Αρχειοθήκη ιστολογίου

Αλέξανδρος Γ. Σφακιανάκης
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5
Άγιος Νικόλαος Κρήτη 72100
2841026182
6032607174

Τετάρτη 8 Νοεμβρίου 2017

Poly-L-lactic acid for the Improvement of photodamage and rhytids of the décolletage

Summary

Background

Poly-L-lactic acid (PLLA) is a biostimulatory filler approved for use in HIV lipoatrophy as well as cosmetic improvement in facial folds and wrinkles in immunocompetent patients. Similar to the face and hands, the décolletage is commonly subject to photodamage and the resulting appearance of rhytids and crepiness, which could benefit from PLLA treatment.

Objectives

The objective of the study was to assess the safety and efficacy of injected PLLA for the improvement in rhytids and crepiness of the décolletage.

Methods

In this open-label, prospective, interventional study, 25 healthy female volunteers aged 40-to-70 years with moderate-to-severe crepiness and wrinkling of the décolletage were injected with 1 vial of PLLA at each of three treatments. The Fabi-Bolton 5-point chest wrinkling scale was used by both investigators and subjects to assign pretreatment and post-treatment follow-up scores at 1 month, 3 months, and 6 months. Adverse events were reported at each visit.

Results

All post-treatment mean scores had statistically significant improvement compared to the pretreatment baseline means as rated by both investigators and subjects. At 1 month following the last treatment, compared to baseline, investigators rated 83% of subjects had improved by at least one point on the scale. Subjects rated 74% of subjects improved by at least one point. At 6 months, 90% of subjects, as rated by the investigators, and 57% of subjects, as rated by the subjects, had improvement from baseline.

Conclusion

PLLA is safe and effective for improvement in the rhytids and skin quality of the photodamaged décolletage.



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Open access: Is there a predator at the door?



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The influence of dexamethasone on postoperative swelling and neurosensory disturbances after orthognathic surgery: a randomized controlled clinical trial

Orthognathic surgery is associated with considerable swelling and neurosensory disturbances. Serious swelling can lead to great physical and psychological strain. A randomized, prospective, controlled clinical...

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Speech Production Quality of Cochlear Implant Users with Respect to Duration and Onset of Hearing Loss

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Purpose: To assess whether postlingual onset and shorter duration of deafness before cochlear implant (CI) provision predict higher speech intelligibility results of CI users. Methods: For an objective judgement of speech intelligibility, we used an automatic speech recognition system computing the word recognition rate (WR) of 50 adult CI users and 50 age-matched control individuals. All subjects were recorded reading a standardized text. Subjects were divided into three groups: pre- or perilingual deafness (A), both >2 years before implantation, postlingual deafness 2 years before implantation (C). Results: CI users with short duration of postlingual deafness (B) had a significantly higher WR (median 74%) than CI users with long duration of postlingual deafness (C; 68%, p p Conclusions: The speech production quality of adult CI users shows dependencies on the onset and duration of deafness. These features need to be considered while planning rehabilitation.
ORL 2017;79:282-294

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A ravenous defense: canonical and non-canonical autophagy in immunity

Payel Sil | Ginger Muse | Jennifer Martinez

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Global oral health status of athletes with intellectual disabilities

Abstract

Background

The aim of this study is to identify the oral health status and treatment needs of Special Olympics athletes with intellectual disabilities from 181 countries by the assessment of oral health parameters and differences between world regions.

Material and methods

Data were collected through interview and oral examinations within the Healthy Athletes Screening. These data were analysed with descriptive statistics of oral health parameters of athletes from Africa, Asia Pacific, East Asia, Europe/Eurasia, Latin America, Middle East North Africa (MENA) and North America. Mean differences of untreated visible dental caries, gingival signs and missing teeth were tested between regions by one-way ANOVA test and between age groups (8–11, 12–18, 19–39 and 40+) by chi-square tests for multiple comparisons with Hochberg-adjusted p value. The level of significance for all tests was set at a p value < 0.05.

Results

A total of 149,272 athletes with intellectual disabilities were screened. More than 80% of the athletes reported that they cleaned their mouths at least once a day. Athletes in Europe/Eurasia, Latin America, and MENA presented higher rates of signs of gingival disease than other regions. The prevalence of untreated dental caries was significantly higher in Latin America and the group of 8–11-year-olds from Latin America, Europe/Eurasia and Asia Pacific.

Conclusions

The data provided by this study demonstrate that continuous efforts for preventive and restorative oral health care are needed for the oral health of these athletes with ID especially in Latin America, MENA and Europe/Eurasia regions.



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Blood eosinophils: The forgotten man of inhaled steroid dose titration

Abstract

Blood eosinophil counts which were once regarded as normal, have become of increasing interest in the era of Interluekin-5 (IL-5) asthma treatment. Blood eosinophils as low as 150 cells/μL have been suggested as treatment cut-offs for eosinophil depleting therapies such as mepolizumab [1], whilst a value of 300 cells/μL has been deemed a more pragmatic cut off by the National Institute for Health and Care Excellence (United Kingdom). In this era of eosinophil post-truths, inhaled corticosteroids (ICS), the eosinophil's oldest adversary, are very much the forgotten man.

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Linear IgA bullous dermatosis: a rare manifestation of vancomycin hypersensitivity

Vancomycin is one of the most widely used antibiotics and, because of its prevalent use, several common side effects have been well described, such as "red man" syndrome, agranulocytosis, and ototoxicity. In addition, it has been associated with hypersensitivity reactions including immunoglobulin E–mediated anaphylaxis, linear immunoglobulin A (IgA) bullous dermatosis (LABD), drug reaction with eosinophilia and systemic symptoms syndrome, acute interstitial nephritis, and Stevens-Johnson syndrome and toxic epidermal necrolysis.

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Writing a better research paper: Advice for young authors



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Correcting the literature

We make important therapeutic decisions based on the best available evidence and it is important to correct the literature when results are in question. Appropriate actions may include publication of a correction, links to previously cited data to avoid double counting of outcomes, expressions of concern about study methods or integrity, and retraction of a published article. Corrections should be published as soon as possible, appear in a prominent position on a numbered page in the journal that originally published the article, and include the complete original citation to help ensure that an appropriate reference to the published erratum will be added to the MEDLINE citation.

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Responding to reviewers: Advice to young (and some older) authors



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Duplicate publication



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Authorship



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Common reasons why manuscripts are rejected: Advice for young investigators



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Ethics and fairness during the review and publication process



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Planning better research projects: Advice for young researchers



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Presentation of data



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Advice for reviewers (and authors and readers)



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Getting the most out of on-line literature searches – More on Boolean logic



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Psoriasis and the Risk of Diabetes: A Prospective Population-Based Cohort Study.

Data evaluating the impact of objectively measured psoriasis severity on type 2 diabetes mellitus (T2DM) risk are lacking.

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Sample size



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Study design and statistical analysis



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Misclassification of Study Designs in the Dermatology Literature

The appropriate classification of study designs is important for review and assessment of the relevant scientific literature as a basis for decision-making. However, little is known about whether study designs have been appropriately reported in the dermatology literature.

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Objective Outcome Measures: Collecting Meaningful Data on Alopecia Areata

Although alopecia areata is a common disorder, it has no FDA approved treatment and evidence-based therapeutic data is lacking.

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Successful treatment of moderate-to-severe alopecia areata improves health-related quality of life



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An extemporaneous approach for optimizing acitretin dosing in pediatric patients



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Getting the most out of on-line literature searches Tips for advanced searches

Thorough and efficient literature searches are important to authors and practicing physicians alike, and modern search engines have many tools to expedite the process. In databases such as PubMed, new logic, or natural language, is set up to answer questions by simply typing them in.

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Vasculitis and IgA monoclonal gammopathy of cutaneous significance

Abstract

IgA vasculitis (Henoch-Schonlein purpura) is a small vessel systemic vasculitis involving IgA immunoglobulin polyclonal activation1. Monoclonal gammopathy of cutaneous significance is a subgroup of monoclonal gammopathy with skin disease, without myeloma or lymphoproliferative disorder2. We report 3 patients with vasculitis and IgA monoclonal gammopathy of cutaneous significance. Three men, 38, 37 and 50 years old, had a vascular purpura for more than 10 years with partial remission and frequent necrotic flares (Figure 1).

This article is protected by copyright. All rights reserved.



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Patients’ experience of the monitoring of free flaps after reconstruction for oral cancer

Regular monitoring of free flaps is essential after microvascular free tissue transfer, but the frequency and duration of the observations vary between units and there is no consensus nationally. Best practice can be informed by the feedback of patients, but as we know of no such studies, we did a cross-sectional survey of a consecutive group of patients after free tissue transfer to find out what they thought about monitoring. We designed a study-specific questionnaire after consultation with the patient and carer forum, and sent it to 150 patients who had had free tissue transfer in the maxillofacial department at Aintree University Hospital during 2015 and 2016.

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Three-dimensionally printed personalized guide plate for percutaneous radiofrequency thermal coagulation in idiopathic trigeminal neuralgia

Radiofrequency thermocoagulation (RFT) is used widely for the treatment of idiopathic trigeminal neuralgia (TN). Precise puncture and placement of the electrode needle tip are crucial for successful RFT. This technical note introduces a novel method for performing RFT using a customized, three-dimensionally (3D)-printed guide plate. Eleven patients with idiopathic TN were treated using this method between February and July 2016. Three had V2 branch TN and eight had V3 branch TN. Punctures in eight patients were successful at the first attempt; slight adjustments were required subsequently in the other three patients.

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Who has anaphylaxis in Brazil? Validation of a questionnaire for population studies

The incidence of anaphylaxis is increasing in several parts of the world; thus, determining the prevalence of the disease in a given region is important to understand the factors involved and to promote measur...

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Non-protease native allergens partially purified from bodies of eight domestic mites using p-aminobenzamidine ligand

Publication date: Available online 8 November 2017
Source:Allergologia et Immunopathologia
Author(s): T. Erban, R. Klubal
BackgroundOptimised purification steps for concentrating trace target native antigens are needed. Combining the p-aminobenzamidine ligand with protease inactivation enables partial purification of mite non-protease allergens lacking proteases.ObjectiveWe sought to analyse in detail proteins obtained using this method from eight species of synanthropic acaridid mites and tested IgE reactivity using pooled human sera.Materials and methodsProteins affinity bound to p-aminobenzamidine as a ligand were identified by MALDI TOF/TOF. After electroblotting, the proteins were visualised using the fluorescent SYPRO-Ruby protein blot stain, and IgE reactivity was further analysed using pooled human sera collected from patients allergic to house dust mites.ResultsMS/MS identification confirmed previous results that no proteases were purified. Protein patterns corresponding to the allergens Der f 7, Der f 30 and actins indicated that these proteins are purified using p-aminobenzamidine and are present across a wide spectrum of acaridid mites. When using Dermatophagoides farinae, apolipophorins (Der f 14), chitinase-like Der f 15 and 18, 70-kDa heat shock protein, and a Der f Alt a10 allergen homolog (gi|37958173) were also detected. The target antigens tropomyosins and paramyosins showed similar IgE binding among the mite species tested. IgE reactivity with miscellaneous D. farinae antigen was also observed.ConclusionsPartial purification of mite non-protease antigens using a strategy combining p-aminobenzamidine with protease inactivation was verified by 1D-E and 2D-E analyses. IgE binding to p-aminobenzamidine-purified native non-protease mite antigens was tested using pooled sera. This preliminary study allows for further work on individual serum samples, allowing confirmation of immunoreactivity.



