents.

Conclusions

Ustekinumab was associated with the highest drug survival, and secukinumab with the lowest, albeit that most patients on secukinumab were non-naïve. Switching from originator to biosimilar had no significant impact on drug survival, and the safety profiles were comparable. Adverse events occurred most frequently with secukinumab. Future studies are warranted to assess the long-term safety of novel biologics for psoriasis.

This article is protected by copyright. All rights reserved.

http://ift.tt/2xLyRqh

Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa

Summary

Background

Epidemiology data regarding hidradenitis suppurativa (HS) are conflicting and prevalence estimates vary 80-fold, from 0.05% in a population-based study, to 4%.

Objectives

To assess the hypothesis that previous population-based studies under-estimated true HS prevalence by missing undiagnosed cases.

Methods

We performed a population-based observational and case-control study using the UK Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics data. Physician-diagnosed cases in CPRD were identified from specific Read codes. Algorithms identified unrecognised 'proxy' cases, with at least five Read code records for boils in flexural skin sites. Validation of proxy cases was undertaken with General Practitioner questionnaires to confirm criteria-diagnosed cases. A case-control study assessed disease associations.

Results

On 30 June 2013, 23,353 physician-diagnosed HS cases were documented in 4,364,308 research-standard records. 68,890 proxy cases were identified, reduced to 10,146 criteria-diagnosed cases after validation, extrapolated from 107 completed questionnaires (61% return rate). Overall point prevalence was 0.77% (95% CI 0.76% to 0.78%). An additional 18,417 cases had a history of 1-4 flexural skin boils.

In physician-diagnosed cases, ORs for current smoker and obesity (BMI>30) were 3.61 (95% CI 3.44 to 3.79) and 3.29 (95% CI 3.14 to 3.45). HS was associated with type 2 diabetes, Crohn's disease, hyperlipidaemia, acne and depression and not associated with ulcerative colitis or polycystic ovary syndrome.

Conclusions

Contrary to results of previous population-based studies, HS is relatively common, with a UK prevalence of 0.77%, one-third being unrecognised, criteria-diagnosed cases using the most stringent disease definition. If probable cases are included, HS prevalence rises to 1.19%.

This article is protected by copyright. All rights reserved.

http://ift.tt/2z5Mzpk

Pain, Psychological Comorbidities, Disability, and Impaired Qualify of Life in Hidradenitis Suppurativa

Abstract

Purpose of Review

Hidradenitis suppurativa (HS) is a chronic, painful dermatologic disease characterized by recurrent inflammatory nodules and abscesses of intertriginous areas such as the axilla and groin. People with HS suffer from greater pain and associated psychological comorbidities, including depression, anxiety, disability, and impairments in quality of life (QoL), compared to those with other dermatologic conditions. Our review focuses on the occurrence of pain and these relationships.

Recent Findings

The existing literature indicates that acute and chronic pain, depression, anxiety, and disability all contribute to poor quality of life in individuals with HS. Despite the central role of pain and distress in the presentation of HS, few studies have empirically evaluated the impact of pain and gaps remain in the existing psychosocial literature. There are no formal guidelines for treating HS-specific pain or psychological comorbidities.

Summary

The results of this review show a clear and pressing need to develop treatment recommendations and effective interventions for addressing acute and chronic pain, psychological comorbidities, disability, and impaired quality of life among people with HS. This review outlines a multidisciplinary approach to treating and managing pain and psychological comorbidities.

http://ift.tt/2ymtD8M

Influence of pneumococcal conjugate vaccines on acute otitis media in Japan

This study investigated: (i) changes in the incidence of acute otitis media (AOM) following introduction of public funding for free inoculation with 7- and 13-valent pneumococcal conjugate vaccines (PCV7 and PCV13, respectively) and (ii) changes in the rate of myringotomies for AOM (MyfA) in children 1year following the publication of the first edition of the clinical practice guidelines for the diagnosis and management of AOM in children in Japan.

http://ift.tt/2z6tXrO

Maintenance of Certification: A Grandfatherly Ethical Analysis

http://ift.tt/2zpADlc

Rosacea comorbidities and future research: The 2017 update by the National Rosacea Society Expert Committee

Although causal relationships have not been determined, many recent studies have uncovered associations between rosacea and increased risk for a variety of systemic disorders, many with potentially serious outcomes (Table I).1-17 This might significantly increase the clinical significance of rosacea because evidence that rosacea might be an outcome of systemic inflammation is mounting. In addition, current scientific knowledge has pointed to a variety of promising research avenues that might help further illuminate rosacea's etiology, pathophysiology, and clinical implications.

http://ift.tt/2z5A2Ck

Nonbullous cutaneous pemphigoid: a systematic review

Cutaneous pemphigoid (bullous pemphigoid) is an autoimmune bullous disease that typically presents with tense bullae and severe pruritus. However, bullae may be lacking, a subtype termed nonbullous cutaneous pemphigoid.

http://ift.tt/2zbVO9Q

Merkel Cell Carcinoma: Current United States Incidence and Projected Increases based on Changing Demographics

Merkel cell carcinoma (MCC) incidence rates are rising and strongly age-associated, relevant for an aging population.

http://ift.tt/2zoFQK6

Reexamining mechanic’s hands as a characteristic skin finding in dermatomyositis

Mechanic's hands is a poorly defined clinical finding that has been reported in a variety of rheumatologic diseases. Morphologic descriptions include hyperkeratosis on the sides of the digits that sometimes extends to the distal tips, diffuse palmar scale, and, more recently observed, linear discrete scaly papules in a similar lateral distribution. The association of mechanic's hands with dermatomyositis, although recognized, is still debatable. In this review, most studies have shown that mechanic's hands is commonly associated with dermatomyositis and displays histopathologic findings of interface dermatitis, colloid bodies and interstitial mucin which are consistent with a cutaneous connective tissue disease.

http://ift.tt/2zoFTFM

The Use of Vessel Loop to Bolster Mattress Sutures and to Prevent Scars

http://ift.tt/2zbVNmi

Therapeutic pearl: 5-fluorouracil tattoo for idiopathic guttate hypomelanosis

http://ift.tt/2zc1sbQ

A simple device for ablation of keloidal tissue and serial deposition of intralesional drugs

http://ift.tt/2zckm2s

Cause specific mortality in adults with atopic dermatitis

Adult atopic dermatitis (AD) has been associated with several co-morbidities, but cause-specific mortality risk is unknown.

http://ift.tt/2zpAEFM

Beyond JAAD January 2018

http://ift.tt/2zbGgTx

Porcine Xenografts for Surgical Defects: A Single Center Experience with 128 Cases

http://ift.tt/2zoFVgS

The influence of microorganisms in allergic diseases

Publication date: November–December 2017
Source:Allergologia et Immunopathologia, Volume 45, Issue 6
Author(s): M. Tortajada-Girbés, Javier Torres-Borrego




http://ift.tt/2A7gXjp

Epidemiology and pathophysiology of malignancy in common variable immunodeficiency?

Publication date: November–December 2017
Source:Allergologia et Immunopathologia, Volume 45, Issue 6
Author(s): A. Tak Manesh, G. Azizi, A. Heydari, F. Kiaee, M. Shaghaghi, N. Hossein-Khannazer, R. Yazdani, H. Abolhassani, A. Aghamohammadi
Common variable immunodeficiency (CVID) is a diagnostic category of primary immunodeficiency (PID) which may present with heterogeneous disorders including recurrent infections, autoimmunity, granulomatous diseases, lymphoid and other types of malignancies. Generally, the incidence of malignancy in CVID patients is around 1.5–20.7% and usually occurs during the 4th–6th decade of life. Non-Hodgkin lymphoma is the most frequent malignancy, followed by epithelial tumours of stomach, breast, bladder and cervix. The exact pathological mechanisms for cancer development in CVID are not fully determined; however, several mechanisms including impaired genetic stability, genetic predisposition, immune dysregulation, impaired clearance of oncogenic viruses and bacterial infections, and iatrogenic causes have been proposed to contribute to the high susceptibility of these patients to malignancies.



http://ift.tt/2xNaR6j

Is the evidence of breast feeding protection against coeliac disease real?

