We report the case of a 69-year-old female who underwent a Baerveldt implant placement for severe-stage primary open-angle glaucoma and developed a bacterial infection of the conjunctiva and abscess of the scleral patch graft with subsequent tube exposure. The infection was identified 3 weeks postoperatively and a topical antibiotic was immediately initiated. A concurrent systemic staphylococcal infection was discovered by an outside physician and oral cephalexin was initiated. Despite antibiotic treatment, the conjunctival erosion progressed, and tube revision was required. Culture of the abscess revealed coagulase-negative Staphylococcus. As alluded to above, the patient also had multiple abscesses on the skin that cultured positive for Staphylococcus aureus. To our knowledge, this is the first case in the literature of coagulase-negative Staphylococcus causing an early postoperative abscess of the scleral patch graft following glaucoma drainage device placement.
Case Rep Ophthalmol 2017;8:521–526
http://ift.tt/2hGpqWu
Πέμπτη 16 Νοεμβρίου 2017
Baerveldt Scleral Patch Graft Abscess Secondary to Coagulase-Negative Staphylococcus
Asymmetric bone remodeling in mandibular and maxillary tori
Abstract
Objectives
Tori are frequent paucisymptomatic bony outgrowths of the oral cavity in three locations: torus palatinus (TP), mandibularis (TM), and maxillaris (TMax). Their usually described histological characteristics are unspecific: normal cortical bone with more or less trabecular bone. The aim of this study was to describe tori's specific morphological and histomorphometric characteristics.
Materials and methods
Histological characteristics in a series of 18 tori collected after surgical removal were analyzed. Microcomputed tomography provided a 3D analysis. Mineral apposition rate (MAR) was measured after double tetracycline labeling. Osteoid tissue was identified by Goldner's trichrome and osteoclasts by the tartrate resistant acid phosphatase identification in undecalcified sections. Iron and aluminum were detected by histochemical staining methods. Osteoid thickness and MAR were determined at the outer surface of the torus and in the Haversian canals.
Results
Tori appeared made of lamellar Haversian bone in 16/18 cases. Osteoid thickness did not differ between the outer surface and within the canals. An asymmetric bone remodeling was observed in the Haversian canals of 15 tori: osteoid seams were deposited on the side close to the free torus surface, and Howship's lacunae with numerous osteoclasts were observed on the opposite side. A high MAR was found at the surface of the tori and within the canals. There was no iron or aluminum deposit.
Conclusions
Tori may be characterized by a specific asymmetric bone remodeling which seems to determine their shape.
Clinical relevance
This finding could constitute a specific histological feature allowing to differentiate tori from exostoses.
http://ift.tt/2A7XJgK
The elevated activation of NFκB and AP-1 is correlated with differential regulation of Bcl-2 and associated with oral squamous cell carcinoma progression and resistance
Abstract
Objectives
Oral cancer is the sixth most common cancer in the world. Failure of chemoradiation therapy is a major concern for treating oral cancer patients. The objective of this study is to determine the B cell lymphoma-2 (bcl-2) expression and its regulation by nuclear factor κB (NFκB) and activator protein 1 (AP-1) in oral cancer progression and chemoradiation resistance.
Materials and methods
In the present study, a total of 123 (n = 123) human samples were included. Briefly, 64 fresh samples were from adjacent normal (AN), primary oral tumors without treatment (PT), and tumors with resistance to chemoradiation therapy with local recurrence (RCRT). Fifty-nine samples were human tongue cancers and normal samples (TMA). Messenger RNA (mRNA) expression levels of bcl-2 and protein levels of bcl-2, NFκB, AP-1, and inactive GSK3α/β were measured by semiquantitative RT-PCR, immunohistochemistry, Western blot, and ChIP analysis.
Results
Increased bcl-2 expression was observed in PT compared to AN. The RCRT tumors showed maximum expression of bcl-2 mRNA and protein over the PT and AN groups. Bcl-2 protein and mRNA expression were positively correlated with NFκB and AP-1 expression. AP-1 expression was strongly correlated with bcl-2 in the RCRT group of tumors. Further, inactive GSK3α/β showed a positive trend with bcl-2 expression in oral tongue cancer specimens.
Conclusion
Collectively, our results demonstrated cumulative effect of AP-1 and NFĸB for bcl-2 gene regulation in overall PT progression and chemoradiation resistance. The study provides evidence of increased bcl-2 mRNA/protein fueled by NFĸB in PT and AP-1 in RCRT. These regulations of bcl-2 by NFκB and AP-1 are important in OSCC progression and chemoradiation resistance.
http://ift.tt/2A6bk8b
Four-year outcomes of restored posterior tooth surfaces—a massive data analysis
Abstract
Objectives
There is only sparse knowledge concerning the outcomes of treatments with posterior permanent restorations in general practice settings. This study aimed at evaluating outcomes based on a large dataset by using a novel approach on a tooth surface basis.
Materials and methods
The study based on routine data from a major German national health insurance company. Respective treatment fee codes allowed for tracking the clinical courses on a tooth surface level. The study intervention was defined as the placement of a restoration on an interproximal or occlusal posterior tooth surface regardless of its actual extension and material on which no information was available. All surfaces restored between January 1st, 2010 and December 31st, 2013 were included. Kaplan-Meier survival analyses were conducted to estimate four-year survival. The primary outcome was a restorative re-intervention on the same tooth surface. Separate analyses were performed for the secondary outcomes "crowning" and "extraction".
Results
Over ten million interproximal surfaces and eight million occlusal surfaces in nine million posterior teeth had been restored. At 4 years, the cumulative survival rates concerning the primary outcome "re-intervention" for mesial surfaces (81.4%; CI 81.3–81.5%) and distal surfaces (81.2%; CI 81.1–81.2%) differed significantly from those for occlusal surfaces (77.0%; CI 76.9–77.0%). Restored surfaces in premolars showed significantly higher survival rates compared to molars. Four-year survival rates for the secondary outcome "crowning" were 91.9% (CI 91.8—91.9%) for mesial surfaces, 92.1% (CI 92.1–92.2%) for distal surfaces and 93.3% (CI 93.2–93.3%) for occlusal surfaces. The respective rates for the secondary outcome "extraction" were 94.5% (CI 94.5–94.5%) for mesial surfaces, 94.8% (CI 94.7–94.8%) for distal surfaces and 95.4% (CI 95.4–95.5%) for occlusal surfaces.
Conclusions
Re-interventions after restorative treatment play a significant role in general practice settings. Surface-related survival rates of restorations reveal a need for improvement.
Clinical relevance
This study allows the estimation of the probability of re-interventions after restoring posterior tooth surfaces. It is based on several million cases from general practises under the terms and conditions of a national health insurance system.
http://ift.tt/2A6TQsy
How does sinus surgery affect topical irrigation distribution?.
http://ift.tt/2zNBmtT
How does sinus surgery affect topical irrigation distribution?.
http://ift.tt/2zNBmtT
Asthma biomarkers in the age of biologics
The heterogeneous nature of asthma has been understood for decades, but the precise categorization of asthma has taken on new clinical importance in the era of specific biologic therapy. The simple categories ...
http://ift.tt/2hz0NHA
Buccal Mucosal Epithelial Cells Downregulate CTGF Expression in Buccal Submucosal Fibrosis Fibroblasts
Abstract
Introduction
Oral submucosal fibrosis (OSMF) is a chronic debilitating fibrotic disease of the oral cavity and is a serious health hazard in south Asia and, increasingly, the rest of the world. The molecular basis behind various treatment modalities to treat OSMF still remains unclear. In this study, we have investigated the in vitro ability of the buccal mucosal cells to reduce the proliferation of the fibroblasts of the fibrotic area in co-culture of cells and also at the molecular levels to reduce the level of connective tissue growth factor (CTGF) in the OSMF fibroblasts (SMF-F).