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Lessons from the Meningitis Vaccine Project

Viral Immunology , Vol. 0, No. 0.


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Maternal folic acid use during pregnancy, MTHFR polymorphism, and child's lung function and asthma

Abstract

Background

Folic acid supplement use during pregnancy might affect childhood respiratory health, potentially mediated by methylenetetrahydrofolate-reductase polymorphism C677T (MTHFR-C677T) carriership.

Objectives

We examined the associations of maternal folic acid supplement use and folate, vitamin B12 and homocysteine concentrations during pregnancy with childhood lung function and asthma.

Methods

This study was embedded in a population-based prospective cohort study among 5,653 children. Folic acid supplement use was assessed by questionnaires. Folate, vitamin B12 and homocysteine plasma concentrations were measured in early pregnancy and at birth. At age 10 years, forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, forced expiratory flow between 25% and 75% (FEF25-75), at 75% of FVC (FEF75), and asthma were examined.

Results

Maternal folic acid supplement use during pregnancy was associated with higher childhood FEV1 and FVC and with a lower FEV1/FVC, compared with no folic acid supplement use. Among mothers carrying MTHFR-C677T variants, preconceptional start of folic acid supplement use was associated with lower FEV1/FVC (-0.17 (-0.32, -0.02)) and FEF25-75 (-0.24 (-0.40, -0.07)). Among children carrying MTHFR-C677T wildtype, a higher vitamin B12 level at birth was associated with a lower FEV1 (-0.07 (-0.12, -0.01)) and FVC (-0.09 (-0.15, -0.04). Folate and homocysteine concentrations were not consistently associated with lower childhood lung function or asthma.

Conclusions

Preconceptional start of maternal folic acid supplement use and higher vitamin B12 concentrations at birth might adversely affect childhood lung function depending on MTHFR-C677T carriership. The clinical implications need to be evaluated.

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Zoonotic helminth exposure and risk of allergic diseases: a study of two generations in Norway

Abstract

Background

Animal and human studies indicate that definitive host helminth infections may confer protection from allergies. However, zoonotic helminths, such as Toxocara species (spp.), have been associated with increased allergies.

Objective

We describe the prevalence of Toxocara spp. and Ascaris spp. seropositivity, and associations with allergic diseases and sensitisation, in two generations in Bergen, Norway.

Methods

Serum levels of total IgG4, anti-Toxocara spp. IgG4 and Ascaris spp. IgG4 were established by ELISA in two cohorts; parents born 1945-1972 (n=171) and their offspring born 1969-2003 (n=264). Allergic outcomes and covariates were recorded through interviews and clinical examinations including serum IgEs and skin prick tests.

Results

Anti-Ascaris spp. IgG4 was detected in 29.2% of parents and 10.3% of offspring, and anti-Toxocara spp. IgG4 in 17.5% and 8.0% of parents and offspring, respectively. Among offspring anti-Toxocara spp. IgG4 was associated with pet keeping before age 15 (OR=6.15; 95% CI=1.37-27.5) and increasing BMI (1.16[1.06-1.25] per kg/m2). Toxocara spp. seropositivity was associated with wheeze (2.97[1.45- 7.76]), hay fever (4.03[1.63-9.95]), eczema (2.89[1.08-7.76]) and cat sensitization (5.65[1.92-16.6]) among offspring, but was not associated with allergic outcomes among parents. Adjustment for childhood or current pet keeping did not alter associations with allergies. Parental Toxocara spp. seropositivity was associated with increased offspring allergies following a sex-specific pattern.

Conclusions & Clinical Relevance

Zoonotic helminth exposure in Norway was less frequent in offspring than parents; however, Toxocara spp. seropositivity was associated with increased risk of allergic manifestations in the offspring generation, but not among parents. Changes in response to helminth exposure may provide insights into the increase in allergy incidence in affluent countries.

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Patients’ experience of the monitoring of free flaps after reconstruction for oral cancer

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Publication date: Available online 8 November 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): H. Nazir, D. Lowe, S.N. Rogers
Regular monitoring of free flaps is essential after microvascular free tissue transfer, but the frequency and duration of the observations vary between units and there is no consensus nationally. Best practice can be informed by the feedback of patients, but as we know of no such studies, we did a cross-sectional survey of a consecutive group of patients after free tissue transfer to find out what they thought about monitoring. We designed a study-specific questionnaire after consultation with the patient and carer forum, and sent it to 150 patients who had had free tissue transfer in the maxillofacial department at Aintree University Hospital during 2015 and 2016. A total of 106 (71%) responded, and a quarter (30/106, 28%) would have liked more information about monitoring. Generally, patients were worried little by the observations (91/106, 86%), but one-third (34/106, 32%) reported disturbed sleep. Just over half (n=55/104, 53%) were relieved when the monitoring changed from hourly to four-hourly, and almost all (99/101, 98%) were not worried by this. Nearly half (47/105, 45%) would have preferred fewer observations when asleep. In conclusion, our findings could help to inform a leaflet for patients about monitoring. Consideration could be given to reducing its frequency, for example, the checks at 1, 3, and 5am could be omitted during the second night, which could make a substantial difference to the patient. However, its impact on salvage needs to be audited.



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Journal Club.

No abstract available

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Scheduled Intravenous Acetaminophen Improves Patient Satisfaction With Postcraniotomy Pain Management: A Prospective, Randomized, Placebo-controlled, Double-blind Study.

Background: Postcraniotomy pain can be difficult to manage with opioids due to opioid-related side effects, including drowsiness, nausea/vomiting, confusion, and pupillary changes, potentially masking the signs of postoperative neurological deterioration. Intravenous (IV) acetaminophen, a nonopioid analgesic, has been reported to have opioid-sparing effects after abdominal and orthopedic surgeries. This study investigates whether IV acetaminophen has similar effects after craniotomy. Materials and Methods: In this prospective, randomized, placebo-controlled, double-blind clinical trial, 100 adult patients scheduled to undergo supratentorial craniotomy for excision of a brain mass were randomized to receive either IV acetaminophen or placebo preincision and then every 6 hours for a total of 24 hours after surgery. Total 24-hour opioid consumption, pain scores, satisfaction with overall pain management, time to meet postanesthesia care unit discharge criteria, and incidence of opioid-related side effects were compared. Results: There was no difference in the 24-hour postoperative opioid consumption in morphine equivalents between the IV acetaminophen group (median, 11 mg; n=45) and the placebo group (median, 10.1 mg; n=41). No statistically significant difference of visual analog scale pain score was observed between 2 treatment groups. Patient satisfaction with overall postoperative pain management was significantly higher in the IV acetaminophen group than the placebo group on a 1 to 10 scale (8.1+/-0.4 vs. 6.9+/-0.4; P=0.03). There was no significant difference in secondary outcomes, including the incidence of opioid-related side effects. Conclusions: IV acetaminophen, as adjunctive therapy for craniotomy procedures, did not show an opioid-sparing effect in patients for the 24 hours after craniotomy; however, it was associated with improved patient satisfaction regarding overall pain control. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved

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Speech audiometry and data logging in CI patients

Abstract

Background

As part of postoperative cochlear implant (CI) diagnostics, speech comprehension tests are performed to monitor audiological outcome. In recent years, a trend toward improved suprathreshold speech intelligibility in quiet and an extension of intelligibility to softer sounds has been observed. Parallel to audiometric data, analysis of the patients' acoustic environment can take place by means of data logging in modern CI systems.

Objectives

Which speech test levels reflect the individual listening environment in a relevant manner and how can these be reflected in a clinical audiometric setting?

Patients and methods

In a retrospective analysis, data logs of 263 adult CI patients were evaluated for sound level and the listening situation (quiet, speech in quiet, noise, speech in noise, music, and wind). Additionally, monosyllabic word comprehension in quiet was analyzed in experienced CI users at presentation levels of 40–80 dB.

Results

For the sound level in the acoustic environment of postlingually deafened adult CI users, data logging shows a maximum occurrence of speech signals in the range of 50–59 dB. This demonstrates the relevance of everyday speech comprehension at levels below 60 dB.

Conclusion

Individual optimization of speech intelligibility with a CI speech processor should not be performed in the range of 65–70 dB only, but also at lower levels. Measurements at 50 dB currently seem to be a useful addition.



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A network meta-analysis in comparing prophylactic treatments of radiotherapy-induced oral mucositis for patients with head and neck cancers receiving radiotherapy

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Publication date: December 2017
Source:Oral Oncology, Volume 75
Author(s): Hao Peng, Bin-Bin Chen, Lei Chen, Yu-Pei Chen, Xu Liu, Ling-Long Tang, Yan-Ping Mao, Wen-Fei Li, Yuan Zhang, Ai-Hua Lin, Ying Sun, Jun Ma
ObjectivesThe objective of this network meta-analysis is to optimize the prophylactic treatment for radiotherapy-induced oral mucositis in patients with head and neck cancer (HNSCC) receiving postoperative or definitive radiotherapy with or without chemotherapy.Materials and methodsWe searched electronic databases to identify all eligible randomized clinical trials on oral mucositis. The endpoint was grade 0–2 oral mucositis. Odds ratios (OR) and the corresponding 95% confidence intervals (CI) were extracted. Network meta-analysis was performed using the frequentist approach to conduct multiple treatment comparisons.ResultsIn total, 57 trials with 5261 patients were eligible for this study. Both direct and network meta-analysis revealed that low-level laser additional to standard oral care (SOC) was better than most of the other treatments and achieved the highest effect on grade 0–2 oral mucositis, with a surface under the cumulative ranking curve (SUCRA) of 95.8%; however, SOC with or without placebo had worse effect than most of the other treatments and was ranked worst (SUCRA = 0.4%). Moreover, sensitivity analysis performed after we had combined the SOC and placebo groups (non-medication treatment, NMT) yielded similar results, with SUCRA of 91.3% and 3.5% for low-level laser and NMT, respectively.ConclusionsLow-level laser additional to SOC may be a more effective prophylactic treatment for reducing severe radiotherapy-induced oral mucositis; SOC alone is insufficient for patients with HNSCC receiving postoperative or definitive radiotherapy with or without chemotherapy.



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The Utility Of Monitoring Trimellitic Anhydride (TMA)-Specific IgG To Predict IgE-mediated Sensitization in An Immunosurveillance Program

Abstract

Background

Workplace exposure to Trimellitic Anhydride (TMA) can elicit TMA-specific IgE (sIgE), which may lead to occupational asthma (OA). An occupational immunosurveillance program (OISP) has been implemented to monitor TMA exposure and immunologic outcomes. The purpose of this study was to determine whether TMA-specific IgG (sIgG) responses can discriminate between TMA-exposed workers with and without sIgE responses.

