Head and Neck Medicine by Alexandros G.Sfakianakis: 11/17/17

Παρασκευή 17 Νοεμβρίου 2017

Q-switched 532nm laser energy causes significant vascular damage in the capillary plexus – how does this affect laser tattoo removal?

Abstract

Tattoos can be effectively removed using Q-switched and picosecond lasers at four wavelengths – 1064, 755, 694 and 532nm^1,2,3,4. However, there are two particular problems with the 532nm line. Firstly, it is well absorbed by the melanin in the epidermis, due to its relatively high absorption coefficient⁵, (μ_{a_mel} = 56 cm⁻¹ for typical Caucasian skin). Secondly, 532nm is also strongly absorbed in the haemoglobin located in the capillary plexus⁵ (μ_{a_HbO} = 260 cm⁻¹).

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How well are reporting guidelines and trial registration used by dermatology journals to limit bias? A meta-epidemiological study

Abstract

Reporting guidelines were created to ensure research is reported in a transparent, complete manner that minimizes reporting bias. Further, these guidelines assist editors and peer reviewers when reviewing manuscripts for publication and readers when critically appraising published articles ¹. Though reporting guidelines and trial registration have been associated with improved reporting quality, the full effect of these guidelines has yet to manifest because many journals do not require their use ².

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The expanding spectrum of clinical phenotypes associated with PSTPIP1 mutations: from PAPA to PAMI syndrome and beyond

Abstract

Mutations in the PSTPIP1 gene encoding proline-serine-threonine-phosphatase interactive protein 1 were first identified in an autosomal dominant syndrome called PAPA associated with pyogenic sterile arthritis, pyoderma gangrenosum (PG) and cystic acne.^1,2. We report a patient with an autoinflammatory syndrome called PSTPIP1-associated myeloid-related proteinemia inflammatory (PAMI) syndrome.³ A 23-year-old man had a 3-year-history of skin ulcerations.

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Response to ‘Clinical presentation of terbinafine-induced severe liver injury and the value of laboratory monitoring: a critically appraised topic’

Abstract

We read with interest the article by Kramer et al entitled "Clinical presentation of terbinafine-induced severe liver injury and the value of laboratory monitoring: a critically appraised topic". ¹ We would like to bring to focus our experience in this regard. With increasing concerns of reduced susceptibility to terbinafine² and an upsurge of recalcitrant cutaneous dermatophytoses, dermatologists in India have been using higher doses of terbinafine for cutaneous dermatophytoses, as used in the early literature with this drug (upto 500mg/day in single or divided doses) ³; and for longer periods of time.

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Response to “IL-36 in hidradenitis suppurativa: Evidence for a distinctive pro-inflammatory role and a key factor in the development of an inflammatory loop”

Abstract

we read with interest the recent paper of Hessam et al.¹ regarding the involvement of IL-36 in hidradenitis suppurativa (HS). They have showed that agonist members of IL-36 were significantly overexpressed in HS lesional skin.

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Chronic sun exposure is associated with distinct histone acetylation changes in human skin

Abstract

Background

Photoaging is attributed to continuous sunlight or artificial UV exposure and manifests the clinical and histological changes of skin. Epigenetic changes have been found to be involved in the pathogenesis of photoaging. However, the underlying mechanisms are unclear.

Objectives

To analyse histone modification patterns in sun-exposed and non-exposed skins, and identify the abnormally histone modified-genes related to photoaging.

Methods

Skin biopsies were collected both from the outer forearm (sun-exposed area) and the buttock (sun-protected area) in 20 healthy middle-aged female volunteers. Global histone H3/H4 acetylation and H3K4/H3K9 methylation statuses were assessed by ELISA. Expression levels of HATs and HDACs were measured by RT-qPCR and western blot. ChIP-chip assay with anti-acetyl-histone H3 antibody in sun-exposed Pool (combining six sun-exposed skin samples) and non-exposed Pool (combining six non-exposed skin samples) was conducted to explore the abnormal histone H3 acetylation genes related to photoaging, then ChIP-qPCR was followed to verify the results of ChIP-chip.

Results

We observed higher global histone H3 acetylation level, increased P300 and decreased HDAC1 and SIRT1 expression in sun-exposed skins, compared with matched non-exposed skins. Further, ChIP-chip assay results showed that 227 genes displayed significant hyperacetylation of histone H3, and 81 genes displayed significant hypoacetylation of histone H3 between the two groups. Histone H3 acetylations levels on the promoters of PDCD5, ITIH5, MMP1 and AHR were positively correlated with the mRNA expression of the corresponding gene.

Conclusions

Chronic sun exposure induced histone H3 hyperacetylation may play a critical role in the pathogenesis of skin photoaging.

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Aprepitant improves refractory pruritus in primary cutaneous T-cell lymphomas: experience of the Spanish Working Group on Cutaneous Lymphomas

Abstract

Aprepitant has shown a promising anti-itch activity in several cases of cutaneous T-cell lymphomas (CTCLs)^1-8. We sought to determine its antipruritic efficacy in a large multicenter series of CTCLs patients with refractory pruritus and, secondarily, to define possible clinical predictors of response.A retrospective, analytical review of the Spanish Working Group on Cutaneous Lymphoma database was designed to collect patients with CTCLs and refractory pruritus, treated with aprepitant from 2009 to 2013.

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Correction to: Pain, Psychological Comorbidities, Disability, and Impaired Quality of Life in Hidradenitis Suppurativa

Abstract

The original version of this article contains an error in the spelling of the title. The title should read: Pain, Psychological Comorbidities, Disability, and Impaired Quality of Life in Hidradenitis Suppurativa.

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8 Cereals proteins

Publication date: 2018
Source:Proteins in Food Processing
Author(s): N. Guerrieri, M. Cavaletto
The cereals are the most important food crop in the world; the proteins of maize, rice, and wheat are the most popular energy food. Since the world demand for food is constantly increasing, minor cereals and pseudocereal proteins are gaining more and more attention. They have been utilized from ancient times for the production of local traditional foods; now, they are introduced on international markets as innovative products and healthy foods. Cereal proteins are mainly stored in the endosperm, the largest portion of the seed, and are traditionally classified in albumin, globulin, prolamin, and glutelin. This chapter highlights the impact of cereal proteins on functional properties for food processing, since the bulk of all cereals, with the exception of rice, are consumed in processed foods.

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Allergen manufacturing and quality aspects for allergen immunotherapy in Europe and the United States: An analysis from the EAACI AIT Guidelines Project

Abstract

Adequate quality is essential for any medicinal product to be eligible for marketing. Quality includes verification of the identity, content and purity of a medicinal product in combination with a specified production process and its control. Allergen products derived from natural sources require particular considerations to ensure adequate quality. Here, we describe key aspects of the documentation on manufacturing and quality aspects for allergen immunotherapy products in the European Union and the United States. In some key parts, requirements in these areas are harmonized while other fields are regulated separately between both regions. Essential differences are found in the use of Reference Preparations, or the requirement to apply standardized assays for potency determination. Since the types of products available are different in specific regions, regulatory guidance for such products may also be available in one specific region only, such as for allergoids in the European Union. Region-specific issues and priorities are a result of this. As allergen products derived from natural sources are inherently variable in their qualitative and quantitative composition, these products present special challenges to balance the variability and ensuring batch-to-batch consistency. Advancements in scientific knowledge on specific allergens and their role in allergic disease will consequentially find representation in future regulatory guidelines.

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Patient-reported health outcomes in patients with non-melanoma skin cancer and actinic keratosis: Results from a large scale observational study analysing effects of diagnoses and disease progression

Abstract

Background

Non-melanoma skin cancer (NMSC) and actinic keratosis (AK) are very common among fair-skinned individuals. A disease continuum from AK to squamous cell carcinoma (SCC) has been frequently postulated. AK and NMSC may influence quality of life (QL) of patients, and it can be suspected that disease progression entails a QL reduction. The purpose of this study was to document QL in patients with NMSC and AK using the health-outcome questionnaire EQ-5D-5L.

Methods

The study was designed as a non-interventional, prospective, cross-sectional study. Patients with AK, SCC, basal cell carcinoma (BCC) or multiple diagnoses were enrolled in this study in 29 dermatological centres across Germany. Patients were asked to complete the EQ-5D-5L (compromising EQ Index and EQ VAS), and the dermatologists provided diagnosis, disease history and treatment data.

Results

A total of 1,184 patients were enrolled and diagnosed as follows: 73% AK, 49% BCC and 17% SCC. 66% had a single diagnosis, 28% two different diagnoses and 6% three different diagnoses. QL was strongly associated with patients' diagnosis. Patients with a single AK diagnosis had significantly higher mean EQ VAS (78) than patients with BCC (74), SCC (72), and BCC plus SCC (69), p < .050. When the effects of disease progression were calculated, patients with AK plus SCC reported significantly less mean EQ VAS (71) than patients with a single AK diagnosis (78), p < .011.

Conclusions

While rarely being imminently life-threatening, NMSC and AK have an impact on QL as quantified by the EQ-5D-5L. This impact is associated with diagnosis (AK vs. NMSC) and clinical progression (AK vs. AK plus SCC). Both lead to a clear decline in QL. This shows that disease progression is perceived and judged as detrimental by patients and that AK and NMSC should be diligently treated to preserve and restore QL.

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Sodium chloride pica causing recurrent nephrolithiasis in a patient with iron deficiency anemia: a case report

Iron deficiency anemia is a common finding in women of child-bearing age. Pica, or the ingestion of non-food or non-nutritive items, is a well-known manifestation of iron deficiency. A high sodium diet increas...

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Metabolic Profile in Patients with Mild Obstructive Sleep Apnea

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

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The Challenge of Emerging Viruses

Viral Immunology , Vol. 0, No. 0.

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The Unexpected Impact of Vaccines on Secondary Bacterial Infections Following Influenza

Viral Immunology , Vol. 0, No. 0.