Materials and Methods
The study compares isolation, morphological and proliferation kinetics of SMF-F and BMF cells with and without co-culturing with BMEs. In addition, we have compared the mRNA expression levels of CTGF in SMF-F co-cultured BME and non-co-cultured SMF-F cells using validated real-time quantitative PCR (RT-qPCR) method.
Results
The basic morphological characteristics of SMF-F were similar to BMF, but the former cells had higher proliferation rate in early passages compared to late passage state. We also observed that the CTGF expression levels in SMF-F under co-culture conditions of BME were consistently and significantly downregulated in all four different SMF-F-derived cells from four different patients.
Conclusion
Rapid proliferation and collagen synthesis in SMF-F as against BMF cells are the factors that confirm the innate nature of fibrosis fibroblasts (SMF-F). Further, the CTGF expression level in SMF-F was significantly suppressed by BME in co-culture conditions against controls (BMF). Considered together, this suggests that the cell therapeutic candidate of BME could be used in treating OSMF.
http://ift.tt/2APCkFc
Potential Effect of Leukocyte-Platelet-Rich Fibrin in Bone Healing of Skull Base: A Pilot Study
Background. Reconstruction of surgical defects following cranial base surgery is challenging. Others have demonstrated that leukocyte-platelet-rich fibrin (L-PRF) stimulates tissue healing and bone regeneration. However, these studies have addressed mostly maxillofacial surgical wounds. Objective. The objective of this study was to assess the possible adjuvant role of L-PRF in inducing neoossification of the surgical bone defect in anterior skull base surgery. Methods. We identified patients who had undergone an endoscopic endonasal surgery of the anterior skull base in which L-PRF membranes were used for the reconstruction of the bone defect and who were followed up with postoperative CT scans. CT findings were then correlated with baseline scans and with the CT scans of a patient who had undergone imaging and histologic analysis after maxillofacial surgery in which L-PRF was used and in which we demonstrated bone formation. Results. Five patients fulfilled the inclusion criteria. In four patients, the CT scan demonstrated closure of the bony defect by neoosteogenesis; however, the bone appeared less dense than the surrounding normal bone. A comparison with the control patient yielded similar radiological features. Conclusion. This case series suggests that L-PRF may induce bone healing and regeneration at the surgical site defect. Multi-institutional studies with a larger series of patients are required to confirm this possibility.
http://ift.tt/2hwfv1I
Comprehensive Geriatric Assessment and Head and Neck Elderly Cancer Patients
Intervention: Other: CGA and geriatric follow-up
Sponsors: Assistance Publique - Hôpitaux de Paris; National Cancer Institute (NCI); Cancéropole Ile De France
Recruiting
http://ift.tt/2j0QOed
Use of enzyme-linked immunosorbent assay to screen for aflatoxins, ochratoxin A, and deoxynivalenol in dry pet foods
Abstract
The objective of this study was to perform a market survey on dry pet foods using enzyme-linked immunosorbent assay (ELISA) to detect total aflatoxins (AFs), ochratoxin A (OTA), and deoxynivalenol (DON). Pet food products (n = 58) marketed for dogs, cats, birds, and rabbits were tested in duplicate with ELISA, and results above the limit of quantitation were confirmed using liquid chromatography tandem mass spectrometry (LC-MS/MS). OTA was detected in one product (rabbit food) and AFs were detected in two products (one dog treat and one bird treat). In contrast, DON was detected in the majority (74%) of products tested. Bird and rabbit products were the most affected by DON, with levels above 0.5 μg/g in 50 and 80% of samples, respectively. One rabbit sample tested positive for both OTA and DON. Overall, the findings of this study revealed a low incidence of AFs and OTA in commercial pet food. Although DON was detected in numerous products, the levels were well below those associated with acute toxic effects.
http://ift.tt/2A3QcPT
Production of fumonisins by endophytic strains of Tolypocladium cylindrosporum and its relation to fungal virus infection
Abstract
Fumonisins were first discovered in Fusarium verticillioides, a fungus associated to disease and asymptomatic infections in maize. Afterwards, other fungal taxa have been found to produce fumonisins. The entomopathogenic ascomycete Tolypocladium cylindrosporum has been isolated from soil and also as an endophyte from leaves of grasses. The objectives of this work were to determine the in vitro production of fumonisin B (FB) mycotoxins and the immunosuppressive compound cyclosporine A (CyA) in several strains of T. cylindrosporum, and to examine the effect of fungal virus infection and temperature in FB production. FB1 was detected in 30% of the strains, ranging from 0.16 to 5.52 μg cm−2 in solid media, and FB2 was detected in 78% of the strains, ranging from 0.764 to 40.92 μg cm−2. CyA was not detected in any strain. The mean FB2 concentration of the endophytic strain Tc37W was three times greater (p < 0.05) than that of any other strain. Up to 34% more of FB2 was detected in strains infected by the virus TcV3 than in the corresponding virus-free versions. The effect of temperature on FB2 content was interactively significantly dependent on fungal strain and growth medium; in the YES medium, the FB2 of virus-infected strains Tc37-1V and Tc37W increased by 67 and 16%, respectively, at 26 °C as compared to 20 °C. The FB concentration in some fungal strains was similar to that in fungi associated to food and feed intoxications.
http://ift.tt/2A3n4Z5
Blood plasma biomarkers of citrinin and ochratoxin A exposure in young adults in Bangladesh
Abstract
Citrinin (CIT) and Ochratoxin A (OTA) are nephrotoxic mycotoxins which can co-occur in food commodities, resulting in internal exposure. Studies in many countries reported on the presence of OTA in human blood; however, such biomonitoring data for CIT is still scarce. This study was conducted to characterize both CIT and OTA biomarker levels in plasma of volunteers since food analysis data are insufficient to assess human exposure in Bangladesh. In total 104 blood samples were collected from university students in 2013 (sampling 1: n = 64, midsummer) and 2014 (sampling 2: n = 40, end winter) for analysis of CIT and OTA and their metabolites HO-CIT and OTα by LC-MS/MS and HPLC-FD techniques, respectively. CIT and HO-CIT were detected in 90% (max 2.70 ng/mL) and 85% (max 1.44 ng/mL) of all samples. Mean levels in sampling 2 (CIT 0.47 ng/mL; HO-CIT 0.40 ng/mL) were higher than in sampling 1 (0.25 ng/mL; 0.37 ng/mL) indicative of variable CIT exposure. OTA was present in all (max 6.63 ng/mL) and OTα in 98% (max 0.99 ng/mL) of the samples. In sampling 1, mean OTA (0.85 ng/mL) was higher than in sampling 2 (0.51 ng/mL); the reverse situation was found for OTα mean levels. The calculated dietary OTA intake among the students (mean 9.9; max 91.7 ng/kg bw/week) was lower than the tolerable weekly intake for this mycotoxin (120 ng/kg bw/week) set by EFSA. But frequent co-exposure to CIT should be considered, and the results of this study indicate the necessity to identify major sources of CIT and OTA intake in the Bangladeshi population.
http://ift.tt/2AS4Oz6
Surgical Treatment of Fibroosseous Lesion in Young Patient with Reduced Mouth Opening
Cranial Maxillofac Trauma Reconstruction
DOI: 10.1055/s-0037-1608697
Fibrous dysplasia is a benign fibroosseous disorder that can affect the maxillary bones, causing aesthetic deformity and functional impairment. This article reports the case of a 13-year-old male patient at the time of diagnosis. The patient showed increased facial volume with relevant asymmetry, having reported the onset of the condition 12 months before. Upon examination, the patient presented an 8-mm mouth opening and an acute inflammatory process associated with tooth 37 pericoronal hood. Upon imaging exam, exuberant bone growth in the left mandibular ramus area of ground glass aspect was observed. After incisional biopsy, fibrous dysplasia was diagnosed and sequentially treated with osteoplasty and coronoid process removal. The patient evolved to a 43-mm mouth opening and favorable aesthetics without recurrence in a 3-year follow-up period. In this case, coronoidectomy and bone plasty proved to be effective, returning aesthetics and function. The patient is supposed to be followed up in the long term.
