Παρασκευή 10 Νοεμβρίου 2017
Author index∗∗July, pp. 1-196; August, pp. 197-390; September, pp. 391-590; October, pp. 591-794; November, pp. 795-994; December, pp. 995-1252.
Aboul-Fettouh N, Hinojosa J, Tovar-Garza A, Pandya AG. The majority of patients presenting with vitiligo have a clinical sign of activity. 2017;77:774-5 (Research letter)
http://ift.tt/2zyDJ5G
Topical 15% resorcinol for hidradenitis suppurativa: An uncontrolled prospective trial with clinical and ultrasonographic follow-up
To the Editor: Boer and Jemec first described the use of topical 15% resorcinol for hidradenitis suppurativa (HS) in a small retrospective study in 2010,1 reporting a marked decrease in pain and mean duration of the lesions. In this study we assessed the effects of resorcinol in a prospective open trial in HS by using both clinical measures and ultrasonography. Ultrasound examination in HS provides anatomic information that is clinically unavailable and may be helpful for follow-up.2,3 We recruited participants with Hurley stage I and II HS.
http://ift.tt/2hm7UD6
The water-drop test for the diagnosis of koilonychia
Koilonychia is a common concave nail dystrophy in which the nail plate is depressed centrally and elevated laterally.1 The term has Greek origins, with koilos meaning spoon. The pathophysiology of koilonychia, or spoon nails, is poorly understood. It has been associated with dermatologic disorders such as alopecia areata, psoriasis, and lichen planus; endocrinopathies such as hypothyroidism, hyperthyroidism, and diabetes mellitus; nutritional deficiencies, notably iron deficiency anemia; genodermatoses; and traumatic and occupational exposures.
http://ift.tt/2zA52gh
Doctors' mental health, burnout, and suicidality: Professional and ethical issues in the workplace
This case scenario engenders multiple ethical and professional issues for practicing dermatologists and dermatology residents, the most central of which are mental health and suicidality among physicians. When a physician's mental health is compromised, so may the safety and quality of the medical care provided. If a physician's mental state deteriorates to the point that his or her practice becomes impaired and professional obligations cannot be safely carried out, and the physician refuses to seek help, there is an ethical responsibility for a colleague(s) to report the impaired practitioner to an appropriate body or licensing authority.
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Circumventing iPLEDGE: Circumventing ethical responsibility?
Prescribing isotretinoin in the United States is regulated through iPLEDGE, a program aimed at reducing the risk for fetal exposure to isotretinoin. Isotretinoin is a pregnancy category X medication and is associated with major birth defects affecting 4%-28% of exposed fetuses.1,2 This Food and Drug Administration—approved program strives to ensure that no woman of child-bearing potential starts the medication while pregnant or becomes pregnant while on the medication. It is a centralized pregnancy risk management program requiring registration from all parties involved in the chain of distribution: wholesalers, prescribers, pharmacies, and patients.
http://ift.tt/2hm7Q6k
Injection of filler for volume replacement of the whole face using a single-entry method
Many practitioners use the standard approach of injecting fillers through multiple points into the area of a defect. In the midface, physicians will inject the cheeks and the tear troughs through different sets of entry points. Although the results of this method are acceptable, the risk of bruising is high.
http://ift.tt/2zyDA28
Lymphedema
Lymphedema is a localized form of tissue swelling resulting from excessive retention of lymphatic fluid in the interstitial compartment and caused by impaired lymphatic drainage. Lymphedema is classified as primary or secondary. Primary lymphedema is caused by developmental lymphatic vascular anomalies. Secondary lymphedema is acquired and arises as a result of an underlying systemic disease, trauma, or surgery. We performed PubMed and Google Scholar searches of the English-language literature (1966-2017) using the terms lymphedema, cancer-related lymphedema, and lymphatic complications.
http://ift.tt/2hl2IPW
A novel clinical sign to aid in the diagnosis of superficial basal cell carcinoma
Basal cell carcinoma (BCC) is the most common type of skin cancer worldwide.1 The diagnosis of BCC is often made clinically and confirmed histologically. Superficial BCCs, which represent a common histologic subtype, characteristically present as bright pink plaques or patches with variable scale.2 Even for experienced dermatologists, some superficial BCCs might elude early detection because of their variable color, ranging from skin-colored to bright pink. Early superficial BCCs are easier to treat and associated with less morbidity.
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Inpatient dermatology consultations: Motivation and practice of requesting providers
To the Editor: Given limited access to inpatient dermatology services, inpatient dermatologic management is handled by primary teams.1-4 These teams (eg, medicine, intensive care services, surgery) must decide when it is necessary to request dermatologic expert opinion, though many hospitals lack access to inpatient dermatology consults.4 When available, the decision to call a consult is unique and complex, shaped by patient-driven and provider-driven factors. Our aim was to survey inpatient providers prospectively to capture the factors that inform their decision to request dermatology consults and to characterize the perceived utility of the inpatient consult service.
http://ift.tt/2hl2Gri
The hungry caterpillar flap: A variant of the V-to-Y island pedicle flap
Subcutaneous and myocutaneous island pedicle flaps are versatile closure options that are able to close large surgical defects with robust vascular supply.1 However, one of the shortcomings of these closures is the formation of triangular scars. Straight lines are visually arresting and the triangular scars created by island pedicle flaps can be distinctly conspicuous.
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Correction of vermilion lip retraction after mucosal advancement flap: A countertraction technique
Squamous cell carcinoma of the lip accounts for a third of all oral cavity cancers in the United States, and the lower lip is the most frequent site of occurence.1 Surgical resection is the mainstay of treatment. Several size-dependent options can be utilized for repair: a small defect can be closed with a simple primary closure, whereas a local flap or skin graft is required for massive tissue loss. The mucosal advancement flap is a useful method with satisfactory results for large vermilion lip defects.
http://ift.tt/2zyDt6I
High-risk category for early annual ophthalmology screening of patients receiving hydroxychloroquine
To the Editor: Although the recent article "Updated recommendations on the use of hydroxychloroquine in dermatologic practice" by Fernandez was overall both excellent and timely,1 I wish to offer a comment of clarification on the use of annual screening among hydroxychloroquine users. In the article, the author states, "Annual ocular toxicity screening is recommended to begin only after 5 years of use unless patients are considered high-risk or develop ophthalmologic symptoms." However, there are 2 caveats to this statement.
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Reply to: Comment on “Efficacy and safety of etanercept and adalimumab with and without a loading dose for psoriasis: A systematic review”
To the Editor: We would like to thank Dr Asahina and Dr Nakagawa1 for taking interest in our publication entitled "Efficacy and safety of etanercept and adalimumab with and without a loading dose for psoriasis: A systematic review."2 In our initial assessment of their clinical trial report (M04-688; NCT00338754), we were not able to infer any statistical difference in efficacy between the 2 dosing regimens, 40 mg every other week (EOW) and 80-mg loading dose followed by 40 mg EOW.3 However, we are pleased to learn that a statistical analysis directly comparing the efficacy of the 2 groups was completed and established a more rapid improvement of psoriatic plaques with the regimen including a loading dose.
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Reintroducing the Sodium–Iodide Symporter to Anaplastic Thyroid Carcinoma
Thyroid , Vol. 0, No. 0.
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Are Evidence-Based Guidelines Reflected in Clinical Practice? An Analysis of Prospectively Collected Data of the Italian Thyroid Cancer Observatory
Thyroid , Vol. 0, No. 0.
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Alignment Strategy for Constricted Maxillary Dental Arch in Patients With Unilateral Cleft Lip and Palate Using Fixed Orthodontic Appliance.
The purpose of this study was to compare the alignment pattern of the constricted maxillary dental arch by fixed orthodontic treatment (FOT) in the well-aligned and constricted arches of unilateral cleft lip and palate (UCLP) patients. 19 UCLP patients were divided into Group 1 (well-aligned arch, n = 9) and Group 2 (constricted arch, n = 10). After the cephalometric and maxillary dental arch variables before (T1) and after FOT (T2) were measured, statistical analysis was performed. There were no significant differences in the surgical timing of cheiloplasty, palatoplasty, and secondary alveolar bone grafting and in the surgical method of cheiloplasty between the 2 groups. However, Group 2 had a higher percentage of palatoplasty method, which could leave the denuded bone for secondary healing than Group 1 (P
http://ift.tt/2zyZArH
http://ift.tt/2zyZArH
Firm Elevation of Reconstructed Auricle Using Polydactyly Digit in Microtia.
Total ear reconstruction for microtia is usually accomplished in 2 stages which is known as Nagata technique. After framework fabrication and implantation, the elevation procedure is required as a second step surgery. The authors are introducing a novel material for augmenting projection of rib cartilage framework in microtia treatment. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2iLXE7i
http://ift.tt/2iLXE7i
Valgus Hindfoot Deformity Secondary to Neonatal Intravenous Infiltration.
Orthopedic complications of intravenous (IV) infiltration are rare, with only a handful of cases reported in the literature. Because of the relatively high rate of IV infiltration in neonates, however, such complications do occur and can include growth arrest, limb length discrepancy, and joint deformities that require surgical intervention. The risk of these complications is highest in preterm neonates. A 7-year-old girl presented to our institution with a severe valgus hindfoot deformity that developed secondary to a neonatal IV infiltration injury. Management consisted of a medial displacement calcaneal osteotomy followed 5 years later by a triple arthrodesis, Strayer procedure, and free flap transfer. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2zCQ1s5
http://ift.tt/2zCQ1s5
Comparative Cost Analysis of Single and Mutli-Stage Temporal Deformity Correction Following Neurosurgical Procedures.