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Victimization and Human Immunodeficiency Virus-Related Risk Among Transgender Women in India: A Latent Profile Analysis

Violence and Gender , Vol. 0, No. 0.

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Patients with Spitz nevi in the Greek population: Epidemiologic, Clinical, and histopathological characteristics

Abstract

Background

Spitz nevi may present with clinical and histopathological atypical features that do not affect patient prognosis, but may become worrisome for patients ≥40 years presenting with newly appearing SN.

Objective

Patient characteristics and sun behavior patterns were investigated in correlation with age. SN characteristics and histopathological attributes were also investigated in correlation with age.

Methods

Patients with histopathologicaly confirmed diagnosis of SN were invited for a clinical examination. Data such as skin type, number of banal/atypical nevi, sun exposure patterns, personal/family history etc., were collected. Histopathology preparations were re-examined by two different histopathologists and characteristics were collected based on a prespecified checklist. Patients were afterwards followed-up every 6 months.

Results

110 patients with SN were identified and assigned to 3 age groups. The most common area of presentation was the trunk, for the ≥40 years age group, and the limbs for the other age groups. Patients ≥40 years had a higher possibility of presenting with a nevus count ≥50 and at least one atypical nevus compared to the other age groups. Patients ≥40 years presented more commonly with a history of painful sunburn (100%) before the appearance of the SN, used less sunscreen, had higher sun exposure times and more clinical signs of solar skin damage compared to the other age groups. Finally, patients ≥40 years presented more commonly with signs of histopathological atypia such as presence of mitoses, cellular atypia and prominent nucleolus.

Conclusion

Patients ≥40 were more likely to report a history of longer sun exposure times, of never using a sunscreen and of having a history of painful sunburn. However, the importance of this observation remains to be elucidated since these patients also presented more commonly with lesions located on non-sun exposed areas (trunk), and higher nevus/atypical nevus counts.

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Acute and Recurrent Facial Pustulosis: A Unique Clinical Entity?

We report a series of three patients encountered in a tertiary referral center that share a rare constellation of clinical and histopathologic findings. In each case, a healthy female patient reported recurrent episodes of rapidly-appearing, tightly-clustered, fine pustules on a background of light erythema involving the chin, forehead, cheeks, and neck (Figure 1). These episodic eruptions, which occurred approximately 4-6 episodes per year, were associated with mild pruritus, and relapsed and remitted within 5 days without therapeutic intervention.

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A Slowly Developed Severe Cutaneous Adverse Reaction to Idelalisib

Intracellular signal mediator phosphatidylinositol-3-kinase (PIK3K) –δ, an isoform of PIK3K, is expressed in hematopoietic cells especially in lymphoid lineage 1. Idelalisib is a novel PIK3K-δ targeted kinase inhibitor which is approved for relapsed follicular B-cell non-Hodgkin lymphoma as a monotherapy and in combination with rituximab, an anti-CD20 antibody, for relapsed chronic lymphocytic leukemia (CLL) 2. Only one case describing the clinical features of severe cutaneous adverse reaction (SCAR) of idelalisib in detail has been previously published 3. Here we expand the clinical picture of SCAR caused by idelalisib with its histological profile.

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Plantar Eumycetoma by Madurella mycetomatis in a heart-transplanted patient living in Portugal

Eumycetoma is a chronic granulomatous fungal infection of dermal and subcutaneous tissue rarely seen in Europe. It is characterized by a painless subcutaneous mass with drainage of macroscopic grains through sinus tracts,^1,2 spreading with severe tissue destruction, including fascia and bone.

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Finding the needle in the haystack is teledermoscopy's task

We read with interest the recent letter in this journal by Kukutsch et al. as to the opinion of an international group of experts on dermoscopy about the practice of teledermoscopy (TDC) between primary care physicians (PCPs) and a remote dermatologist.

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Recognizing the haystack is the task of the primary care physician

In a reply to our letter Ferrandiz and colleagues wondered why dermoscopy experts did not already fully embrace teledermoscopy (TD) for suspicious pigmented skin lesions.¹ Our study showed that the structure of the health systems that were investigated differed, with countries where primary care physicians (PCP) hold a gate keeper function and others with direct access to a dermatologist. Significant differences in waiting time and travel distance were observed.² Since we believe that there is enough evidence that the addition of high quality dermoscopic pictures to a teleconsultation leads to higher accuracy of the diagnosis we did not investigate this question in our survey.

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Editorial Board

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Optimal blood pressure decreases acute kidney injury after gastrointestinal surgery in elderly hypertensive patients: A randomized study

To determine the appropriate mean arterial pressure (MAP) control level for elderly patients with hypertension during the perioperative period.

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Bi-orifice approach to nasal intubation in children: A case series of anticipated difficult airways undergoing orthognathic surgeries

Airway management of pediatric patients with craniofacial disorders can be challenging, especially when compounded by the surgical requirement for nasal intubation. Life-threatening complications can occur during induction of general anesthesia in patients with abnormal anatomy (laryngospasm, inability to mask ventilate due to obstruction, total loss of airway, death) [1,2,3]. Although awake nasal fiberoptic intubation (FOI) is a common method of securing adult difficult airways, it may not be appropriate for children due to emotional, physiological, and anatomical differences.

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The effect of sevoflurane compared to propofol maintenance on post-surgical quality of recovery in patients undergoing an ambulatory gynecological surgery: A prospective, randomized, double-blinded, controlled, clinical trial

The main objective of the current investigation was to evaluate the effect of propofol used as anesthetic maintenance compared to sevoflurane on global post-surgical quality of recovery in female patients undergoing ambulatory gynecological surgery.

http://ift.tt/2zNPTrw

A case of midazolam anaphylaxis during a pediatric patient's first anesthetic

Perioperative anaphylaxis remains a relatively rare (with an estimated incidence 1:3,5000 to 1:20,000) but important cause of morbidity and mortality [1]. Common causes include neuromuscular blockers, antibiotics, and latex [1,2]. Diagnosis of perioperative anaphylaxis may be delayed, as general anesthesia may mask the characteristic symptoms of hypotension, rash, and airway swelling. Herein we present a case of midazolam anaphylaxis in a child's first anesthetic.

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Anesthetic management of a patient with benign tracheal tumor identified at induction of general anesthesia

Benign tumors of the tracheobronchial tree are quite rare [1] and are sometimes misdiagnosed as asthma or chronic obstructive pulmonary disease (COPD) when the symptoms are not severe [1,2,3]. Delayed diagnosis is common and these tumors may not be identified for a long time if they are slow growing [1,2,3]. In such cases, routine examinations such as chest radiography will not reveal the tumor before elective surgery [1,3] and it is possible that induction of general anesthesia will be initiated before the anesthetist recognizes that there is a tumor in the tracheobronchial tree.

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Intermittent bilateral anterior sub-costal quadratus lumborum block for effective analgesia in lower abdominal surgery

As one of new quadratus lumborum (QL) blocks, the anterior sub-costal QL block has been reported to be an effective analgesic in lower abdominal surgery [1]. However, there have been no reports on the efficacy of the anterior sub-costal QL block over the long postoperative period. In this article, we report two successful cases of intermittent anterior sub-costal QL block in lower abdominal surgery for pain management during the long postoperative period.

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A novel approach for performing ultrasound-guided maxillary nerve block

Maxillary nerve block has traditionally been performed using fluoroscopy. In recent years, ultrasonography has provided a useful method for needle guidance when performing maxillary nerve block, as well as other blocks [1–5]. The coronoid approach is popular for ultrasound guidance [1–4]. However, this approach is challenging due to some disadvantages of the technique.

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Combined spinal epidural in a parturient with tinea versicolor

Tinea versicolor is a benign condition with a prevalence of 2–8% in the United States [1]. The yeast, Malassezia globosa, a normal component of skin flora, can become pathogenic with exposure to heat and humidity and in immunosuppressive conditions such as pregnancy. Tinea versicolor responds to antifungal medications but recurrence is common. We present a case of a pregnant patient with a longstanding diagnosis of tinea versicolor in whom we performed a combined spinal technique for labor analgesia after exploring and discussing the theoretical risks.

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Postpartum tubal ligation: A retrospective review of anesthetic management at a single institution and a practice survey of academic institutions

The primary aim was to evaluate institutional anesthetic techniques utilized for postpartum tubal ligation (PPTL). Secondarily, academic institutions were surveyed on their clinical practice for PPTL.

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Surgeon assisted quadratus lumborum block – ‘Gaurav-Aditi’ technique case series

Quadratus lumborum block (QLB) is a new abdominal wall block which has been used successfully for the post operative pain management of patients undergoing abdominal surgeries [1,2]. Classically QLB can be given in four different approaches using ultrasound [3]. In many developing countries like India ultrasound is still not available at all centers. Many times in patients with central obesity it is difficult to perform this block using ultrasound [4]. So we present a new 'Gaurav-Aditi' technique of performing the QLB, wherein post-operative pain of six patients who were undergoing open radical nephrectomy was managed successfully.

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Anesthetic management for retrieval of a large aspirated denture in a patient with Parkinson's disease

Airway foreign body aspiration is uncommon in adults. It is particularly likely in patients with impaired cough reflexes and reduced sensorium due to drugs, alcohol, or neurological dysfunction. Dental prosthetics are the most common foreign bodies aspirated in patients with Parkinson's disease [1]. If a large denture is aspirated, the airway can become totally obstructed. Below, we describe the challenging anesthetic management of a patient with Parkinson's disease who required removal of a large intratracheal denture via rigid bronchoscopy.

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Reversal of trend in near infrared spectroscopy [NIRS] values in a patient with carotid artery stenosis

Near Infrared Spectroscopy (NIRS) monitors continuous non-invasive regional oxygen balance within the frontal cerebral cortex. Cerebral vasoneural coupling ensures that local brain metabolism increase is met normally with augmented regional blood flow [1]. Anaesthetics agents play a vital role and so rising doses of cortical suppressant anaesthetics may increase rSO2 as oxygen consumption is decreased [2].