[...]
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Article in Thieme eJournals:
Table of contents | Abstract | Full text
http://ift.tt/2ANG36p
Pathology and management of mass in accessory parotid gland region: 24-year experience at a single institution
Masses in the accessory parotid gland (APG) region are clinically rare and their management can lead to conflicts between the need for tumor resection and facial cosmesis. The aim of this study was to analyze the pathological classifications and management of APG lesions in our hospital.
http://ift.tt/2yPhsh3
Cancer-related hypercalcemia in oral cancer
Cancer-related hypercalcemia (CRH) is a critical paraneoplastic disorder in advanced cancer patients. In clinical practice, patients with CRH have a poor prognosis. The medical records of 3198 oral cancer patients with CRH diagnosed at Taichung Veterans General Hospital from 1 January 2003 to 31 December 2015 were reviewed. The criteria for patient enrolment were a diagnosis of hypercalcemia or the use of antihypercalcemia medication. Patients who met any of the following criteria were excluded: use of total parenteral nutrition, incomplete serum calcium data, and unknown date of death.
http://ift.tt/2zLb51p
Cosmetic and Reconstructive Surgery of Congenital Ear Deformities
It is my privilege and great pleasure to introduce this issue of Facial Plastic Surgery Clinics of North America with a comprehensive focus on cosmetic and reconstructive surgery of congenital ear deformities. First and foremost, I wish to thank sincerely our many wonderful authors who graciously offered their time, commitment, and world-class expertise in this specialty subject for the benefit of our readership.
http://ift.tt/2jyU9p2
Cosmetic Otoplasty
Otoplasty for prominent ears is a rewarding yet exacting surgery that demands the precise application of anatomic knowledge, anthropometric norms, and surgical creativity. The practitioner must be able to use a variety of different techniques to provide durable and acceptable cosmetic results to patients. This article provides an in-depth description of normal and abnormal auricular anatomy, the historical context for modern otoplasty, and describes in detail the common otoplastic procedures currently performed.
http://ift.tt/2jt1oyB
Autologous Rib Microtia Construction
Nagata technique becomes most popular method of autologous rib microtia construction. To achieve successful outcome, 3 keys must be perfect: skin envelope, 3D cartilage framework, and proper location of the construct. The first step of the surgery is to identify "auricular rectangle." Relationship between the auricular rectangle and the vestige will determine if the vestige is usable for surgery. Rib cartilage must be harvested without perichondrium to prevent chest deformity. Lobule split technique is the hallmark of the Nagata technique, which allows skin envelope expansion, and allows deeper conchal cavity. Surgeons must master 3D framework construct before clinical cases.
http://ift.tt/2js9F5M
Surgical Otoplasty
Otoplasty is one of the first procedures learned during residency. A myriad of surgical techniques and nuances exist. Many have merit, some are ineffective, some destructive, and some frankly fanciful. Adopting an effective and safe technique should be based on proven efficacy and effectiveness to avoid early disappointments. We present a review of traditional otoplasty techniques and more recent innovations. Their pros and cons are discussed in view of the relative risks/benefits balance. Recurrence rates are low for most techniques. Some techniques carry a higher risk of significant complications. A ladder approach preferring techniques that minimize cartilage damage appears advisable.
http://ift.tt/2jtpVU7
Auricular Prostheses in Microtia
The progress made in the development of the silicones and percutaneous titanium implants allow for rehabilitation of patients with microtia with an inconspicuous auricular prosthesis. The art of making the prosthesis by the dedicated anaplastologist is the key for the success of this approach. Most patients with microtia desire camouflage. The greatest advantage of the auricular prosthesis is that it can be manufactured as a mirrored replica of the opposite side. The outcome is predictable. Computer science with virtual planning and rapid prototyping is about to revolutionize the process of prosthetic auricular rehabilitation.
http://ift.tt/2jvf102
Cosmetic and Reconstructive Surgery of Congenital Ear Deformities
FACIAL PLASTIC SURGERY CLINICS OF NORTH AMERICA
http://ift.tt/2hD4OhC
Atresiaplasty in Congenital Aural Atresia
Patients with microtia and congenital aural atresia should have a comprehensive hearing assessment early in life. Options for hearing habilitation should be presented, and children with bilateral aural atresia should be fitted with a bone conducting hearing device to support normal speech and language development. If atresia surgery is pursued, the microtia surgeon must be aware of certain principles. This article presents recommendations on options for potentially improving hearing in children with congenital aural atresia: assessing surgical candidacy; chronology and timing of surgeries; functional importance of certain ear structures; and understanding the possible locations of an aberrant facial nerve to avoid injury in these patients.
http://ift.tt/2jvBqdQ
Auricular Reconstruction Using Porous Polyethylene Implant Technique
Alloplast-based ear reconstruction has become more popular over the years because it offers many advantages compared with the traditional staged autologous costal cartilage approach. Advantages include earlier reconstruction in the setting of microtia, fewer procedures, less donor site morbidity, shorter surgeon learning curve, and improved consistency in the final aesthetic result. Although other implantable materials have been used in auricular reconstruction with variable success, porous high-density polyethylene frameworks combined with recent advances in the creation of the soft tissue coverage have significantly improved outcomes with minimal complications and long-term viability. This article describes the authors' technique.
http://ift.tt/2hE6aIX
Otoplasty for Congenital Auricular Malformations
Among the less common congenital auricular anomalies are cryptotia, Stahl ear, constricted ear, and macrotia. The vast majority of these occur spontaneously without accompanying syndromes or other deformities. This article provides a comprehensive overview of these anomalies, as well as common techniques to correct these anomalies.
http://ift.tt/2jwmxaZ
Pediatric Microtia Reconstruction with Autologous Rib
Reconstruction of the microtic ear is one of the most challenging, yet gratifying surgical experiences. Careful planning, attention to detail, and conservative tissue management are necessary for excellent results. Technologies continue to evolve; with the advancement of cartilage tissue engineering, the future of ear reconstruction is very promising.
http://ift.tt/2hEFJmp
Nonsurgical Management of Congenital Auricular Anomalies
Congenital auricular deformities often can be corrected by neonatal ear molding techniques, which have evolved significantly over a 25-year period with commercially available molding systems now available. Indications for molding and methodology for best optimizing results have been well described in the literature, although recent studies have explored methodology for reduction in the cost of technique and also called for increased awareness among pediatric practitioners of the importance of early institution of therapy.
http://ift.tt/2juGijx
Psoriasis Tied to Higher Risk of Serious Liver Disease
People with chronic inflammatory disorders like psoriasis and rheumatoid arthritis may have an increased risk of developing serious liver damage, a recent study suggests.