Purpose: Temporal hollowing deformity (THD) is a visible concavity/convexity in the temporal fossa; a complication often seen following neurosurgical/craniofacial procedures. Although numerous techniques have been described, no study to date has shown the healthcare costs associated with temporal hollowing correction surgery. Thus, the purpose here is to compare and contrast the direct costs related to temporal cranioplasty using various methods including: liquid poly-methyl-methacrylate (PMMA) implants with screw fixation, prebent, modified titanium mesh implants, and customized cranial implants (CCIs) with dual-purpose design. Understanding the financial implications related to this frequently encountered complication will help to motivate surgeons/healthcare facilities to better prevent and manage THD. Methods: This is a single-surgeon, single-institution retrospective review of 23 THD patients randomly selected from between 2008 and 2015. Cost analysis variables include length of hospital stay, facility/professional fees, implant material fees, payer information, reimbursement rate, and net revenue. Results: Of the 23 patients, ages ranged from 23 to 68 years with a mean of 48.3 years (SD 11.6). Within this cohort, 39.1% received dual-purpose PMMA CCIs (CCI PLUS), 17.4% received modified titanium mesh implants, and 43.5% received hand-molded, liquid PMMA implants with screw fixation. Total facility and/or professional charges ranged from $1978.00 to $126478.00. Average total facility charges per patient with dual-purpose CCIs were $34775.89 (SD +/- $22205.09) versus $35826.00 (SD +/- $23509.93) for modified titanium mesh implants and $46547.90 (SD +/- 81061.70) for liquid PMMA implants with screws. Mean length of inpatient stay was 5.7 days (SD = 8.1), and did not differ between implant types (P = 0.387). Conclusion: Temporal hollowing deformity is an expensive complication post-neurosurgery, and in the most severe form, requires a revision surgery for definitive correction. Therefore, surgeons should take further initiatives to employ reconstructive methods capable of minimizing risk for costly revision surgery, reducing morbidity related to visible deformity and accompanying social stigmata, and improving overall patient satisfaction. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2iLXAEA
http://ift.tt/2iLXAEA
Internal Distraction Resulted in Improved Patient-Reported Outcomes for Midface Hypoplasia.
Background: Both internal and external distraction devices have been used successfully in correcting midface hypoplasia. Although the indication for surgery and the osteotomy techniques may be similar, deciding when to use internal versus external devices has not been studied. The authors studied patient-reported outcomes with FACE-Q and functional surveys for internal and external devices for midface distraction patients. Methods: Patients who underwent distraction advancement after Le Fort I and Le Fort III were surveyed using the FACE-Q survey and a functional survey. Equal groups of internal and external device patients were compared (n = 64). Data recorded included: sex, age, follow-up, diagnosis, operating room time, expected blood loss, length of stay, distraction length, consolidation time, and complications. Results: Internal and external device groups were similar with regards to patient diagnosis, operative time, expected blood loss, distraction length but consolidation times differed (internal = 3.6 versus external = 1.1 months). For FACE-Q appearance appraisal, there were similarities in domain and scale. For the functional survey (airway/breathing, ocular/vision, occlusion/eating, speech/articulation), there was also similar scoring. However, internal device patients had superior FACE-Q scores for Quality of Life: Social Function (80.9 versus 68.9), Early Life Impact (92.9 versus 62.4), Dental Anxiety (70.2 versus 48.3), Psychological Well-being (87.8 versus 68.6); and Decision Satisfaction (81.2 versus 56.9) and Outcome Satisfaction (91.0 versus 84.7). Conclusions: Internal and external midface distraction patients had similar patient-reported outcomes for appearance and functional improvement; however, internal device patients were more satisfied with their quality of life and their decision to undergo the procedure. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2zAlUkT
http://ift.tt/2zAlUkT
A Novel Secretome Biotherapeutic Influences Regeneration in Critical Size Bone Defects.
Severe traumatic injuries often result in critical size bone defects, which are unable to heal without treatment. Autologous grafting is the standard of care but requires additional surgeries for graft procurement. Amnion-derived multipotent progenitor cells release a secretome of biomolecules identified as integral to the process of bone regeneration and angiogenesis. This secretome is currently under development as a biotherapeutic. The efficacy of this secretome biotherapeutic was evaluated in vitro on the proliferation and migration of mesenchymal stem cells and osteoprogenitor cells as well as in vivo using a critical size rat calvarial defect model. The secretome biotherapeutic was loaded onto a collagen scaffold and placed into the defect, which was allowed to heal for 4 and 12 weeks. The secretome biotherapeutic enhanced the proliferation and migration of mesenchymal stem cells and proliferation of osteoprogenitor cells. Further, the secretome biotherapeutic improved new bone volume and connectivity by 12 weeks and significantly improved angiogenesis at 4 weeks and bone density at 4 and 12 weeks with no deleterious effects. The improvement in new bone volume, connectivity, and angiogenesis suggests that the secretome biotherapeutic has beneficial effects for bone healing and a higher dose of the secretome biotherapeutic may further improve regeneration. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2zCPYwp
http://ift.tt/2zCPYwp
Treatment of Maxillary Hypoplasia in Cleft Lip and Palate: Segmental Distraction Osteogenesis With Hyrax Device.
The objective of this work is to describe a segmental maxillary distraction osteogenesis (SDO) with segmental Lefort I with an inexpensive device. Four patients who presented severe class III and maxillary hypoplasia due to cleft lip and palate sequel were treated. A SDO was performed using a dental-anchored Hyrax device, achieving enlargement of the upper jaw without altering speech, with adequate and stable occlusion. Dental implants in a new formed bone were installed. The authors can conclude that SDO is a good treatment alternative for patients with maxillary hypoplasia. It preserves velopharyngeal function and is a stable treatment, maintaining the overjet achieved with distraction osteogenesis, without changes in posterior occlusion. The open bite generated with tooth-borne devices can be solved with temporary anchorage devices and intermaxillary elastics during consolidation phase. Modified Hyrax device allows expanding and moving forward the maxillary arch, with a low cost. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2iLLITa
http://ift.tt/2iLLITa
Cone Beam Computed Tomography Assessment of Accessory Infraorbital Foramen and Determination of Infraorbital Foramen Position.
There is no evidence about evaluating accessory infraorbital foramen by 3-dimensional analysis like multi slice computed tomography or cone beam computed tomography (CBCT) in human subjects. To authors' best knowledge this is a first study to assess the accessory infraorbital foramen and position of infraorbital foramen in relation to crown of maxillary teeth using CBCT. This study primarily aimed to assess the location and number of accessory infraorbital foramen (AIOF), to measure the distance between main infraorbital foramen and AIOF and secondarily to determine the position of infraorbital foramen in relation to crowns of maxillary second premolar, first molar, and second molar. Cone beam computed tomography volumes of 200 patients were retrieved from the digital imaging and communications in medicine archive folder. Accessory infraorbital foramen was recognized in 29% of the patients among whom 46.6% were present on the right side, 31% on the left side, and 22.4% located bilaterally. The most frequent position of infraorbital foramen was found to be in line with crown of second premolar. The presence of AIOF and inability to recognize it in preoperative evaluation could be considered among the other reasons of failure or incomplete anesthesia. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2zCPKW5
http://ift.tt/2zCPKW5
A Personal Approach to Bilateral Cleft Lip Repair.
Dr Michael B. Lewis has been using his personal approach to bilateral cleft lip (BCL) repair for 30 years to achieve a loose, pouting upper lip, a 90-degree columellar-labial angle, and a projecting nasal tip. This article describes technique and results. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2iMjMyr
http://ift.tt/2iMjMyr
Use of Acellular Dermal Matrix in Craniosynostosis.
In craniofacial surgery, a wide spectrum of pathological conditions are usually treated. The aetiology of these could be congenital, traumatic, infective, post-tumor resection, postradiation, autoimmune, iatrogenic, or other miscellaneous conditions. The surgical approach for the procedures is usually via a coronal incision. In a large proportion of the patients, the frontal bone is removed to obtain intracranial access. The frontal bone is then replaced either in its original form or in a remodeled state. In congenital conditions the supraorbital bar and frontal bone is often also removed, remodeled, and replaced. One of the common late sequelae following craniofacial surgery is contour irregularities of the frontal region. These irregularities can vary in their extent. They are invariably palpable and often visible. Surgeons have attempted various methods to improve the contour irregularities. Despite these measures contour irregularities can still ensue. In the authors' unit, the authors have been using acellular dermal matrix in an attempt to diminish the contour irregularities in the frontal region following craniofacial reconstruction for craniosynostosis. This has been used in 35 patients undergoing craniosynostosis correction. Of the 35 patients, 12 were for plagiocephaly, 7 for brachycephaly, 10 for scaphocephaly, 4 for trigonocephaly, and 2 for combined coronal and metopic synostosis. The age of the patients ranged from 5 months to 12 years (mean 20.5 months). There were 21 males and 14 females. The follow-up ranged from 10 to 48 months (mean 23 months). (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2zCPAxX
http://ift.tt/2zCPAxX
Effect of Long-Term Use of Facemask With Miniplate on Maxillary Protraction in Patients With Cleft Lip and Palate.