Publication date: November–December 2017
Source:Allergologia et Immunopathologia, Volume 45, Issue 6
Author(s): A. Girbovan, G. Sur, G. Samasca, I. Lupan
Many recent studies discredit breastfeeding protection against coeliac disease. We will try to answer the question: "Is the evidence of breast feeding protection against coeliac disease real?"



http://ift.tt/2A7gLAH

Under the superficial dichotomy pathogen and allergen are two manifestations of same immune activation and pathogenesis mechanisms

Publication date: November–December 2017
Source:Allergologia et Immunopathologia, Volume 45, Issue 6
Author(s): S. Patel
Pathogens and allergens are deemed as two contrasting facets of host immune status, deficiency and exuberant. In silico domain analysis of a diverse panel of pathogen and allergen proteins has revealed the shortcoming of this notion. Both the pathogen and allergen proteins elicit immune activation, with the outcome of immune agitation depending on the pathogen strain, allergen exposure duration, and host factors. Pathogens can replicate within the host and constantly irritate the immune system, leading to blood coagulation, respiratory collapse and death. Allergens, being non-viable, can only provoke the immune system transiently; however, depending on the allergen dose and extent exposed to, inflammation and fatality can occur. In silico analysis of pathogen and allergen proteins showed the conserved domains to be AAA, WR1, VKc, Kelch, Hr1, HAMP, HELICc, Dak2, CHAD, CHASE2, Galanin, PKS_TE, Robl_LC7, Excalibur, DISIN, etc. This exciting discovery can have far-reaching effects in drug target identification approaches.



http://ift.tt/2xM8MYe

Surgical management of severe osteoradionecrosis of the mandibular bone by using double free flap reconstruction

Radiation therapy (RT) plays an essential role in the management of head and neck malignancies. RT is commonly used as an adjuvant to surgical intervention in cases of large tumors or metastasis, but also as a primary treatment modality (Deshpande et al., 2015; Rice et al., 2015). If primary or adjuvant RT is essential, osteoradionecrosis (ORN) of the jaws represents one of the most severe complications, with an incidence of 5–15%, mainly in the first few years after the end of treatment (Epstein et al., 1987; Reuther et al., 2003; Rice et al., 2015).

http://ift.tt/2ymP89m

Reaching the vertical versus horizontal target position in multi-segmental Le Fort I osteotomy is more difficult, but yields comparably stable results to one-segment osteotomy

This retrospective cohort study evaluated the postoperative outcomes of preoperatively planned positional changes for Le Fort I osteotomy in 77 patients (average age 26.6 years). Movement relapse and planning accuracy were evaluated by lateral cephalometric analysis, with an average follow-up of 257 days. In one-segment osteotomy cases, 73% of the horizontal movements were positioned within 2mm of the surgical plan. With posterior–inferior repositioning of the maxilla, results fell within 2mm of the prescribed plan in 60% of cases.

http://ift.tt/2imBEQq

Prospective, Multicenter, Randomized, Crossover Clinical Trial Comparing the Safety and Effectiveness of Cooled Radiofrequency Ablation With Corticosteroid Injection in the Management of Knee Pain From Osteoarthritis.

Background and Objectives: Osteoarthritis (OA) of the knee affects the aging population and has an associated influence on the health care system. Rigorous studies evaluating radiofrequency ablation for OA-related knee pain are lacking. This study compared long-term clinical safety and effectiveness of cooled radiofrequency ablation (CRFA) with intra-articular steroid (IAS) injection in managing OA-related knee pain. Methods: This is a prospective, multicenter, randomized trial with 151 subjects with chronic (>=6 months) knee pain that was unresponsive to conservative modalities. Knee pain (Numeric Rating Scale [NRS]), Oxford Knee Score, overall treatment effect (Global Perceived Effect), analgesic drug use, and adverse events were compared between CRFA and IAS cohorts at 1, 3, and 6 months after intervention. Results: There were no differences in demographics between study groups. At 6 months, the CRFA group had more favorable outcomes in NRS: pain reduction 50% or greater: 74.1% versus 16.2%, P IAS (P = 0.02). There were no procedure-related serious adverse events. Conclusions: This study demonstrates that CRFA is an effective long-term therapeutic option for managing pain and improving physical function and quality of life for patients with painful knee OA when compared with IAS injection. Clinical Trial Registration: ClinicalTrials.gov (NCT02343003). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

http://ift.tt/2iSfKbF

A young female presenting with unilateral sacroiliitis following dengue virus infection: a case report

Dengue is a common arthropod-borne viral infection in Sri Lanka which is spread by the mosquitos of the genus Aedes. The clinical features of dengue include high-grade fever associated with arthralgia and myal...

http://ift.tt/2z56jJU

Recurrent allograft C3 glomerulonephritis and unsuccessful eculizumab treatment

Publication date: Available online 31 October 2017
Source:Clinical Immunology
Author(s): Kati Kaartinen, Leena Martola, Anne Räisänen-Sokolowski, Seppo Meri
There is a great lack of efficient treatments for membranoproliferative glomerulonephritis (MPGN) and recently emerged complement therapies have been proposed to be useful. We report a patient with a complement-mediated MPGN having recurrencies in kidney allografts and an unsuccessful treatment with complement inhibitor, eculizumab (anti-C5 monoclonal antibody). Nephritic factor (C3Nef), an autoantibody against C3bBb, in the patient serum activated C3 but not C5 showing that major damage was mediated by C3 activation with clearly less involvement of C5 explaining unresponsiveness to eculizumab. Analyzing C3Nef-mediated C3 and C5 activation separately could help in choosing the right patients for eculizumab therapy.



http://ift.tt/2hvEbbl

Editorial Board

Publication date: October 2017
Source:Clinical Immunology, Volume 183





http://ift.tt/2hvE2oj

Improving margin revision: Characterization of tumor bed margins in early oral tongue cancer

Publication date: Available online 1 November 2017
Source:Oral Oncology
Author(s): Arpan V. Prabhu, Charles D. Sturgis, Chi Lai, Jessica H. Maxwell, Mihai Merzianu, Juan C. Hernandez-Prera, Bibianna Purgina, Lester D.R. Thompson, Madalina Tuluc, Xiu Yang, Raja R. Seethala, Robert L. Ferris, Simion I. Chiosea
ObjectivesTo improve margin revision, this study characterizes the number, fragmentation, and orientation of tumor bed margins (TBM) in patients with pT1-2 pN0 squamous cell carcinoma (SCC) of the oral tongue.Materials and MethodsPathology reports (n=346) were reviewed. TBM parameters were indexed. In Group 1 patients all margins were obtained from the glossectomy specimen and there were no TBM. In Revision Group/Group 2 (n=103), tumor bed was sampled to revise suboptimal margins identified by examination of the glossectomy specimen. In Group 3 (n=124), TBM were obtained before examination of the glossectomy specimen.Results and ConclusionsFewer TBMs were obtained per patient in Group 2 compared to Group 3 (57/103, 55% of patients with <3 vs. 117/124, 94%, ≥3 TBMs, respectively). The new margin surface was more frequently indicated in Group 2 compared to Group 3 (59/103, 57%, vs. 19/124, 15%, p<.001). If glossectomy specimen margins are accepted as the reference standard, then the TBM was 15% sensitive in Group 2 (95% confidence interval [CI], 7–29) and 32% sensitive in Group 3 (95% CI, 15–55). TBM fragmentation (23/103, 22% vs. 42/124, 34%) and frozen vs. permanent discrepancies (8/103, 3% vs. 3/124, 2%) were similar between Groups 2 and 3. The new margin surface was not indicated in 6 of 11 cases with discrepant frozen vs. permanent pathology findings, precluding judgment on final margin status. To facilitate the assessment of final margins, TBM should be represented by one tissue fragment with a marked new margin surface.