Reuters Health Information
http://ift.tt/2zIUWdc
Metastasis in the mandibular condyle: a case report
Most bone metastases are observed in the trunk of the body. Metastasis in the mandibular condyle is rare. In many case reports, temporary common temporomandibular joint disorder-like symptoms can be a sign of ...
http://ift.tt/2mwHTGt
Denguefieber
Zusammenfassung
Dengueinfektionen gehören zu den häufigsten Ursachen fieberhafter Erkrankungen im tropischen Umfeld. Die Infektion wird durch ein Flavivirus verursacht, das durch Aedes-Moskitos übertragen wird. Hauptüberträger für Dengueviren sind die weltweit in den Tropen verbreiteten Aedes-aegypti-Stechmücken. Da diese einerseits tagaktiv und andererseits sog. „container breeder" sind, bedarf es besonderer Vorbeugungs- und Bekämpfungsmaßnahmen. Die Schwere der Symptomatik variiert und kann vom milden grippeähnlichen klinischen Bild bis hin zu schweren Hämorrhagien und Schock reichen. Zu den häufigsten Symptomen bei Reisenden gehören Fieber, Muskelschmerzen, Kopfschmerzen und Hautausschlag. Zur Diagnostik kommen, in Abhängigkeit vom Stadium der Infektion, patientennah einsetzbare Schnellteste oder – in der virämischen Phase – molekulare Erregerdirektnachweise infrage. Die serologische Diagnostik ist aufgrund von serologischen Kreuzreaktionen mit anderen Flaviviren hinsichtlich ihrer Interpretation anspruchsvoll.
http://ift.tt/2in3soj
Anti-aminoacyl-tRNA synthetase-related myositis and dermatomyositis: clues for differential diagnosis on muscle biopsy
Abstract
Anti-synthetase syndrome is an autoimmune disease characterized by autoantibodies toward amino acyl-tRNA synthetases (ARS), anti-Jo 1 being the most commonly detected. Muscle damage develops in up to 90% of ARS-positive patients, characterized by a necrotizing myositis restricted to the perifascicular region. This topographic distribution of muscle damage may lead to a misdiagnosis of dermatomyositis (DM) at muscle biopsy. We compared morphological, immunohistochemical, and histoenzymatic features of muscle from ARS-positive patients (n = 11) with those of DM (n = 7) providing clues for their differential diagnosis. In addition, we evaluated markers of mitochondrial damage to provide a further distinction between these two entities. Necrosis occurred in the majority of ARS patients, mainly located in the perifascicular region. It was often limited to small foci of fibers, always associated with myocyte regeneration. This last often overwhelmed necrosis, representing occasionally the main finding. In DM, necrosis/regeneration was scarce while the peculiar feature was a diffuse atrophy of perifascicular fibers. These last showed decreased cytochrome c oxidase (COX) stain and mitochondrial DNA depletion, consistent with mitochondrial dysfunction. In contrast to DM, ARS displayed scattered COX-deficient fibers, not restricted to the perifascicular region. This feature occurred in up to 91% of patients, being prominent only in two.
http://ift.tt/2zJo1VO
Peak Airflow Measurement in Patients With Glottic Insufficiency After Vocal Fold Augmentation
http://ift.tt/2hwo8JT
Implementing Quality Improvement and Patient Safety in Residency Education
http://ift.tt/2zLOge0
Association of Enrollment in an Aerodigestive Clinic With Reduced Hospital Stay
http://ift.tt/2xQyb20
Anesthesia Exposure and Neurotoxicity in Children
http://ift.tt/2zLOdik
Survival Outcomes for T3N0M0 Squamous Cell Carcinoma of the Glottic Larynx
http://ift.tt/2yzBLkW
Reporting of Effect Size and Confidence Intervals
http://ift.tt/2zLfotE
Error in Byline
http://ift.tt/2hwo1hr
Laryngoscopic Findings and Response to Gabapentin
http://ift.tt/2zLfmC2
Measuring Institutional Quality in Head and Neck Surgery Using Hospital-Level Data
http://ift.tt/2yzJLCi
Prognosis of 5-Year Survival of Chemoradiotherapy-Treated Patients With Nasopharyngeal Carcinoma
http://ift.tt/2hwnSdT
Nationwide Variation in Rates of Thyroidectomy Among US Medicare Beneficiaries
http://ift.tt/2xQk9gS
Extracapsular Dissection vs Superficial Parotidectomy
http://ift.tt/2hwyk55
Interferon-γ Treatment of Human Laryngotracheal Stenosis–Derived Fibroblasts
http://ift.tt/2zO6s4M
Minimal Important Difference in Voice Handicap Index–10
http://ift.tt/2xQihow
Double Parathyroid Adenomas in Monozygotic Twins
http://ift.tt/2xQjYSX
Krouse Classification for Sinonasal Inverted Papilloma With Recurrence
http://ift.tt/2yzNSOO
JAMA Otolaryngology–Head & Neck Surgery
http://ift.tt/2zNPX8N
Unusual Cause of Recurrent Meningitis
http://ift.tt/2hwsHUk
Analysis of the Growth Pattern of Thyroid Cancer in Young Patients
http://ift.tt/2zJ17xD
Rethinking the Growth Pattern of Thyroid Cancer in Young Patients Based on the Fukushima Database
http://ift.tt/2hvkfET
Editorial Board
Source:American Journal of Otolaryngology, Volume 38, Issue 6
http://ift.tt/2ALiVW2
Table of Contents
Source:American Journal of Otolaryngology, Volume 38, Issue 6
http://ift.tt/2ilI7vp
Guidelines for Contributing Authors
Source:American Journal of Otolaryngology, Volume 38, Issue 6
http://ift.tt/2AMixXh
Cutaneous squamous cell carcinomas (SCC) associated with cosmetic skin whitening: 8 cases reported in Senegal
Source:Annales de Dermatologie et de Vénéréologie
Author(s): F. Ly, P. Diousse, C. Ndiaye, A. Déme, B.A. Diatta, M.T. Ndiaye, M. Diallo, A. Diop, A.D. Kebe, F. Fall, A. Kane
BackgroundThe cosmetic use of bleaching products is common among women from sub-Saharan Africa. The most frequently used products are highly potent corticosteroids (clobetasol propionate) and hydroquinone. Herein, we report 8 cases of SCC in women using skin bleaching products for cosmetic purposes. Our aim is to describe the epidemiological, clinical and pathological aspects of the carcinomas observed during the course of skin lightening.MethodsWe conducted a descriptive multicentre study from August 2005 to January 2016 in three dermatology units in Senegal. We included all patients consulting for cutaneous squamous cell carcinoma associated with skin bleaching. Sociodemographic, clinical, paraclinical and therapeutic data were recorded.ResultsA total of 8 female patients were included. The mean age was 48.1 years (37–63 years). Topical hydroquinone and highly potent corticosteroids were the main products used over the whole body, for an average duration of 20.3 years. No pre-neoplastic skin disease was found in our patients. The clinical aspects of tumours were as follows: cauliflower-like (n=4), ulcerated (n=3) and nodular (n=1). The average development time before consultation was 6.75 months. All the cutaneous squamous cell carcinomas were localized to lichenoid lesions or exogenous ochronotic lesions on photo-exposed areas: face (n=1), neck (n=3) or upper back (n=4). The most common histopathological type was the infiltrating form and there was one case of in situ carcinoma. The outcome was favourable in six of eight patients after surgical resection. Two deaths occurred: one through tumour recurrence and the other through haemorrhagic shock.ConclusionsFrom 2005 to 2016, eight cases of cutaneous squamous cell carcinomas associated with cosmetic use of bleaching products were reported in Senegal. The mechanism was not fully elucidated and further studies are necessary. These observations provide an additional argument for combating this practice and including skin bleaching among known risk factors for squamous cell carcinoma.
http://ift.tt/2juvhi1
Source estimation of epileptic activity using eLORETA kurtosis analysis
Exact low-resolution brain electromagnetic tomography (eLORETA) is a technique for three-dimensional representation of the distribution of sources of electrical activity in the brain. Kurtosis analysis allows for identification of spiky activity in the brain. To evaluate the reliability of eLORETA kurtosis analysis, the results of the analysis were compared with those of equivalent current dipole (ECD) and synthetic aperture magnetometry (SAM) kurtosis analysis of magnetoencephalography (MEG) data in a patient with epilepsy with elementary visual seizures in a 6-year follow-up.