The purpose of this retrospective study was to investigate the effect of a long-term use of facemask with miniplate (FM-MP) on maxillary protraction in cleft lip and palate (CLP) patients. The subjects were 21 CLP patients (16 unilateral CLP and 5 bilateral CLP patients), who were treated with identical lip and palate surgical method and FM-MP therapy performed by single surgeon and single orthodontist. Lateral cephalogram was taken before (T1; mean age, 11.1 years) and after maxillary protraction (T2; mean age, 16.9 years). The mean duration of FM-MP was 68.0 months. After 17 cephalometric variables were measured, statistical analysis was performed. During T1-T2, the maxilla showed significant forward movement ([DELTA]A-vertical reference plane, 4.8 mm, P 0.05). Long-term use of FM-MP is effective on maxillary protraction in adolescent CLP patients without clockwise rotation of the mandible, the main drawback of conventional facemask with tooth-borne anchorage. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2iMf1Fc
http://ift.tt/2iMf1Fc
Oral-Health-Related Quality of Life After Surgical Treatment of Osteonecrosis of the Jaws.
The aim of this study is to analyze the clinical outcome and the change in oral-health-related quality of life (QoL) of osteoporotic patients affected by medication-related osteonecrosis of the jaws (MRONJ). Forty-one patients, consecutively treated for a 10-year period, were retrospectively analyzed. All the patients underwent a marginal osseous resective jaw surgery. A clinical 12 months postoperative evaluation has been performed and the complete mucosal healing, the absence of swelling and suppuration, and no signs of disease recurrence were defined like success parameters. Quality-of-life surveys tests like EORTC QQ-C30 and QLQ-HN35 appendices in conjunction with a perceived oral health visual analog scale (VAS) were administered before (time of diagnosis of MRONJ) and after surgery (at least 6 months) in order to record the different oral health status of the treated patients. The majority of MRONJ-diagnosed patients complained symptoms like pain, eating discomfort, and sense problems, with occasional involvement of the social dimension. There was a prevalence of troubles with social eating and social contact. The complete mucosal healing was achieved in 100% of the patients and the administered survey tests reported a significant improvement in all the investigated spheres. Similarly, an increased mean score of perceived oral health VAS was reported. Marginal-resective surgery of the necrotic jaw bone can be an effective treatment of osteoporotic patients affected by localized MRONJ. Quality-of-life parameters are demonstrated to be useful for recording the patient-centered outcome of MRONJ treatment. (C) 2017 by Mutaz B. Habal, MD.
http://ift.tt/2zCPsOZ
http://ift.tt/2zCPsOZ
Editorial Board
Publication date: December 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 4
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Contents
Publication date: December 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 4
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Future and recent issues
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 4
http://ift.tt/2i4e4Z3
Information for authors
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 4
http://ift.tt/2AtC5zI
Masthead
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 4
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Highlights in immune response, microbiome and precision medicine in allergic disease and asthma
Milena Sokolowska | Cezmi A. Akdis
http://ift.tt/2jjmGOV
Eine seltene Differentialdiagnose des supraglottischen Larynxödems
Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-121343
Georg Thieme Verlag KG Stuttgart · New York
Article in Thieme eJournals:
Table of contents | Full text
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New routes of allergen immunotherapy
Publication date: Available online 10 November 2017
Source:Allergologia et Immunopathologia
Author(s): C.R. Juesas, C.M. Aguilar, S. Vieths
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In-vitro comparison of mechanical resistance between two straight plates and a Y-plate for fixation of mandibular condyle fractures
To compare the mechanical resistance of conventional plates with a modified Y-plate in mandibular condyle fracture.
http://ift.tt/2zyZAb7
Unrelated immunodeficiency states may impact outcomes and immune checkpoint molecule expression in patients with mycosis fungoides: A clinicopathologic case-control study
Immunodeficiency (ID) correlates with worse outcomes and decreased immune checkpoint molecule expression in melanoma. The impact of ID in mycosis fungoides (MF) is unknown.
http://ift.tt/2yqWa9a
Adherence with epinephrine autoinjector prescriptions in primary care
The aim of this study was to estimate primary adherence for epinephrine autoinjector (EA) prescriptions in primary care practices in Manitoba, Canada.
http://ift.tt/2AzC3XZ
An infrequent case of anaphylaxis
We present the case of a 40-year-old woman with no relevant background. On December 29, 2014, immediately after eating pizza (made with turkey, cheese, onion, tomato, buckwheat, and oregano) and eggplant with baked cheese, she presented with intense diaphoresis, generalized erythema, abdominal pain, dyspnea, foreign body sensation in the throat, and unconsciousness with urinary and fecal incontinence for 15 minutes.
http://ift.tt/2yRQ9Xh
Tailored resections in oral and oropharyngeal cancer using narrow band imaging
In a previous pilot study we observed that intra-operative narrow-band imaging (NBI) helps achieve clear superficial resection margins. The aim of this study was to verify if the use of intra-operative NBI can help to obtain tailored resections and if it is influenced by the lesion site, aspects not investigated in our previous study.
http://ift.tt/2jglNH8
Intrahepatic biliary cystadenoma mimicking hydatid cyst of liver: a clinicopathologic study of six cases
Intrahepatic biliary cystadenomas are rare hepatic neoplasms, which are usually cystic. These tumors are often misdiagnosed as simple liver cysts and hydatid cysts clinically and radiologically owing to nonspe...
http://ift.tt/2i1W0it
Monocyte-Derived Procoagulant Microvesicles Induced by High Glucose Can Be Attenuated by the Antioxidant N-Acetyl-L-Cysteine, Partly Through the P38/MAPK Pathway
Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.
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Blood glucose concentrations in prehospital trauma patients with traumatic shock: A retrospective analysis
BACKGROUND Deranged glucose metabolism after moderate to severe trauma with either high or low concentrations of blood glucose is associated with poorer outcome. Data on prehospital blood glucose concentrations and trauma are scarce. OBJECTIVES The primary aim was to describe the relationship between traumatic shock and prehospital blood glucose concentrations. The secondary aim was to determine the additional predictive value of prehospital blood glucose concentration for traumatic shock when compared with vital parameters alone. DESIGN Retrospective analysis of the predefined, observational database of a nationwide Helicopter Emergency Medical Service (34 bases). SETTING Emergency trauma patients treated by Helicopter Emergency Medical Service between 2005 and 2013 were investigated. PATIENTS All adult trauma patients (≥18 years) with recorded blood glucose concentrations were enrolled. OUTCOMES Primary outcome: upper and lower thresholds of blood glucose concentration more commonly associated with traumatic shock. Secondary outcome: additional predictive value of prehospital blood glucose concentrations when compared with vital parameters alone. RESULTS Of 51 936 trauma patients, 20 177 were included. In total, 220 (1.1%) patients died on scene. Hypoglycaemia (blood glucose concentration 2.8 mmol l−1 or less) was observed in 132 (0.7%) patients, hyperglycaemia (blood glucose concentration exceeding 15 mmol l−1) was observed in 265 patients (1.3%). Blood glucose concentrations more than 10 mmol l−1 (n = 1308 (6.5%)) and 2.8 mmol l−1 or less were more common in patients with traumatic shock (P
http://ift.tt/2mfIqws
http://ift.tt/2mfIqws
Reconstruction of oral cavity defect using versatile buccinator myomucosal flaps in the treatment of cT2–3, N0 oral cavity squamous cell carcinoma: Feasibility, morbidity, and functional/oncological outcomes
Source:Oral Oncology, Volume 75
Author(s): Dongbin Ahn, Gil Joon Lee, Jin Ho Sohn
ObjectivesTo evaluate the results of oral cavity reconstruction using various types of buccinator myomucosal flap (BMMF) for the treatment of cT2–3 oral cavity squamous cell carcinoma (OCSCC).Materials and methodsTwenty-two consecutive patients who underwent surgical management for OCSCC and reconstruction using various types of BMMF were enrolled. Surgical results, complications, speech/swallowing outcomes, and recurrence were evaluated.ResultsThe mean flap harvest time was 28.6 min. Complete flap necrosis occurred in one (4.5%) patient in whom an island flap was used. There were no other major complications. All patients demonstrated normal speech and swallowing functions, with articulation correctness >90% and a mean swallowing satisfaction score of 9.6. Occult neck lymph node metastasis was found in three (13.6%) patients; however, no recurrence at level I was observed.ConclusionsReconstruction of the oral cavity using various types of BMMF is feasible for treatment of cT2–3 OCSCC, and yields favorable outcomes with minimal morbidity.
http://ift.tt/2i1T2KC
Prognostic value of masticatory muscle involvement in nasopharyngeal carcinoma patients treated with intensity-modulated radiation therapy
Source:Oral Oncology, Volume 75
Author(s): Min Kang, Pingting Zhou, Xueyin Liao, Meng Xu, Rensheng Wang
Background and PurposeIn 2017, the 8th edition of the nasopharyngeal carcinoma (NPC) staging manual published by the Union for International Cancer Control/American Joint Committee on Cancer (UICC/AJCC) defined new rules regarding the involvement of anatomical masticatory muscles (MM). The purpose of this study is to evaluate the validity of the current T-staging system after the addition of revisions regarding MM involvement.MethodsWe performed a retrospective review of 608 patients, who were newly diagnosed with NPC and treated with intensity-modulated radiotherapy (IMRT) between January 2008 and March 2010.ResultsWe found MM involvement in 398 NPC cases (65.4%). We observed a significant difference in overall survival (OS; 75.6% vs. 86.7%, P = .043) and in local relapse-free survival (LRFS; 81.5% vs. 88.6%, P = .048) between patients with and without MM involvement, but no difference in distant metastasis-free survival (DMFS; 80.3% vs. 85.0%, P = .147) or disease-free survival (DFS; 77.9% vs. 81.6%, P = .081). Significant differences in OS and LRFS were also found among different types of MM involvement. Compared with patients who had concurrent involvement of the lateral pterygoid muscle (LP), patients with tumors invading only the medial pterygoid muscle (MP) had a higher OS and LRFS rates, according to univariate and multivariate analysis (P < .05).ConclusionsMM involvement is an independent prognostic factor for OS and LRFS. We conclude that the decision to down-stage MP as T2 in the 8th edition staging system is valid. However, tumors with LP involvement were more rational classified into a higher T-staging category than tumors with only-MP involvement.