Methods

Serum TMA-specific antibody (IgG, IgG4 and IgE) levels were estimated longitudinally (years 2006 to 2014) in TMA-exposed workers recruited in low, medium and high exposure areas. sIgG and sIgE titers plotted against exposure duration were compared between workers with (a) sIgG only and (b) with sIgG who developed sIgE.

Results

Among 92 TMA-exposed workers continuously monitored for sIgG and sIgE, 38 developed sIgG; 11 developed a sIgE response 342.38 ± 186.03 days post-hire and were removed from exposure. The average detection time of sIgG in removed workers (159±92 days) was significantly shorter than for actively exposed workers with only sIgG (346±187 days). Workers with earlier sIgG responses of higher titer (mean value 42.25 ug/ml) compared to delayed responders with lower sIgG titers (mean value 14.79 ug/ml) more frequently developed sIgE responses. Hierarchical clustering showed the initial magnitude and exposure time required for detectable sIgG production discriminated between workers with only sIgG from workers who subsequently produced sIgE.

Conclusions

This study demonstrates the utility of longitudinally monitoring TMA-specific antibodies in an OISP as exposed workers with early sIgG responses and of higher magnitude are more likely to develop TMA sIgE sensitization.

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Segmentale Neurofibromatose

Zusammenfassung

Bei einem nun 48-jährigen Patienten entwickelten sich 13 Jahre zuvor zahlreiche Neurofibrome in einem umschriebenen Areal thorakal rechts. Zeitgleich wurde ein beidseitig vorliegendes Seminom diagnostiziert und behandelt. Aktuelle Untersuchungen ergaben keine Hinweise für weitere Begleiterkrankungen einer Neurofibromatose. Die Familienanamnese war unauffällig. Die bei dem Patienten vorliegende segmentale Neurofibromatose (SN) ist Ausdruck einer Mosaikbildung infolge einer Mutation des NF1-Gens, einem Tumorsuppressorgen. Begleiterkrankungen, wie sie für die Neurofibromatosis generalisata (NFG) typisch sind und zu denen auch maligne Neoplasien gezählt werden, stellen bei der SN die Ausnahme dar.



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Error in End Matter

In the Editorial titled "Industry Influence in Dermatology Clinical Practice Guideline Development" by Katz, the end matter has been corrected by adding "Additional Information: Dr Katz is a member of the AAD and is co-chair of the AAD's Expert Resource Group on LGBT/Sexual and Gender Minority Health, and a member of the AAD's Bylaws Committee."

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Topical Timolol for Paronychia and Pseudopyogenic Granuloma

This study evaluated the efficacy and tolerability of topical timolol, 0.5%, gel as a treatment of paronychia and pseudopyogenic granuloma induced by antineoplastic agents.

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Interdisciplinary Perspectives on Sun Safety

This article describes efforts to harness interdisciplinary perspectives to enhance understanding of sun exposure risk and improve sun protection interventions.

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Confirmed Gadolinium Presence Within Cutaneous Sclerotic Bodies

This case report describes the confirmation of gadolinium presence within cutaneous sclerotic bodies via laser ablation inductively coupled plasma mass spectrometry

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Probiotic Strains for Children With Moderate Atopic Dermatitis

This randomized clinical trial investigates whether a mixture of oral probiotics is safe and effective in the treatment of atopic dermatitis symptoms and evaluates its influence on the use of topical steroids in children.

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Resilience and Depression in Patients With Hidradenitis Suppurativa

This survey study uses clinical data from a set of self-administered, self-graded questionnaires to examine the correlation among resilience, depression, and health-related quality of life for patients with hidradenitis suppurativa.

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Dental Properties, Ultrastructure, and Pulp Cells Associated With a Novel DSPP Mutation

Abstract

Objective

To investigate physical characteristics and behaviours of dental pulp cells of teeth isolated from a dentinogenesis imperfecta (DGI) patient with a novel DSPP mutation.

Subjects And Methods

Whole exome and Sanger sequencing were employed to identify mutations. Physical characteristics of the teeth were examined. Pulp cells' behaviors including cell proliferation, colony forming unit, osteogenic differentiation, pluripotent markers, and mesenchymal stem cell markers were investigated.

Results

The proband had opalescent brown primary teeth with extensive loss of enamel. Mutation analysis revealed a novel heterozygous 4-bp deletion, c.1915_1918delAAGT (p.K639QfsX674), in exon 5 of the DSPP associated with DGI. Analysis of the extracted primary incisor demonstrated a decrease in brightness but an increase in yellow and red chroma. The dentin showed reduced mineral density. The dentinal tubules were present in the predentin, but progressively collapsed in the dentin. The pulp cells exhibited markedly reduced CD105 expression, decreased cell proliferation, and smaller colony forming units.

Conclusions

We identified a novel mutation in the DSPP gene which disturbed dentin characteristics and pulp cells' behaviours. Our study expands the mutation spectrum and understanding of pathologic dentin phenotypes related to the frameshift deletion in the DPP region of the DSPP gene.

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Salivary scintigraphy for Sjögren's syndrome in patients with xerostomia: a retrospective study

Abstract

Objectives

The value of salivary gland scintigraphy in the diagnosis of Sjögren's syndrome remains controversial. The primary aim of this study was to estimate the diagnostic accuracy of salivary gland scintigraphy in the diagnosis of Sjögren's syndrome among 237 patients with xerostomia.

Methods

We retrospectively compared eight scintigraphy parameters between 106 Sjögren patients and 131 non-Sjögren patients.

Results

Seven of the eight parameters were significantly decreased in Sjögren patients; however their diagnostic accuracy was low, with AUCs ranging from 0.58 (95% CI 0.50-0.65) to 0.63 (95% CI: 0.55-0.70). The prestimulatory oral activity index allowed discrimination between primary and secondary Sjögren's syndrome (AUC 0.73, 95% CI: 0.62-0.84) and the secretion velocity for parotid glands allowed discrimination between Sjögren patients and Burning Mouth Syndrome patients (AUC 0.71, 95% CI 0.59-0.82).

Conclusion

The accuracy of scintigraphy parameters for the diagnosis of Sjögren's syndrome among patients with xerostomia was low, however, some functional indices appeared to assist discrimination between primary and secondary SS patients and between sub-groups of patients with different causes of xerostomia.

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Hypomorphic RAG1 defect in a child presented with pulmonary hemorrhage and digital necrosis

Publication date: Available online 7 November 2017
Source:Clinical Immunology
Author(s): Ekim Z. Taşkıran, Hafize E. Sönmez, Deniz Ç. Ayvaz, Can Koşukcu, Ezgi D. Batu, Saliha Esenboğa, Rezan Topaloğlu, Diclehan Orhan, Yelda Bilginer, Mehmet Alikaşifoğlu, Seza Özen, İlhan Tezcan




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Enhanced activation of circulating plasmacytoid dendritic cells in patients with Chronic Obstructive Pulmonary Disease and experimental smoking-induced emphysema

Publication date: Available online 8 November 2017
Source:Clinical Immunology
Author(s): Shi-lin Qiu, Liang-jian Kuang, Qi-ya Tang, Min-chao Duan, Jing Bai, Zhi-yi He, Jian-quan Zhang, Mei-hua Li, Jing-min Deng, Guang-nan Liu, Xiao-ning Zhong
Plasmacytoid dendritic cells (pDCs) are key cells bridging the innate with adaptive immunity. However, the phenotypic characteristics of circulating pDCs and its role in smoking related-Chronic Obstructive Pulmonary Disease (COPD) remain largely unknown. The aim of this study was analyzed the phenotype of circulating pDCs and the expression of IFN-γ producing CD8+T cells and IL-17-producing CD8+T cells in patients with COPD by using multi-colour flow cytometry. The cytokine profiles in peripheral blood from all subjects were measured by ELISA. The influence of cigarette smoke on pDCs was evaluated in an experimental mouse model of emphysema. Circulating pDCs in patients with COPD and in mice exposed to cigarette smoke expressed high levels of co-stimulatory molecules CD40 or CD86 accompanied by exaggerated IFN-γ producing CD8+T cells and IL-17-producing CD8+T cells. In vitro, cigarette smoke directly promoted pDCs maturation and release of IFN-α, IL-6 and IL-12, subsequently inducing differentiation of IFN-γ producing CD8+T cells and IL-17-producing CD8+T cells from mouse naïve CD8+T cells. These data suggested that circulating pDCs display an enhanced activation phenotype in patients with COPD and in experimental smoking mouse model of emphysema, which might contribute to exaggerated IFN-γ producing CD8+T and IL-17-producing CD8+T cell-mediated immune responses.



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It is vital to identify the underlying cause of chronic laryngopharyngeal neuropathy

Publication date: Available online 7 November 2017
Source:American Journal of Otolaryngology
Author(s): Zhengcai Lou




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Study Names Top Apps for Patients to Manage Illnesses

Healthcare apps are growing not only in number but also in their ability to improve patient outcomes and reduce costs, according to a new report from the IQVIA Institute.
Medscape Medical News

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Private Practice--Down but Far From Out

While the percentage of doctors in private practice is declining, some employed doctors, seeking deeper fulfillment, are striking out on their own. The odds of success are tough--but not impossible.
Medscape Business of Medicine

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Tumor-derived high-mobility group box 1 and thymic stromal lymphopoietin are involved in modulating dendritic cells to activate T regulatory cells in a mouse model

Abstract

High-mobility group box 1 (HMGB1) is involved in the tumor-associated activation of regulatory T cells (Treg), but the mechanisms remain unknown. In a mouse tumor model, silencing HMGB1 in tumor cells or inhibiting tumor-derived HMGB1 not only dampened the capacity of tumor cells to produce thymic stromal lymphopoietin (TSLP), but also aborted the tumor-associated modulation of Treg-activating DC. Tumor-derived HMGB1 triggered the production of TSLP by tumor cells. Importantly, both tumor-derived HMGB1 and TSLP were necessary for modulating DC to activate Treg in a TSLP receptor (TSLPR)-dependent manner. In the therapeutic model, intratumorally inhibiting tumor-derived HMGB1 (causing downstream loss of TSLP production) attenuated Treg activation, unleashed tumor-specific CD8 T cell responses, and elicited CD8α+/CD103+DC- and T cell-dependent antitumor activity. These results suggest a new pathway for the activation of Treg involving in tumor-derived HMGB1 and TSLP, and have important implications for incorporating HMGB1 inhibitors into cancer immunotherapy.



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Descriptive Error in the Text

In the Original Investigation titled "Prevalence of Pubic Hair Grooming–Related Injuries and Identification of High-Risk Individuals in the United States," published online August 16, 2017, there was a descriptive error in the text. The term vagina was used rather than the more accurate labia majora in 4 instances. This article has been corrected online.

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Patient Perceptions of Primary Care–Based Skin Cancer Screening

This analysis of a series of interviews seeks to better understand patient perceptions of primary care–based skin cancer screening.

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Prior Authorizations for Diagnostic Skin Biopsies

This Viewpoint outlines how managed care policies on prior authorization for diagnostic skin biopsies are affecting costs, access to care, and quality of care for patients.