The results of electroencephalography (EEG) eLORETA kurtosis analysis indicative of a right superior temporal spike source partially overlapped with MEG ECD/SAM kurtosis results in all recordings, with a total overlapping at the end of the follow-up period. Overall findings suggest that eLORETA kurtosis analysis of EEG data may aid in the localisation of spike activity sources in patients with epilepsy.
http://ift.tt/2z7XH8B
Endovascular rescue treatment through stent positioning after surgical clipping of intracranial aneurysms complicated by parent artery obstruction
During aneurysm clipping, ischemic complications may occur and require a rescue treatment, usually surgical. We present two such cases that required urgent rescue treatment, performed through an endovascular route. Our first case presented with a non-ruptured right posterior inferior cerebellar artery (PICA) aneurysm. After permanent clip positioning, occlusion of the PICA occurred. An unsuccessful attempt of clip repositioning was performed. We therefore positioned a stent obtaining complete flow restoration. Our second case was that of a ruptured giant left middle cerebral artery aneurysm with focal critical stenosis of the parent vessel, likely due to an underlying dissection. Initially, the aneurysm was secured through coiling. However, after permanent clip positioning, parent artery occlusion occurred. DSA showed occlusion of the parent artery downstream to the clip and persistence of the preaneurismatic stenosis. We achieved full recanalization through stent positioning. In both cases, there were no ischemic or hemorrhagic complications.
http://ift.tt/2mwNtc1
Rare cause of adrenal insufficiency
A 72-year-old man presented with weight loss, night sweats and haemoptysis and was hypotensive. CT imaging showed rapidly enlarging bilateral adrenal masses, and he was found to have primary adrenal insufficiency. An adrenal gland biopsy revealed the rare diagnosis of primary adrenal lymphoma. This unique case highlights possible rare causes of adrenal masses and adrenal insufficiency, their investigation and management principles.
http://ift.tt/2z7TAt4
Primary intraventricular haemorrhage due to rupture of giant varix of the basal vein of Rosenthal in a patient with long-standing direct CCF: angiographic features and treatment considerations
Direct carotid cavernous fistulae (CCF) are often detected early and treated promptly resulting in a paucity of literature regarding its long-term evolution. We present a case of high flow post-traumatic direct CCF that was neglected for over 6 years and presented with a rare manifestation of primary intraventricular haemorrhage. Occlusions of the primary venous outlets likely resulted in engorgement of the deep venous system. The segmental anatomy of the shunting basal vein is critical to the clinical presentation and may range from basal ganglia or brainstem oedema/infarctions to uniquely, as in our case, isolated intraventricular haemorrhage secondary to variceal rupture. Treatment in such chronic cases requires a consideration of cerebral hyperperfusion syndrome necessitating deconstructive techniques with subsequent anticoagulation to avoid accelerated thrombosis of the venous varices.
http://ift.tt/2mvA9o9
Keratoderma blennorrhagica
Description
A 26-year-old woman, previously healthy, that a month ago started complaining of pain in the soles of both feet, which followed, additionally, to the right knee, the left knee, left elbow and right shoulder. She reported morning stiffness exceeding 1 hour that decreased with physical activity, worsened with rest, but improved with administration of non-steroidal anti-inflammatory drugs (NSAIDs). Three weeks later, skin lesions appeared on the soles of the feet.
Seven to 8 weeks before, the patient would have had two successive episodes of a urinary tract infection, treated, respectively, with fosfomycin and ciprofloxacin. The patient did not present gastrointestinal symptoms, previous weight loss or sweating.
On physical exam , it was verified pain at knee mobilisation, more intense in the left, where it presented articular effusion.
The cutaneous lesions were about 0.5 cm in diameter, were maculopapular, on a background of diffuse erythema and of desquamation on large blades (
http://ift.tt/2z6ylYD
Assessing the clinical applicability of prior head imaging in patients with chronic rhinosinusitis
Background
Patients often have received some modality of head imaging prior to being evaluated for chronic sinonasal complaints, and the clinical significance of these scans on current sinonasal symptomatology is unknown.
Methods
We performed a retrospective, cohort study of 578 patients with chronic sinonasal indications for maxillofacial computed tomography scans (CTs) in 2016. Patients were included if previous head cross-sectional imaging had been performed. Lund-McKay (LM) scores were calculated on the prior CT scan for each patient and compared to LM scores of the most recent scan. Scans with LM scores ≤3 were deemed normal, scores >3 were deemed positive, and Δ >3 was deemed a significant change.
Results
Of 578 patients, 153 (26.5%) patients had previous imaging. Overall, a strong correlation was noted between scans (r = 0.791, p < 0.001). Significant correlations remained with the subset of positive prior scans (r = 0.743, p < 0.001). The 3 most common prior imaging modalities were maxillofacial CT, head CT, and brain magnetic resonance imaging (MRI). Correlations between these modalities and subsequent maxillofacial CTs range from strong to moderately strong. Women were significantly more likely to have negative prior imaging (p = 0.048). Patients with negative prior imaging (80/153) were significantly more likely to remain unchanged (71/80) compared to patients with positive prior scans (56/73) (p = 0.023).
Conclusion
Prior head imaging highly correlates to future maxillofacial CT in patients with chronic sinonasal complaints, and patients with prior negative scans are likely to remain negative on future imaging. If prior head scans exist, practitioners may want to avoid ordering additional scans in the absence of changing symptoms.
http://ift.tt/2mxSFft
Eustachian tube dysfunction symptoms in patients treated in a tertiary rhinology clinic
Background
Ear symptoms are common among patients presenting to a rhinology clinic. Validated inventories are available for patient quality-of-life in sinonasal disease and Eustachian tube dysfunction (ETD). This study sought to determine the extent of ETD symptoms, using validated metrics, in a large population of patients presenting to a tertiary rhinology clinic.
Methods
Seven-item Eustachian Tube Dysfunction Questionnaires (ETDQ-7) and 22-item Sino-Nasal Outcome Tests (SNOT-22) were prospectively collected from 492 patients treated in a tertiary rhinology clinic. Patient diagnoses were retrospectively determined from the medical record. Correlation between reported SNOT-22 and ETDQ-7 scores were analyzed, in addition to the number of patients meeting the criterion score for ETD.
Results
A total of 213 patients reported mean ETDQ-7 scores >2.1, consistent with a diagnosis of ETD. Overall SNOT-22 scores were strongly correlated with ETDQ-7 scores (r = 0.679, p < 0.001). The SNOT-22 ear subdomain was very strongly correlated with the ETDQ-7 score (r = 0.847, p < 0.001), while there was a moderate correlation with the SNOT-22 rhinologic subdomain (r = 0.486, p < 0.001). Patients with allergic fungal sinusitis had decreased ETDQ-7 scores compared to patients with other rhinologic diagnoses (p = 0.010).