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Strategies to prevent ischemic optic neuropathy following major spine surgery: A narrative review

Postoperative vision loss following a major spine operation is a rare but life-changing event. Most of reports have been linked to ischemic optic neuropathy, and patients undergoing surgery for scoliosis correction or posterior lumbar fusion seem to be at the highest risk. Despite that some key risk factors have been identified, much of the pathophysiology still remain unknown. In fact, whereas only a minority of patients at high risk will present this complication, others with similar risk factors undergoing different procedures may not develop it at all.

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Medicaid insurance as primary payer predicts increased mortality after total hip replacement in the state inpatient databases of California, Florida and New York

To confirm the relationship between primary payer status as a predictor of increased perioperative risks and post-operative outcomes after total hip replacements.

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Incidence of complications in the post-anesthesia care unit and associated healthcare utilization in patients undergoing non-cardiac surgery requiring neuromuscular blockade 2005–2013: A single center study

The use of neuromuscular blockade agents (NMBA), had been associated with significant residual post-operative paralysis and morbidity. There is a lack of clinical evidence on incidence of postoperative complications within the post-anesthesia care unit (PACU) in patients exposed to intraoperative NMBA's. This study aims to estimate the incidence of post-operative complications associated with use of NMBAs and assessing its association with healthcare resource utilization.

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Measuring satisfaction and anesthesia related outcomes in a surgical day care centre: A three-year single-centre observational study

To evaluate patient satisfaction and patient reported anaesthesia related outcome parameters after outpatient surgery.

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Paraneuraxial Nerve Blocks: A well-defined novel terminology that is clinically essential for regional anesthesia

We read with great interest the articles "Clinical Experiences of the Continuous Thoracolumbar Interfascial Plane (TLIP) Block" by Ueshima et al. [1]. We would like to share our thoughts regarding this study as we have performed several continuous (TLIP) Blocks in the past 2months.

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Emergency surgery in a newborn patient with severe congenital hypothyrodism

We aimed to discuss anaesthesia management in a newborn with severe hypothyroidism for whom we could not provide hypothyroidism treatment due to tracheoesophageal fistula and anal atresia.

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Postpartum infective endocarditis with Enterococcus faecalis in Japan: a case report

The clinical characteristics of infective endocarditis include the presence of predisposing cardiac disease, a history of illegal drug use, and high morbidity in the elderly. Only a few cases of the disease af...

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Effect of laser activated bleaching on the chemical stability and morphology of intracoronal dentin

Publication date: February 2018
Source:Archives of Oral Biology, Volume 86
Author(s): Fabiane Carneiro Lopes, Renato Roperto, Anna Akkus, Ozan Akkus, Regina Guenka Palma-Dibb, Manoel Damião de Sousa-Neto
ObjectivesTo evaluate the effect of the bleaching with 35% hydrogen peroxide either activated or not by a 970nm diode laser on the chemical stability and dentin surface morphology of intracoronary dentin.MethodsTwenty-seven slabs of intracoronary dentin specimens (3×3mm) were distributed into three groups (n=9), according to surface treatment: HP – 35% hydrogen peroxide (1×4'), DL – 970nm diode laser (1×30"/0,8W/10Hz), HP+DL – 35% HP activated with 970nm diode laser (1×30"/0,8W/10Hz leaving the gel in contact to the surface for 4′ after activation). Three Raman spectra from each fragment were obtained to calculate the mean intensity of peaks of inorganic component (a.u.), organic collagen content (a.u.), and the ratio of inorganic/organic content, before and after treatment. Analyses of the samples by confocal laser microscopy were performed to evaluate the surface roughness, percentage of tubules, perimeter and area percentage of tubules, before and after treatment. Data were analyzed by Kruskal-Wallis, Dunn's, and Wilcoxon test (P<0.05).ResultsData analysis showed that HP+DL did not change the inorganic content peaks 8.31 [29.78] or the inorganic/organic ratio 3.37 [14.67] (P>0.05). Similarly, DL did not affect the chemical stability of the dentin surface (P>0.05). However, HP significantly increased inorganic content peaks 10.87 [22.62], as well as the inorganic/organic ratio 6.25 [27.78] (P<0.05). Regarding the morphological alterations, all surface treatments increase tubules exposure; HP treatment significantly increases perimeter and area percentage; and HP+DL increases surface roughness.ConclusionsBleaching HP combined with DL offers an improvement in terms of intracoronal dentin surface protection, yielding better maintenance of dentin chemical stability and morphology.

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New roles and controls of mast cells

Eric Espinosa | Salvatore Valitutti

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Recent advances in inflammasome biology

David E Place | Thirumala-Devi Kanneganti

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Type I interferon-mediated autoinflammation and autoimmunity

Stefanie Kretschmer | Min Ae Lee-Kirsch

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Effect of laser activated bleaching on the chemical stability and morphology of intracoronal dentin

Mechanisms of propofol attenuation of ketamine-induced neonatal brain injury

OBJECTIVE: We studied the mechanisms of protective effects of propofol on ketamine-induced damage to neonatal cognitive function.

MATERIALS AND METHODS: We utilized a rat model of ketamine anaesthesia. Eighty neonatal rats (7 days after birth) were divided into four groups: normal saline group, ketamine group, and low- and high-dose propofol combined with ketamine groups. Six hours after anaesthesia, we obtained hippocampal tissue, and quantified apoptotic index and total protein concentration, and assessed global proteomics changes induced by two tested drugs. The latter changes were documented by two-dimensional electrophoresis and matrix-assisted laser desorption/ ionization time of flight mass spectrometry. To evaluate cognitive functions, water maze test was applied after animals grew for 21 days. We further repeated proteomics studies at 21 days post-anaesthesia.

RESULTS: Ketamine markedly up-regulated apoptotic index and decreased total protein concentration. Propofol dose-dependently reverted these adverse changes. Six hours post-anaesthesia, combined propofol and ketamine administration up-regulated the following proteins in the hippocampus: PD1A3, NDUFB10, HSPA8, ATP5JD, and PSMA1. Furthermore, the following proteins were down-regulated: PPIA, PKM2, GFAP, NSE, PPIA, PKM2, and GFAP. After 21 days, animals treated with ketamine showed marked disturbances in cognitive function as demonstrated by increased time of the water maze test, whereas propofol diminished these changes. In addition, expression of proteins largely normalized in propofol-treated animals, with only two up-regulated proteins (FUBP3 and PRDX5) and three down-regulated proteins (GAPDH, AKR1A1, and VCP).

CONCLUSIONS: Adverse effects of ketamine on cognitive function are reverted by propofol, also through beneficial effects on protein expression in the hippocampus.

L'articolo Mechanisms of propofol attenuation of ketamine-induced neonatal brain injury sembra essere il primo su European Review.

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Lumbar Spine Anatomy in Women Sustaining Unintentional Dural Puncture During Labor Epidural Placement: A Descriptive Study Using Magnetic Resonance Imaging and Ultrasound.

Background and Objectives: Unintentional dural puncture is one of the most frequent complications of the epidural technique. One previous study suggested that atypical sonoanatomy of the ligamentum flavum/dura mater unit may be a risk factor for this complication. In this study, we describe the anatomy of the lumbar spine, assessed by magnetic resonance imaging (MRI) and ultrasound, in women sustaining unintentional dural puncture during epidural catheter placement for labor analgesia. Methods: We approached women who sustained a recognized unintentional dural puncture. Following consent, technical aspects of the epidural catheter placement were documented. Postpartum MRI of the lumbar spine and bedside spinal ultrasound were performed. Ultrasound images of the ligamentum flavum/dura mater unit in the transverse view were classified as typical, atypical, or inconclusive. Magnetic resonance imaging images were reviewed by a neuroradiologist, who was blinded to the level of the puncture. Results: We included 10 women with unintentional dural punctures in the study. In 5 of the 10 women, these dural punctures occurred despite epidural catheter insertion by experienced practitioners. These women had a mean body mass index of 28.5 kg/m2 (range, 24-38 kg/m2). Two women suffered dural punctures twice. Ultrasound imaging in the paramedian view produced typical images in all patients. In the transverse view, 7 of 10 women showed atypical or inconclusive images, with atypical images seen at either L4/5 or L5/S1. Magnetic resonance imaging results revealed no anatomical abnormalities, with the exception of 1 woman who showed a ligamentum flavum gap away from the puncture site. Conclusions: Our results suggest that unintentional dural punctures occur in likely anatomically normal women. Furthermore, the transverse ultrasound views may fail to demonstrate typical ligamentum flavum/dura mater unit at the lower lumbar levels despite its confirmed presence by MRI. Copyright (C) 2017 by American Society of Regional Anesthesia and Pain Medicine.

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Intrapartum assessment of fetal well-being

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Treatment withdrawal and end-of-life care in the intensive care unit

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Prehabilitation

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Anaesthesia for head and neck cancer surgery

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Principles of resource allocation in critical care

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You Will Never Walk Alone: A Simulation Experience for Caregiver’s Family and Friends

No abstract available

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Enhanced Recovery After Surgery: Current Controversies and Concerns

No abstract available

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Role of Urine Drug Testing in the Current Opioid Epidemic

While the evidence for urine drug testing for patients on chronic opioid therapy is weak, the guidelines created by numerous medical societies and state and federal regulatory agencies recommend that it be included as one of the tools used to monitor patients for compliance with chronic opioid therapy. To get the most comprehensive results, clinicians should order both an immunoassay screen and confirmatory urine drug test. The immunoassay screen, which can be performed as an in-office point-of-care test or as a laboratory-based test, is a cheap and convenient study to order. Limitations of an immunoassay screen, however, include having a high threshold of detectability and only providing qualitative information about a select number of drug classes. Because of these restrictions, clinicians should understand that immunoassay screens have high false-positive and false-negative rates. Despite these limitations, though, the results can assist the clinician with making preliminary treatment decisions. In comparison, a confirmatory urine drug test, which can only be performed as a laboratory-based test, has a lower threshold of detectability and provides both qualitative and quantitative information. A urine drug test's greater degree of specificity allows for a relatively low false-negative and false-positive rate in contrast to an immunoassay screen. Like any other diagnostic test, an immunoassay screen and a confirmatory urine drug test both possess limitations. Clinicians must keep this in mind when interpreting an unexpected test result and consult with their laboratory when in doubt about the meaning of the test result to avoid making erroneous decisions that negatively impact both the patient and clinician.