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November 2017 Issue Highlights



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Attempting to Define “Hypoallergenic”

The North American Contact Dermatitis Group (NACDG) commends Xu et al for bringing attention to challenges facing dermatologists and consumers. Their original approach of using sales data provides a snapshot of what consumers are actually using (lotions!), and their assessment of commonly used marketing terms and their connection to cost and product composition are innovative.

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Purpura Annularis Telangiectodes of Majocchi Associated With Apremilast

This case report describes a patient with purpura annularis telangiectodes of Majocchi associated with the initiation and rechallenge of apremilast for psoriasis vulgaris

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Delay and Disparity in Time to Surgical Treatment for Melanoma

The relationship between patient health insurance status, health care use, and outcomes has been explored in great depth and detail over decades for myriad diseases in the United States. Likewise, health services research has become increasingly relevant within the specialty of dermatology, especially as the emergence of "big data" and advanced analytics continue to transform overall health care delivery.

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Robert Chesebrough and the Dermatologic Wonder of Petroleum Jelly

Robert Chesebrough (1837-1933) was an American chemist whose serendipitous discovery and scientific tenacity led to one of the most common and enduring treatments in dermatology. He began his career in Brooklyn isolating kerosene from whale oil, but in 1858, his business's viability was threatened by the first successful American oil well, located in Titusville, Pennsylvania.

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Performance Characteristics of and Allergens in Best-selling Moisturizers

This cohort study examines the product performance characteristics and ingredients of best-selling moisturizers.

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Coverage of IVIG for Autoimmune Blistering Diseases by US Insurers

In this study, the authors examine coverage for IVIG to treat autoimmune blistering diseases by public and private insurers in the United States.

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Association of Delays in Surgery for Melanoma With Insurance Type

This cohort study investigates whether patients with Medicaid are more likely than patients with Medicare or private insurance to experience delays in surgery for melanoma.

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Secukinumab-Induced Psoriasiform Eruption

This case report describes a patient with secukinumab-induced psoriasiform eruption.

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Pubic Hair Grooming Injuries and Identification of High-Risk Individuals

This cross-sectional study of US adults identifies demographic and behavioral risk factors associated with pubic hair grooming–related injuries to characterize individuals at high risk for injury and develop recommendations for safe grooming practices.

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The Treatment of Actinic Keratoses—The Rule Rather Than the Exception

To the Editor We read with great interest the article by Berry et al entitled "Influence of Information Framing on Patient Decisions to Treat Actinic Keratosis." This work highlights a critical aspect of the physician-patient relationship—communication. As expected, the findings suggest that the verbiage used to describe actinic keratoses (AKs) can affect the patient's decision to pursue treatment. Interestingly, regardless of how the question was framed, most patients preferred to treat these lesions.

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Improvement of Genetic Testing for Cutaneous Melanoma

This study evaluates the efficiency of using the "rule of 3" vs the widely accepted "rule of 2" for the detection of melanoma-prone mutations in France, a country with low to moderate melanoma incidence.

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The Black Panther, From Politics to Popular Culture

Although the black panther is not a true animal species, the term is used to describe black pigmentation in a number of large feline species, including jaguars and leopards. Studies show that their dark pigmentation patterns are linked to polymorphisms in 2 genes, the melanocortin-1 receptor (MC1R) and the agouti-signaling protein (ASIP). The melanocortin-1 receptor is activated by binding of α-melanocyte–stimulating hormone, leading to the production of eumelanin, which is responsible for dark pigmentation. Conversely, the melanocortin-1 receptor is inhibited by the antagonist ASIP, leading to the production of pheomelanin, which is responsible for light pigmentation. Therefore, activating mutations in MC1R and inactivating mutations in ASIP are thought to underlie the melanization of the captivating black panther. In 1966, these striking animals became a symbol for one of the most influential civil rights groups, as well as the inspiration for Marvel Comics' first black superhero.

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Risk Factors for Melanoma in Renal Transplant Recipients

This cohort study uses data from the United States Renal Data System to investigate risk factors and characteristics of renal transplant recipients who develop melanoma.

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Nathaniel Hawthorne’s “The Birthmark”

A short story titled "The Birthmark," written by Nathaniel Hawthorne in 1843, revolves around none other than a prominent birthmark. The main character, Aylmer, is an intelligent, retired scientist whose love of science is only matched by his love for his spectacularly beautiful new wife, Georgiana. But soon after the two wed, Aylmer becomes obsessed with a crimson, hand-shaped mark on his bride's left cheek, a mark Georgiana had considered a "charm" prior to Aylmer's mention. Georgiana's perception of her mark turns to disgust with each passing day of her husband's obsession. Aylmer believes he can liberate his wife from this mark, her only flaw, and he spends the length of the story seeking a method to do so.

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Pneumocystis Pneumonia in Patients With Autoimmune Blistering Diseases

This analysis assesses the incidence of Pneumocystis pneumonia in patients with autoimmune blistering diseases receiving no routine prophylaxis.

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Erythema With Nonscarring, Tense Blisters and No Anti-BP180 Antibodies

A woman in her 80s had scaly erythematous plaques with nonscarring, tense blister formation without circulating anti-BP180 antibodies. What is your diagnosis?

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Development of CD3 cell quantitation algorithms for renal allograft biopsy rejection assessment utilizing open source image analysis software

Abstract

Renal allograft rejection diagnosis depends on assessment of parameters such as interstitial inflammation; however, studies have shown interobserver variability regarding interstitial inflammation assessment. Since automated image analysis quantitation can be reproducible, we devised customized analysis methods for CD3+ T-cell staining density as a measure of rejection severity and compared them with established commercial methods along with visual assessment. Renal biopsy CD3 immunohistochemistry slides (n = 45), including renal allografts with various degrees of acute cellular rejection (ACR) were scanned for whole slide images (WSIs). Inflammation was quantitated in the WSIs using pathologist visual assessment, commercial algorithms (Aperio nuclear algorithm for CD3+ cells/mm2 and Aperio positive pixel count algorithm), and customized open source algorithms developed in ImageJ with thresholding/positive pixel counting (custom CD3+%) and identification of pixels fulfilling "maxima" criteria for CD3 expression (custom CD3+ cells/mm2). Based on visual inspections of "markup" images, CD3 quantitation algorithms produced adequate accuracy. Additionally, CD3 quantitation algorithms correlated between each other and also with visual assessment in a statistically significant manner (r = 0.44 to 0.94, p = 0.003 to < 0.0001). Methods for assessing inflammation suggested a progression through the tubulointerstitial ACR grades, with statistically different results in borderline versus other ACR types, in all but the custom methods. Assessment of CD3-stained slides using various open source image analysis algorithms presents salient correlations with established methods of CD3 quantitation. These analysis techniques are promising and highly customizable, providing a form of on-slide "flow cytometry" that can facilitate additional diagnostic accuracy in tissue-based assessments.



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Epidemiologie des CUP-Syndroms in Deutschland

Zusammenfassung

Der Artikel gibt einen Überblick über Inzidenz‑, Mortalitäts- und Überlebensraten des „cancer of unknown primary" (CUP) in Deutschland, beruhend auf den Daten der epidemiologischen Krebsregister in Deutschland sowie der amtlichen Todesursachsenstatistik. Danach erkrankten in Deutschland zuletzt jährlich rund 11.000 Personen an einem CUP, was einem Anteil von 2,3 % an allen Malignomen entspricht. Bei knapp 10.000 Menschen wird ein unbekannter oder nicht näher bezeichneter Primärtumor (ICD-10: C80) als Todesursache angegeben. Aktuelle internationale Vergleichsdaten deuten allerdings darauf hin, dass die Inzidenz für das echte CUP-Syndrom eher niedriger liegen dürfte, wahrscheinlich weil die Unterscheidung zwischen einem tatsächlich unbekannten und einem lediglich nicht näher bezeichneten Primärtumor v. a. bei den nur über Todesbescheinigungen identifizierten Fällen schwierig ist. Morphologisch überwiegt das Adenokarzinom; in etwa 30 % der Fälle sind nur unspezifische Histologien angegeben. Die Prognose des CUP entspricht mit relativen Fünfjahresüberlebensraten um 18 % etwa der des Lungenkarzinoms, wobei Patienten in jüngerem Alter und solche mit Plattenepithelkarzinomen deutlich höhere Überlebenschancen aufweisen.



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Aktuelle pathologische und molekulare Aspekte des Harnblasenkarzinoms

Zusammenfassung

Hintergrund und Ergebnisse

Eckdaten der WHO-Klassifikation 2016 für die Entität Harnblasenkarzinom werden zusammengestellt. Die eindeutige Diktion der Diagnostik ist zusammen mit den klinischen Daten des Befunds in der Harnblase eine wichtige Grundlage, um das molekulargenetische Verständnis der Tumoren und deren Entstehung voranzutreiben. Gleichzeitig zeigen zunehmende molekulare Daten Aussagemöglichkeiten für Subtypen und Varianten des Urothelkarzinoms bis hin zu ersten Daten für Therapieansprechen, sodass insgesamt wesentliche Fortschritte für das Harnblasenkarzinom gemacht worden sind. Nicht zuletzt aus den molekulargenetischen Daten wird mehr Sicherheit über den Einsatz immunhistochemischer Untersuchungen abgeleitet. Die Immunhistochemie hat einen Stellenwert in der Entitätszuordnung (z. B. bei Metastasen) und in der eindeutigen Zuordnung von Malignität in Abgrenzung gegen reaktive Veränderungen. Zum Beispiel mit der Darstellung von gezielten Molekülen der Immuncheckpointkontrolle bietet die Immunhistochemie auch eine prädiktive Komponente.

Schlussfolgerung

Neuere genetische und proteomische Methoden finden zunehmend Eingang auch in die Diagnostik von Urin und Gewebe.



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Comparing aspheric ablation profile with standard corneal ablation for correction of myopia and myopic astigmatism, a contralateral eye study

Abstract

The purpose of this study is to compare visual outcomes of myopic refractive surgery, using tissue saving (TS), a standard ablation profile by a Technolas 217z100, and aberration smart ablation (ASA), an aspheric algorithm by a MEL 80 excimer laser in two eyes of one patient. In this prospective interventional paired-eye controlled study, a total of 100 eyes of 50 participants with myopia with or without astigmatism underwent thin-flap Femto-LASIK, using a Femto LDV femtosecond laser (Ziemer Ophthalmic Systems AG, Port, Switzerland). For each patient, one eye was randomly treated with tissue-saving algorithm (TS group) by the Technolas 217z100 excimer laser and the other eye was treated with optimized smart ablation profile (ASA group) by the MEL 80 excimer laser. Outcome measures were uncorrected distance visual acuities (UDVAs), corrected distance visual acuities (CDVAs), manifest refraction, higher-order aberrations (HOAs), contrast sensitivity, and patient satisfaction 12 months after surgery. At 12 months postoperative, "45 subjects returned with mean" UDVA was − 0.02 ± 0.08 Logarithm of mean angle of resolution (LogMAR) for TS group and − 0.02 ± 0.09 LogMAR for ASA group (P = 0.91). Of the TS eyes, 42/45 (93.3%) and 32/45 (71.1%) were within ± 0.5 D and ± 0.25 D of target refraction, respectively, and of the ASA eyes, 41/45 (91.1%) and 30/45 (66.6%) were within ± 0.5 D and ± 0.25 D of target refraction, respectively. No statistically significant differences were observed between groups in HOAs changes and contrast sensitivity function. Aspheric and non-aspheric LASIKs using the two different excimer lasers provide similar results in myopic and myopic astigmatism patients.