Conclusion
Symptoms of ETD are common in patients treated in a rhinology clinic, with 43.3% of patients reporting symptom scores consistent with a formal diagnosis of ETD. Increased SNOT-22 scores are correlated with increased ETDQ-7 scores, even when only the SNOT-22 rhinologic subdomain is considered. Patients presenting for treatment of rhinologic symptoms likely have an increased prevalence of otologic symptoms and ETD.
http://ift.tt/2z82tmo
Fibroadipose vascular anomaly treated with sirolimus: Successful outcome in two patients
Abstract
Fibroadipose vascular anomaly (FAVA) is a rare, complex mesenchymal malformation combining fibrofatty replacement of the affected muscles and slow-flow vascular malformation. The condition is characterized by localized swelling, severe pain, phlebectasia, and contracture of the affected limb. Treatment paradigms are not well established for this rare, recently recognized condition. We report two cases of FAVA in which treatment with sirolimus produced rapid, dramatic improvement in pain and quality of life.
http://ift.tt/2jwurRO
Considerations in surgical management of a Buschke–Lowenstein tumor in Netherton syndrome: A case report
Abstract
Netherton syndrome is an autosomal recessive ichthyosis caused by mutations in SPINK5, with the classic triad of linearis circumflexa, trichorrhexis invaginata, and atopy. There are few reports of surgical management in individuals with Netherton syndrome and clinicians may be reluctant to operate for fear of wound-healing complications. This report describes a pediatric case of a Buschke–Lowenstein tumor of the natal cleft in a patient with Netherton syndrome that had failed to respond to medical management. We reviewed the literature for previous cases of surgery in individuals with Netherton syndrome using MEDLINE and PubMed searches. Our patient underwent surgery to remove the lesion without complication. Using conventional dressings and topical negative-pressure therapy, the wound was managed and healed within a reasonable time frame despite the underlying skin condition. This case indicates that surgery and topical negative-pressure therapy is a safe and reasonable treatment for individuals with Netherton syndrome.
http://ift.tt/2jxSgZH
Infantile hemangiomas with conjunctival involvement: An underreported occurrence
Abstract
Background/Objectives
Infantile hemangiomas (IHs) involving the conjunctiva are only anecdotally reported in the literature and little is known about their clinical course. In a retrospective case series we aimed to better delineate the clinical presentation, complications, and response to treatment of this uncommon subtype of IH. A classification of conjunctival IH is proposed.
Methods
Medical charts at three academic pediatric dermatology institutions were retrospectively analyzed. Data were collected on the clinical characteristics, ophthalmologic findings, treatments, and outcomes of 22 individuals with conjunctival IH.
Results
Growth characteristics of conjunctival IH closely mirrored those of their cutaneous counterparts. Ophthalmologic abnormalities were associated with the IH in six individuals (27%); in three, they were considered severe. Seventeen subjects (77%) required treatment, most commonly because of risk of ocular compromise. All treated individuals responded favorably to topical timolol or systemic propranolol.
Conclusion
Conjunctival IH have clinical characteristics similar to those of cutaneous IH and respond readily to beta-blocker treatment. Ocular complications may occur in a minority of individuals receiving treatment.
http://ift.tt/2j0fio8
The triad of pruritus, xanthomas, and cholestasis: Two cases and a brief review of the literature
Abstract
When encountered in children, xanthomas are most commonly associated with a group of disorders known as familial hyperlipidemias. Aside from cosmetic concerns, these xanthomas are typically asymptomatic, but when generalized pruritus is a prominent associated symptom, clinicians should consider a different set of diagnoses that includes cholestasis of the liver. In this article we present two illustrative cases of children with cholestatic disease, pruritus, and xanthomas and discuss other disorders that may include this triad.
http://ift.tt/2hEf1dS
Evaluation of patient satisfaction in pediatric dermatology
Abstract
Background/Objectives
There remains a lack of investigation into which factors patients and families value the most in their experience at pediatric dermatology clinics. Most of the current literature on quality improvement in dermatology does not encompass the pediatric population. To determine the drivers that are most predictive of a positive patient experience, we observed the indirect relationship between several factors of the patient experience and their role in patient satisfaction.
Methods
Patient satisfaction surveys were distributed after their visits to patients at four pediatric dermatology clinics in one children's academic health system. Data were collected and organized into the top 30 survey variables with which patients expressed satisfaction on a 5-point Likert scale. Pearson product-moment correlation coefficients (r) for each variable with regard to "likelihood of your recommending our practice to others" were calculated.
Results
A total of 516 families completed patient satisfaction surveys. Analyses of top box scores showed that the strongest predictors of patient satisfaction were the likelihood of recommending care provider (r = .77, P = <.001), cheerfulness of practice (r = .76, P = <.001), care provider spoke using clear language (r = .73, P = <.001), patient confidence in care provider (r = .70, P = <.001), and our sensitivity to patient needs (r = .70, P = <.001).
Conclusion
The patient-physician relationship, along with the environment of the practice and its sensitivity to patients' personal needs, contributes most to the patient experience in pediatric dermatology. Identifying such variables that shape patients' assessments of their experience can guide future quality improvement plans in the specialty.
http://ift.tt/2zMTnZh
Characterization of children with recurrent eczema herpeticum and response to treatment with interferon-gamma
Abstract
Background/Objectives
Interferon gamma (IFN-γ) has been used treat severe atopic dermatitis, with equivocal results. Recurrent eczema herpeticum is an underappreciated, therapeutically challenging complication of severe atopic dermatitis. Defects in IFN-γ and other cytokine pathways have been identified in individuals with confirmed eczema herpeticum. This suggests possible benefit from IFN-γ treatment for confirmed eczema herpeticum. The objective of the current study was to evaluate immunologic and microbial parameters and response to IFN-γ treatment in children with confirmed eczema herpeticum.
Methods
We performed a retrospective review of medical records from eight children with confirmed eczema herpeticum and two children with severe atopic dermatitis without a history of eczema herpeticum treated with subcutaneous IFN-γ.
Results
Our cohort of children with confirmed eczema herpeticum was predominantly male and had high total serum immunoglobulin E, evidence of insufficient toll-like receptor responses, and streptococcal skin and pharyngeal colonization. The duration of IFN-γ administration was 4.5-25 months. Five children had initial control and then relapse. Three had interval flares. Two had no improvement. Injections were well tolerated, without significant adverse effects. Treatment was associated with an increase in total immunoglobulin E. Poor adherence complicated therapy in five patients. All 10 discontinued IFN-γ for poor perceived efficacy.