Graphical abstract

http://ift.tt/2zokxIV

Expression of Cat Podoplanin in Feline Squamous Cell Carcinomas

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.


http://ift.tt/2zn3eHW

Establishment of EMab-134, a Sensitive and Specific Anti-Epidermal Growth Factor Receptor Monoclonal Antibody for Detecting Squamous Cell Carcinoma Cells of the Oral Cavity

Monoclonal Antibodies in Immunodiagnosis and Immunotherapy , Vol. 0, No. 0.


http://ift.tt/2zcv6Of

Corrigendum to “ Mineralization-defects are comparable in fluorotic impacted human teeth and fluorotic mouse incisors” [Archives of Oral Biology 29 (July (83)) (2017) 214–221]

Publication date: December 2017
Source:Archives of Oral Biology, Volume 84
Author(s): Rosita Jalali, Franck Guy, Samaneh Ghazanfari, Don Lyaruu, Leo van Ruijven, Pamela DenBesten, Stefania Martignon, Gina Castiblanco, Antonius Bronckers




http://ift.tt/2zXVwjG

Inhibition of malodorous gas formation by oral bacteria with cetylpyridinium and zinc chloride

Publication date: December 2017
Source:Archives of Oral Biology, Volume 84
Author(s): Jeong Hyun Kang, Dae Jeong Kim, Bong Kyu Choi, Ji Woon Park
ObjectiveThe antimicrobial efficacy of zinc- (ZnCl2) and cetylpyridinium-chloride (CPC) and their inhibition capacity on volatile sulfur compound (VSC) production by oral bacterial strains were investigated.DesignMinimum inhibitory concentrations (MIC) and growth curves were determined for ZnCl2, CPC, and CPC with ZnCl2 solutions against eight oral microorganisms (Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Treponema denticola, Tannerella forsythia, Staphylococcus aureus and Streptococcus mutans) known to be involved in the pathophysiology of both halitosis and periodontal disease. Gas chromatography was applied to measure VSCs (H2S, CH3SH, (CH3)2S) production levels of each strains following exposure to the solutions.ResultsZnCl2 and CPC effectively inhibited growth of all eight strains. ZnCl2 was generally more effective than CPC in suppressing bacterial growth excluding A. actinomycetemcomitans, P. intermedia, and T. forsythia. Synergism between CPC and ZnCl2 was shown in A. actinomycetemcomitans. The MIC for CPC was significantly lower than ZnCl2. VSC production was detected in five bacterial strains (A. actinomycetemcomitans, F. nucleatum, P. gingivalis, T. denticola, and T. forsythia). Each bacterial strain showed unique VSCs production profiles. H2S was produced by F. nucleatum, P. gingivalis, and T. denticola, CH3SH by all five strains and (CH3)2S by A. actinomycetemcomitans, F. nucleatum, P. gingivalis, and T. denticola. Production of CH3SH, the most malodorous component among the three major VSCs from mouth air was evident in F. nucleatum and T. forsythia.ConclusionBoth ZnCl2 and CPC effectively inhibit bacterial growth causative of halitosis and periodontal disease, resulting in a direct decrease of bacterial VSCs production.



http://ift.tt/2huyNoU

Aims & Scope/Editorial board

Publication date: December 2017
Source:Archives of Oral Biology, Volume 84





http://ift.tt/2zXVnNa

Corrigendum to: “Saliva initiates the formation of pro-inflammatory macrophages in vitro” [Arch. Oral Biol. 73 (January) (2017) 295–301]

Publication date: December 2017
Source:Archives of Oral Biology, Volume 84
Author(s): Solmaz Pourgonabadi, Heinz-Dieter Müller, João Rui Mendes, Reinhard Gruber




http://ift.tt/2huVbOP

Corrigendum to “ Mineralization-defects are comparable in fluorotic impacted human teeth and fluorotic mouse incisors” [Archives of Oral Biology 29 (July (83)) (2017) 214–221]

Publication date: December 2017
Source:Archives of Oral Biology, Volume 84
Author(s): Rosita Jalali, Franck Guy, Samaneh Ghazanfari, Don Lyaruu, Leo van Ruijven, Pamela DenBesten, Stefania Martignon, Gina Castiblanco, Antonius Bronckers




http://ift.tt/2zXVwjG

Inhibition of malodorous gas formation by oral bacteria with cetylpyridinium and zinc chloride

Publication date: December 2017
Source:Archives of Oral Biology, Volume 84
Author(s): Jeong Hyun Kang, Dae Jeong Kim, Bong Kyu Choi, Ji Woon Park
ObjectiveThe antimicrobial efficacy of zinc- (ZnCl2) and cetylpyridinium-chloride (CPC) and their inhibition capacity on volatile sulfur compound (VSC) production by oral bacterial strains were investigated.DesignMinimum inhibitory concentrations (MIC) and growth curves were determined for ZnCl2, CPC, and CPC with ZnCl2 solutions against eight oral microorganisms (Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Treponema denticola, Tannerella forsythia, Staphylococcus aureus and Streptococcus mutans) known to be involved in the pathophysiology of both halitosis and periodontal disease. Gas chromatography was applied to measure VSCs (H2S, CH3SH, (CH3)2S) production levels of each strains following exposure to the solutions.ResultsZnCl2 and CPC effectively inhibited growth of all eight strains. ZnCl2 was generally more effective than CPC in suppressing bacterial growth excluding A. actinomycetemcomitans, P. intermedia, and T. forsythia. Synergism between CPC and ZnCl2 was shown in A. actinomycetemcomitans. The MIC for CPC was significantly lower than ZnCl2. VSC production was detected in five bacterial strains (A. actinomycetemcomitans, F. nucleatum, P. gingivalis, T. denticola, and T. forsythia). Each bacterial strain showed unique VSCs production profiles. H2S was produced by F. nucleatum, P. gingivalis, and T. denticola, CH3SH by all five strains and (CH3)2S by A. actinomycetemcomitans, F. nucleatum, P. gingivalis, and T. denticola. Production of CH3SH, the most malodorous component among the three major VSCs from mouth air was evident in F. nucleatum and T. forsythia.ConclusionBoth ZnCl2 and CPC effectively inhibit bacterial growth causative of halitosis and periodontal disease, resulting in a direct decrease of bacterial VSCs production.



http://ift.tt/2huyNoU

Aims & Scope/Editorial board

Publication date: December 2017
Source:Archives of Oral Biology, Volume 84





http://ift.tt/2zXVnNa

Corrigendum to: “Saliva initiates the formation of pro-inflammatory macrophages in vitro” [Arch. Oral Biol. 73 (January) (2017) 295–301]

Publication date: December 2017
Source:Archives of Oral Biology, Volume 84
Author(s): Solmaz Pourgonabadi, Heinz-Dieter Müller, João Rui Mendes, Reinhard Gruber




http://ift.tt/2huVbOP

Risk Stratification of Thyroid Nodules on Ultrasonography: Current Status and Perspectives

Thyroid , Vol. 0, No. 0.


http://ift.tt/2h3e7ag

Treating laryngopharyngeal reflux: Evaluation of an anti-reflux program with comparison to medications

Publication date: Available online 31 October 2017
Source:American Journal of Otolaryngology
Author(s): Jin Yang, Salem Dehom, Stephanie Sanders, Thomas Murry, Priya Krishna, Brianna K. Crawley
ObjectiveTo determine if an anti-reflux induction program relieves laryngopharyngeal reflux (LPR) symptoms more effectively than medication and behavioral changes alone.Study designRetrospective study.SettingTertiary care academic center.Subjects and methodsA database was populated with patients treated for LPR. Patients were included in the study group if they completed a two-week anti-reflux program (diet, alkaline water, medications, behavioral modifications). Patients were included in the control group if they completed anti-reflux medications and behavioral modifications only. Patients completed the voice handicap index (VHI), reflux symptom index (RSI), cough severity index (CSI), dyspnea index (DI) and eating assessment tool (EAT-10) surveys and underwent laryngoscopy for examination and reflux finding score (RFS) quantification.ResultsOf 105 study group patients, 96 (91%) reported subjective improvement in their LPR symptoms after an average 32-day first follow-up and their RSI and CSI scores improved significantly. No significant differences were found in VHI, DI, or EAT-10 scores. Fifteen study patients who had previously failed adequate high-dose medication trials reported improvement and their CSI and EAT-10 scores improved significantly. Ninety-five percent of patients with a chief complaint of cough reported improvement and their CSI scores improved significantly from 12.3 to 8.2. Among 81 controls, only 39 (48%) patients reported improvement after an average 62-day first follow-up. Their RSI scores did not significantly change.ConclusionThe anti-reflux program yielded rapid and substantial results for a large cohort of patients with LPR. It compared favorably with medication and behavioral modification alone. It was effective in improving cough and treating patients who had previously failed medications alone.