http://ift.tt/2AsCwKH
Oncogenic DNA viruses found in salivary gland tumors
Source:Oral Oncology, Volume 75
Author(s): Alyce A. Chen, Tarik Gheit, Marco Stellin, Valentina Lupato, Giacomo Spinato, Roberto Fuson, Anna Menegaldo, Sandrine Mckay-Chopin, Elisa Dal Cin, Giancarlo Tirelli, Maria Cristina Da Mosto, Massimo Tommasino, Paolo Boscolo-Rizzo
BackgroundPrevious investigations studying the association of DNA viruses with salivary gland tumors (SGTs) have led to conflicting results. The aim of this study was to determine the prevalence of different DNA viruses by using a highly sensitive assay in a multi-center series of over 100 fresh frozen salivary gland samples.MethodsDNA was isolated from 84 SGTs (80 parotid tumors and 4 submandibular gland tumors) and 28 normal salivary tissue samples from 85 patients in Northeast Italy. Using a highly sensitive type-specific multiplex genotyping assay, we analyzed the samples for the presence of DNA from 62 different viruses including 47 papillomaviruses, 10 polyomaviruses, and 5 herpesviruses.ResultsWe observed a high prevalence of beta human papillomavirus DNA in malignant tumors. In contrast, polyomavirus DNA was present in benign, malignant, and non-tumor control samples. Most striking was the significant distribution of herpesvirus DNA in the SGT samples, in particular the high prevalence of Epstein-Barr type 1 and type 2 DNA in Warthin's tumor samples.ConclusionOur data provides evidence for the presence of DNA viruses in SGTs. Mechanistic studies are needed to further attribute tumor formation to these viruses.
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Construction of mass spectra database and diagnosis algorithm for head and neck squamous cell carcinoma
Source:Oral Oncology, Volume 75
Author(s): Kei Ashizawa, Kentaro Yoshimura, Hisashi Johno, Tomohiro Inoue, Ryohei Katoh, Satoshi Funayama, Kaname Sakamoto, Sen Takeda, Keisuke Masuyama, Tomokazu Matsuoka, Hiroki Ishii
ObjectivesIntraoperative identification of tumor margins is essential to achieving complete tumor resection. However, the process of intraoperative pathological diagnosis involves cumbersome procedures, such as preparation of cryosections and microscopic examination, thus requiring more than 30 min. Moreover, intraoperative diagnoses made by examining cryosections are occasionally inconsistent with postoperative diagnoses made by examining paraffin-embedded sections because the former are of poorer quality. We sought to establish a more rapid accurate method of intraoperative assessment.Materials and methodsA diagnostic algorithm of head and neck squamous cell carcinoma (HNSCC) using machine learning was constructed by mass spectra obtained from 15 non-cancerous and 19 HNSCC specimens by probe electrospray ionization mass spectrometry (PESI-MS). The clinical validity of this system was evaluated using intraoperative specimens of HNSCC and normal mucosa.ResultsA total of 114 and 141 mass spectra were acquired from non-cancerous and cancerous specimens, respectively, using both positive- and negative-ion modes of PESI-MS. These data were fed into partial least squares-logistic regression (PLS-LR) to discriminate tumor-specific spectral patterns. Leave-one-patient-out cross validation of this algorithm in positive- and negative-ion modes showed accuracies in HNSCC diagnosis of 90.48% and 95.35%, respectively. In intraoperative specimens of HNSCC, this algorithm precisely defined the borders of the cancerous regions; these corresponded with those determined by examining histologic sections. The procedure took approximately 5 min.ConclusionThis diagnostic system, based on machine learning, enables accurate discrimination of cancerous regions and has the potential to provide rapid intraoperative assessment of HNSCC margins.
http://ift.tt/2i2J8st
Targeting and suppression of HER3-positive breast cancer by T lymphocytes expressing a heregulin chimeric antigen receptor
Abstract
Chimeric antigen receptor-modulated T lymphocytes (CAR-T) have emerged as a powerful tool for arousing anticancer immunity. Endogenous ligands for tumor antigen may outperform single-chain variable fragments to serve as a component of CARs with high cancer recognition efficacy and minimized immunogenicity. As heterodimerization and signaling partners for human epidermal growth factor receptor 2 (HER2), HER3/HER4 has been implicated in tumorigenic signaling and therapeutic resistance of breast cancer. In this study, we engineered T cells with a CAR consisting of the extracellular domain of heregulin-1β (HRG1β) that is a natural ligand for HER3/HER4, and evaluated the specific cytotoxicity of these CAR-T cells in cultured HER3 positive breast cancer cells and xenograft tumors. Our results showed that HRG1β-CAR was successfully constructed, and T cells were transduced at a rate of 50%. The CAR-T cells specifically recognized and killed HER3-overexpressing breast cancer cells SK-BR-3 and BT-474 in vitro, and displayed potent tumoricidal effect on SK-BR-3 xenograft tumor models. Our results suggest that HRG1β-based CAR-T cells effectively suppress breast cancer driven by HER family receptors, and may provide a novel strategy to overcome cancer resistance to HER2-targeted therapy.
http://ift.tt/2yOJf54
Vocal fold augmentation under local anesthesia using autologous fascia
Abstract
Vocal fold augmentation by injection of autologous fascia has been used since the 1990s with excellent safety record in 500 operations done under general anaesthesia. It is safe from risks arising from allergic or other foreign body adverse reactions. Fascia provides long-term augmentation and remains stable 3-10 years after injection.
Vocal fold augmentation under local anaesthesia is excellent alternative for those unfit for general anaesthesia, providing aid to fragile and weak persons with vocal fold paralysis. However, all of available synthetic materials resorb within 6-24 months.
Fascia injection under local anaesthesia provides the possibility for a long-term vocal fold medialization while avoiding risk of general anaesthesia. Fascia lata harvesting and processing is easily done (as shown in video) followed by injection into the vocal fold. The whole procedure is done under local anaesthesia. Procedure offers long-term vocal fold medialization, fine tuning the amount of the medialization by immediate feedback from the patient's voice. Operation time is one hour.
This article is protected by copyright. All rights reserved.
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Treatment of chronic spontaneous urticaria: Immunomodulatory approaches
Source:Clinical Immunology
Author(s): de Montjoye Laurence, Herman Anne, Nicolas Jean-François, Baeck Marie
This paper summarizes and reviews the mechanisms of action and data concerning efficacy of recommended treatments as well as other treatments that have been tested, independently of the outcomes, in the management of chronic spontaneous urticaria. Due to the central role of mast cells and histamine in the pathophysiology of this disease, H1-antihistamines remain the first-line treatment. However, current knowledge about this complex disease, also recognizes an important role for T lymphocytes, B lymphocytes, and autoantibodies. Implications of these others mediators thus provide further targets for treatment. Indeed, agents previously used to treat other autoimmune and inflammatory diseases, have demonstrated efficacy in chronic spontaneous urticaria and are therefore potential therapeutic alternatives for antihistamine unresponsive patients.
http://ift.tt/2zzbNfW
mTOR inhibitor rapamycin induce polymorphonuclear myeloid-derived suppressor cells mobilization and function in protecting against acute graft-versus-host disease after bone marrow transplantation
Source:Clinical Immunology
Author(s): Yu Lin, Binsheng Wang, Wei Shan, Yamin Tan, Jingjing Feng, Lin Xu, Limengmeng Wang, Biqing Han, Mingming Zhang, Jian Yu, Xiaohong Yu, He Huang
The mammalian target of rapamycin (mTOR) inhibitor rapamycin (RAPA) has been shown to be an effective immunosuppressor in the management of acute graft-versus-host disease (aGVHD) after bone marrow transplantation. Myeloid-derived suppressor cells (MDSCs) also have a protective effect in aGVHD regulation. However, the relationship between RAPA and MDSCs in aGVHD models is unclear. Meanwhile, the effect of RAPA on different subgroups of MDSCs is also less well described. In this study, we demonstrate that in vivo administration of RAPA results in the expansion and functional enhancement of polymorphonuclear MDSCs (PMN-MDSCs) in a murine model of aGVHD. RAPA treatment can enhance the suppressive function of PMN-MDSCs via up-regulation of arginase1 (Arg1) and induced nitric oxide synthase (iNOS) at later time points. Moreover, RAPA can also induce a strong immunosuppressive function in PMN-MDSCs from murine bone marrow in vitro, but has a contrary effect on monocytic MDSCs (M-MDSCs). We found that RAPA-treated PMN-MDSCs can restrain the differentiation of Th1/Th2 cells and promote induction of regulatory T cells in in vitro studies.