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Comparison between performance of single-fiber reflectance spectroscopy (SFRS) system and colposcopy: a phase III trial

Abstract

Herein, the performance of single-fiber reflectance spectroscopy (SFRS) in detection of cervical pre-cancerous squamous intraepithelial lesions (SIL) was compared with colposcopy. Based on the previous results obtained from 167 samples and finding the contributing parameters in differentiating SILs from non-SILs, a user-friendly interface was developed to detect the SILs using SFRS system. Detection of SILs in 301 patients was performed by both SFRS system and routine colposcopy. In addition to physician-determined sites, four quarters of the cervix were measured by SFRS system and suspicious lesions detected by either method were biopsied. Histopathologic results of the biopsied species were compared to the physician judgments based on colposcopy and the results of SFRS system. SFRS could differentiate between SILs and non-SILs with mean sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 38.3, 60.9, 15.2, and 84.3%, respectively. These values were obtained as 88.3, 10.6, 15.4, and 83.1% for the colposcopy, respectively. Although sensitivity of SFRS in detection of SILs is about twofold less than the colposcopy, it can reduce the number of unnecessary biopsies by a factor of more than 5.5. Therefore, the aid of SFRS system to the physician can reduce the number of unnecessary biopsies. On the other hand, both colposcopy and SFRS methods equally suffer from low detection worth in terms of positive/negative predictive values. In conclusion, using the online, simple and non-invasive SFRS system to choose between several suspicious sites in a patient in the clinic may be recommended.



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Effects of photobiomodulation on experimental models of peripheral nerve injury

Abstract

Phototherapy has demonstrated positive effects in the treatment of peripheral nerve injury, but there is a need to investigate the dosimetric parameters. Thus, the aim of the present study was to conduct a literature review on the effects of photobiomodulation with the use of low-level laser therapy (LLLT) on the treatment of peripheral nerve injury in experimental models. The databases of PubMed/MEDLINE, SCOPUS, and SPIE Digital Library were searched for articles on the use of LLLT in experimental models of peripheral nerve injury published in English between January 2007 and March 2016. The laser parameter variability was wavelength (632.8 to 980 nm), power (10 to 190 mW), and total energy (0.15 to 90 J) in pulsed or continuous wave and single or multiple points. Eighteen original articles demonstrating the effects of LLLT on the acceleration of functional recovery, morphological aspects as well as the modulation of the expression inflammatory cytokines, and growth factors were selected. LLLT is a viable phototherapeutic modality for the treatment of peripheral nerve injury, demonstrating positive effects on the neuromuscular repair process using either red or infrared light. The majority of studies used a power of up to 50 mW and total energy of up to 15 J administered to multiple points. The determination of these parameters is important to the standardization of a LLLT protocol to enhance the regeneration process following a peripheral nerve injury.



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The Microbiology And Assoicated Risk Factor In Alloplastic Total Joint Infections: A Twenty-Year Retrospective Study

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Publication date: Available online 8 November 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Rhae Riegel, Kevin Sweeney, Gino Inverso, Peter Quinn, Eric J. Granquist
PurposeProsthetic joint infection (PJI) is a rare complication of temporomandibular joint replacement (TJR). This study aims to evaluate TJR PJI at our institution over a 20-year period including: microorganisms cultured, antibiotic resistances patterns, and intraoperative protocols of TJR.Patients and MethodsPatients were identified using CPT, ICD-9 codes, and surgical logs from January 1995-2015. Inclusion criteria: adults > 18 years with previous total alloplastic joint replacement, and the presence of infection of the prosthetic at explant. Exclusion criteria: patients < 18 years and who received hemiarthroplasty. Primary outcomes include culture data, and antibiotic selection for PJI. Secondary outcomes include intraoperative duration and in-vivo duration.ResultsEleven patients were identified and fifteen joints explanted. Average length in-vivo was 232 months (STD 478.9 months). Six percent (n=1) were identified as early PJI (0-3 months), 46% (n=7) intermediate PJI (3 months- 2 years), and 33% (n=5) late PJI (>2 years). One patient was not able to be classified as early, intermediate, or late. Staphylococcus aureus was present in 53% of subjects and was the predominant organism isolated. Propionibacterium acnes were isolated in 33% of subjects. Penicillin was the antibiotic with the most organism resistance (46%).ConclusionIn the current study, the most commonly cultured organisms were Staphylococcus aureus (53%) a finding consistent with current literature. The prevalence of Propionibacterium acnes colonization was noted in 33% of cases. Although the significance of P. acnes and its contribution to PJI still requires further investigation, it is known to be associated with PJI and biofilm formation. Consideration could be given, based on this study, for the use of vancomycin and first generation cephalosporins as perioperative antibiotic coverage.



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Is there a difference with intraarticular injections of corticosteroids, hyaluranate or placebo for temporomandibular osteoarthritis

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Publication date: Available online 8 November 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Yan Liu, Jiashun Wu, Wei Fei, Xiao Cen, Yi Xiong, Shasha Wang, Yaling Tang, Xinhua Liang
PurposeCorticosteroids are widely used for treatment of temporomandibular joint (TMJ) osteoarthritis. The purpose of this study is to investigate the effects of corticosteroids on TMJ osteoarthritis compared to placebo or hyaluronate.MethodsThe investigators designed and implemented a systematic review and meta-analysis to compare the effects of an intra-articular injection of a corticosteroid, hyaluronate, or placebo for TMJ osteoarthritis patients. We searched related randomized controlled studies electronically in multiple English- and Chinese-language electronic databases. The predictor variable was intra-articular injection with corticosteroid, hyaluronate or placebo. The primary outcome variables were pain intensity, and maximal mouth opening. Other variables included success rate and adverse events. Meta-analyses were performed with Rev Man 5.3.ResultsEight studies met the inclusion criteria. The meta-analysis revealed that corticosteroid injections after arthrocentesis were superior to placebo in relieving pain assessed with VAS (MD -0.74, 95%CI -1.34 to -0.13; P=0.02, I2=0%) in long-term effect, but was inferior in increasing maximal mouth opening (MD -2.06, 95%CI -2.76 to -1.36; P<0.00001, I2=28%). Although both corticosteroid and hyaluronate injections without arthrocentesis reduced pain and improved maximal mouth opening, the corticosteroid group had a significantly lower success rate (OR 0.41, 95%CI 0.17 to 1.00; P=0.05, I2=0%) than hyaluronate group in the short-term effect.ConclusionCorticosteroid injections after arthrocentesis were recommended to be taken for TMJ osteoarthritis patients to relieve joint pain rather than increase maximal mouth opening. Both corticosteroid and hyaluronate have a great effectiveness on TMJ osteoarthritis; however, hyaluronate might be the better alternative to some extent.



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Actualités dans les toxidermies

Publication date: Available online 8 November 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A. Barbaud




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Description des pratiques des médecins généralistes dans le diagnostic et la prise en charge de la gale commune

Publication date: Available online 8 November 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A.R. Schmidt-Guerre, B. Aranda-Hulin, M. Maumy-Bertrand, F. Aubin
IntroductionLa gale connaît depuis quelques années une recrudescence et il existe peu d'études évaluant les pratiques médicales en termes de diagnostic et de traitement.ObjectifNous avons souhaité enquêter sur les pratiques de prise en charge de la gale commune par les médecins généralistes (MG).Matériel et méthodesUn questionnaire anonyme comportant 13 questions sur les cas de gale commune vus en consultation entre janvier et juin 2015 a été adressé par voie postale aux 524 MG du département du Doubs.RésultatsLe taux de réponses était de 57 % (n=299). Parmi les répondants, 89 % déclaraient avoir diagnostiqué au moins un cas de gale commune au cours des six mois précédents, et 59 % plus de trois cas. Le principal argument clinique du diagnostic était la localisation du prurit. Dans 94 % des cas, aucun examen complémentaire n'était demandé. Lorsqu'il en était prescrit un, il s'agissait exclusivement d'un prélèvement parasitologique. Un avis dermatologique était demandé systématiquement par 3 % des MG, seulement en cas de doute diagnostique par 78 % et jamais par 19 %, alors que 66 % des MG se trouvaient à moins de dix kilomètres du cabinet d'un dermatologue. L'ivermectine (IVM) était prescrite seule par 38 % des MG, en une seule prise (22 %) ou deux prises (16 %), et le traitement topique seul par 2 %. Seuls 26 % des MG prescrivaient l'association d'IVM et de scabicide topique, en une seule fois (19 %) ou en deux cures (7 %). Le premier cercle du patient était traité par 77 % des MG, mais 9 % ne traitaient pas l'entourage. Des conseils pour décontaminer l'environnement étaient donnés par 100 % des MG. Une récidive de gale était constatée par 25 % des MG malgré un traitement systématique du premier cercle réalisé dans 93 % des cas.DiscussionCes résultats confirment la fréquence de la gale commune en médecine générale et l'intérêt des MG pour cette enquête sur leurs pratiques. Ils montrent aussi l'hétérogénéité des prises en charge de la gale par les MG, malgré les recommandations émises en 2012 par le Haut conseil de santé publique.ConclusionNotre travail démontre l'importance du rôle du MG dans la gestion de première ligne de la gale. Une meilleure diffusion des recommandations disponibles semble nécessaire pour optimiser cette prise en charge.BackgroundAlthough there is evidence suggesting an epidemiologic increase of scabies in France, few studies have assessed medical practice in terms of diagnosis and treatment.ObjectivesTo describe the management of scabies by general practitioners (GPs).Patients and MethodsA questionnaire was addressed to the 524 GPs of the Doubs department in France regarding the management of cases of scabies diagnosed between January and June 2015.ResultsThe response rate was 57 % (n=299). At least one case of scabies was observed by 89 % of GPs in the previous six months and more than three cases were diagnosed by 59 % of GPs. The main clinical criterion for diagnosis was the specific localization of pruritus (82 %). No diagnostic test was used by 94 % of GPs other than except direct parasitological examination, which was used by 6 %. A systematic examination by a dermatologist was prescribed by 3 % of GPs, by 78 % of them in the case of diagnostic doubt, and not at all by 19 %, even though 66 % of GPs' offices were located under 10 kilometers from a dermatologist's office. Ivermectin (IVM) alone was prescribed by 38 % of GPs, either as a single dose (22 %) or as two repeated doses (16 %). Topical treatment alone was prescribed by 2 % of GPs and the association of IVM and topical treatment was used by 26 %, either as a single dose (19 %) or as two repeated doses (7 %). All household members and any sexual contacts were systematically treated by 77 % of GPs, but 9 % did not prescribe any treatment. Decontamination advice was given by 100 % of GPs. Recurrence of scabies was observed by 25 % of GPs despite systematic treatment (93 %) of patients' close contacts.DiscussionOur study confirms the frequency of scabies in general medicine and the interest of GPs in this evaluation of practice. Our data also demonstrate the heterogeneity of management by GPs and the limitations of/poor compliance with national recommendations on scabies proposed by the Haut conseil de santé publique (Public Health Council) in 2012.ConclusionOur study emphasizes the critical role of GPs in the management of scabies and the need for specific recommendations concerning their practices.