http://ift.tt/2z6E9yg

Medical Scribes in an Academic Dermatology Practice

This study examines the implementation of a multipractice quality improvement pilot program evaluating medical scribe impact on dermatologist documentation time and physician satisfaction.

http://ift.tt/2z5d4LK

The Importance of Population-Based Estimates of Melanocytic Pathology

In this issue of JAMA Dermatology, Lott et al describe a novel and innovative approach to estimating the prevalence of different types of melanocytic lesions in all adults undergoing skin biopsies in a population. Using an automated natural language processing tool, they analyzed 80 368 written pathology reports of skin biopsies from 47 529 adult patients drawn from an underlying health system patient population, which was representative of the general adult population. For analysis of each pathology report, the diagnosis was first dichotomized as either a melanocytic or nonmelanocytic lesion. For melanocytic lesions, the cases were then assigned to 1 of 4 diagnostic categories based on the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MPATH-Dx), with differing management implications: class I, benign lesion requiring no further treatment; class II, low-risk lesion requiring complete excision with narrow (<5-mm) margins; class III, higher-risk lesion such as melanoma in situ requiring reexcision with 5-mm to 1-cm margins; and class IV/V, invasive melanoma requiring wide reexcision with 1-cm margins or greater. Approximately one-quarter of all skin biopsies were of melanocytic lesions. Of these, over 90% were benign or low risk (class I or II); 4.5% were melanoma in situ or similar-risk lesion (class III); and 4.1% were invasive melanoma (class IV/V).

http://ift.tt/2z4T1zp

Population-Based Frequencies and Distribution of Melanocytic Lesions

This large-scale analysis of pathology reports in electronic medical records, using the natural language processing technique, evaluates population-based distributions and pathologic characteristics of melanocytic proliferations.

http://ift.tt/2z4G7Pu

Prescription-Strength Topical Steroids Sold Without Prescription

This case report describes the use of a prescription-strength topical steroids obtained without prescription.

http://ift.tt/2iQbIjV

The European Society of Anaesthesiology research support programme at 15 years: a lot done, still more to do

No abstract available

http://ift.tt/2gVdT1x

KIDS SAVE LIVES: School children education in resuscitation for Europe and the world

No abstract available

http://ift.tt/2gVdPij

Perioperative cerebral oxygenation in patients undergoing aortic valve replacement

No abstract available

http://ift.tt/2gTtePT

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

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

http://ift.tt/2gTA3RA

Predicting outcome after cardiac arrest with serum S-100B protein and procalcitonin: A prospective observational study

No abstract available

http://ift.tt/2gTA08m

High quality of evidence is uncommon in Cochrane systematic reviews in Anaesthesia, Critical Care and Emergency Medicine

BACKGROUND: The association between the quality of evidence in systematic reviews and authors' conclusions regarding the effectiveness of interventions relevant to anaesthesia has not been examined. OBJECTIVE: The objectives of this study were: to determine the proportion of systematic reviews in which the authors made a conclusive statement about the effect of an intervention; to describe the quality of evidence derived from outcomes in reviews that used the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) working group system for grading the quality of evidence; and to identify review characteristics associated with conclusiveness. DESIGN: Cross-sectional analysis of Cochrane systematic reviews from the Anaesthesia, Critical Care and Emergency Review Group was undertaken. DATA SOURCES: The Cochrane webpage was used to identify reviews for inclusion (http://.ace.cochrane.org/ ). ELIGIBILITY CRITERIA: New and updated versions of systematic reviews published up to 17 September 2015 were eligible. Protocols for systematic reviews were excluded. RESULTS: A total of 159 reviews were included. GRADE was used in 103 reviews (65%). Of these, high-level evidence for the primary outcome was identified in 11 reviews (10%). The main reasons that quality of evidence for the primary outcome was downgraded were risk of bias (n = 44; 43%) and imprecision (n = 36; 35%). Authors of 47% (n = 75) of the total number of reviews made conclusive statements about the effects of interventions. Independent predictors of conclusiveness in the subgroup of reviews with GRADE assessments were quality of evidence for the primary outcome (odds ratio 2.03; 95% confidence interval: [1.18 to 3.52] and an increasing number of studies included in reviews (OR 1.05; 95% CI: [1.01 to 1.09]). CONCLUSION: It was common for conclusive statements to be made about the effects of interventions despite evidence for the primary outcome being rated less than high quality. Improving methodological quality of trials would have the greatest impact on improving the quality of evidence.

http://ift.tt/2ilq1ZR

Impact of prior smoking cessation on postoperative pulmonary complications in the elderly: secondary analysis of a prospective cohort study

No abstract available

http://ift.tt/2ilpY07

Anaesthesiology research in the European Union and the European Free Trade Association: An overview from 2001 to 2015

BACKGROUND: Publication performance in anaesthesiology hints at research activity and attractiveness for a particular centre or country for anaesthetists. OBJECTIVE: The aim of this retrospective bibliographic study is to compare the publication performance of anaesthesiology departments within the countries of the European Union (EU) and European Free Trade Association (EFTA) combined. Outcome measures were the number of publications, the number of original articles, the average impact factor and the number of publications and average impact factor per million inhabitants. METHODS: Articles from anaesthesiology departments within the EU and EFTA countries published between 1 January 2001 and 31 December 2015 were included. Articles were electronically imported from Medline into a database and linked to anaesthesiology departments according to the authors' affiliations. Publication performance was assessed for 2001 to 2005, 2006 to 2010, 2011 to 2015 and 2001 to 2015. RESULTS: From 2001 to 2015, the absolute number of articles increased from 10 513 to 19 037 (+81%), whereas the number of original research articles decreased from 3786 to 1563 (−58%). Germany had the most publications (8948) with 1967 of these being original articles. Denmark achieved not only the highest average impact factor per million inhabitants (319.9) but also the most articles per anaesthesiologist (1.46), and per million habitants (105.7). Countries which moved up the income scale to a higher income class also increased the number of publications. DISCUSSION: In the EU and EFTA countries, the total number of publications increased from 2001 to 2015, but the number of original research articles fell by more than 50%. CONCLUSION: Between 2001 and 2015, in the EU and EFTA countries, the number of publications increased, whereas the number of original articles decreased. Germany published most, but Denmark had most publications per anaesthesiologist and per capita, and also achieved the highest impact factor per article.

http://ift.tt/2ilr7EN

Can nonstandardised, simplified autonomic function tests be used for risk profiling in the anaesthesia population?

No abstract available

http://ift.tt/2gTzGGG

Research ethics committee approval as reported for abstracts submitted to the annual Euroanaesthesia meeting

BACKGROUND: The annual congress of the European Society of Anaesthesiology (ESA) is one of the largest anaesthesia congresses in the world and exhibits more than 1200 abstracts annually. OBJECTIVES: The aims of this study were to quantify the frequency of inadequate evidence of ethical approval for abstracts submitted to the ESA congress and to examine whether abstracts without appropriate ethical approval were subsequently accepted. DESIGN AND SETTING: All abstracts submitted in 2015 were adjudicated according to European ethical criteria. MAIN OUTCOME MEASURE: The proportion of submitted abstracts that lacked evidence of appropriate ethics committee approval. Secondary outcomes included the proportion of accepted abstract that lacked evidence of appropriate ethical approval; the proportion of correctly identified case reports; the proportion of accepted abstracts that lacked evidence of appropriate ethics committee approvals corresponding to location (within/outside Europe); and the proportion of accepted abstracts that lacked evidence of appropriate ethics committee approvals corresponding to a specific area of research. RESULTS: In total, 1792 abstracts were reviewed and 1572 (87.7%) involved humans. In 527 (29.4%), the authors failed to demonstrate adequate ethical approval with higher rates in abstracts submitted from Europe (32.1%) than the rest of the world (23.5%), P 

http://ift.tt/2gU4c3d

Evaluation of the ‘no pain, no gain theory’ in postoperative care following cardiac surgery

No abstract available

http://ift.tt/2ilqM4Z

Role of the internet as an information resource before anaesthesia consultation: A French prospective multicentre survey