http://ift.tt/2yr0AwQ
Tailored resections in oral and oropharyngeal cancer using narrow band imaging
Source:American Journal of Otolaryngology
Author(s): Giancarlo Tirelli, Marco Piovesana, Alberto Vito Marcuzzo, Annalisa Gatto, Matteo Biasotto, Rossana Bussani, Lorenzo Zandonà, Fabiola Giudici, Francesca Boscolo Nata
PurposeIn a previous pilot study we observed that intra-operative narrow-band imaging (NBI) helps achieve clear superficial resection margins. The aim of this study was to verify if the use of intra-operative NBI can help to obtain tailored resections and if it is influenced by the lesion site, aspects not investigated in our previous study.Materials and methodsThe resection margins of 39 oral and 22 oropharyngeal squamous cell carcinomas were first set at 1.5cm from the macroscopic lesion boundary (white light, WL, tattoo). Then, the superficial tumor extension was more precisely defined with NBI, giving rise to three possible situations: NBI tattoo larger than the WL tattoo, NBI tattoo coinciding with the WL tattoo, or NBI tattoo smaller than the WL tattoo. For each of these situations the space comprised between the NBI and WL tattoos was defined "NBI positive", "NBI null", and "NBI negative", respectively. Resections were performed following the outer tattoo. The number of clear superficial resection margins, and the pathological response on the "NBI-positive" and the "NBI-negative" areas were recorded.ResultsWe obtained 80.3% negative superficial resection margins. NBI provided a more precise definition of superficial tumor extension in 43 patients. Sensitivity, specificity, positive and negative predictive values were 94.4%, 64%, 79.1% and 88.9%, respectively; a test of proportions demonstrated they were not influenced by tumor site.ConclusionsNBI could allow for real-time definition of superficial tumor extension with possible tailored resections and fewer positive superficial resection margins; it is not influenced by tumor site.
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Reconstruction of preauricular soft tissue defects using a superiorly based rotation advancement scalp flap - A novel approach to the surgical treatment of preauricular sinuses
Source:American Journal of Otolaryngology
Author(s): Bernard Tan, Lee Tee Sin, Ian Loh
http://ift.tt/2jjgmab
A Cross-sectional Epidemiological Study of Hidradenitis Suppurativa in an Irish Population
Abstract
Background
Hidradenitis suppurativa (HS), a chronic inflammatory disease that affects apocrine gland–bearing skin, has a significant impact on patient quality of life. Estimates of the epidemiologic prevalence of HS are highly variable, and clinical data on disease characteristics and patient burden of disease remain limited.
Objective
The primary objective of this study was to determine the number of patients with HS attending dermatology clinics in a hospital setting in Ireland (within a 6-month time period). Secondary objectives included the assessment of disease characteristics and the collection of patient responses on disease burden and work productivity.
Methods
This was an epidemiologic, non-interventional, cross-sectional study across 4 dermatology clinics in Ireland over a 6-month time period. The disease prevalence was estimated by calculating the percentage of total patients with a diagnosis of HS (the primary population) across the selected sites. Secondary analyses were performed using the full analysis set, which consisted of eligible adults (≥18 years of age) from the primary population who provided informed consent. Data from these analyses are presented as descriptive summary statistics, with the use of an analysis of covariance for continuous endpoints.
Results
The prevalence of HS across the 4 selected sites was estimated at 1.4% (95% CI, 1.24–1.62). One hundred fifty eligible patients comprised the full analysis set. The majority of participants were white (95%), female (70%), cigarette smokers (56%), and overweight or obese (body mass index ≥25 kg/m2, 82%). Most patients presented with Hurley stage II (45%), and more than a third had a relative with HS (35%). Questionnaire responses revealed a profound impact on quality of life, including diminished work productivity and various psychological comorbidities.
Conclusion
This study offers insight into the clinical features and disease burden of hidradenitis suppurativa in an Irish population.
This article is protected by copyright. All rights reserved.
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Milker's nodule:an occupational infection and threat to the immunocompromised
Abstract
Milker's nodule virus, also called paravaccinia virus is a DNA virus of the parapoxvirus genus transmitted from infected cows to humans. It results from contact with cattle, cattle byproducts, or fomites. Classified as an occupational disorder, those at risk of exposure include farmers, butchers, and agricultural tourists. The viral infection begins 5-15 days after inoculation as an erythematous-purple, round nodule with a clear depressed center, and a surrounding erythematous ring. While familiar to those in farming communities, the presence of the nodule may be concerning to others, particularly the immunosuppressed. Milker's nodules are self-limited in immunocompetent individuals and heal without scarring within 8 weeks.
Another member of the Parapoxvirus genus, the orf virus, is also transmitted from animals to humans by direct-contact. While complications are rare, hematopoietic stem cell transplant recipients are at risk of graft-versus-host disease, as the parapoxvirus may trigger these complications in immunocompromised individuals. In addition, paravaccinia may serve as the antigen source for the development of erythema multiforme.
The unique structure and replication process of viruses in the Poxvirus family, while includes the Parapoxvirus genus, have been a focus for treatment of infections and cancer. Manipulation of these viruses has demonstrated promising therapeutic possibilities as vectors for vaccines and oncologic therapy.
This article is protected by copyright. All rights reserved.
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Integration of dermoscopy and reflectance confocal microscopy for distinguishing melanomas from nevi of the breast area
Abstract
Background
Nevi of special sites encompass a class of benign lesions characterized by the presence of atypical clinical and histopathologic features that can be difficult to distinguish from melanoma. Dermoscopy and reflectance confocal microscopy may improve the clinical assessment of melanocytic lesions in order to avoid unnecessary excisions.
Objectives
The aim of this study was to assess the value of specific dermoscopic and confocal criteria in distinguishing melanomas from nevi of the breast area.
Methods
Dermoscopic and confocal images from consecutive patients with at least 1 clinically and/or dermoscopically equivocal melanocytic skin lesion of the breast area were retrospectively evaluated. In this case-control study, only histopathologically-proven melanomas (cases) and nevi (controls) were included. Spearman's coefficients were first calculated to flag significant correlation; then univariate and multivariate logistic regression analysis were performed to assess which factors were independently associated with the histopathological diagnosis. Finally, a mixed dermoscopic/confocal score was created to distinguish nevi from melanomas on the breast area.
Results
The study population included 55 skin lesions of the breast area, 34 (61.8%) nevi and 21 (38.2%) melanomas. Among dermoscopic criteria, atypical network and irregular pigmentation resulted independently associated with melanoma diagnosis (OR: 11.1; 95%CI 1.0-119.9; P:.048 and OR: 6.5; 95%CI 1.1-37.5; P:.037, respectively). Furthermore, on RCM examination the presence of pagetoid cells was an independent positive predictor for melanoma (OR: 38.5; 95%CI 3.9-379.6; P:.002). The mixed score showed high levels of sensitivity and specificity, 95.2% and 82.4%, respectively, which were higher than dermoscopic and confocal evaluations alone.
Conclusion
The combined use of dermoscopy and confocal microscopy in the triage of pigmented lesions of the breast area may help in increasing the diagnostic accuracy and avoiding unnecessary excisions.
This article is protected by copyright. All rights reserved.
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Micrognathia with temporomandibular joint ankylosis and obstructive sleep apnea treated with mandibular distraction osteogenesis using skeletal anchorage: a case report
Abstract
Background
We describe the case of a 16-year-old female patient with micrognathia, temporomandibular joint (TMJ) ankylosis, and obstructive sleep apnea, who was treated with mandibular distraction osteogenesis (DO) combined with sliding genioplasty, using skeletal anchorage.
Case presentation
We first performed interpositional arthroplasty, in which an interposition of fascia temporalis and surrounding fat tissue was inserted into the defect after bilateral condylectomy, increasing the maximum mouth opening from 5.0 to 32.0 mm. Subsequently, orthodontic treatment and advancement of the mandible were carried out by mandibular DO, using miniscrews and miniplates. Finally, sliding genioplasty was performed to bring the tip of the mandible forward. The total amount of mandibular advancement at the menton was 16.0 mm. An improved facial appearance and good occlusion were eventually achieved, and the apnea-hypopnea index decreased from 37.1 to 8.7. There was no obvious bone resorption or pain in the temporomandibular region, limited mouth opening (maximum mouth opening: 33.0 mm), myofascial pain or headache, downward rotation of the mandible, or lateral shift of mandibular position evident at 5 years and 6 months after mandibular DO.
Conclusion
Mandibular DO using skeletal anchorage with intermaxillary elastics is useful for preventing extrusion of the upper and lower anterior teeth, thereby preventing rotation of the mandible. In addition, mandibular DO combined with sliding genioplasty is effective at improving both dentofacial deformities and impaired respiratory function.
http://ift.tt/2AqwHNO
The influence of immediately loaded implant treatment in the atrophic edentulous maxilla on oral health related quality of life of edentulous patients: 3-year results of a prospective study
Abstract
Background
To evaluate oral health related quality of life (OHQoL) in edentulous patients treated with immediately loaded implants in the maxilla.
Methods
Fifty-one edentulous patients in two centers received six maxillary implants each were loaded within 24 h with provisional restoration. Definitive restoration was delivered 20–24 weeks later. OHQoL was evaluated preoperatively with the Oral Health Impact Profile 49 questionnaire (OHIP-49) and on five subsequent occasions. OHIP-49 includes seven domains representing functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. A reduction in OHIP scores indicated an improved OHQoL.
Results
Forty-five patients reached the three-year follow up. OHQoL improved after treatment. A plateau of OHQoL improvement was observed at 12 months after surgery. The seven domains improved at different pace, 12 weeks to 12 months after treatment. OHIP showed continuously low scores with no significant changes at consecutive visits 12 months to three years after treatment. Dental status with removable prosthesis in the mandible had a negative impact on OHQoL prior to and during treatment, but did not affect OHQoL after permanent restoration was placed. Patients age or gender did not affect OHQoL.