Conclusion
Children with confirmed eczema herpeticum have evidence of impaired innate and adaptive immunity. IFN-γ did not result in dramatic improvement in either subset. Specific evaluation for IFN-γ production, function, or receptor defects may help predict response.
http://ift.tt/2zMTkwz
Acute appendicitis presenting as a complicated inguinal hernia: a case of left-sided Amyand’s hernia in an elderly man
http://ift.tt/2AKRYll
Colon adenocarcinoma after jejunoileal bypass for morbid obesity
http://ift.tt/2AKNpaQ
Repair of giant inguinoscrotal hernia with loss of domain
http://ift.tt/2ALyehH
Predicting the atopic march: Results from the Canadian Healthy Infant Longitudinal Development Study
Source:Journal of Allergy and Clinical Immunology
Author(s): Maxwell M. Tran, Diana L. Lefebvre, Christoffer Dharma, David Dai, Wendy Y.W. Lou, Padmaja Subbarao, Allan B. Becker, Piush J. Mandhane, Stuart E. Turvey, Malcolm R. Sears
BackgroundThe atopic march describes the progression from atopic dermatitis during infancy to asthma and allergic rhinitis in later childhood. In a Canadian birth cohort we investigated whether concomitant allergic sensitization enhances subsequent development of these allergic diseases at age 3 years.MethodsChildren completed skin prick testing at age 1 year. Children were considered sensitized if they produced a wheal 2 mm or larger than that elicited by the negative control to any of 10 inhalant or food allergens. Children were also assessed for atopic dermatitis by using the diagnostic criteria of the UK Working Party. At age 3 years, children were assessed for asthma, allergic rhinitis, food allergy, and atopic dermatitis. Data from 2311 children were available.ResultsAtopic dermatitis without allergic sensitization was not associated with an increased risk of asthma at age 3 years after adjusting for common confounders (relative risk [RR], 0.46; 95% CI, 0.11-1.93). Conversely, atopic dermatitis with allergic sensitization increased the risk of asthma more than 7-fold (RR, 7.04; 95% CI, 4.13-11.99). Atopic dermatitis and allergic sensitization had significant interactions on both the additive (relative excess risk due to interaction, 5.06; 95% CI, 1.33-11.04) and multiplicative (ratio of RRs, 5.80; 95% CI, 1.20-27.83) scales in association with asthma risk. There was also a positive additive interaction between atopic dermatitis and allergic sensitization in their effects on food allergy risk (relative excess risk due to interaction, 15.11; 95% CI, 4.19-35.36).ConclusionsAtopic dermatitis without concomitant allergic sensitization was not associated with an increased risk of asthma. In combination, atopic dermatitis and allergic sensitization had strong interactive effects on both asthma and food allergy risk at age 3 years.
http://ift.tt/2hDITH6
Collagen: A review on its sources and potential cosmetic applications
Summary
Collagen is a fibrillar protein that conforms the conjunctive and connective tissues in the human body, essentially skin, joints, and bones. This molecule is one of the most abundant in many of the living organisms due to its connective role in biological structures. Due to its abundance, strength and its directly proportional relation with skin aging, collagen has gained great interest in the cosmetic industry. It has been established that the collagen fibers are damaged with the pass of time, losing thickness and strength which has been strongly related with skin aging phenomena [Colágeno para todo. 60 y más. 2016. http://ift.tt/2hEKgFt.]. As a solution, the cosmetic industry incorporated collagen as an ingredient of different treatments to enhance the user youth and well-being, and some common presentations are creams, nutritional supplement for bone and cartilage regeneration, vascular and cardiac reconstruction, skin replacement, and augmentation of soft skin among others [J App Pharm Sci. 2015;5:123-127]. Nowadays, the biomolecule can be obtained by extraction from natural sources such as plants and animals or by recombinant protein production systems including yeast, bacteria, mammalian cells, insects or plants, or artificial fibrils that mimic collagen characteristics like the artificial polymer commercially named as KOD. Because of its increased use, its market size is valued over USD 6.63 billion by 2025 [Collagen Market By Source (Bovine, Porcine, Poultry, Marine), Product (Gelatin, Hydrolyzed Collagen), Application (Food & Beverages, Healthcare, Cosmetics), By Region, And Segment Forecasts, 2014 – 2025. Grand View Research. http://ift.tt/2sgOUco. Published 2017.]. Nevertheless, there has been little effort on identifying which collagen types are the most suitable for cosmetic purposes, for which the present review will try to enlighten in a general scope this unattended matter.
http://ift.tt/2hC5ow2
High plasma 25-hydroxyvitamin D and high risk of non-melanoma skin cancer: a Mendelian randomisation study of 97849 individuals
Abstract
Background
High plasma 25-hydroxyvitamin D (25 (OH)D) concentration has been associated observationally with high risk of non-melanoma skin cancer, while many studies suggest that vitamin D could have a protective effect on cancer. The true association between vitamin D and risk of skin cancer remains unclear.
Objectives
In this Mendelian randomisation study we tested the hypothesis that genetically high plasma 25(OH)D protects against non-melanoma skin cancer.
Methods
We included 103084 individuals from the Danish general population, of whom 35 298 had plasma 25(OH)D measured and 97849 were genotyped for four genetic variants near the DHCR7 and CYP2R1 genes associated with 25(OH)D concentrations. We tested the association between plasma 25(OH)D levels and non-melanoma skin cancer observationally, and between genetically determined 25(OH)D levels and non-melanoma skin cancer through an instrumental variable approach.
Results
Multivariable adjusted hazard ratios of non-melanoma skin cancer were 3.27 (95%CI: 2.22;4.84) for plasma 25(OH)D≥50 nmol/L versus <25 nmol/L. Genetic variants around DHCR7 and CYP2R1 genes were associated with up to 8.2 nmol/L higher 25(OH)D concentrations (F=314). The odds ratio for a genetically determined 20 nmol/L higher plasma 25(OH)D was 1.11 (0.91-1.35) for non-melanoma skin cancer, with a corresponding observational multivariable adjusted odds ratio of 1.13 (1.10-1.17).
Conclusion
Genetically determined high 25(OH)D did not appear to protect against non-melanoma skin cancer, while high plasma 25(OH)D concentrations were associated with high risk of non-melanoma skin cancer in observational analysis. Thus, the observational association likely reflects confounding by sun exposure rather than causality.
This article is protected by copyright. All rights reserved.
http://ift.tt/2z7x7fO
Analysis of anti-TNF-induced skin lesions reveals strong Th1 activation with some distinct immunological characteristics
Abstract
Background
Psoriasiform and eczematous eruptions are the most common dermatological adverse reaction linked to anti-TNF-α therapy. Yet, a detailed characterization of their immune phenotype is lacking.
Objectives
We sought to characterize anti-TNF-α induced inflammatory skin lesions on a histopathologic, cellular and molecular level, compared to psoriasis, eczema (atopic dermatitis), and healthy control skin.
Methods
Histopathologic evaluation, gene expression (quantitative RT-PCR) and computer-assisted immunohistologic studies (TissueFAXS) were performed on 19 skin biopsies from IBD (n=17) and rheumatoid arthritis (n=2) patients with new-onset inflammatory skin lesions during anti-TNF-α-therapy.
Results
While most biopsies showed a psoriasiform and/or spongiotic (eczematous) histopathologic architecture, these lesions were inconsistent with either psoriasis or eczema on a molecular level using an established CCL27/iNOS classifier. Despite some differences in immune skewing depending on the specific histopathologic reaction pattern, all anti-TNF-α-induced lesions showed strong IFN-γ activation, at higher levels than in psoriasis or eczema. IFN-γ was most likely produced by CD3/CD4/Tbet-positive Th1 lymphocytes.
Conclusions
New-onset anti-TNF-α-induced eruptions previously classified as psoriasis or spongiotic dermatitis (eczema) exhibit a molecular profile that is different from either of these disorders.
This article is protected by copyright. All rights reserved.
http://ift.tt/2mw9847
Don’t crush the sensitive snout. Reply to: Sensitivity is not enough
http://ift.tt/2ASoHG8
Landmarks in UK anaesthesia
http://ift.tt/2yM12WJ
Limitations of clinical studies evaluating tertiary hyperalgesia
http://ift.tt/2ARIAx0
Intraoperative permissive oliguria – how much is too much?
http://ift.tt/2ARIrcW
Author's reply to Thomas et al.
http://ift.tt/2yKMJl7
Cerebral blood flow and its autoregulation - when will there be some light in the black box?
http://ift.tt/2AR1WCB
Reply to: Pulse oximeter perfusion index for assessment of brachial plexus block: a holy grail or a design fail?