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Dr Ted Eger Obituary

No abstract available

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The “Ear-Sternal Notch” Line—How Should You Lie?

No abstract available

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The Search for the Optimal Tidal Volume: Why Do We Use Body Weight?

No abstract available

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General Anesthesia Imposes Negative Effects on Heart Rate and Blood Pressure Regulation in Patients With a History of Head and Neck Radiation Therapy

BACKGROUND: Head and neck radiation therapy (HNRT) impairs baroreflex sensitivity, and it may potentiate the effects of anesthetics on heart rate (HR) and blood pressure (BP) regulation. Currently, the impacts of HNRT on HR and BP under anesthesia remain unclear. METHODS: In this study, 472 patients with primary oral cavity or oropharyngeal cancer at all stages were examined. Half of the patients underwent HNRT plus surgery. The other half underwent surgery only and was matched with the treatment patients according to age, sex, and body mass index at a 1:1 ratio. The HRs and BPs in the 2 groups during anesthetic induction, skin incision, and emergence were compared retrospectively. A multivariable model of repeated measures with unstructured covariance structure was used to examine the associations of HNRT with intraoperative HRs and BPs after adjusting for baseline HR and BP, time, use of β-blockers, history of chemotherapy, and American Society of Anesthesiologists physical status score. BPs and HRs were collected every 5 minutes. The baseline HR and BP measurements were not included in the outcome vector and were only used as adjustment for baselines. RESULTS: Compared with corresponding baseline values in controls, the baseline HR was significantly higher (P = .0012) and the baseline systolic BP was lower (P

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When Is “Never Enough” (Data) … Enough?

No abstract available

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Noninfectious Fever in the Near-Term Pregnant Rat Induces Fetal Brain Inflammation: A Model for the Consequences of Epidural-Associated Maternal Fever

BACKGROUND: Women laboring with epidural analgesia experience fever much more frequently than do women who chose other forms of analgesia, and maternal intrapartum fever is associated with numerous adverse consequences, including brain injury in the fetus. We developed a model of noninfectious inflammatory fever in the near-term pregnant rat to simulate the pathophysiology of epidural-associated fever and hypothesized that it would produce fetal brain inflammation. METHODS: Twenty-four pregnant Sprague-Dawley rats were studied at 20 days gestation (term: 22 days). Dams were treated by injection of rat recombinant interleukin (IL)-6 or vehicle at 90-minute intervals, and temperature was monitored every 30 minutes. Eight hours after the first treatment, dams were delivered of fetuses and then killed. Maternal IL-6 was measured at delivery. Fetal brains (n = 24) were processed and stained for ED-1/CD68, a marker for activated microglia, and cell counts in the lateral septal and hippocampal brain regions were measured. Fetal brains were also stained for cyclooxygenase-2 (COX-2), a downstream marker of neuroinflammation. Eight fetal brains were further analyzed for quantitative forebrain COX-2 by Western blotting compared to a β-actin standard. Maternal temperature and IL-6 levels were compared between treatments, as were cell counts, COX-2 staining, and COX-2 levels by Mann-Whitney U test, repeated-measures analysis of variance, or Fisher exact test, as appropriate. RESULTS: Injection of rat IL-6 at 90-minute intervals produced an elevation of maternal temperature compared to vehicle (P

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Intraoperative Anemia Monitoring: Another Obstacle to Blood Conservation in the Surgical Patient

No abstract available

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Subcellular Energetics and Metabolism: A Cross-Species Framework

No abstract available

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The Aortocaval Compression Conundrum

No abstract available

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Understanding the Significance of Aerosolized Vasodilator Use in Pulmonary Hypertension: What Is Numerically, Statistically, and Clinically Meaningful?

No abstract available

http://ift.tt/2AQtUNW

Do No Harm, Except Unto Thyself

No abstract available

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Do You Do What I Do? Cardiac Anesthesia Surveys From Around the Globe

No abstract available

http://ift.tt/2ARapFg

Effect of an Intravenous Dexamethasone Added to Caudal Local Anesthetics to Improve Postoperative Pain: A Systematic Review and Meta-analysis With Trial Sequential Analysis

BACKGROUND: Caudal anesthesia has been used for postoperative pain control in pediatric surgical patients, but the duration of the analgesic effect is occasionally unsatisfactory. Intravenous steroids have been shown to be effective for postsurgical pain management after certain surgeries. The aim of this meta-analysis with trial sequential analysis (TSA) was to evaluate the analgesic effect of steroids in patients administered with caudal anesthesia. METHODS: This study was a systematic review and meta-analysis. A search of published literature was conducted in the MEDLINE, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials databases and in trial registration sites. Randomized controlled trials that compared intravenous steroids with a placebo in pediatric patients who had received caudal anesthesia for surgery were included in the study. The primary outcomes from the present meta-analysis were the analgesic duration and the number of patients who required rescue analgesics. The analgesic duration and incidence of rescue use were summarized using mean difference or risk ratio with a 97.5% confidence interval (CI), respectively. If the 97.5% CI of the mean difference or risk ratio included a value of 0 or 1, respectively, we considered the difference not to be significant. We used the random effects model to combine the results. Heterogeneity was quantified with the I2 statistic. The quality of the trials was evaluated using the Cochrane methodology. Moreover, a TSA with a risk of type 1 error of 2.5% and power of 90% was performed. We established the minimum clinically meaningful difference of analgesic duration as 3 hours. The target sample size for meta-analysis was also calculated in the TSA. We also assessed adverse events. RESULTS: Six trials with 424 patients were included; 211 patients received intravenous steroids. All trials compared dexamethasone of at least 0.5 mg/kg dose with a placebo. Dexamethasone prolonged the duration of caudal analgesia (mean difference, 244 minutes; 97.5% CI, 188–300). Heterogeneity was considerable with an I2 value of 94.8%. Quality of evidence was very low. The TSA suggested that only 17.0% of the target sample size had been reached, but the cumulative Z score crossed the trial sequential monitoring boundary to indicate a benefit. Rescue use was reported in 4 studies with 260 patients. Rescue use was not significantly reduced in the dexamethasone group (risk ratio, 0.53; 97.5% CI, 0.09–3.30; I2, 98.7%). No increase in adverse events was reported. CONCLUSIONS: Intravenous dexamethasone prolongs the analgesic duration of caudal anesthesia. Trials to investigate the effectiveness of a lower dose of the dexamethasone in prolonging analgesic effects would be of interest. Further trials with a low risk of bias are necessary.

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Association of Surgery and Anesthesia With Mental Disorder Diagnoses: What Would Sir Austin Bradford Hill Say?

No abstract available

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Opioid Prescribing for the Treatment of Acute Pain in Children on Hospital Discharge

BACKGROUND: The epidemic of nonmedical use of prescription opioids has been fueled by the availability of legitimately prescribed unconsumed opioids. The aim of this study was to better understand the contribution of prescriptions written for pediatric patients to this problem by quantifying how much opioid is dispensed and consumed to manage pain after hospital discharge, and whether leftover opioid is appropriately disposed of. Our secondary aim was to explore the association of patient factors with opioid dispensing, consumption, and medication remaining on completion of therapy. METHODS: Using a scripted 10-minute interview, parents of 343 pediatric inpatients (98% postoperative) treated at a university children's hospital were questioned within 48 hours and 10 to 14 days after discharge to determine amount of opioid prescribed and consumed, duration of treatment, and disposition of unconsumed opioid. Multivariable linear regression was used to examine predictors of opioid prescribing, consumption, and doses remaining. RESULTS: Median number of opioid doses dispensed was 43 (interquartile range, 30–85 doses), and median duration of therapy was 4 days (interquartile range, 1–8 days). Children who underwent orthopedic or Nuss surgery consumed 25.42 (95% confidence interval, 19.16–31.68) more doses than those who underwent other types of surgery (P

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Being Mindful in Managing Pain: Integrative Medicine in Chronic Pain Management

No abstract available

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Using Integrative Medicine in Pain Management: An Evaluation of Current Evidence

Complementary medicine therapies are frequently used to treat pain conditions such as headaches and neck, back, and joint pain. Chronic pain, described as pain lasting longer than 3–6 months, can be a debilitating condition that has a significant socioeconomic impact. Pharmacologic approaches are often used for alleviating chronic pain, but recently there has been a reluctance to prescribe opioids for chronic noncancer pain because of concerns about tolerance, dependence, and addiction. As a result, there has been increased interest in integrative medicine strategies to help manage pain and to reduce reliance on prescription opioids to manage pain. This article offers a brief critical review of integrative medical therapies used to treat chronic pain, including nutritional supplements, yoga, relaxation, tai chi, massage, spinal manipulation, and acupuncture. The goal of this article is to identify those treatments that show evidence of efficacy and to identify gaps in the literature where additional studies and controlled trials are needed. An electronic search of the databases of PubMed, The Cochrane Library, EMBASE, PsycINFO, and Science Citation Index Expanded was conducted. Overall, weak positive evidence was found for yoga, relaxation, tai chi, massage, and manipulation. Strong evidence for acupuncture as a complementary treatment for chronic pain that has been shown to decrease the usage of opioids was found. Few studies were found in which integrative medicine approaches were used to address opioid misuse and abuse among chronic pain patients. Additional controlled trials to address the use of integrative medicine approaches in pain management are needed.