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Apport de la microscopie confocale par réflectance dans le diagnostic de mélanose conjonctivale primitive acquise sans atypie

Publication date: Available online 8 November 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): M. Kaspi, T. Garcin, C. Habougit, C. Douchet, J.-M. Dumollard, D. Grivet, G. Thuret, P. Gain, B. Labeille, E. Cinotti, J.-L. Perrot




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Kératoacanthomes sur tatouages récents : deux cas

Publication date: Available online 7 November 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): N. Kluger, D. Douvin, F. Dupuis-Fourdan, J.-M. Doumecq-Lacoste, V. Descamps
IntroductionLe nombre croissant de cas de kératoacanthomes (KA) solitaires ou multiples, ou de carcinomes épidermoïdes (CE), sur des parties rouges de tatouages, tend à suggérer un lien non fortuit avec le tatouage. Nous rapportons ici deux présentations différentes : une forme de KA multiples éruptifs sur les zones rouges et photo-exposées d'un tatouage récent et une forme de lésion isolée typique sur les tracés d'un tatouage récent. Nous discutons les problèmes liés à la distinction entre KA et CE dans ce contexte particulier.ObservationsCas no 1 : un homme de 55 ans avec de nombreux tatouages présentait de multiples lésions kératosiques verruqueuses restreintes à un tatouage rouge. Celui-ci avait été réalisé par un tatoueur professionnel durant l'été 2016, la semaine précédant les symptômes. Une partie du tatouage était restée exposée au soleil et les lésions étaient strictement localisées aux tracés photo-exposés. En janvier 2017, le patient consultait avec une dizaine de lésions. L'analyse histologique d'une lésion prélevée par shaving était en faveur d'un CE à type de KA. L'examen clinique était sans particularité. Il n'avait aucun antécédent de cancer cutané. Deux semaines plus tard, une partie des lésions avait régressé. Sur la base de l'histoire clinique et des aspects histologiques, le diagnostic de KA éruptifs était finalement posé. Les lésions résiduelles étaient traitées par cryothérapie ou par exérèse. Cas no 2 : une femme de 72 ans présentait, trois semaines après un tatouage de l'avant-bras gauche, une lésion nodulaire douloureuse de 1cm avec un cratère central. L'exérèse complète confirmait le diagnostic de KA.DiscussionÀ ce jour, 31 cas (17 hommes, âge médian 50,5 ans) de KA ou de CE sur tatouage ont été rapportés. Les lésions se développent le plus souvent rapidement, une semaine à quelques mois après le tatouage. Les cas survenus sur de « vieux » tatouages sont exceptionnels. La couleur rouge est le plus souvent concernée. La principale difficulté porte sur la distinction entre KA et CE. Actuellement, les pathologistes s'accordent à considérer le KA comme une variante de CE. Cependant, les formes éruptives de KA constituent une situation particulière. Elles peuvent avoir une cause génétique, et des KA associés à des traumatismes physiques ou des traitements médicaux ont été décrits. Comme d'autres auteurs, nous pensons que les CE sur tatouage rouge appartiennent plus au spectre du KA. La physiopathogénie des KA éruptifs sur tatouage est probablement multifactorielle, impliquant : le traumatisme induit par les aiguilles ; le processus inflammatoire et de cicatrisation ; un composant de l'encre rouge ; des facteurs environnementaux comme l'exposition aux UV durant la cicatrisation et une prédisposition personnelle. La survenue de KA solitaires ou éruptifs sur des tatouages récents est une complication non fortuite. Ces lésions doivent cependant être excisées et un suivi instauré. Des analyses toxicologiques sur des spécimens tumoraux sont nécessaires pour identifier la ou les molécules responsables de ces réactions au sein des encres.BackgroundIncreasing numbers of reports of rapidly arising, isolated or eruptive keratoacanthomas (KA) and squamous cell carcinomas (CSC) on the red part of tattoos tend to suggest a non-fortuitous link with the procedure. We report herein two different presentations of KAs on tattoos: one patient with multiple eruptive KAs on sun-exposed areas of a recent red tattoo and another with a solitary lesion on a recent tattoo. We discuss the issues related to the distinction between KAs and CSCs in this particular context.Patients and methodsCase No. 1: A 55-year-old heavily tattooed man presented multiple round keratotic verrucous-like lesions restricted to a red tattoo. The tattoo had been performed by a professional tattooist in summer 2016, a week before the onset of the symptoms. The patient did not protect a part of his tattoo from sun-exposure during the healing phase and lesions developed only on the sun-exposed tattooed parts. In January 2017, he consulted with about ten lesions. The histologic study by shaving of a lesion militated in favor of a CSC, KA type. The physical examination was unremarkable. He had no previous history of skin cancer. Two weeks later, most of the lesions regressed spontaneously. Based on the clinical history and progression of the lesions, a diagnosis was made of eruptive KA on a red tattoo. Residual lesions were treated by cryotherapy or excision. Case No. 2: A 72-year-old woman developed a 1-cm painful dome-shaped nodule with a central crust three weeks after tattooing. Full excision confirmed the diagnosis of KA.DiscussionTo date, we have found 31 case reports and series (17 men, median age: 50.5 years) of KA and CSC on tattoos. Lesions usually develop rapidly after completion of the tattoo, after between one week and several months. Exceptional cases have been described in old tattoos. Red tattoo ink is most commonly the culprit. The main difficulty lies in distinguishing between KA and CSC. Nowadays pathologists agree that a KA should be considered as a variant of CSC. Eruptive forms of KA present a peculiar situation. They may sometimes be inherited, and KA on recent traumatized areas or drug-induced have been described. Like other authors, we believe that cases of CSC on red tattoos belong rather to the KA type. The physiopathogenesis of tattoo-associated eruptive KA and CSC is not clearly understood, but could be multifactorial, involving: the trauma induced by tattooing, local inflammatory reaction, a component of the red ink, external factors such UV exposure, and a possible genetic predisposition. Rapidly arising KA and eruptive KA on top of recent (red) tattoos are not fortuitous. The lesions should be excised and the patient monitored. Additional studies on tumor specimens are warranted to identify the possible causative agents in tattoo ink that may be responsible for such reactions.



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Hyperpigmentation cutanée chez un patient traité par minocycline pour une polyarthrite rhumatoïde

Publication date: Available online 8 November 2017
Source:Annales de Dermatologie et de Vénéréologie
Author(s): C. Prouteau, X. Guennoc, L. Tisseau, L. Darrieux, G. Safa




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Endoplasmic Reticulum Stress and Allergic Diseases

Abstract

Purpose of Review

In this review, we will integrate recent knowledge on endoplasmic reticulum (ER) stress and allergy, thereby highlighting the therapeutic potential of ER stress in the context of precision medicine for allergic diseases.

Recent Findings

Emerging evidence suggests that allergic diseases are very heterogeneous having numerous endotypes. This leads to the new era of modern medicine, which assumes that a particular endotype-driven therapy, called precision medicine, would be more efficacious in a specific group of patients rather than in all patients. Currently, a dichotomy involving type 2/non-type 2 immune response underlies most of the studies on inflammatory and immunologic mechanisms of allergic disorders. Whereas there are several approved or investigational endotype-driven therapeutic agents targeting type 2 immune responses, investigation of mechanisms and endotype-driven interventions regarding non-type 2 immune response lags far behind.

Summary

Considering that non-type 2 immune response may represent a significant proportion of allergic disease, particularly corticosteroid-resistant severe disease, defining a novel concept of endotype-driven approach may be essential. Recently, stress responses originate from the endoplasmic reticulum (ER) and the associated inflammatory molecular platform has been suggested as a crucial player of immune and inflammatory responses. This implies that ER stress-related pathways may represent a new endotype-driven therapeutic strategy in the treatment of allergic diseases.



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Correction: Chronische Urtikaria im Kindesalter

Correction:

Hautarzt 2017

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Sehr geehrte Leserin, sehr geehrter Leser,

im oben genannten Beitrag ist auf S. 8, im 2. Absatz unter der Zwischenüberschrift Omalizumab, leider ein Fehler unterlaufen. Der Satz sollte lauten: „Omalizumab wird unabhängig von …



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Influence of a calcium hydroxide-based intracanal dressing on the quality of the root canal filling assessed by capillary flow porometry

Abstract

Objective

The objective of this study is to evaluate the influence of a calcium hydroxide intracanal dressing (CH) on the short- and long-term sealing ability of the root canal filling using capillary flow porometry (CFP).

Materials and methods

To verify the repeatability of the method, five obturated specimens were submitted to CFP. Measurements were repeated three times and compared with the non-parametric Friedman test. Forty-five instrumented palatal roots were randomly divided into three groups. Group 1: specimens were obturated in one step without placement of any dressing. Group 2: CH was placed and removed after 1 week with syringe irrigation before obturation. Group 3: CH was placed and removed after 1 week with ultrasonic activation before obturation. CFP measurements were conducted at 1 week and 6 months after obturation. The inter-group comparisons were performed using the Kruskal-Wallis test and the intra-group comparison over time using the Wilcoxon signed-rank test. Significance level was set at 0.05.

Results

In the five specimens, no difference could be detected between the consecutive measurements for minimum, mean flow, and maximum pore diameter indicating repeatability of the method. No difference in sealing ability could be detected neither between the 3 groups at 1 week and at 6 months nor within each group between the 1 week and the 6 months measurements.

Conclusions

Placement of a CH did not affect significantly the short- and long-term sealing ability of the root canal filling.

Clinical relevance

The use of an intermediary CH does not negatively influence the quality of the root canal filling.



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Mandibular kinematics and maximum voluntary bite force following segmental resection of the mandible without or with reconstruction

Abstract

Objectives

The purpose was to analyze mandibular kinematics and maximum voluntary bite force in patients following segmental resection of the mandible without and with reconstruction (autologous bone, alloplastic total temporomandibular joint replacement (TMJ TJR)).

Materials and methods

Subjects operated from April 2002 to August 2014 were enrolled in the study. Condylar (CRoM) and incisal (InRoM) range of motion and deflection during opening, condylar retrusion, incisal lateral excursion, mandibular rotation angle during opening, and maximum voluntary bite force were determined on the non-affected site and compared between groups. Influence of co-factors (defect size, soft tissue deficit, neck dissection, radiotherapy, occlusal contact zones (OCZ), and time) was determined.

Results

Twelve non-reconstructed and 26 reconstructed patients (13 autologous, 13 TMJ TJR) were included in the study. InRoM opening and bite force were significantly higher (P ≤ .024), and both condylar and incisal deflection during opening significantly lower (P ≤ .027) in reconstructed patients compared with non-reconstructed. Differences between the autologous and the TMJ TJR group were statistically not significant. Co-factors defect size, soft tissue deficit, and neck dissection had the greatest impact on kinematics and number of OCZs on bite force.

Conclusions

Reconstructed patients (both autologous and TMJ TJR) have better overall function than non-reconstructed patients.