BACKGROUND: Use of the internet as an information search tool has increased dramatically. Our study assessed preoperative use of the internet by patients to search for information regarding anaesthesia, surgery, pain or outcomes. OBJECTIVE(S): The aim of this study was to test whether patients used the internet prior to surgery and what kinds of information they looked for (anaesthetic technique, pain, adverse events, outcomes and surgery). Correlation between patient age and information sought about surgery from the internet was also explored. DESIGN: A prospective multicentre observational study. SETTING: In total, 14 French private and public institutions from May 2015 to January 2016. PATIENTS: In total, 3161 adult patients scheduled for elective surgery under regional or general anaesthesia. INTERVENTION(S): An anonymous questionnaire was presented to adult patients scheduled for elective surgery under regional or general anaesthesia for completion before the first meeting with the anaesthesiologist. The investigator at each centre completed specific items that the patient could not complete. MAIN OUTCOME MEASURES: We defined the primary endpoint as the number of patients who searched for information about their anaesthesia or surgery on the internet by the time of the their preanaesthetic consultation. RESULTS: Of the 3234 questionnaires distributed, responses were received from 3161 patients. Within this respondent sample, 1304 (45%) were professionally active and 1664 (59%) used the internet at least once per day. Among 3098 (98%) patients who answered the question concerning the primary endpoint, 1506 (48%) had searched the internet for information about their health. In total, 784 (25%) used the internet to find information about their surgery and 113 (3.5%) looked for specific information about anaesthesia. Of the 3161, 52% reported difficulty searching for appropriate information about anaesthesia on the internet. 'Daily use of the web' [odds ratio (OR) 2.0; (95% CI: 1.65 to 2.55) P 

http://ift.tt/2im7X1L

Flow-assisted basophil activation test for sevoflurane hypersensitivity: A dose-finding in-vitro experimental study

No abstract available

http://ift.tt/2ilvQ9A

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

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

http://ift.tt/2im7BrX

Capillary glucose meters cannot substitute serum glucose measurement to determine the cerebrospinal fluid to blood glucose ratio: A prospective observational study

No abstract available

http://ift.tt/2zp9Y8d

Cover

http://ift.tt/2zcHf5T

In This Issue

http://ift.tt/2zb0GvI

Anti-tumor immunity via the superoxide-eosinophil axis induced by a lipophilic component of Mycobacterium lipomannan

Abstract

Mycobacterium bovis Bacille Calmette–Guérin (BCG) has been shown to possess potent anti-tumor activity particularly in various animal models, while the cellular and molecular mechanisms underlying its activity are not well understood. We found that lipomannan (BCG-LM), a lipophilic component of the mycobacterial cell envelope, specifically inhibits tumor growth and induces the infiltration of eosinophils at local tumor invasion sites. In contrast, neither lipoarabinomannan (BCG-LAM) nor the cell wall of Mycobacterium bovis BCG (BCG-CW) exerted anti-tumor immunity. BCG-LM enhances cytotoxic activity of eosinophils via the increased production of superoxide. Global transcriptomic analyses of BCG-LM-pulsed dendritic cells identified C-C motif ligand (CCL) 5 as a crucial chemokine for the anti-tumor immunity induced by BCG-LM, indicating that CCL5 plays an important role for the accumulation of eosinophils in the tumor microenvironment. Furthermore, BCG-LM and memory T_h2 cells exerted a synergetic effect on tumor progression by cooperatively enhancing the eosinophil function. Thus, this study revealed an un-identified BCG-LM-mediated anti-tumor mechanism via superoxide produced by infiltrated eosinophils in the tumor microenvironment. Since BCG-LM activates this unique pathway, it may have potent therapeutic potential as immune cell therapy for cancer patients.

http://ift.tt/2zaKuug

Subscriptions

http://ift.tt/2z9kuQc

Table of Contents

http://ift.tt/2zcHeyR

Involvement of Zizimin2/3 in the age-related defect of peritoneal B-1a cells as a source of anti-bacterial IgM

Abstract

Zizimin2 (Ziz2), also known as dedicator of cytokinesis 11 (DOCK11), is a guanine nucleotide exchange factor that is predominantly expressed in lymphoid tissues. Recent findings demonstrated that Ziz2 is involved in the development of B cells, including germinal centre B cells and marginal zone B cells. However, limited information is currently available on the roles of Ziz2 in B-1 cells, a B-cell subset that resides in body cavities and contributes to protection against foreign pathogens in a T-cell-independent manner. We herein show that Ziz2 and its widely expressed isoform Ziz3 (also known as DOCK10) may be involved in defective production of anti-bacterial IgM by aged B-1a cells, a CD5⁺ subset of B-1 cells. Natural IgM against typical bacterial epitopes was defectively produced by peritoneal B-1a cells from aged mice. The down-regulation of Ziz2/3 in B-1a cells appeared to be responsible for this defective IgM production, as demonstrated by Ziz2/3 double-knockout mice. Mechanistically, lower levels of basal AKT phosphorylation did not allow for the differentiation of Ziz2/3-deficient B-1a cells into plasma cells. Defective production of anti-bacterial IgM was not fully rescued by immunization, resulting in slightly weaker protection in Ziz2/3-deficient mice. Thus, the down-regulation of Ziz2/3 in B-1a cells may at least partly account for defective protection in aged mice.

http://ift.tt/2zbM6UL

Expression of KIR2DS1 does not significantly contribute to NK cell cytotoxicity in HLA-C1/C2 heterozygous haplotype B donors

Abstract

NK cells are functionally controlled by the killer immunoglobulin-like receptor (KIR) family that comprises inhibitory (iKIR) and activating (aKIR) members. Genetic association studies suggest that donors expressing aKIRs next to iKIRs will be superior donors in the setting of hematopoietic stem cell transplantation of patients with leukemia. However, contrary evidence states that aKIR expression may be irrelevant or even detrimental. Using a complex methodology incorporating KIR-Q-PCR, double fluorescence and viSNE analysis, we characterized subset distribution patterns and functionality in haplotype A donors which lack aKIRs and haplotype B donors that express a variety of B-specific genes. Here, we show that the alloreactive KIR2DS1⁺ NK cell subset in HLA-C1/C2 donors is highly responsive towards C2-expressing targets but quantitatively small and as such does not significantly contribute to cytotoxicity. Thus, we fail to find a direct link between haplotype allocation status and NK cell cytotoxicity at least in HLA-C1/C2 heterozygous donors.

http://ift.tt/2zoh0dB

Hyperferritinemia and inflammation

Abstract

Understanding of ferritin biology has traditionally centered on its role in iron storage and homeostasis, with low ferritin levels indicative of deficiency and high levels indicative of primary or secondary hemochromatosis. However, further work has shown that iron, redox biology and inflammation are inexorably linked. During infection, increased ferritin levels represent an important host defense mechanism that deprives bacterial growth of iron and protects immune cell function. It may also be protective, limiting the production of free radicals and mediating immunomodulation. Additionally, hyperferritinemia is a key acute-phase reactants, used by clinicians as an indication for therapeutic intervention, aimed at controlling inflammation in high-risk patients. One school of thought maintains that hyperferritinemia is an 'innocent bystander' biomarker of uncontrolled inflammation that can be used to gauge effectiveness of intervention. Other schools of thought maintain that ferritin induction could be a protective negative regulatory loop. Others maintain that ferritin is a key mediator of immune dysregulation, especially in extreme hyperferritinemia, via direct immune-suppressive and pro-inflammatory effects. There is a clear need for further investigation of the role of ferritin in uncontrolled inflammatory conditions both as a biomarker and mediator of disease because its occurrence identifies patients with high mortality risk and its resolution predicts their improved survival.

http://ift.tt/2zbPnU0

A clinical update on inflammasomopathies

Abstract

Inflammasomes are important elements of the innate immune defense. The most common autoinflammatory syndromes, as well a number of rare ones, are due to hereditary defects in the inflammasomes, hence are called inflammasomopathies. The recent clinical advances in these diseases will be reviewed, with special emphasis on reflecting the international collaborative work in the field. Recent recommendations for familial Mediterranean fever, cryopyrin-associated periodic syndromes and hyper-IgD syndrome/mevalonate kinase deficiency will be presented and diagnostics tests, treatment alternatives and follow-up recommendations will be summarized. The other rare inflammasomopathies will be briefly discussed based on clinical features; these diseases are pyogenic arthritis, pyoderma gangrenosum and acne, NLRC4-related macrophage-activation syndrome of enterocolitis, mutations in NLRP12 that cause hereditary periodic fever syndromes (familial cold inflammatory syndrome 2) and NLRP1-associated autoinflammation with arthritis and dyskeratosis.

http://ift.tt/2zaKryA

Management of Patients with Left Ventricular Assist Devices requiring Teeth Extraction: Is Halting Anti-Coagulation Appropriate?