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Massive Transfusion Protocols: When to Turn On, and Off, the Fire Hose

No abstract available

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Initiation and Termination of Massive Transfusion Protocols: Current Strategies and Future Prospects

The advent of massive transfusion protocols (MTP) has had a significant positive impact on hemorrhaging trauma patient morbidity and mortality. Nevertheless, societal MTP guidelines and individual MTPs at academic institutions continue to circulate opposing recommendations on topics critical to MTPs. This narrative review discusses up-to-date information on 2 such topics, the initiation and termination of an MTP. The discussion for each begins with a review of the recommendations and supporting literature presented by MTP guidelines from 3 prominent societies, the American Society of Anesthesiologists, the American College of Surgeons, and the task force for Advanced Bleeding Care in Trauma. This is followed by an in-depth analysis of the main components within those recommendations. Societal recommendations on MTP initiation in hemorrhaging trauma patients emphasize the use of retrospectively validated massive transfusion (MT) prediction score, specifically, the Assessment of Blood Consumption and Trauma-Associated Severe Hemorrhage scores. Validation studies have shown that both scoring systems perform similarly. Both scores reliably identify patients that will not require an MT, while simultaneously overpredicting MT requirements. However, each scoring system has its unique advantages and disadvantages, and this review discusses how specific aspects of each scoring system can affect widespread applicability and statistical performance. In addition, we discuss the often overlooked topic of initiating MT in nontrauma patients and the specific tools physicians have to guide the MT initiation decision in this unique setting. Despite the serious complications that can arise with transfusion of large volumes of blood products, there is considerably less research pertinent to the topic of MTP termination. Societal recommendations on MTP termination emphasize applying clinical reasoning to identify patients who have bleeding source control and are adequately resuscitated. This review, however, focuses primarily on the recommendations presented by the Advanced Bleeding Care in Trauma's MTP guidelines that call for prompt termination of the algorithm-guided model of resuscitation and rapidly transitioning into a resuscitation model guided by laboratory test results. We also discuss the evidence in support of laboratory result–guided resuscitation and how recent literature on viscoelastic hemostatic assays, although limited, highlights the potential to achieve additional benefits from this method of resuscitation.

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Letter to the Editor regarding “Robotic or non-robotic transoral laryngectomy”

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Reply to Letter to the Editor regarding “Robotic or non-robotic transoral laryngectomy”

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Pneumoparotitis as a complication of long-term oronasal positive airway pressure for sleep apnea

Abstract

Background

Parotid swelling is rarely caused by pneumoparotitis from retrograde insufflation of air into Stensen's duct. Previous reports have identified occupational exposures, self-induced habits, exercise, spirometry, and short-term positive pressure airway ventilation as causes of salivary duct insufflation.

Methods

We present 2 cases of pneumoparotitis in patients on long-term oronasal continuous positive airway pressure (CPAP) for obstructive sleep apnea.

Results

A diagnosis of pneumoparotitis was made by CT scan in case 1 and sialography in case 2. Patients were advised to transition from oronasal to nasal-only CPAP. One patient was successfully transferred and had good symptomatic improvement, whereas the second patient did not tolerate nasal CPAP and had persistent symptoms on oronasal CPAP.

Conclusion

Long-term use of oronasal CPAP is a potential cause of pneumoparotitis.

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Top 10 research priorities in head and neck cancer: Results of an Alberta priority setting partnership of patients, caregivers, family members, and clinicians

Abstract

Background

The epidemiology, etiology, and management of head and neck cancer are evolving. Understanding the perspectives and priorities of nonresearchers regarding treatment uncertainties is important to inform future research.

Methods

Using the James Lind Alliance approach, patients, caregivers, and clinicians responded to a survey regarding their unanswered questions about treating and managing head and neck cancer. Distinct uncertainties were extracted from responses and sorted into themes. Uncertainties already answered in the literature were removed. Those remaining were ranked by patients and clinicians to develop a short list of priorities, which were discussed at a workshop and reduced to the top 10.

Results

One hundred sixty-one respondents posed 818 uncertainties, culminating in 77 for interim ranking and 27 for discussion at a workshop. Participants reached consensus on the top 10, which included questions on prevention, screening, treatment, and quality of life.

Conclusion

Nonresearchers can effectively collaborate to establish priorities for future research in head and neck cancer.

http://ift.tt/2AZmNnh

Predictive factors for osteoradionecrosis of the jaws: A retrospective study

Abstract

Background

Osteoradionecrosis of the jaw (ORNJ) is a well-recognized complication of radiotherapy. The purpose of this study was to assess predictive factors for the development of ORNJ.

Methods

A retrospective study of 325 patients with head and neck squamous cell carcinoma (HNSCC) treated at one institution between January 1, 1999, and December 31, 2008, was conducted. Outcome measure was the presence/absence of ORNJ. Time to event was recorded and Cox proportional hazard regression analysis was used to determine statistically significant predictive factors.

Results

Fifty-nine patients had ORNJ. Statistical analysis using Cox regression analysis identified several statistically significant variables: dentoalveolar surgery; peri-resective surgery of the jaw; continued tobacco usage after radiotherapy, diabetes mellitus type 2 (DM2); and total radiation dose.

Conclusion

Patients at greater risk of developing ORNJ can be identified and measures can be instituted to reduce its incidence and expedite management when it does occur.

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In Response

No abstract available

http://ift.tt/2yTcnEq

Risk of Cognitive Impairment by Sleep-Disordered Breathing

No abstract available

http://ift.tt/2AXLEI3

Comparison of Transcranial Doppler and Ultrasound-Tagged Near Infrared Spectroscopy for Measuring Relative Changes in Cerebral Blood Flow in Human Subjects

BACKGROUND: Currently, no reliable method exists for continuous, noninvasive measurements of absolute cerebral blood flow (CBF). We sought to determine how changes measured by ultrasound-tagged near-infrared spectroscopy (UT-NIRS) compare with changes in CBF as measured by transcranial Doppler (TCD) in healthy volunteers during profound hypocapnia and hypercapnia. METHODS: Ten healthy volunteers were monitored with a combination of TCD, UT-NIRS (c-FLOW, Ornim Medical), as well as heart rate, blood pressure, end-tidal PCO2 (PEtCO2), end-tidal O2, and inspired O2. Inspired CO2 and minute ventilation were controlled to achieve 5 stable plateau goals of EtCO2 at 15–20, 25–30, 35–40, 45–50, and 55–60 mm Hg, for a total of 7 measurements per subject. CBF was assessed at a steady state, with the TCD designated as the reference standard. The primary analysis was a linear mixed-effect model of TCD and UT-NIRS flow with PEtCO2, which accounts for repeated measures. Receiver operating characteristic curves were determined for detection of changes in CBF. RESULTS: Hyperventilation (nadir PEtCO2 17.1 ± 2.4) resulted in significantly decreased mean flow velocity of the middle cerebral artery from baseline (to 79% ± 22%), but not a consistent decrease in UT-NIRS cerebral flow velocity index (n = 10; 101% ± 6% of baseline). Hypercapnia (peak PEtCO2 59.3 ± 3.3) resulted in a significant increase from baseline in both mean flow velocity of the middle cerebral artery (153% ± 25%) and UT-NIRS (119% ± 11%). Comparing slopes versus PEtCO2 as a percent of baseline for the TCD (1.7% [1.5%–2%]) and UT-NIRS (0.4% [0.3%–0.5%]) shows that the UT-NIRS slope is significantly flatter, P

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Not All Calcium Formulations Are Alike

No abstract available

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Unadjusted Bivariate Two-Group Comparisons: When Simpler is Better

Hypothesis testing involves posing both a null hypothesis and an alternative hypothesis. This basic statistical tutorial discusses the appropriate use, including their so-called assumptions, of the common unadjusted bivariate tests for hypothesis testing and thus comparing study sample data for a difference or association. The appropriate choice of a statistical test is predicated on the type of data being analyzed and compared. The unpaired or independent samples t test is used to test the null hypothesis that the 2 population means are equal, thereby accepting the alternative hypothesis that the 2 population means are not equal. The unpaired t test is intended for comparing dependent continuous (interval or ratio) data from 2 study groups. A common mistake is to apply several unpaired t tests when comparing data from 3 or more study groups. In this situation, an analysis of variance with post hoc (posttest) intragroup comparisons should instead be applied. Another common mistake is to apply a series of unpaired t tests when comparing sequentially collected data from 2 study groups. In this situation, a repeated-measures analysis of variance, with tests for group-by-time interaction, and post hoc comparisons, as appropriate, should instead be applied in analyzing data from sequential collection points. The paired t test is used to assess the difference in the means of 2 study groups when the sample observations have been obtained in pairs, often before and after an intervention in each study subject. The Pearson chi-square test is widely used to test the null hypothesis that 2 unpaired categorical variables, each with 2 or more nominal levels (values), are independent of each other. When the null hypothesis is rejected, 1 concludes that there is a probable association between the 2 unpaired categorical variables. When comparing 2 groups on an ordinal or nonnormally distributed continuous outcome variable, the 2-sample t test is usually not appropriate. The Wilcoxon-Mann-Whitney test is instead preferred. When making paired comparisons on data that are ordinal, or continuous but nonnormally distributed, the Wilcoxon signed-rank test can be used. In analyzing their data, researchers should consider the continued merits of these simple yet equally valid unadjusted bivariate statistical tests. However, the appropriate use of an unadjusted bivariate test still requires a solid understanding of its utility, assumptions (requirements), and limitations. This understanding will mitigate the risk of misleading findings, interpretations, and conclusions. Accepted for publication October 4, 2017. Funding: None. The authors declare no conflicts of interest. Address correspondence to Thomas R. Vetter, MD, MPH, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Health Discovery Bldg, Room 6.812, 1701 Trinity St, Austin, TX 78712. Address e-mail to thomas.vetter@austin.utexas.edu. © 2017 International Anesthesia Research Society

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Low- Versus High-Chloride Content Intravenous Solutions for Critically Ill and Perioperative Adult Patients: A Systematic Review and Meta-analysis