Clinical relevance

Reconstruction of segmental mandibular resection has positive effects on mandibular function. TMJ TJR seems to be a suitable technique for the reconstruction of mandibular defects including the TMJ complex.



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The influence of dexamethasone on postoperative swelling and neurosensory disturbances after orthognathic surgery: a randomized controlled clinical trial

Abstract

Background

Orthognathic surgery is associated with considerable swelling and neurosensory disturbances. Serious swelling can lead to great physical and psychological strain. A randomized, prospective, controlled clinical trial was realized in order to evaluate the effect of a preoperative intravenous dexamethasone injection of 40 mg on postoperative swelling and neurosensory disturbances after orthognathic surgery.

Methods

Thirty-eight patients (27 male and 11 female) patients, all with the indication for an orthognathic surgery, were enrolled in this study (mean age: 27.63 years, range: 16–61 years) and randomly divided into two groups (study group/ control group). Both groups underwent either maxillary and/or mandibular osteotomies, resulting in three subgroups according to surgical technique (A: LeFort I osteotomy, B: bilateral sagittal split osteotomy (BSSO), C: bimaxillary osteotomy). The study group received a single preoperative intravenous injection of 40 mg dexamethasone. Facial edema was measured by 3D surface scans on the 1st, 2nd, 5th, 14th and 90th postoperative day. Furthermore, neurosensory disturbances on the 2nd, 5th, 14th and 90th postoperative day were investigated by thermal stimulation.

Results

Facial edema after LeFort I osteotomy, BSSO and bimaxillary osteotomy showed a significant decrease in the study group compared to the control group (P = 0.048, P = 0.045, P < 0.001). The influence of dexamethasone on neurosensory disturbances was not significant for the inferior alveolar nerve (P = 0.746) or the infraorbital nerve (P = 0.465).

Conclusions

Patients undergoing orthognathic surgery should receive a preoperative injection of dexamethasone in order to control and reduce edema. However, there was no influence of dexamethasone on reduction of neurosensory disturbances.

Trial registration

DRKS00009033.



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Endoplasmic Reticulum Stress and Allergic Diseases

Abstract

Purpose of Review

In this review, we will integrate recent knowledge on endoplasmic reticulum (ER) stress and allergy, thereby highlighting the therapeutic potential of ER stress in the context of precision medicine for allergic diseases.

Recent Findings

Emerging evidence suggests that allergic diseases are very heterogeneous having numerous endotypes. This leads to the new era of modern medicine, which assumes that a particular endotype-driven therapy, called precision medicine, would be more efficacious in a specific group of patients rather than in all patients. Currently, a dichotomy involving type 2/non-type 2 immune response underlies most of the studies on inflammatory and immunologic mechanisms of allergic disorders. Whereas there are several approved or investigational endotype-driven therapeutic agents targeting type 2 immune responses, investigation of mechanisms and endotype-driven interventions regarding non-type 2 immune response lags far behind.

Summary

Considering that non-type 2 immune response may represent a significant proportion of allergic disease, particularly corticosteroid-resistant severe disease, defining a novel concept of endotype-driven approach may be essential. Recently, stress responses originate from the endoplasmic reticulum (ER) and the associated inflammatory molecular platform has been suggested as a crucial player of immune and inflammatory responses. This implies that ER stress-related pathways may represent a new endotype-driven therapeutic strategy in the treatment of allergic diseases.



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IFN-β regulates Th17 differentiation partly through the inhibition of osteopontin in experimental autoimmune encephalomyelitis

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Publication date: January 2018
Source:Molecular Immunology, Volume 93
Author(s): Qing Zhao, Wenjing Cheng, Yebin Xi, Zheyi Cao, Yunzhi Xu, Ting Wu, Chengzhen Li, Xiaoyin Niu, Guangjie Chen
Multiple sclerosis (MS) and the corresponding animal model, experimental autoimmune encephalomyelitis (EAE), are chronic neuroinflammatory autoimmune diseases. Increased activation of CD4+T cells, especially the Th1 and Th17 subsets, is thought to play a causal role in this disease. IFN-β is widely used in the treatment of MS and is found to decrease IL-17 and OPN production in MS patients and EAE mice. However, a definitive molecular mechanism has not yet been fully elucidated. In this study, we investigated the immunomodulatory effect of IFN-β on the EAE model. We observed disease progression and determined the percentage of Th1/Th17 cells in the peripheral immune organs, brain, and spinal cord of mice. Furthermore, the levels of related cytokines and transcription factors were measured in splenocytes, and the effects of IFN-β on Th17 differentiation were assessed in vitro. Compared to the control group, IFN-β treatment significantly reduced the incidence of EAE and the associated pathological damage. Th1 and Th17 cells in IFN-β-treated mice were significantly reduced, and the levels of cytokines, such as IFN-γ, IL-17, and OPN, were significantly decreased in splenocyte supernatants as well as the levels of corresponding transcription factors. IFN-β inhibited downstream inflammatory cytokines through the inhibition of PI3K/AKT/NF-κB axis and p38, JNK-MAPK, as well as the regulation of mTOR complexes. Moreover, IFN-β inhibited Th17 differentiation and neutralizing OPN antibodies offset the inhibitory effect of IFN-β on Th17 cells. Meanwhile, IFN-β influenced the acetylation of the Il17a and Opn gene promoters. The findings described herein provide novel evidence for the role of IFN-β in Th17 differentiation partly through the inhibition of OPN.



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Role of autophagy in MHC class I-restricted antigen presentation

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Publication date: Available online 8 November 2017
Source:Molecular Immunology
Author(s): Luc Van Kaer, Vrajesh V. Parekh, J. Luke Postoak, Lan Wu
Major histocompatibility complex (MHC) class I molecules present peptide antigens to MHC class I-restricted CD8+ T lymphocytes. The peptides loaded onto MHC class I molecules are typically derived from cytosolic antigens, which includes both self and foreign proteins. In addition to this classical MHC class I antigen presentation pathway, some cell types, especially dendritic cells can present antigens from exogenous sources to MHC class I-restricted CD8+ T cells, in a process called cross-presentation. A variety of cellular processes, including endocytosis, vesicle trafficking, and autophagy, play critical roles in these antigen presentation pathways. In this review article, we discuss the role of autophagy, an intracellular degradation system that delivers cytoplasmic constituents to lysosomes, in MHC class I-restricted antigen presentation. A mechanistic understanding of the role of autophagy-related proteins in MHC class I restricted antigen presentation may guide future efforts in manipulating autophagy to prevent or treat human disease.



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Human myeloma IgG4 reveals relatively rigid asymmetric Y-like structure with different conformational stability of CH2 domains

Publication date: December 2017
Source:Molecular Immunology, Volume 92
Author(s): Vladimir M. Tischenko, Zav'yalov Vladimir P., Sergey N. Ryazantsev
Human IgG4 (hIgG4) has weak pro-inflammatory activity. The structural basis for this is still unclear. Here a 3D model of myeloma hIgG4 was created at ∼3nm resolution using electron microscopy (EM) with negative staining and single-particle 3D reconstruction. The hIgG4 model reveals relatively rigid asymmetric Y-like structure. The model shows that one Fab subunit is closer to the upper portion of the Fc subunit (CH2 domain) than the other Fab. This is in agreement with X-ray crystallography and X-ray/neutron scattering, recently published by others. The same hIgG4 sample was studied with differential scanning calorimetry (DSC) and fluorescence. The thermodynamics and fluorescence observations indicate that one CH2 domain displays less conformational stability than the other. This finding is consistent with the flipping of one CH2 domain, observed in pembrolizumab (recombinant hIgG4) by X-ray crystallography. The specific feature of hIgG4 CH2 domains together with relatively rigid asymmetric Y-like structure, in which one Fab subunit is closer to the upper portion of the Fc subunit (CH2 domain) than the other Fab, can explain the unique biological properties of hIgG4, such as its weak pro-inflammatory activity.

Graphical abstract

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Liposome-based immunity-inducing systems for cancer immunotherapy

Publication date: Available online 8 November 2017
Source:Molecular Immunology
Author(s): Eiji Yuba
Cancer immunotherapy has gained much attention for next-generation cancer treatment. To conduct cancer immunotherapy, efficient antigen delivery systems must be able to deliver an antigen selectively to antigen-presenting cells, release it at suitable sites for induction of cross-presentation, and simultaneously induce activation of immunocompetent cells. Liposomes are a candidate for use as such multifunctional antigen delivery carriers because of their capability for easy functionalization. This review describes the rational design of liposome-based antigen delivery systems. Surface modification of liposomes by pH-responsive or fusogenic materials can achieve cytoplasmic delivery of antigen, leading to cross-presentation of exogenous antigen via a "cytosolic pathway." In contrast, targeting surface receptors on antigen presenting cells or the selective release of antigen in early endosome induced "vacuolar pathway"-mediated cross-presentation. Introduction of adjuvant molecules such as Toll like receptor agonists, synthetic cationic lipids or bioactive polysaccharides to liposomes improved their immunity-inducing ability. Combination with cancelling systems of immunosuppression in tumor microenvironment enhanced antitumor immunity of antigen delivery systems. Further understanding of immunity-inducing mechanism and molecular basis of tumor immunosuppressive environments and purposeful design of liposome-based antigen delivery systems can provide effective immunity-inducing systems for cancer immunotherapy.

Graphical abstract

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Adipose tissue as a potential source of hormones and cytokines involved in asthma pathogenesis

Publication date: Available online 7 November 2017
Source:Alergologia Polska - Polish Journal of Allergology
Author(s): Izabela Szymczak-Pajor, Rafal Pawliczak
Asthma and obesity are chronic inflammatory diseases affecting millions of people worldwide. Numerous epidemiological data have revealed increased adiposity as a potential risk factor for severity and incidence of asthma. In addition, obesity is not only risk factor for asthma but is also related to its poor control. Despite the mechanism underlying obesity–asthma relation is not fully understood, it has been proposed that the common inflammatory mechanism plays a crucial role in determination of this relation. Adipose tissue is referred as extremely active endocrine organ secreting numerous hormones and cytokines that regulate immune responses and metabolism. In the lean state, the high levels of anti-inflammatory adipokines such as adiponetctin as well as low levels of pro-inflammatory adipokines i.e. leptin, and pro-inflammatory cytokines such as TNF-α, IL-8, IL-6 are secreted by adipose tissue. On the other hand, in the obese state, hypertrophic adipocytes and activated macrophages produce decreased level of adiponectin and increased levels of pro-inflammatory adipokines and cytokines leading to "metabolic inflammation". It may be possible that these obesity-related pro-inflammatory adipokines may be associated with airway inflammation in obesity-related asthma. In the current review, we summarized the recent knowledge concerning possible molecular mechanisms mediating the relation between obesity and asthma.