Publication date: Available online 31 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Visakha Suresh, Muath Bishawi, Michael W. Manning, Chetan Patel, Joseph Rogers, Carmelo Milano, Jacob Schroder, Mani Daneshmand, David Powers
IntroductionAn increasing number of end-stage heart failure patients are supported with left ventricular assist device (LVAD) implantation and must be maintained on a consistent anticoagulation regimen. Preemptive extraction of carious teeth in these patients is necessary to seeding of the implanted device and endocarditis. Thus, the objective of this study was to evaluate bleeding complications after minor oral surgery, specifically teeth extractions, in this unique patient population requiring chronic anticoagulation.MethodsThis study was a retrospective single center review. Adult patients supported on an implanted, continuous flow LVAD from January 1, 2007 to December 31, 2016 were included. Baseline characteristics were collected via retrospective chart review and the institutional LVAD registry. All extractions were performed in the operating room, under local anesthesia with moderate sedation or general anesthesia with nasal intubation, while LVAD settings were monitored by a trained perfusionist. Preoperative and postoperative hematology lab values, such as hemoglobin, international normalized ratio (INR), were collected via chart review. Continuous variables were presented as mean ± standard deviations, and compared using the Student t-test. Categorical variables were presented as proportions and percentages, and compared using chi-squared test or Fisher Exact test as appropriate. Statistical significance was established at a p < 0.05.ResultsAfter screening 798 patients, 32 (4%) were found to have undergone dental extractions after LVAD implantation. The sample was composed of 32 subjects with a mean age of 60.13 years and 81.25% were male. The average time from LVAD implantation to extraction was 445.19 ± 1108.53 days. Average pre-operative INR was 1.76 ± 0.47. Pre-operative FFP was not administered to any patients. 28 (87.5%) patients were on coumadin pre-operatively. In 11 (39.3%) of the 28, Coumadin was held preoperatively. The average post-operative change in hemoglobin was -0.79 ± 1.45. Only one patient (3%) required post-operative blood transfusion for a hemoglobin of 7.6 that responded appropriately. There were no re-operations for bleeding.ConclusionsMinor oral surgical procedures can be performed safely for patients being supported on LVAD therapy. With primary closure of the gingiva at the site of extraction, dental extractions can be performed without the full reversal of anticoagulation.



http://ift.tt/2z4yzfL

Eczema Can Predict Severity of Asthma Hospitalization

A family history of asthma and a patient's own history of atopic dermatitis are linked to a more severe hospital experience, according to a study that could influence care decisions.
Medscape Medical News

http://ift.tt/2z0X3ZA

Mutations de la préséniline dans la maladie de Dowling-Degos : lien avec l’occlusion folliculaire et avec la voie notch

Publication date: Available online 31 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): O. Dereure




http://ift.tt/2xMsRgP

Polémiques sur la vitamine D

Publication date: Available online 31 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M.-T. Leccia




http://ift.tt/2zpnfhl

Nouveautés dans la prise en charge des épidermolyses bulleuses congénitales

Publication date: Available online 31 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): D. Murrell




http://ift.tt/2xKiRoi

L’hyperplasie épithéliale verruqueuse du pénis

Publication date: Available online 31 October 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J.-N. Dauendorffer, B. Cavelier Balloy, M. Bagot, C. Renaud-Vilmer




http://ift.tt/2zmwyOM

Issue Information

http://ift.tt/2z4iYz5

Radiotherapy With or Without Concurrent Chemotherapy for Extensive Lymphatic Metastasis of Esophageal Cancer - 3JECROG-P03

Condition:   IMRT With or Without Concurrent Chemotherapy for Esophageal Cancer
Interventions:   Radiation: SIB-IMRT;   Drug: Paclitaxel;   Drug: Platinum-Based Drug;   Other: Elective Nodal Irradiation (ENI);   Other: Involved Field Irradiation (IFI)
Sponsor:   Chinese Academy of Medical Sciences
Recruiting

http://ift.tt/2z4sdzi

Major Radiation Reduction for HPV+ Oropharyngeal Carcinoma

Conditions:   HPV-Associated Oropharyngeal Squamous Cell Carcinoma;   Squamous Cell Carcinoma of the Neck
Interventions:   Diagnostic Test: F-FMISO PET/CT Scan;   Radiation: 30 Gy over 3 weeks;   Drug: Cisplatin;   Drug: Carboplatin;   Drug: 5Fluorouracil
Sponsor:   Memorial Sloan Kettering Cancer Center
Recruiting

http://ift.tt/2h3SmqW

Susuk or charm needle: a strange object detected on orthodontic diagnostic radiographs

Description

Uncommon and peculiar radiological findings resulting from cultural or religious beliefs and practices may be seen in individuals from certain parts of the world. With people migrating from these locations to other parts of the world, such findings often mystifies clinicians who may be unfamiliar with such traditions.1 Susuks or charm needles are one such cultural practices common in southeast Asia. These are metallic pins usually made of silver, gold or its alloys, measuring about 5–10 mm in length and 0.5 mm in diameter. It is claimed that susuk makes its wearers more beautiful, keeps them young, improves health, relieves pain and even help them attain an affluent career. A shaman would slowly rub the skin and gently insert the pins while doing some chanting. The procedure is painless with minimal or no bleeding and the pins remain in the soft tissues without causing any visible scarring...

http://ift.tt/2h2Qkr9

Resting and re-emergent tongue tremor in Parkinsons disease

Description

An 82-year-old man was referred to our department for re-evaluation of parkinsonism. The patient had a 2-year history of parkinsonism followed by dementia and was treated with 300 mg of levodopa/decarboxylase inhibitor. The patient previously had a significant response of motor symptoms including rest and re-emergent tremor to levodopa therapy. The medical history included chronic subdural haematoma. Neurological examination showed bradykinesia and rigidity involving the neck and upper and lower extremities. Resting tremor at the jaw, tongue and right foot was observed. Re-emergent tongue tremor was observed (see online ). The patient was in Hoehn and Yahr stage 5 in an 'on' state. He had dementia with visual hallucinations. Brain MRI showed diffuse cortical atrophy with preserved midbrain tegmentum and pons. A diagnosis of Parkinson's disease (PD) with dementia was made. Reduced uptake of the early and delayed heart-to-mediastinum ratios of cardiac 123I-metaiodobenzylguanidine scintigraphy and anosmia supported the diagnosis.

...

http://ift.tt/2z4wt1U

Multiple endocrine neoplasia type 1 presenting with refractory seizures

We report a case of 29-year-old woman referred to us for management of refractory epilepsy. Under observation, she was detected to have recurrent hypoglycaemia during the episodes of seizures. On investigation, she was found to have hyperinsulinemic hypoglycaemia. Her triple-phase CT scan of abdomen showed neuroendocrine tumour of pancreatic head, with bilateral renal calculi. Screening of other endocrine glands revealed pituitary microadenoma and parathyroid adenoma on imaging, which was also supported by biochemical and hormonal profile. On the basis of tumours involving parathyroid, pancreatic islets and pituitary gland, she was diagnosed as a case of multiple endocrine neoplasia type 1. Pancreatic tumour removal was done and bromocriptine was started. She was followed up for 6 months postoperatively and never had seizures even without antiepileptic drugs. This case report highlights an exceptional treatable cause of uncontrolled seizures.

http://ift.tt/2h2Qb75

Inferior dermal flap in breast reconstruction with tissue expanders

A surgical case, in which inferior dermal flap was used to cover a tissue expander for breast reconstruction, is reported. In spite of the skin necrosis on the seventh postoperative day, flap coverage successfully protected the tissue expander from exposition.