BACKGROUND: To assess whether use of low-chloride solutions in unselected critically ill or perioperative adult patients for maintenance or resuscitation reduces mortality and renal replacement therapy (RRT) use when compared to high-chloride fluids. METHODS: Systematic review and meta-analysis with random-effects inverse variance model. PubMed, Cochrane library, EMBASE, LILACS, and Web of Science were searched from inception to October 2016. Published and unpublished randomized controlled trials in any language that enrolled critically ill and/or perioperative adult patients and compared a low- to a highchloride solution for volume maintenance or resuscitation. The primary outcomes were mortality and RRT use. We conducted trial sequential analyses and assessed risk of bias of individual trials and the overall quality of evidence. Fifteen trials with 4067 patients, most at low risk of bias, were identified. Of those, only 11 and 10 trials had data on mortality and RRT use, respectively. A total of 3710 patients were included in the mortality analysis and 3724 in the RRT analysis. RESULTS: No statistically significant impact on mortality (odds ratio, 0.90; 95% confidence interval, 0.69–1.17; P = .44; I2 = 0%) or RRT use (odds ratio, 1.12; 95% confidence interval, 0.80–1.58; P = .52; I2 = 0%) was found. Overall quality of evidence was low for both primary outcomes. Trial sequential analyses highlighted that the sample size needed was much larger than that available for properly powered outcome assessment. CONCLUSIONS: The current evidence on low- versus high-chloride solutions for unselected critically ill or perioperative adult patients demonstrates no benefit, but suffers from considerable imprecision. We noted a limited exposure volume for study fluids and a relatively low risk of the populations in each study. Together with the relatively small pooled sample size, these data leave us underpowered to detect potentially important differences. Results from well-conducted, adequately powered randomized controlled trials examining sufficiently large fluid exposure are necessary. Accepted for publication October 6, 2017. Funding: This meta-analysis was supported by the Brazilian Ministry of Health. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Leticia Kawano-Dourado, MD, Research Institute - Hospital do Coracao (HCor), Rua Abilio Soares 250, 12o andar, cep: 04005-000, São Paulo-SP, Brazil. Address e-mail to ldourado@hcor.com.br. © 2017 International Anesthesia Research Society

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In Response

No abstract available

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Increased Hyperalgesia and Proinflammatory Cytokines in the Spinal Cord and Dorsal Root Ganglion After Surgery and/or Fentanyl Administration in Rats

BACKGROUND: Perioperative fentanyl has been reported to induce hyperalgesia and increase postoperative pain. In this study, we tried to investigate behavioral hyperalgesia, the expression of proinflammatory cytokines, such as interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α), and the activation of microglia in the spinal cord and dorsal root ganglion (DRG) in a rat model of surgical plantar incision with or without perioperative fentanyl. METHODS: Four groups of rats (n = 32 for each group) were subcutaneously injected with fentanyl at 60 μg/kg or normal saline for 4 times with 15-minute intervals. Plantar incisions were made to rats in 2 groups after the second drug injection. Mechanical and thermal nociceptive thresholds were assessed by the tail pressure test and paw withdrawal test on the day before, at 1, 2, 3, 4 hours, and on the days 1–7 after drug injection. The lumbar spinal cord, bilateral DRG, and cerebrospinal fluid of 4 rats in each group were collected to measure IL-1β, IL-6, and TNF-α on the day before, at the fourth hour, and on the days 1, 3, 5, and 7 after drug injection. The lumbar spinal cord and bilateral DRG were removed to detect the ionized calcium-binding adapter molecule 1 on the day before and on the days 1 and 7 after drug injection. RESULTS: Rats injected with normal saline only demonstrated no significant mechanical or thermal hyperalgesia or any increases of IL-1β, IL-6, and TNF-α in the spinal cord or DRG. However, injection of fentanyl induced analgesia within as early as 4 hours and a significant delayed tail mechanical and bilateral plantar thermal hyperalgesia after injections lasting for 2 days, while surgical plantar incision induced a significant mechanical and thermal hyperalgesia lasting for 1–4 days. The combination of fentanyl and incision further aggravated the hyperalgesia and prolonged the duration of hyperalgesia. The fentanyl or surgical incision upregulated the expression of IL-1β, IL-6, and TNF-α in the spinal cord and bilateral DRG for more than 7 days and increase of ionized calcium-binding adapter molecule 1 in the spinal cord. The combination of fentanyl and incision resulted in higher increase of IL-1β, IL-6, and TNF-α in the spinal cord and bilateral DRG. CONCLUSIONS: The surgical plantar incision with or without perioperative fentanyl induced significant mechanical and thermal hyperalgesia, an increased expression of IL-1β, IL-6, TNF-α in the spinal cord and DRG, and activation of microglia in the spinal cord. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Accepted for publication September 19, 2017. Funding: This study was supported by National Natural Science Foundation of China (Project No. 81571071) and Guangdong Provincial Natural Science Foundation of China (Project No. 2014A030313203). The authors declare no conflicts of interest. The authors Chang and Ye contributed equally to this study. Reprints will not be available from the authors. Address correspondence to Haihua Shu, MD, PhD, Department of Anesthesiology, Guangdong Second Provincial General Hospital, 466# Xingang Middle Rd, Guangzhou, Guangdong 510317, China. Address e-mail to shuhaihua@hotmail.com. © 2017 International Anesthesia Research Society

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Asthma: personalized and precision medicine

Purpose of review In this review, we herein describe the progress in management of severe asthma, evolving from a 'blockbuster approach' to a more personalized approach targeted to the utilization of endotype-driven therapies. Recent findings Severe asthma characterization in phenotypes and endotypes, by means of specific biomarkers, have led to the dichotomization of the concepts of 'personalized medicine' and 'precision medicine', which are often used as synonyms, but actually have conceptual differences in meaning. The recent contribute of the omic sciences (i.e. proteomics, transcriptomics, metabolomics, genomics, …) has brought this initially theoretic evolution into a more concrete level. Summary This step-by-step transition would bring to a better approach to severe asthmatic patients as the personalization of their therapeutic strategy would bring to a better patient selection, a more precise endotype-driven treatment, and hopefully to better results in terms of reduction of exacerbation rates, symptoms, pulmonary function and quality of life. Correspondence to Professor Giorgio W. Canonica, Personalized Medicine, Asthma and Allergy Clinic, Humanitas University and Research Hospital, Via Alessandro Manzoni 113, Rozzano, Milano, Italy. Tel: +39 02 82247741; e-mail: giorgio_walter.canonica@hunimed.eu Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Role of epigenetics and DNA-damage in asthma

Purpose of review Although asthma is a common disease worldwide, its pathogenesis remains to be fully elucidated. There is increasing evidence of the interaction between epigenetics, DNA-damage, and environmental allergens in the development of asthma. In this review, we will focus on the role of epigenetics and DNA-damage in asthma. Recent findings There is growing evidence of environmental allergens, particularly house dust mite, stimulating oxidative DNA damage in airway epithelial cells. The repair of this DNA damage has been implicated in the secretion of Th2 cytokines and the induction of allergic inflammation. Summary Studies of the role of epigenetics, DNA-damage, and environmental allergens have begun to reveal the their complex interactions and their roles in the development of asthma. Further study in these areas may lead to novel prevention and treatment approaches. Correspondence to Adil S. Zahiruddin, UTMB Health, Division of Allergy and Immunology, 301 University Boulevard, Galveston, TX 77555-0144, USA. Tel: (409) 772 1755; fax: (409) 772 5462; e-mails: aszahiru@utmb.edu; sasur@utmb.edu Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Pharmacological considerations in the elderly

Purpose of review This review discusses the pharmacology of contemporary anesthetic medications in geriatric patients, neurophysiological changes with aging, current recommendations for dosing anesthetic drugs. It also addresses current practice patterns and ongoing studies, which are likely to affect future anesthetic drug management in the elderly. Recent findings Potency of anesthetic drugs is increased in the elderly. In addition to changes at the receptor level, neurophysiological changes in functional connectivity with aging contributes to increased sensitivity of anesthetic drugs. However, the extent of reduction is underappreciated by the practitioners and dose adjustment is not uniformly applied in practice. Large database studies demonstrate association of short-term intraoperative hypotension and CNS depression, to poor perioperative outcomes. These perturbations are probably of greater consequence in frail, elderly patients with reduced reserves. Summary Anesthetic dosing should be more closely age-adjusted to prevent anesthetic-induced hypotension and increased depth of anesthesia in the elderly. Pharmacologic studies are required in the elderly population (>80 years). Correspondence to Shamsuddin Akhtar, Associate Professor, Anesthesiology and Pharmacology, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP # 3, PO Box 208051, New Haven, CT 06520-8051, USA. Tel: +1 203 785 2802; fax: +1 203 785 6664; e-mail: shamsuddin.akhtar@yale.edu Copyright © 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Asthma: personalized and precision medicine

Role of epigenetics and DNA-damage in asthma

High PDL1 mRNA expression predicts better survival of stage pT1 non-muscle-invasive bladder cancer (NMIBC) patients

Abstract

Introduction and objectives

Checkpoint inhibition has emerged as new therapeutic option in muscle-invasive bladder cancer. The objective of the present study was to evaluate the prognostic role of PD1 and PDL1 expression in non-muscle-invasive bladder cancer (NMIBC) and establish an objective measuring method using RNA quantification.

Materials and methods

We retrospectively analyzed clinical data and formalin-fixed paraffin-embedded tissues (FFPE) of patients with stage pT1 NMIBC who underwent transurethral resection of the bladder. mRNA expression of PD1, PDL1 and CD3 was measured by single step RT-qPCR and correlated to clinicopathological parameters, recurrence-free survival (RFS), progression-free survival (PFS) and carcinoma-specific survival (CSS).