Conclusions
Patients with edentulous maxilla who received prosthetic rehabilitation on immediately loaded implants experienced the highest improved OHQoL 12 months after implant installation. Quality of life related to oral health continued to be high after three years. Edentulous patients with atrophy of the maxilla experience an improved OHQoL after implant treatment with immediate loading protocol.
Trial registration
ClinicalTrials.gov Identifier NCT00711022.
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Wip1 regulates blood-brain barrier function and neuro-inflammation induced by lipopolysaccharide via the sonic hedgehog signaling signaling pathway
Source:Molecular Immunology, Volume 93
Author(s): Hong Zhen, Lize Zhao, Zhangjun Ling, Li Kuo, Xiarui Xue, Jiaxiu Feng
The blood brain barrier (BBB) is a diffusion barrier that maintains the brain environment. Wip1 is a nuclear phosphatase induced by many factors and involved in various stresses, tumorigenesis, organismal aging, and neurogenesis. Wip1's role in BBB integrity has not been thoroughly investigated. The purpose of the present study was to investigate the effect and mechanism of Wip1 on lipopolysaccharide (LPS)-induced BBB dysfunction and inflammation in an in vitro BBB model. The in vitro BBB model was established by co-culturing human brain-microvascular endothelial cells and human astrocytes and then exposing them to 1μg/ml LPS for 6, 12, 18, 24, and 48h. Wip1 expression was significantly elevated by LPS treatment. Knockdown of Wip1 aggravated the increased permeability and decreased transepithelial electrical resistance, protein expression of ZO-1, and occludin induced by LPS. Wip1 silencing augmented the elevated inflammatory cytokines TNF-α, IL-1β, IL-12, and IL-6 of the BBB induced by LPS, whereas overexpression of Wip1 showed a contrary effect. Sonic hedgehog signaling (SHH) was activated by Wip1 overexpression and inhibited by Wip1 silencing. Additionally, activating or inhibiting the SHH pathway by purmorphamine or cyclopamine, respectively, abolished the Wip1-induced changes in transepithelial electrical resistance and permeability and inflammatory responses in the LPS-injured BBB model. Our results demonstrate that Wip1 may protect the BBB against LPS-induced integrity disruption and inflammatory response through the SHH signaling pathway.
http://ift.tt/2hnhARi
Size and heterologous elements predict metastases in malignant phyllodes tumours of the breast
Abstract
Phyllodes tumours (PTs) of the breast are uncommon fibroepithelial neoplasms comprising 0.3–1.0% of all primary breast tumours. The majority of PTs are benign and generally well managed with surgery. However, malignant PTs, and occasionally borderline PTs, can behave in a clinically aggressive manner by metastasizing to distant organs. Although distant metastasis is rare, the prognosis of patients with metastasis is dismal as many are unresponsive to standard chemotherapy and the risk of death is high. In this study, we correlated clinicopathological parameters to survival outcomes in a cohort of patients diagnosed with malignant PTs in our institution. The study cohort comprised 83 cases of malignant PTs diagnosed at the Department of Anatomical Pathology, Singapore General Hospital from 1994 to 2015. Clinicopathological features and follow-up were obtained from hospital records. Metastasis-free survival (MFS) and overall survival (OS) were estimated with the Kaplan-Meier method and compared between groups using the log-rank test. Cox regression was carried out to identify factors predictive for metastasis. Mean and median age of patients was 48 years (range 21–71 years). Tumour size measured from 30 to 220 mm (mean 90 mm, median 77 mm). Follow-up data was available for 68 patients. Mean and median follow-up was 90 and 57 months, respectively, with a maximum of 291 months. Distant metastasis occurred in 16 out of 68 patients (23.5%). The most common site of metastasis was the lung. Malignant heterologous elements were observed in 16 (19.3%) cases. Individual clinicopathological parameters had no impact on outcome. On Kaplan-Meier analysis, women with large tumours and presence of malignant heterologous elements showed trends for poorer MFS (p = 0.217 and p = 0.566, respectively). However, the combination of large tumours (≥ 90 mm) containing malignant heterologous elements disclosed significantly worse MFS (p = 0.043) and a trend for poorer OS (p = 0.238). On multivariate analysis, large tumours harbouring malignant heterologous elements independently predicted metastasis (95% CI 1.041–12.517, HR 2.434, p = 0.049). Our study demonstrates that tumour size and presence of malignant heterologous elements predicted metastasis in malignant PTs. Further work needs to be done in determining if protein biomarkers and genomic aberrations are able to additionally refine metastatic risk and define therapeutic targets.
http://ift.tt/2zvldv7
Classification of eosinophilic disorders of the small and large intestine
Abstract
Eosinophilic gastrointestinal diseases (EGIDs), including eosinophilic gastroenteritis and eosinophilic colitis, have been increasing in prevalence in Western countries in recent years. Eosinophils are normally scanty in the gastrointestinal tract, and increased numbers of eosinophils can denote pathology. Normal values for tissue eosinophils vary widely between different segments of the colon, thus location of the biopsy is critically important for the interpretation of findings. However, no standard diagnostic criteria have been proposed for the diagnosis of eosinophilic gastroenteritis or eosinophilic colitis. Gut eosinophilia encompasses entitites that are predominantly immunoglobulin E (IgE)-mediated, the primary EGIDs and those that are secondary and not IgE-mediated. A final diagnosis of eosinophilic gastrointestinal diseases requires careful pathological assessment, clinical correlation and exclusion of several differential diagnoses.
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The Next 19 Years of the American Head and Neck Society.
The Next 19 Years of the American Head and Neck Society.
JAMA Otolaryngol Head Neck Surg. 2017 Nov 09;:
Authors: Myers JN
Abstract
Jeffrey N. Myers, MD, PhD, president of the American Head and Neck Society (AHNS) for 2016 to 2017, offered his perspectives on the AHNS's history, present-day activities, and future plans at this year's annual meeting of the society. The society was created from the 1998 merger of 2 societies, the Society for Head and Neck Surgeons (SHNS), founded in 1954, and the American Society for Head and Neck Surgery (ASHNS), founded in 1959, to become the largest organization in North America for the advancement of research and education in head and neck oncology. At a recent AHNS leadership retreat, a clear mission statement and core values were codified: the mission of the AHNS is to advance education, research, and the quality of care for head and neck oncology patients, and the core values are patient-centric, ethical, collaborative, innovative, value-based, and global. The educational mission of the society includes its annual meeting held at the Combined Otolaryngology Spring Meetings, and an International Conference on Head and Neck Cancer and hands-on instructional courses in head and neck ultrasonography and transoral robotic surgery. There are also web-based educational opportunities, including surgical videos and a journal club, as well as the oversight of the training of Fellows in Oncologic Head and Neck Surgery through the Advanced Training Council (ATC). The ATC conducts site visits to evaluate each training program every 5 years and is currently focused on developing core curricula for our training programs. Research is another mission critical activity of the AHNS. Each year, the research committee reviews applications from established researchers and trainees for several grants totaling more than $80 000 annually. Prior to this year, the money to support these awards has come from general operating funds from the AHNS annual budget. However, the Research and Education Foundation of the AHNS recently completed one of its major goals of raising $3 million. The interest on this corpus will now provide enough money to make these awards every year in perpetuity, thereby freeing up the AHNS's general operating funds to support other mission critical activities. Given these significant advances in education, research, and fundraising, the AHNS is in "great health" and has a tremendous future in the hands of a talented and diverse group of current and emerging leaders.
PMID: 29121199 [PubMed - as supplied by publisher]
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Granulomatosis With Polyangiitis-A Moral Impetus for Change.
Granulomatosis With Polyangiitis-A Moral Impetus for Change.
JAMA Otolaryngol Head Neck Surg. 2017 Nov 09;:
Authors: Lubitz MG
PMID: 29121164 [PubMed - as supplied by publisher]
http://ift.tt/2AAgMxm
Association Between Cognitive Function and Quality of Life in Patients With Head and Neck Cancer.
Association Between Cognitive Function and Quality of Life in Patients With Head and Neck Cancer.
JAMA Otolaryngol Head Neck Surg. 2017 Nov 09;:
Authors: Williams AM, Lindholm J, Cook D, Siddiqui F, Ghanem TA, Chang SS
Abstract
Importance: There is a dearth of research examining the associations between cognitive function and quality of life (QoL) in patients with head and neck cancer (HNC), despite much research examining QoL and some research examining cognitive function in this population.
Objective: To identify the associations between cognitive functioning and QoL in patients prior to treatment for HNC within a multidisciplinary care team.
Design, Setting, and Participants: Case series with planned data collection of cognitive function, QoL, and psychosocial variables at an urban Midwest academic medical center including 83 patients with a diagnosis of HNC between August 2015 and December 2016 who underwent a pretreatment assessment with a clinical health psychologist and a speech and language pathologist.
Main Outcomes and Measures: At pretreatment assessment, the Montreal Cognitive Assessment and Functional Assessment of Cancer Therapy-Head & Neck, version 4, were administered along with a semistructured interview to gather data on psychiatric symptoms, social support, and substance use. Patient demographic, clinical, and psychosocial variables were extracted via medical record review.