Correlational studies of unconsciousness under anaesthesia: how far can preclinical studies take us?
http://ift.tt/2yL8Ho2
New nomenclature: Clarion call or siren song. Reply to: perioperative cognitive disorders
http://ift.tt/2yMo5Re
In the December issue…
http://ift.tt/2yMVknx
25th Annual Meeting of Chinese Society of Anesthesiology
http://ift.tt/2AQNAlT
Why has NHS England introduced an innovation and technology tariff to improve safer arterial systems in England?
http://ift.tt/2yLN470
Pulse oximeter perfusion index for assessment of brachial plexus block: a holy grail or a design fail?
http://ift.tt/2ARzoJh
Formulation of a National Surgical Plan in Rwanda: a model for integration of physician and non-physician anaesthetists
http://ift.tt/2yLMTsm
Sensitivity is not enough. Response to: Postoperative delirium portends descent to dementia
http://ift.tt/2ATwrrK
The role of propofol for remote ischaemic preconditioning in the setting of cardiac surgery – a Cochrane systematic review †
http://ift.tt/2yNrJud
Perioperative cognitive disorders. Response to: Postoperative delirium portends descent to dementia
http://ift.tt/2yO6zvF
Does intraoperative magnesium lessen pain after knee replacement surgery?
http://ift.tt/2yKkDX3
Response to: ‘Failed supraglottic airway’: an algorithm for suboptimally placed supraglottic airway devices based on videolaryngoscopy
http://ift.tt/2yKA8OL
Reply to: Does intraoperative magnesium lessen pain after knee replacement surgery?
Headache in Resource-Limited Settings
Abstract
Purpose of Review
This review summarizes the unmet need of headache burden and management in resource-limited settings. It provides a general overview of the nuances and peculiarities of headache disorders in resource-limited settings. The review delivers perspectives and explanations for the emerging burden of both primary and secondary headache disorders. Important discussion on demographic and epidemiologic transition pertinent to low-resource settings is included. A critical analysis of headache disorders is made within the context of growing burden non-communicable disorders in low-resource countries. Challenges are examined and prospective feasible solutions tailored to existing resources are provided to address headache disorders in resource-limited settings.
Recent Findings
Many low-resource countries are entering into the third epidemiological transition featuring increasing burden of non-communicable disorders of which headache disorders contribute a significant proportion. Exponential population growth involving youthful demographic and massive rural-urban migration is taking place in low-resource countries. Youthful demographic is the natural cohort for primary headache such as migraine. Socioeconomic mobility and lifestyle changes are leading to higher levels of physical inactivity and obesity, both of which are related to headache. Life expectancy is rising in some resource-restricted countries; this increases prevalence of secondary headache attributed to neurovascular causes. Many low-resource countries are still burdened with tropical infectious causes of secondary headache. Health care facilities are primarily designed to respond to infectious epidemic and not to chronic burden such as headache. Many low-resource-restricted settings are plagued by poor and corrupt governance, ill-equipped regimes with malfunctioning health policies, war, and poverty. Many low-resource settings do not have access to generic headache medications such as triptans. Headache training and expertise is low. Healthy lifestyle changes emphasizing on improving regular exercise can be inexpensive method to reducing primary headache burden and its comorbidities (e.g. obesity).
Summary
Addressing the increasing burden of headache disorders in resource-limited settings is important to avert accrued disability which in turn lowers productivity and socioeconomic performance in a young booming population.
http://ift.tt/2zLnAKf
Patterns of allergic sensitization and atopic dermatitis from 1 to 3 years: effects on allergic diseases
Abstract
Background
While allergic sensitization and atopic dermatitis (AD) are known to increase the risk for allergic diseases, the impact of different temporal and clinical patterns of sensitization and AD is less well defined.
Objective
We investigated patterns of sensitization and AD from early infancy to age 3, and the differential risk for developing allergic diseases within each pattern in a general cohort.
Methods
Children (n=2629) from the Canadian Healthy Infant Longitudinal Development (CHILD) Study underwent skin prick tests and were assessed clinically for AD at ages 1 and 3 years. We applied an unsupervised latent class analysis (LCA) to the following 5 factors at these ages: AD, food sensitization, inhalant sensitization, poly-sensitization to foods, and poly-sensitization to inhalants. The risks for developing asthma, allergic rhinitis and food allergy at 3 years were evaluated for each identified group.
Results
Five distinct classes were revealed by LCA: healthy (81.8%), atopic dermatitis (7.6%), inhalant sensitization (3.5%), transient sensitization (4.1%), and persistent sensitization (3.2%). Using healthy children as the baseline, children in the "atopic dermatitis" group had the next lowest risk for all allergic outcomes at 3 years; those in the "inhalant sensitization" group had the highest risk for allergic rhinitis; children in the "transient sensitization" group were at an increased risk for food allergy; while children in the "persistent sensitization" group had the highest risk for all allergic diseases.
Conclusion and Clinical Relevance
There is substantial heterogeneity among allergen-sensitized children. Researchers and clinicians need to be aware of the non-specificity associated with labelling children simply as "atopic" and "non-atopic" without considering the timing of their atopic history, type of sensitization, and AD status. Children with AD who were poly-sensitized to foods at an early age appear to be at greatest risk of developing other allergic diseases.
This article is protected by copyright. All rights reserved.
http://ift.tt/2jv6DOe
Asthma and Lung Function in Adulthood after a Viral Wheezing Episode in Early Childhood
Abstract
Background
Viral etiology of infection has a significant role in the long-term outcome of early-childhood wheezing.
Objective
This study examines asthma and lung function in adulthood after early-childhood wheezing induced by respiratory syncytial virus (RSV) and rhinovirus (RV).
Methods
A total of 100 children were hospitalized for a wheezing episode at less than 24 months of age from 1992 to 1993 in Kuopio University Hospital (Finland). Adenovirus, influenza A and B virus, parainfluenza (1-3) virus, and RSV were tested on admission using antigen detection and antibody assays, and RSV and RV were tested by polymerase chain reaction (PCR). In 2010, 49 cases and 60 population controls attended a follow-up study, which included spirometry with bronchodilation test and fractionally exhaled nitric oxide (FENO) measurements.
Results
Current asthma was present in 64% of the cases with RV-induced wheezing [OR 17.0 (95%CI 3.9-75.3) vs. controls], in 43% of the cases with RSV-induced wheezing episode [6.1 (1.5-24.9) vs. controls], and in 12% of the controls. The RV group showed significantly higher mean FENO values than the RSV group and controls. RV-positive cases had lower MEF50 before bronchodilation and higher MEF50, FEV1, and FEV1/FVC bronchodilation responses than controls. RSV-positive cases had lower FVC than controls before bronchodilation.
Conclusion
Cases with RV- and RSV-induced early-childhood wheezing had increased risk for asthma in adulthood, and RV-positive cases had significantly higher FENO values than RSV-positive cases and controls. Compared to controls RV-positive cases showed more bronchial reactivity, and RSV-positive cases showed lower FVC before bronchodilation in lung function testing.
Clinical relevance
Children with RV- or RSV-induced wheezing in early childhood have an increased risk for asthma and lung function abnormalities in adulthood.
This article is protected by copyright. All rights reserved.
http://ift.tt/2hDCvQo
Case 35-2017: A 57-Year-Old Woman with Hypoesthesia and Weakness in the Legs and Arms
http://ift.tt/2zIAuJc