http://ift.tt/2z4S0r7

Kyrles disease: a cutaneous manifestation of diabetes mellitus

Description

A 52-year-old female patient presented to the dermatology department with complaints of itchy skin lesions all over the body for past 3 months. She was a known case of type 2 diabetes mellitus for 10 years which was poorly controlled on oral antidiabetes medications. On cutaneous examination, multiple, discrete, hyperpigmented, hyperkeratotic papules with central keratotic plugs were present over the neck, trunk, abdomen (figure 1A), gluteal region (figure 1B) and lower limbs with few lesions showing koebnerisation. The differential diagnoses considered on initial examination were prurigo nodularis and perforating dermatosis such as Kyrle's disease, perforating folliculitis and reactive perforating collagenosis. Laboratory investigations revealed poorly controlled diabetes with HbA1c of 11.4% and fasting glucose of 278 mg/dL. Her liver, thyroid and renal functions were normal and there was no evidence of retinopathy or nephropathy on screening. She was started on insulin (split mix regimen) and her blood...

http://ift.tt/2h2resy

Landiolol is effective for the treatment of tachycardia-induced cardiogenic shock in patients during septic shock therapy

Septic shock is a life-threatening condition that occurs when the blood pressure drops to a low level after an infection. Atrial fibrillation (AF) is the most common arrhythmia to complicate its course. Beta (β)-blockers are often administrated to manage supraventricular tachyarrhythmias observed in patients presenting with sepsis. A 74-year-old woman presenting with sepsis demonstrated AF tachycardia characterised by severe hypotension. She was refractory to conventional therapy including verapamil and digoxin; therefore, treatment using landiolol (an ultrashort-acting β-blocker) was initiated. Her clinical course was followed over 48 hours, and she showed a significant improvement in her heart rate and blood pressure without any adverse effect. Landiolol can rapidly control the accelerated heart rate associated with AF in critically decompensated patients presenting with septic shock.

http://ift.tt/2z4kqS4

Hot cross bun and bright middle cerebellar peduncle signs in cerebellar type multiple system atrophy

Description

A 52-year-old female patient presented with progressive gait unsteadiness for 6 months. Over the months, it has worsened to such an extent that she required support for walking. She also complained of frequent episodes of light-headedness on standing up from lying down or sitting down. She had no urge incontinence, urinary retention, increased frequency of micturition or constipation. She had no bradykinesia, rigidity, memory loss or features suggestive of dementia. There was no family history of similar complaints or dementia. On examination, she was found to have gait ataxia, nystagmus and intention tremors. The gait was broad based with sway towards left side. Her eye movements showed dysmetric saccades and jerky pursuit. She was also found to have postural hypotension. Her supine blood pressure was 170/90 mm Hg and her standing blood pressure was 140/70 mm Hg. She had no resting tremor, rigidity or bradykinesia. Babinski's sign was negative....

http://ift.tt/2h2r4kW

Hair thread tourniquet syndrome in a male infant: a rare surgical emergency

Hair thread tourniquet syndrome (HTTS) is a rare surgical emergency that occurs when one or more appendages are acutely circumferentially strangulated by human hair. If left untreated it may induce prolonged ischaemia, resulting in tissue necrosis or autoamputation of the affected digit. It may involve the fingers, toes, penis or labia. It typically occurs in infants, but cases have also been reported in adults. Prompt recognition and treatment by complete removal of the constricting agent is crucial to preserve the affected tissue. We report a case of HTTS affecting the left middle toe of an 8-week-old male infant successfully treated by surgical release of the hair. The authors aim to raise awareness of HTTS among physicians, emergency doctors, paediatricians and surgeons, as prompt recognition and management prevents adverse outcomes and tissue necrosis.

http://ift.tt/2z4n1M0

Penile Mondors disease after anterolateral retroperitoneal approach for lumbar fracture

This is a rare case of thrombosis of the dorsal vein of the penis (Mondor's disease) occurred after an anterior-lateral retroperitoneal approach for a vertebral stabilisation in thoracolumbar vertebral fracture. Potential causes are traumatism, neoplasms, excessive sexual activity or abstinence. Although penile Mondor's disease is a clinical diagnosis, ultrasound imaging is the gold standard to confirm it. In the reported case, 1 week after neurosurgical retroperitoneal procedure of vertebral stabilisation, the patient complained of a painful cord-like mass midshaft of penis. The diagnosis was made by clinical evaluation and ultrasound images. After 2 weeks of therapy with enoxaparin sodium, the patient recovered. The authors report this case evaluating the possible correlation between the anterior-lateral retroperitoneal approach and the development of the rare Mondor's disease.

http://ift.tt/2h2hmPd

Extracorporeal membrane oxygenation for post-transplant hypoxaemia following very severe hepatopulmonary syndrome

Hepatopulmonary syndrome (HPS) associated with end-stage liver disease has a high morbidity when room air PaO₂ is less than 50 mm Hg. Safe levels of oxygenation to facilitate transplantation have not been defined despite advancement in care. Postoperatively, hypoxaemia worsens due to ventilation perfusion mismatch contributed by postoperative pulmonary vasoconstriction and due to decrease in endogenous nitric oxide. A 16-year-old boy with cirrhosis presented with HPS and a PaO₂ of 37 mm Hg on room air and underwent living donor liver transplant. Although stable intraoperatively, he desaturated on the second postoperative day. Despite a number of interventions, oxygenation remained critically low on 100% inspired oxygen. Extracorporeal membrane oxygenator (ECMO) was established with instant improvement in oxygenation (PaO₂68 mm Hg), and the patient was eventually salvaged. We suggest that ECMO could be a means of managing refractory post-transplant hypoxaemia in patients with HPS.

http://ift.tt/2z4km4M

Use of emergency department point-of-care ultrasound in a case of cholecystitis

A 54-year-old man presented with severe right upper quadrant (RUQ) abdominal pain. He denied any infective symptoms. On clinical examination, he was afebrile and anicteric. His abdomen was soft with tenderness elicited on the RUQ. A point-of-care ultrasound in the emergency department demonstrated a distended gallbladder with a thickened wall and an impacted large gallstone at the neck of the gallbladder. Furthermore, the point-of-care ultrasound also identified a highly reflective echo from the anterior surface of the gallstone and marked posterior acoustic shadowing. A diagnosis of cholecysitis was made after confirmatory ultrasonography performed in the radiology department. The patient had a cholecystostomy performed under interventional radiology and was managed with course of intravenous antibiotics for 7 days. He was discharged from hospital with an elective cholecystectomy planned to be performed 8 weeks posthospital discharge.

http://ift.tt/2h3HvNI

Tranexamic acid in treatment-resistant chronic transfusion-dependent gastrointestinal angiodysplasia bleeding

A small proportion of gastrointestinal angiodysplasia bleeding leads to chronic blood cell transfusion dependency. There are no guidelines supporting decision-making among various treatments in patients with gastrointestinal angiodysplasia bleeding. When endoscopic argon plasma coagulation is ineffective, the angiogenesis inhibitors thalidomide and octreotide can be considered. We describe a 77-year-old woman who had side effects of these angiogenesis inhibitors, which caused her to have continued bleeding. She was successfully treated with tranexamic acid with a substantial decrease in need for red blood cell transfusions.

http://ift.tt/2z4k3XG

Gerstmann-Sträussler-Scheinker disease with atypical presentation

We describe a 37-year-old woman who presented with progressive deafness, visual loss and ataxia. She latterly developed neuropsychiatric problems, including cognitive impairment, paranoid delusions and episodes of altered consciousness. She was found to be heterozygous for the Q212P mutation in the prion protein gene. She died over a decade after initial presentation and a diagnosis of prion disease was confirmed at postmortem.

http://ift.tt/2h3b95F

Maternal olmesartan exposure causing neonatal failure

Although angiotensin II receptor blockers (ARBs) are contraindicated during pregnancy, new cases are currently being reported.

A 32-week preterm neonate was admitted after C-section due to maternal oligohydramnios. He presented with Potter phenotype, pulmonary hypoplasia with pneumothorax, systemic hypotension and anuria. He required chest drain insertion and continuous positive airway pressure (CPAP), volume expansion plus inotropic support with persistent renal failure. Mother confirmed olmesartan intake during entire pregnancy. Peritoneal dialysis was started with improvement in renal markers and progressive recovery of renal function. He has been followed up until the age of 2 years, observing improved renal function with a glomerular filtration rate (GFR) of 58 mL/min/1.72 m².