Results: Of 83 patients (64 [77%] male; mean age, 59.54 [95% CI, 57.23-61.73] years), cognitive impairment was identified in 55% (n = 46) at pretreatment. Number of depressive symptoms (mean, 2.43 [95% CI, 2.06-2.89] symptoms) was associated with impairments in delayed recall (r = -0.28; 95% CI, -0.47 to -0.07) and all domains of QoL. Cognitive impairment in delayed recall was associated with lower QoL in both overall QoL and the domains of emotional and functional well-being. Current benzodiazepine use, history of heavy alcohol use, and current and past tobacco use were also associated with lower QoL in specific domains.
Conclusions and Relevance: Cognitive impairment is common in patients with HNC and is associated with QoL and psychosocial variables. Together with previous research indicating that cognitive function and QoL can influence treatment adherence and outcomes, the results argue for the incorporation of cognitive screening and QoL assessment as part of pretreatment assessment for patients.
PMID: 29121151 [PubMed - as supplied by publisher]
http://ift.tt/2yoVJvT
A Systematic Process for Weaning Children With Aspiration From Thickened Fluids.
A Systematic Process for Weaning Children With Aspiration From Thickened Fluids.
JAMA Otolaryngol Head Neck Surg. 2017 Nov 09;:
Authors: Wolter NE, Hernandez K, Irace AL, Davidson K, Perez JA, Larson K, Rahbar R
Abstract
Importance: Thickening of fluids is a common strategy for feeding patients with oropharyngeal dysphagia but has known risks and should be stopped once it is safe to do so. Weaning children from thickened fluids safely can be challenging, and novel methods are required.
Objective: To describe the use of a systematic weaning process (SWP) for children who received thickened liquids owing to oropharyngeal dysphagia and identified risk of aspiration.
Design, Setting, and Participants: Retrospective case series (2010 to 2015) at a tertiary care center of 50 children with documented aspiration by clinical swallowing assessment, airway evaluation, and videofluoroscopic swallow study with at least 4 months of follow-up. All patients were initially receiving thickened fluids. A 10% reduction in thickness was made every 2 weeks based on clinical symptoms. Caregivers progressed to the next incremental level if there were no signs or symptoms of aspiration.
Main Outcomes and Measures: Number of patients weaned to a thin-fluid diet.
Results: Of 50 children (32 [64%] male; median [interquartile range] age, 0.7 [1.0] y at presentation and 1.8 [1.3] y at start of wean) using the SWP, 44 (88%) were able to reduce the amount of thickener used. A successful wean from thickened fluids to thin fluids was completed in 39 (78%). The mean (SD) duration of a successful wean was 0.9 (0.6) years. Five patients tolerated a reduction in thickener but not a full wean to thin fluids. For 6 patients, weaning failed and they continued to receive thickened fluids. Of those whose weaning failed, 2 patients developed pneumonia. Of the 39 successfully weaned patients, 14 (36%) experienced a temporary stall but eventually tolerated thin fluids. Only 2 (5%) developed pneumonia while all other successfully weaned patients (n = 37 [95%]) did not experience any substantial respiratory issues. Overall, 46 (92%) of children required 2 or fewer videofluoroscopic swallow study evaluations.
Conclusions and Relevance: Patients with oropharyngeal dysphagia and aspiration should be gradually weaned off of thickened fluids. The SWP uses small incremental steps to gradually reduce the amount of thickener. Using this method, most children tolerated a reduction in thickeners and a thin-fluid diet. The SWP presents a safe and effective way of gradually returning children to a more normal diet.
PMID: 29121147 [PubMed - as supplied by publisher]
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Association Between Head and Neck Squamous Cell Carcinoma Survival, Smoking at Diagnosis, and Marital Status.
Association Between Head and Neck Squamous Cell Carcinoma Survival, Smoking at Diagnosis, and Marital Status.
JAMA Otolaryngol Head Neck Surg. 2017 Nov 09;:
Authors: Osazuwa-Peters N, Adjei Boakye E, Chen BY, Tobo BB, Varvares MA
Abstract
Importance: While the adverse association between smoking and head and neck squamous cell carcinoma (HNSCC) survival has been well described, there are also inconclusive studies and those that report no significant changes in HNSCC survival and overall mortality due to smoking. There is also a lack of studies investigating the association of marital status on smoking status at diagnosis for patients with HNSCC.
Objective: To examine the association between patient smoking status at HNSCC diagnosis and survival and the association between marital status and smoking in these patients.
Design, Setting, and Participants: This retrospective cohort study was conducted by querying the Saint Louis University Hospital Tumor Registry for adults with a diagnosis of HNSCC and treated at the university academic medical center between 1997 and 2012; 463 confirmed cases were analyzed.
Main Outcomes and Measures: Cox proportional hazards regression analysis was used to evaluate association of survival with smoking status at diagnosis and covariates. A multivariate logistic regression model was used to assess whether marital status was associated with smoking at diagnosis adjusting for covariates.
Results: Of the 463 total patients (338 men, 125 women), 92 (19.9%) were aged 18 to 49 years; 233 (50.3%) were aged 50 to 65 years; and 138 (29.8%) were older than 65 years. Overall, 56.2% of patients were smokers at diagnosis (n = 260); 49.6% were married (n = 228); and the mortality rate was 54.9% (254 died). A majority of patients were white (81.0%; n = 375). Smokers at diagnosis were more likely to be younger (ie, <65 years), unmarried, and to drink alcohol. We found a statistically significant difference in median survival time between smokers (89 months; 95% CI, 65-123 months) and nonsmokers at diagnosis (208 months; 95% CI, 129-235 months). In the adjusted Cox proportional hazards model, patients who were smokers at diagnosis were almost twice as likely to die during the study period as nonsmokers (hazard ratio, 1.98; 95% CI, 1.42-2.77). In the multivariate logistic regression analysis, unmarried patients were 76% more likely to use tobacco than married patients (adjusted odds ratio, 1.76; 95% CI, 1.08-2.84).
Conclusions and Relevance: Smokers were almost twice as likely as nonsmokers to die during the study period. We also found that those who were married were less likely to be smokers at diagnosis. Our study suggests that individualized cancer care should incorporate social support and management of cancer risk behaviors.
PMID: 29121146 [PubMed - as supplied by publisher]
http://ift.tt/2yoSB38
A prospective observational study to compare efficacy of topical triamcinolone acetonide 0.1% oral paste, oral methotrexate, and a combination of topical triamcinolone acetonide 0.1% and oral methotrexate in moderate to severe oral lichen planus
Abstract
Topical corticosteroids are considered to be the most effective treatment for oral lichen planus (OLP). Methotrexate has been found to be effective in extensive cutaneous lichen planus. The objectives of the study were to evaluate the clinical efficacy and safety of topical triamcinolone 0.1% oral paste, oral methotrexate and a combination of these in symptomatic moderate-to- severe OLP. Forty-five patients were recruited and were allocated to three treatment arms with 15 patients in each treatment arm. They were treated for a period of 16 weeks or until complete clinical remission, whichever was earlier. The parameters assessed were clinical severity score, visual analogue score, and quality of life impairment questionnaire score. Forty-three patients completed the study. All three treatment modalities were effective. The patients in the combination group had significantly better reduction in the outcome parameters assessed compared to the other two groups. Nine patients achieved complete clinical remission, 6 in the combination group and 3 in the topical triamcinolone group. Systemic methotrexate, alone or in combination with topical triamcinolone, is effective in management of moderate to severe OLP.
http://ift.tt/2yoEhYA
Treating multiple body parts for skin laxity and fat deposits using a novel focused radiofrequency device with an ultrasound component: Safety and efficacy study
Summary
Background and objectives
Growing demand for noninvasive skin tightening and reduction in fat results in an increasing pressure for devices with good clinical efficacy, consistency of results, and high patient comfort. The objective was to validate clinical efficacy and versatility of a novel device, which combines radiofrequency (RF) and ultrasound for treating skin laxity and fat deposits.
Methods
We treated 34 subjects with facial skin laxity and/or abundant body or arm fat deposits. Subjects were divided based on their indications. Ten subjects received treatments to the face, 7 subjects to arms, 8 subjects to thighs, and 9 subjects on abdomen. All patients received 4 treatments on a weekly basis. Photographs of patients were assessed by blinded evaluators to recognize the baseline images from the 3-month follow-up images. Patient comfort and satisfaction were evaluated using a 5-point Likert scale questionnaire. Any adverse events were recorded.
Results
Patient images were correctly recognized in >90% of cases in all study groups. Patient questionnaires showed overall satisfaction with the therapy course and results. On a scale of 1 to 5, the patients agreed (4.1) that they are satisfied with the results that the treatment is comfortable (4.1) and that they are satisfied with the treatment time (4.1). No adverse events were reported.