Results

We have analyzed 334 patients with NMIBC at stage pT1 for mRNA analysis. Data from 296 patients (79% male, median age: 72 years) could be used. Spearman correlation revealed significant associations between mRNA expressions of PD1/PDL1 (ρ: 0.6024, p < 0.0001), CD3/PDL1 (ρ: 0.5728, p < 0.0001) and CD3/PD1 (ρ: 0.7005, p < 0.0001). Kaplan–Meier analysis revealed that high PDL1 mRNA expression (≥ 33.83) is a favorable prognostic factor with regard to better RFS (p = 0.0018), PFS (p = 0.021) and CSS (p = 0.012). Multivariate Cox-regression analysis proved PDL1 expression to be an independent prognosticator for RFS [HR 0.48 (0.31–0.72), p = 0.0005], PFS [HR 0.45 (0.24–0.80), p = 0.0059] and CSS [HR 0.31 (0.13–0.67), p = 0.0021].

Conclusion

High mRNA expression of PDL1 predicts improved RFS, PFS and CSS of pT1 NMIBC. Following prospective validation, this objective measurement of PD-L1 might help stratify patients with NMIBC for immunotherapy and identify patients who might benefit from early cystectomy.

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HIV patients, healthy aging and transplant recipients can reveal the hidden footprints of CMV

Publication date: Available online 3 November 2017
Source:Clinical Immunology
Author(s): Shelley Waters, Emily Brook, Silvia Lee, Riwanti Estiasari, Ibnu Ariyanto, Patricia Price
Cytomegalovirus (CMV) is a β-herpesvirus. Latent infections are common in all populations. However age-associated increases in levels of CMV-reactive antibody are testament to repeated reactivations and periods of viral replication. CMV has been associated with several diseases of aging, including vasculopathy and neurocognitive impairment. These conditions occur at a younger age in persons with particularly high burdens of CMV - transplant recipients and people living with HIV. Here we define the "clinical footprints" as immunopathologies triggered by CMV that develop over many years.A high burden of CMV also drives accumulation of multifunctional terminally-differentiated αβ T-cells, a novel population of Vδ2⁻ γδ T-cells, and a population of CD56^lo NK cells lacking a key regulatory molecule. An understanding of these "immunological footprints" of CMV may reveal how they collectively promote the "clinical footprints" of the virus. This is explored here in transplant recipients, HIV patients and healthy aging.

http://ift.tt/2zS9gho

To Study the Feasibility and Quality of Life of Medial Group Retropharyngeal Node Sparing in Nasopharyngeal Carcinoma

Condition: Nasopharyngeal Carcinoma
Intervention: Radiation: medial group retropharyngeal node（MRLN） sparing
Sponsor: Sun Yat-sen University
Recruiting

http://ift.tt/2itaoR9

The Translational Research Image-Guided Operating Room (TRIGORA): Intraoperative 3D Imaging for Head & Neck Surgical Patients

Condition: Head and Neck Neoplasms
Intervention: Diagnostic Test: 3D Cone-Beam Imaging
Sponsor: University Health Network, Toronto
Recruiting

http://ift.tt/2AOYnfe

Early and Whole Course Nutritional Support by Nutren® Optimum During IMRT for Nasopharyngeal Carcinoma

Conditions: Nasopharyngeal Carcinoma; Nutritional Support
Interventions: Radiation: Radiotherapy; Drug: Chemotherapy; Dietary Supplement: Nutren® Optimum
Sponsors: Sun Yat-sen University; Nestlé Health Science Spain
Not yet recruiting

http://ift.tt/2iqN86c

Nutrition and Inflammation in Patients With Head and Neck Cancer

Conditions: Head and Neck Neoplasms; Radiotherapy Side Effect; Inflammation; Metabolism
Intervention: Radiation: Radiotherapy
Sponsors: Uppsala University; Swedish Cancer Society; The Kamprad Family Foundation for Entrepreneurship, Research & Charity
Recruiting

http://ift.tt/2AOY6sI

PET-MRI Assessment of Early Tumor Response to Predict Outcomes of HPV-Positive Oropharynx Cancer Patients

Conditions: Squamous Cell Carcinoma; Oropharynx Cancer
Interventions: Radiation: Intensity modulated radiotherapy (IMRT); Drug: Chemotherapy; Diagnostic Test: PET-MRI
Sponsors: University of Wisconsin, Madison; National Cancer Institute (NCI); National Institute of Dental and Craniofacial Research (NIDCR)
Not yet recruiting

http://ift.tt/2ipqaMQ

Nivolumab, Carboplatin, and Paclitaxel in Treating Patients With Stage III-IV Head and Neck Squamous Cell Carcinoma That Can Be Removed by Surgery

Conditions: Name Human Papillomavirus Positive Oropharyngeal Squamous Cell Carcinoma; Stage II Oropharyngeal Squamous Cell Carcinoma; Stage III Hypopharyngeal Squamous Cell Carcinoma; Stage III Laryngeal Squamous Cell Carcinoma; Stage III Oral Cavity Squamous Cell Carcinoma; Stage III Oropharyngeal Squamous Cell Carcinoma; Stage IV Hypopharyngeal Squamous Cell Carcinoma; Stage IV Laryngeal Squamous Cell Carcinoma; Stage IV Oral Cavity Squamous Cell Carcinoma; Stage IV Oropharyngeal Squamous Cell Carcinoma; Stage IVA Hypopharyngeal Squamous Cell Carcinoma; Stage IVA Laryngeal Squamous Cell Carcinoma; Stage IVA Oral Cavity Squamous Cell Carcinoma; Stage IVA Oropharyngeal Squamous Cell Carcinoma; Stage IVB Hypopharyngeal Squamous Cell Carcinoma; Stage IVB Laryngeal Squamous Cell Carcinoma; Stage IVB Oral Cavity Squamous Cell Carcinoma; Stage IVB Oropharyngeal Squamous Cell Carcinoma; Stage IVC Hypopharyngeal Squamous Cell Carcinoma; Stage IVC Laryngeal Squamous Cell Carcinoma; Stage IVC Oral Cavity Squamous Cell Carcinoma; Stage IVC Oropharyngeal Squamous Cell Carcinoma
Interventions: Drug: Paclitaxel; Drug: Carboplatin; Biological: Nivolumab
Sponsors: Sidney Kimmel Cancer Center at Thomas Jefferson University; Bristol-Myers Squibb
Not yet recruiting

http://ift.tt/2ANpWWv

A Study of LY3381916 Alone or in Combination With LY3300054 in Participants With Solid Tumors

Conditions: Solid Tumor; Non Small Cell Lung Cancer; Squamous Cell Carcinoma of the Head and Neck; Urothelial Carcinoma; Brain Metastasis
Interventions: Drug: LY3381916; Drug: LY3300054
Sponsor: Eli Lilly and Company
Not yet recruiting

http://ift.tt/2iqyRGF

KeyLargo: Pembrolizumab + Oxaliplatin + Capecitabine in Gastric Cancer

Conditions: Gastric Cancer; Esophagus Cancer
Intervention: Drug: Oxaliplatin+Capecitabine+Pembrolizumab
Sponsors: Duke University; Merck Sharp & Dohme Corp.
Not yet recruiting

http://ift.tt/2AOXDGY

Outcomes in chronic rhinosinusitis

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Case of the month

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Polymorphisms in inflammasome genes and risk of asthma in Brazilian children

Publication date: January 2018
Source:Molecular Immunology, Volume 93
Author(s): Vinicius Nunes Cordeiro Leal, Isabel Rugue Genov, Márcia C Mallozi, Dirceu Solé, Alessandra Pontillo
Considering its role in inflammation and recently described "alternative" roles in epithelial homeostasis and Th1/Th2 balance, we hypothesize that inflammasome genetics could contribute to the development of asthma. Selected functional polymorphisms in inflammasome genes are evaluated in a cohort of asthmatic children and their families.Gain-of-function NLRP1 variants rs11651270, rs12150220 and rs2670660 resulted significantly associated to asthma in trios (TDT) analysis; and rs11651270 and rs2670660 also with asthma severity and total IgE level in asthmatic children. NLRP1 activators in humans are still unknown, however we hypothesized that individuals with gain-of-function SNPs in NLRP1 could be more prone in activating inflammasome in the presence of asthma-related cell stressors (i.e. ER stress or ROS), and this activation contribute to exacerbate inflammatory response and asthma development.Gain-of-function IL1A rs17561 resulted significantly associated with a reduced pulmonary capacity in asthmatic children. IL18 rs5744256 which lead to lower serum level of IL-18 appeared to be associated to a worse response to bronchodilators.Concluding, this work provides evidences about the contribution of inflammasome genetics in the development of paediatric asthma, both considering its inflammatory role in alveolar macrophages (i.e.: NLRP1) or its homeostatic role in lung epithelial cells (i.e.: IL1A, IL18).

http://ift.tt/2zbqTvm

Association between hepatitis B and hearing status

OBJECTIVE: This study was performed to investigate the correlation between the chronic hepatitis B virus infection and hearing status. This study was performed to investigate the correlation between the chronic hepatitis B virus infection and hearing status.

PATIENTS AND METHODS: This research was based on 76 hepatitis-B infections as the case group (including 35 HBV carriers and 41 chronic hepatitis B (CHB) patients) and 54 normal cases as the control group. They were selected sequentially and audiologic tests were performed on the participants.

RESULTS: The average hearing thresholds (HTs) of control group and hepatitis-B infection were 10.70 and 12.42 dBHL respectively with statistically significant difference (p < 0.01). Frequency-specific HT of 114 ears in control group and hepatitis-B infection were found statistical differences for hearing frequency ranged 250 to 8000 (p < 0.05), and statistically significant differences for 250, 2000 and 4000 Hz (p < 0.01). Significant differences were only measured for HT at 250 Hz frequencies between control and HBV carriers (p < 0.01), while for control and CHB group, the differences were detected for all tested frequency (p < 0.01). The SNR for f2 frequencies (553, 1105, 2211, 3125, 4416, 4416, 6250 Hz) of the CHB patients and HBV carriers were compared with statistical differences (p < 0.01).