Both angiogenesis-converting enzyme inhibitor and ARBs affect nephrogenesis; ARBs being more harmful due to its higher activity. Although some patients may recover normal renal function, its teratogen effect may have fatal consequences. Thus, it is important to emphasise its harmful effects in neonates to avoid new cases.

http://ift.tt/2z3A1Bx

Breast reconstruction in a patient with Noonan syndrome

Noonan syndrome (NS) is a relatively common genetic disorder with an autosomal dominant inheritance pattern affecting 1 in 1000–2500 births. Patients with this syndrome present with characteristic facial, musculoskeletal, cardiac and endocrine abnormalities. Lack of postpubertal breast development is a common manifestation of this syndrome and may result in severe hypomastia and a masculine appearance of the female chest. We report the first case of breast reconstruction in a 24-year-old woman with NS who lacked postpubertal breast development. Technical considerations for addressing the existing chest wall deformity, implant pocket selection as well as emphasis on the role of the plastic surgeon are presented.

http://ift.tt/2h3aNMn

Comparison of the protective effects of direct ischemic preconditioning and remote ischemic preconditioning in a rabbit model of transient spinal cord ischemia

Abstract

Introduction

This study aimed to determine the relative potency of direct ischemic preconditioning (DIPC) and remote ischemic preconditioning (RIPC) for protection against ischemic spinal cord injury in rabbits and to explore the mechanisms involved.

Methods

In experiment 1, we compared the neurological and histopathological outcomes of DIPC, kidney RIPC, and limb RIPC. The DIPC and kidney RIPC groups received two cycles of 5-min occlusion/15-min reperfusion of the abdominal aorta and left renal artery, respectively. The limb RIPC group received two cycles of 10-min occlusion/10-min reperfusion of the femoral arteries bilaterally. Thirty minutes after the conditioning ischemia, spinal cord ischemia was produced by occluding the abdominal aorta for 15 min. In experiments 2 and 3, we investigated whether pretreatment using a free-radical scavenger, dimethylthiourea (DMTU), an adenosine A₁ receptor antagonist, 8-cyclopentyl-1,3-dipropylxanthine (DPCPX), or a mitochondrial ATP-sensitive potassium channel antagonist, 5-hydroxydecanoate (5HD), could attenuate the protective effects of DIPC. In experiment 4, comprehensive analysis of phosphorylated proteins in the spinal cord was performed using a Proteome Profiler Array followed by immunoblotting to elucidate the signal pathway activated by DIPC.

Results

In experiment 1, DIPC improved the neurological and histopathological outcomes, whereas kidney and limb RIPC had no protective effects. In experiments 2 and 3, strong protective effects of DIPC were reconfirmed but were not attenuated by DMTU, DPCPX, or 5HD. In experiment 4, DIPC induced phosphorylation of Akt2.

Conclusions

DIPC, but not kidney or limb RIPC, protected against ischemic spinal cord injury in rabbits. Akt2 might contribute to this protective effect.

http://ift.tt/2zo3aYE

The allergen-specificity of early peanut consumption and the impact on the development of allergic disease in the LEAP Study Cohort

Publication date: Available online 31 October 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): George du Toit, Peter H. Sayre, Graham Roberts, Kaitie Lawson, Michelle L. Sever, Henry T. Bahnson, Helen R. Fisher, Mary Feeney, Suzana Radulovic, Monica Basting, Marshall Plaut, Gideon Lack
BackgroundEarly introduction of dietary peanut in high-risk infants with severe eczema and/or egg allergy prevented peanut allergy at 5 years of age in the LEAP Study; the protective effect persisted after 12 months of avoiding peanuts in the LEAP-On Study. It is unclear whether this benefit is allergen and allergic-disease specific.ObjectiveTo assess the impact of early introduction of peanut on the development of allergic disease, food sensitization and aeroallergen sensitization.MethodsAsthma, eczema and rhinoconjunctivitis were diagnosed by clinical assessment. Reported allergic reactions and consumption of tree nuts and sesame were recorded by questionnaire. Sensitization to food and aeroallergens was determined by skin prick testing and specific IgE measurement.ResultsA high and increasing burden of food and aeroallergen sensitization and allergic disease was noted across study time points; 76% of LEAP participants had at least one allergic disease at 60 months of age. There were no differences in allergic disease between LEAP groups. There were small differences in sensitization and reported allergic reactions for select tree nuts; levels were higher in the LEAP consumption group. Significant resolution of eczema and sensitization to egg and milk occurred in LEAP participants; this was not affected by peanut consumption.ConclusionEarly consumption of peanut in infants at high risk of peanut allergy is allergen-specific and does not prevent the development of other allergic disease, sensitization to other foods and aeroallergens, or reported allergic reactions to tree nuts and sesame. Furthermore, peanut consumption does not hasten the resolution of eczema or egg allergy.

Teaser

The early consumption of peanut in high-risk infants is allergen-specific and protects against peanut allergy but does not prevent the development of sensitization to other allergens or allergic diseases.


http://ift.tt/2z4iNBe

Carcinoma mucoepidermoide de bajo grado de glándula salival menor de lengua en un paciente pediátrico

Publication date: Available online 31 October 2017
Source:Acta Otorrinolaringológica Española
Author(s): María Fernanda Vargas Gamarra, José María Perolada Vilmaña, Miguel Armengot Carceller




http://ift.tt/2z37E3D

BRAF peptide vaccine facilitates therapy of murine BRAF-mutant melanoma

Abstract

Approximately, 50% of human melanomas are driven by BRAF mutations, which produce tumors that are highly immunosuppressive and often resistant to vaccine therapy. We introduced lipid-coated calcium phosphate nanoparticles (LCP NPs) as a carrier to efficiently deliver a tumor-specific antigen, the BRAF^V600E peptide, to drive dendritic cell (DC) maturation and antigen presentation in C57BL6 mice. The BRAF peptide vaccine elicited a robust, antigen-specific cytotoxic T cell response and potent tumor growth inhibition in a murine BRAF-mutant melanoma model. Advanced BRAF-specific immune response was illustrated by IFN-γ production assay and cytotoxic T lymphocyte (CTL) assay. Remodeling of immunosuppressive modules within the tumor microenvironment further facilitated CTL infiltration. Thus, using LCP NPs to deliver the BRAF peptide vaccine is a promising strategy for the BRAF-mutant melanoma therapy.

http://ift.tt/2iR2JyI

A phase I vaccination study with dendritic cells loaded with NY-ESO-1 and α-galactosylceramide: induction of polyfunctional T cells in high-risk melanoma patients

Abstract

Vaccines that elicit targeted tumor antigen-specific T-cell responses have the potential to be used as adjuvant therapy in patients with high risk of relapse. However, the responses induced by vaccines in cancer patients have generally been disappointing. To improve vaccine function, we investigated the possibility of exploiting the immunostimulatory capacity of type 1 Natural killer T (NKT) cells, a cell type enriched in lymphoid tissues that can trigger improved antigen-presenting function in dendritic cells (DCs). In this phase I dose escalation study, we treated eight patients with high-risk surgically resected stage II–IV melanoma with intravenous autologous monocyte-derived DCs loaded with the NKT cell agonist α-GalCer and peptides derived from the cancer testis antigen NY-ESO-1. Two synthetic long peptides spanning defined immunogenic regions of the NY-ESO-1 sequence were used. This therapy proved to be safe and immunologically effective, inducing increases in circulating NY-ESO-1-specific T cells that could be detected directly ex vivo in seven out of eight patients. These responses were achieved using as few as 5 × 10⁵ peptide-loaded cells per dose. Analysis after in vitro restimulation showed increases in polyfunctional CD4⁺ and CD8⁺ T cells that were capable of manufacturing two or more cytokines simultaneously. Evidence of NKT cell proliferation and/or NKT cell-associated cytokine secretion was seen in most patients. In light of these strong responses, the concept of including NKT cell agonists in vaccine design requires further investigation.

http://ift.tt/2iOSmvp

Comparing ultrasound-guided and fiberscope-guided intubation

http://ift.tt/2iQ8Nb2