Conclusions
Consistent clinical efficacy was confirmed across all the treated areas, together with high patient comfort and satisfaction. We conclude the device is a highly versatile solution that can deliver results across body parts and different indications.
http://ift.tt/2yo9efm
Ventilation Defect Percent in Helium-3 MRI as a Biomarker of Severe Outcomes in Asthma
Source:Journal of Allergy and Clinical Immunology
Author(s): David G. Mummy, Stanley J. Kruger, Wei Zha, Ronald L. Sorkness, Nizar N. Jarjour, Mark L. Schiebler, Loren C. Denlinger, Michael D. Evans, Sean B. Fain
Ventilation defect percent (VDP) measured in asthmatics with hyperpolarized helium-3 MRI was more strongly associated with ED visits and hospitalizations due to asthma exacerbation than were conventional biomarkers of lung function and inflammation.
http://ift.tt/2yNFEV5
Identification of atopic dermatitis subgroups in children from two longitudinal birth cohorts
Source:Journal of Allergy and Clinical Immunology
Author(s): Lavinia Paternoster, Olga E.M. Savenije, Jon Heron, David M. Evans, Judith M. Vonk, Bert Brunekreef, Alet H. Wijga, A. John Henderson, Gerard H. Koppelman, Sara J. Brown
BackgroundAtopic dermatitis (AD) is a prevalent disease with variable natural history. Longitudinal birth cohort studies provide an opportunity to define subgroups based on disease trajectories, which may represent different genetic and environmental pathomechanisms.ObjectiveTo investigate the existence of distinct longitudinal phenotypes of AD and test whether these findings are reproducible in two independent cohorts.MethodsThe presence of AD was examined in two birth cohort studies including 9,894 children from the UK (ALSPAC) and 3,652 from the Netherlands (PIAMA). AD was defined by parental report of a typical itchy and/or flexural rash. Longitudinal latent class analysis was used to investigate patterns of AD from birth to the age of 11 to 16 years. We investigated associations with known AD risk factors, including FLG null mutations, 23 other established AD-genetic risk variants and atopic comorbidity.ResultsSix latent classes were identified, representing subphenotypes of AD, with remarkable consistency between the two cohorts. The most prevalent class was early-onset-early-resolving AD, which was associated with male gender. Two classes of persistent disease were identified (early-onset-persistent and early-onset-late-resolving); these were most strongly associated with the AD-genetic risk score as well as personal and parental history of atopic disease. A yet unrecognised class of mid-onset-resolving AD, not associated with FLG mutations, but strongly associated with asthma, was identified.ConclusionSix classes based on temporal trajectories of rash were consistently identified in two population-based cohorts. The differing risk factor profiles and diverse prognoses demonstrate the potential importance of a stratified medicine approach for AD.Clinical ImplicationsAtopic dermatitis ranges from a transient condition to lifelong morbidity. This study has identified distinct subphenotypes of atopic dermatitis in children, which could indicate the importance of a stratified approach to management of this complex disease.
Teaser
Longitudinal latent class analysis models the course of disease subsets over time. Atopic dermatitis in childhood shows diversity in risk factors, prognoses and comorbidities. This study demonstrates robust subphenotypes of AD in two population cohorts.http://ift.tt/2m8DB7S
EoE genetic susceptibility is mediated by synergistic interactions between EoE-specific and general atopic disease loci
Source:Journal of Allergy and Clinical Immunology
Author(s): L.J. Martin, H. He, M.H. Collins, J.P. Abonia, J.M. Biagini Myers, M. Eby, H.E. Johansson, L.C. Kottyan, G.K. Khurana Hershey, M.E. Rothenberg
BackgroundEosinophilic esophagitis (EoE) is an esophageal inflammatory disease associated with atopic diseases. TSLP and CAPN14 genetic variation contribute to EoE, but how this relates to atopy is unclear. The purpose of this study was to explore the relationship between EoE, atopy and genetic risk.MethodsEoE-atopy enrichment was tested using 700 EoE cases and 801 community controls. Probing 372 SNPs in 63 atopy-genes, we evaluated EoE associations using 412 non-atopic and 868 atopic disease controls. Interaction and stratified analyses of EoE-specific and atopy SNPs were performed.ResultsAtopic disease was enriched in EoE (p < 0.0001). Comparing EoE and non-atopic controls, EoE associated strongly with IL4/KIF3A (p = 2.8×10-6; odds ratio (OR) = 1.85), moderately with TSLP (p = 1.5×10-4; OR = 1.43), and nominally with CAPN14 (p = 0.029; OR = 1.35). Comparing EoE to atopic disease controls, EoE associated strongly with ST2 (p = 3.5×10-6; OR = 1.79) and nominally with IL4/KIF3A (p = 0.019, OR = 1.25); TSLP's association persisted (p = 4.7×10-5; OR = 1.37), and CAPN14's association strengthened (p = 0.0001; OR = 1.71). Notably, there was gene-gene interaction between TSLP and IL4 SNPs (p = 0.0074). Children with risk alleles for both genes were at higher risk for EoE (p = 2.0×10-10; OR = 3.67).ConclusionsEoE genetic susceptibility is mediated by EoE-specific and general atopic disease loci which may have synergistic effects. These results may aid in identifying potential therapeutics and predicting EoE susceptibility.Clinical Implications.EoE susceptibility is mediated by multiple genes, which have synergistic effects. These genes include both EoE-specific and general atopic disease loci. Identifying these effects may help customize treatments.
Teaser
TSLP is a susceptibility locus for EoE. We demonstrate that TSLP and IL4 variants interact, partially explaining the high degree of co-morbid atopy. These findings will improve risk prediction and may help identify novel therapeutics.http://ift.tt/2yOfgdO
The β and α2δ auxiliary subunits of Cav1 channels are required for Th2-lymphocyte function and acute allergic airway inflammation
Source:Journal of Allergy and Clinical Immunology
Author(s): Nicolas Rosa, Emily Triffaux, Virginie Robert, Marion Mars, Martin Klein, Gregory Bouchaud, Astrid Canivet, Antoine Magnan, Jean-Charles Guéry, Lucette Pelletier, Magali Savignac
BackgroundT-lymphocytes express not only the cell membrane calcium ORAI1 but also voltage-dependent Cav1 channels. In excitable cells, these channels are composed of the ion forming pore α1 and auxiliary subunits (β and α2δ) needed for proper trafficking and activation of the channel. We previously disclosed the role of Cav1.2 α1 in mouse and human Th2- but not Th1-cell functions and showed that knocking-down Cav1 α1 prevents experimental asthmaObjectiveWe investigated the role of β and α2δ auxiliary subunits on Cav1 α1 function in Th2 lymphocytes and on the development of acute allergic airway inflammation.MethodsWe used antisense oligonucleotides (CavβAS) to knockdown Cavβ and gabapentin, a drug that binds to and inhibits α2δ1 and α2δ2, to test their effects on Th2 functions and their capacity to reduce allergic airway inflammation.ResultsMouse and human Th2-cells express mainly Cavβ1, β3 and α2δ2 subunits. CavβAS reduces TCR-driven calcium responses and cytokine production by mouse and human Th2, with no effect on Th1-cells. Cavβ is mainly involved in restraining Cav1.2 α1 degradation through the proteasome as a proteasome inhibitor partially restores the α1 protein level. Gabapentin impairs TCR-driven calcium response and cytokine production associated with the loss of α2δ2 protein in Th2-cells.ConclusionsThese results stress the role of Cavβ and α2δ2 auxiliary subunits in the stability and activation of Cav1.2 channels in Th2 lymphocytes both in vitro and in vivo as demonstrated by the beneficial effect of CavβAS and gabapentin in allergic airway inflammation.Clinical implicationsThe demonstration that auxiliary subunits are involved in calcium signaling through Cav1 channels and function of mouse and human Th2-lymphocytes supports their potential beneficial effect on allergic asthma.
Teaser
This work demonstrates that Cavβ and α2δ auxiliary subunits of Cav1 calcium channels are required for proper calcium signaling in Th2 lymphocytes and their targeting is beneficial in allergic asthma.http://ift.tt/2m8Dh9a
Hearing Preservation Cochlear Implantation: a Review of Audiologic Benefits, Surgical Success Rates, and Variables That Impact Success
Abstract
Purpose of Review
The objectives of this review are as follows: (1) examine the audiologic benefits of hearing preservation, (2) review rates of successful hearing preservation, and (3) analyze variables that impact hearing preservation success.
Recent Findings
Hearing preservation has been shown to confer the following audiologic benefits: better speech understanding in complex listening environments, superior sound localization, and improved music appreciation. There is a notable lack of standardized criteria for reporting of hearing preservation outcomes—this leads to considerable heterogeneity across studies. Rates of functional (i.e., aidable) hearing preservation generally range between 50 and 90%. Studies demonstrate higher preservation rates and more durable hearing outcomes with shorter, straight electrode arrays.
Summary
With advances in CI technology and surgical techniques, residual hearing can be preserved after CI surgery in the majority of patients. Cochlear implant recipients with preserved hearing demonstrate better speech understanding, sound localization, and improved music appreciation.
http://ift.tt/2ynY3U0
Generating new evidence, improving clinical practice and developing research capacity: the benefits of recruiting to the U.K. Dermatology Clinical Trials Network's STOP GAP and BLISTER trials
Summary
Clinical trials may benefit clinical practice in three ways: firstly, clinicians may change their practice according to the new trial evidence; secondly, clinical processes can improve when working on a trial; and thirdly, research capacity is increased. We held a meeting to present and discuss the results of two large multicentre randomized controlled trials delivered through the U.K. Dermatology Clinical Trials Network. Investigators gave reflections on how the trials had changed their clinical practice. The STOP GAP trial showed that prednisolone and ciclosporin are equally effective as first-line systemic treatment for pyoderma gangrenosum. The final decision of which treatment to use should be based on the different adverse event profiles of the two drugs in relation to comorbidities, along with age, disease severity and patient preference. The BLISTER trial showed that starting people with pemphigoid on doxycycline produces acceptable short-term effectiveness and a superior safety profile to oral corticosteroids. Recruiting to these trials has led to the development of new specialist clinics with improved documentation. It has increased the profile of participating departments and embedded research in the department's activities. Helping to design and run these trials has also allowed trial staff to develop new skills in research design, which has been beneficial for career development. These and other benefits of recruiting to the trials are summarized here. We hope that these reflections will inspire wider involvement in clinical research.
http://ift.tt/2zwjfLd
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