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Effect of Beam Steering on Echogenic and Nonechogenic Needle Visibility at 40°, 50°, and 60° Needle Insertion Angles

Currently, there is little understanding of the role of echogenic needles and beam steering at moderate angles of needle insertion. The ultrasound images of the echogenic and nonechogenic needles inserted into pork at 40°, 50°, and 60° were scored by anesthesiologists on a scale of 0–10. The effect of different levels of beam steer was also explored. At 40°, steep beam steering improves visualization of both nonechogenic and echogenic needles to an equal, satisfactory level. At 50° and 60°, visualization of nonechogenic needles is poor, whereas visibility of an echogenic needle was adequate and may be improved with steep beam steering. Accepted for publication September 27, 2017. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). The abstract of this report was presented as a moderated poster at the American Society of Regional Anesthesia Annual Meeting, New Orleans, Louisiana, in April 2016, and was selected for online publication by Anesthesiology News (May 26, 2016: http://ift.tt/1E4ey7M; search "Prabhakar"; must be registered and logged on to view article). Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Christopher Prabhakar, FRCPC, St Paul's Hospital, 1081 Burrard St, Vancouver, British Columbia, V6Z 1Y6, Canada. Address e-mail to christopher.prabhakar@gmail.com. © 2017 International Anesthesia Research Society

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Validation of a New Method to Automatically Select Cases With Intraoperative Red Blood Cell Transfusion for Audit

BACKGROUND: Hospitals review allogeneic red blood cell (RBC) transfusions for appropriateness. Audit criteria have been published that apply to 5 common procedures. We expanded on this work to study the management decision of selecting which cases involving transfusion of at least 1 RBC unit to audit (review) among all surgical procedures, including those previously studied. METHODS: This retrospective, observational study included 400,000 cases among 1891 different procedures over an 11-year period. There were 12,616 cases with RBC transfusion. We studied the proportions of cases that would be audited based on criteria of nadir hemoglobin (Hb) greater than the hospital's selected transfusion threshold, or absent Hb or missing estimated blood loss (EBL) among procedures with median EBL 50%) that would be audited and most cases (>50%) with transfusion were among procedures with median EBL 9 g/dL, the procedure's median EBL was 9 g/dL and median EBL for the procedure ≥500 mL. CONCLUSIONS: An automated process to select cases for audit of intraoperative transfusion of RBC needs to consider the median EBL of the procedure, whether the nadir Hb is below the hospital's Hb transfusion threshold for surgical cases, and the absence of either a Hb or entry of the EBL for the case. This conclusion applies to all surgical cases and procedures. Accepted for publication August 24, 2017. Funding: Departmental funds. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Franklin Dexter, MD, PhD, Division of Management Consulting, Department of Anesthesia, University of Iowa, 200 Hawkins Dr, 6-JCP, Iowa City, IA 52242. Address e-mail to franklin-dexter@uiowa.edu. © 2017 International Anesthesia Research Society

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Antiemetic Prophylaxis as a Marker of Health Care Disparities in the National Anesthesia Clinical Outcomes Registry

BACKGROUND: US health care disparities persist despite repeated countermeasures. Research identified race, ethnicity, gender, and socioeconomic status as factors, mediated through individual provider and/or systemic biases; little research exists in anesthesiology. We investigated antiemetic prophylaxis as a surrogate marker for anesthesia quality by individual providers because antiemetics are universally available, indicated contingent on patient characteristics (gender, age, etc), but independent of comorbidities and not yet impacted by regulatory or financial constraints. We hypothesized that socioeconomic indicators (measured as insurance status or median income in the patients' home zip code area) are associated with the utilization of antiemetic prophylaxis (as a marker of anesthesia quality). METHODS: We tested our hypothesis in several subsets of electronic anesthesia records from the National Anesthesia Clinical Outcomes Registry (NACOR), fitting frequentist and novel Bayesian multilevel logistic regression models. RESULTS: NACOR contained 12 million cases in 2013. Six institutions reported on antiemetic prophylaxis for 441,645 anesthesia cases. Only 173,133 cases included details on insurance information. Even fewer (n = 92,683) contained complete data on procedure codes and provider identifiers. Bivariate analysis, multivariable logistic regression, and our Bayesian hierarchical model all showed a large and statistically significant association between socioeconomic markers and antiemetic prophylaxis (ondansetron and dexamethasone). For Medicaid versus commercially insured patients, the odds ratio of receiving the antiemetic ondansetron is 0.85 in our Bayesian hierarchical mixed regression model, with a 95% Bayesian credible interval of 0.81–0.89 with similar inferences in classical (frequentist) regression models. CONCLUSIONS: Our analyses of NACOR anesthesia records raise concerns that patients with lower socioeconomic status may receive inferior anesthesia care provided by individual anesthesiologists, as indicated by less antiemetics administered. Effects persisted after we controlled for important patient characteristics and for procedure and provider influences. Findings were robust to sensitivity analyses. Our results challenge the notion that anesthesia providers do not contribute to health care disparities. Accepted for publication August 31, 2017. Funding: This research is supported in part by the National Center for Advancing Translational Sciences, a component of the National Institutes of Health, through CTSA grants 5KL2TR001071-03 and UL1TR001073.Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Michael Andreae, MD, Department of Anesthesiology, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Dr, Hershey, PA 17033. Address e-mail to mhandreae@gmail.com. © 2017 International Anesthesia Research Society

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Healthcare Professionalism: Improving Practice Through Reflections on Workplace Dilemmas

No abstract available

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Assessment of Tricuspid Annular Motion by Speckle Tracking in Anesthetized Patients Using Transesophageal Echocardiography

BACKGROUND: The perioperative assessment of right ventricular (RV) function remains a challenge. Tricuspid annular plane systolic excursion (TAPSE) using M-mode is a widely used measure of RV function. However, accurate alignment of the ultrasound beam with the direction of annular movement can be difficult with transesophageal echocardiography (TEE) to measure TAPSE, precluding effective use of M-mode to measure annular excursion. Tracking of specular reflectors in the myocardium may provide an angle-independent method to assess annular motion with TEE. We hypothesized that TEE speckle tracking of the lateral tricuspid annular motion represents a comparable measurement to the well-validated M-mode TAPSE on transthoracic echocardiogram (TTE), and may be considered as a reasonable alternative to TAPSE. METHODS: This is a prospective, observational cohort study. We included all patients, who were in sinus rhythm, with a preoperative TTE within 3 months of scheduled cardiac surgery that required intraoperative TEE. Tissue motion annular displacements (TMAD) of the lateral (L), septal (S), and midpoint (M) tricuspid annulus were measured (QLAB Cardiac Motion Quantification; Philips Medical, Andover, MA) after induction of general anesthesia. This was compared to the preoperative M-mode TAPSE on TTE. RESULTS: Seventy-two consecutive patients who met eligibility requirements were enrolled from September to November 2016. Twelve were excluded due to poor image quality, allowing TMAD to be analyzed in 60 patients. TMAD was analyzed offline and TMAD analysis was able to track tricuspid annular motion in all patients. The mean TMAD (L), TMAD (S), and TMAD (M) were 17.4 ± 5.2, 10.2 ± 4.8, and 14.2 ± 4.8 mm, respectively. TMAD (L) showed close correlation with M-mode TAPSE on TTE (r = 0.87, 95% confidence interval, 0.79–0.92; P

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Only New Red Blood Cells for Orthotopic Liver Transplant?

No abstract available

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Low Cardiac Output Syndrome After Adult Cardiac Surgery: Predictive Value of Peak Systolic Global Longitudinal Strain

BACKGROUND: Peak systolic global longitudinal strain (GLS) is increasingly used to quantify left ventricular systolic function. The primary objective of this study was to assess whether GLS obtained during intraoperative transesophageal echocardiogram, performed before cardiopulmonary bypass, improves the prediction of postoperative low cardiac output syndrome (LCOS) after adult cardiac surgery. METHODS: GLS from 275 patients undergoing on-pump cardiac surgery was calculated retrospectively using two-dimensional– speckle tracking echocardiography (aCMQ module from Qlab software version 10.5, Philips Medical, Brussels, Belgium). LCOS was defined as the need for inotropic or mechanical circulatory support for >24 hours postoperatively. Patient and procedure characteristics associated with LCOS at the univariable level (P ≤ .05) were entered into a forward stepwise logistic regression to create a first predictive model. A second model was created by adding GLS. The 2 models were compared using the likelihood-ratio test, the area under the receiver operating characteristic (ROC) curve, and the integrated discrimination index. The optimal cutoff value of GLS associated with LCOS was determined by maximizing the Youden index of the ROC curve. Secondary outcomes included time until complete weaning from inotropes, discharge from the intensive care unit and from the hospital, and 30-day mortality. RESULTS: GLS was significantly associated with LCOS (P

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The Pediatric Anesthesiology Workforce: Projecting Supply and Trends 2015–2035

BACKGROUND: A workforce analysis was conducted to predict whether the projected future supply of pediatric anesthesiologists is balanced with the requirements of the inpatient pediatric population. The specific aims of our analysis were to (1) project the number of pediatric anesthesiologists in the future workforce; (2) project pediatric anesthesiologist-to-pediatric population ratios (0–17 years); (3) project the mean number of inpatient pediatric procedures per pediatric anesthesiologist; and (4) evaluate the effect of alternative projections of individual variables on the model projections through 2035. METHODS: The future number of pediatric anesthesiologists is determined by the current supply, additions to the workforce, and departures from the workforce. We previously compiled a database of US pediatric anesthesiologists in the base year of 2015. The historical linear growth rate for pediatric anesthesiology fellowship positions was determined using the Accreditation Council for Graduate Medical Education Data Resource Books from 2002 to 2016. The future number of pediatric anesthesiologists in the workforce was projected given growth of pediatric anesthesiology fellowship positions at the historical linear growth rate, modeling that 75% of graduating fellows remain in the pediatric anesthesiology workforce, and anesthesiologists retire at the current mean retirement age of 64 years old. The baseline model projections were accompanied by age- and gender-adjusted anesthesiologist supply, and sensitivity analyses of potential variations in fellowship position growth, retirement, pediatric population, inpatient surgery, and market share to evaluate the effect of each model variable on the baseline model. The projected ratio of pediatric anesthesiologists to pediatric population was determined using the 2012 US Census pediatric population projections. The projected number of inpatient pediatric procedures per pediatric anesthesiologist was determined using the Kids' Inpatient Database historical data to project the future number of inpatient procedures (including out of operating room procedures). RESULTS: In 2015, there were 5.4 pediatric anesthesiologists per 100,000 pediatric population and a mean (±standard deviation [SD]) of 262 ±8 inpatient procedures per pediatric anesthesiologist. If historical trends continue, there will be an estimated 7.4 pediatric anesthesiologists per 100,000 pediatric population and a mean (±SD) 193 ±6 inpatient procedures per pediatric anesthesiologist in 2035. If pediatric anesthesiology fellowship positions plateau at 2015 levels, there will be an estimated 5.7 pediatric anesthesiologists per 100,000 pediatric population and a mean (±SD) 248 ±7 inpatient procedures per pediatric anesthesiologist in 2035. CONCLUSIONS: If historical trends continue, the growth in pediatric anesthesiologist supply may exceed the growth in both the pediatric population and inpatient procedures in the 20-year period from 2015 to 2035. Accepted for publication August 24, 2017. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Matthew K. Muffly, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, 300 Pasteur Dr H3580, Stanford, CA 94305. Address e-mail to mmuffly@stanford.edu. © 2017 International Anesthesia Research Society

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