CONCLUSIONS: The results showed that the hepatitis-B patients were more prone to hearing loss and that the hepatitis B disease can cause hearing loss. The infection of the inner ear and the pathological changes of the patients with HBV infection still need to be further explored.

L'articolo Association between hepatitis B and hearing status sembra essere il primo su European Review.

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Optimizing functional outcomes in mandibular condyle reconstruction with the free fibula flap using CAD/CAM technology

Publication date: Available online 15 November 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Z-Hye Lee, Tomer Avraham, Casian Monaco, Ashish A. Patel, David L. Hirsch, Jamie P. Levine
IntroductionMandibular defects involving the condyle represent a complex reconstructive challenge for restoring proper function of the temporomandibular joint (TMJ) as it requires precise bone graft alignment for full restoration of joint function. The use of CAD/CAM technology can aid in accurate reconstruction of mandibular condyle defects with a vascularized free fibula flap without the need for additional adjuncts. The purpose of this study is to analyze clinical and functional outcomes following reconstruction of mandibular condyle defects using only a free fibula graft with the help of virtual surgery techniques.MethodsA retrospective review was performed to identify all patients who underwent mandibular reconstruction with only free fibula flap without any TMJ adjuncts after a total condylectomy. Three-dimensional modeling software was used to plan and execute reconstruction for all patients.ResultsBetween 2009 and 2014, total of 14 patients underwent reconstruction of mandibular defects involving the condyle with the aid of virtual surgery technology. The average age was 38.7 (range 11-77) years. The average follow-up period was 2.6 (range 0.8 to 4.2) years. Flap survival was 100% (n=14). All patients reported improved facial symmetry, adequate jaw opening, and normal dental occlusion. In addition, they achieved good functional outcomes including normal, intelligible speech and ability to tolerate a regular diet with solid foods. Maximal intercisal opening range for all patients were 25-38mm with no lateral deviation or subjective joint pain. No patient had progressive joint hypomobility or condylar migration. One patient had ankylosis, which required release.ConclusionTMJ reconstruction poses significant challenges in bone graft alignment for full restoration of joint function. The use of CAD/CAM technology can aid in accurate reconstruction of mandibular condyle defects with a vascularized free fibula flap through precise planning and intra-operative manipulation with optimal functional outcomes.

http://ift.tt/2my5t5y

Magnetic Resonance Neurography of Traumatic and Non-Traumatic Peripheral Trigeminal Neuropathies

Publication date: Available online 16 November 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): John R. Zuniga, Robert V. Walker, Cyrus Mistry, Igor Tikhonov, Riham Dessouky, Avneesh Chhabra
PurposeThe clinical neurosensory testing (NST) is currently the gold-standard for the diagnosis of traumatic and non-traumatic peripheral trigeminal neuropathies (PTN), but exhibits both false positive and negative results when compared to surgical findings and frequently delays treatment decisions. We tested the hypothesis that magnetic resonance neurography (MRN) of PTN can serve as a diagnostic modality by correlating NST, MRN and surgical findings.Materials and MethodsSixty patients with traumatic and non-traumatic PTN of varying etiologies and Sunderland classifications underwent NST followed by MRN on 1.5T and 3.0 T scanners. The protocol included 2D and 3D imaging, including diffusion imaging and isotropic 3D PSIF. The MRN findings were read by two readers in consensus of clinical findings but blinded to the side of abnormality. The MRN results were summarized using Sunderland Classification. In 26 patients, surgery was performed and Sunderland classification was assigned based on surgical photos. Agreement between MRN and NST/Surgical classification was evaluated using kappa statistics. Pearson's Correlation Coefficient (PCC) was used to assess the correlation between continuous measurements of MRN/NST and surgical classification.ResultsNineteen males and 41 females, mean age 41, ranging 12 to 75, with 54 complaints of altered sensation of the lip/chin/or tongue, including 16 with neuropathic pain and 4 with no neurosensory complaint were included. Third molar surgery (n=29) represented the most common cause of traumatic PTN. Assuming one nerve abnormality per patient, the lower class was accepted, a kappa of 0.57 was observed between MRN and NST classification. A kappa of 0.5 existed between MRN and surgical findings with a PCC of 0.67.ConclusionsMRN anatomically maps PTN and stratifies the nerve injury and neuropathies with moderate to good agreement with NST and surgical findings for clinical use.

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Calcified carotid artery atheromas in panoramic radiographs are associated with a first myocardial infarction: a case-control study.

Publication date: Available online 15 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): N. Gustafsson, J. Ahlqvist, U. Näslund, P. Wester, K. Buhlin, A. Gustafsson, E. Levring Jäghagen
ObjectiveThe aim of this case-control study was to investigate whether subjects with a first myocardial infarction (MI) had a higher prevalence of calcified carotid artery atheromas (CCAAs) in panoramic radiographs (PRs) than age, gender, and residential area matched controls without MIs.Study designSix hundred ninety-six cases with a first MI and 696 controls, were included in this sub-study of the Swedish multicentre PAROKRANK study. All subjects had PRs that were evaluated for CCAAs.ResultsThe prevalence of CCAAs detected by PR was 33.8% (235/696) in cases and 27.6% (192/696) in controls (odds ratio [OR]: 1.24, 95% CI: 1.04-1.44; p=0.012). Among males, 32.7% (184/562) of cases and 26.5% (149/562) of controls displayed CCAAs in PRs (OR: 1.24, 95% CI: 1.03-1.48; p=0.022). Among both genders, bilateral CCAAs were significantly more common among cases than among controls (p=0.002).ConclusionCases, i.e. subjects with recent MIs, had a significantly higher prevalence of CCAAs in PRs compared to controls, i.e. subjects without MIs. This difference between groups was more pronounced for bilateral CCAAs. These findings supported the contention that CCAA detection could serve as a risk indicator for future MIs.

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Considerations in the diagnosis of oral hairy leukoplakia – an institutional experience

Publication date: Available online 15 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Andres Flores-Hidalgo, Si On Lim, Alice E. Curran, Ricardo J. Padilla, Valerie Murrah
ObjectiveWe report the 10-year experience with oral hairy leukoplakia (OHL) at the Division of Oral and Maxillofacial Pathology at the University of North Carolina at Chapel Hill.Study DesignAll the associated hematoxylin and eosin (H&E) and EBV encoding region in-situ hybridization (EBER ISH) slides of OHL cases between January 1, 2008 and February 1, 2017 were retrieved and reviewed. Collected demographics, clinical presentation, medical and social history were reviewed and reported.ResultsSix ISH-confirmed OHL cases showed predilection for the lateral tongue. There were three females and three males. The mean age was 50.5 years, with a range of 29 -70 years. One patient had known HIV-positive status prior to the biopsy. Three patients had reported a history of heavy smoking. Other medical conditions reported were history of breast cancer, a long history of corticosteroid inhalers use for asthma treatment, high cholesterol, diabetes and hypertension.ConclusionThese findings demonstrate the need to include OHL as a potential entity in the differential diagnosis of leukoplakic tongue lesions, regardless of the HIV status. Also, the presence of OHL in patient can promote the investigation of various explanations of EBV infection including immunosuppression due to HIV infection or chronic steroid use.

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Comparison between peri-implant bone level changes of implants placed during and 3 months after iliac bone grafting

Publication date: Available online 15 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Emre Tosun, Canseda Avağ, Özgür Başlarlı, Serkan Kiriş, Anıl Öztürk, Murat Akkocaoğlu
ObjectiveThe aim of this study was to compare the peri-implant bone level changes of implants placed during and 3 months after bone grafting from the iliac crest.Study DesignA total of 103 implants were placed; 42 during the grafting, and 61 three months after the grafting procedure. All patients were grafted with iliac bone from the anterior superior iliac crest. Bone resorption was evaluated with cone-beam computed tomography, in all patients, at their last control visit. Periodontal health was assessed via the gingival and plaque indices and pocket depths around the dental implants.ResultsMean bone resorption values at the buccal, lingual, mesial, and distal sides of the implants were 1.08 mm, 0.36 mm, 0.30 mm, and 0.25 mm in the delayed group, and 1.87 mm, 1.25 mm, 0.92 mm, and 1.23 mm in the simultaneous group, respectively; the differences between the groups were significant. There were no significant between-group differences in the gingival or plaque indices, or pocket depths. The mean follow-up period was 29 months.ConclusionFor reconstructing atrophic jaws, bone grafting from the iliac crest and implant placement after 3 months is a reliable technique with a high success rate and less bone resorption.

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Performance of five different displays in the detection of artificial incipient and recurrent caries-like lesions

Publication date: Available online 15 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Shawn Chancy Countryman, Saulo Leonardo Sousa Melo, Manuella Dias Furtado Belem, Francisco Haiter-Neto, Marcos A. Vargas, Veeratrishul Allareddy
ObjectivesTo assess whether auto-calibrating medical-grade monitors perform better than off-the-shelf monitors and tablet computers in detecting artificial incipient and recurrent caries-like lesions.Materials & Methods60 extracted teeth (30 premolars and 30 molars) were selected. All molars received class II amalgam and composite restorations. A 7mm² area on the crowns of half of the teeth was demineralized. Phantoms consisting of four teeth were created. Three observers using a five-point scale evaluated digital periapical radiographs for the presence of caries on five displays: two auto-calibrating medical-grade monitors, two tablets, and an off-the-shelf monitor. Sensitivity, specificity, accuracy, and ROC data were calculated and verified through ANOVA and Tukey tests. Cohen's kappa assessed observer agreements.ResultsIntraobserver agreement ranged from 0.347-0.612 (molars) and 0.617-0.811 (premolars). Interobserver agreement ranged from 0.239-0.559 (molars) and 0.657-0.858 (premolars). The performances of tablets and the off-the-shelf monitor were similar to medical monitors when the same tooth groups were compared. Medical monitors presented fewer statistically significant differences when different lesions where compared within the same display and restorative material.ConclusionEvaluations of similar lesions were not significantly different between the 3 types of displays. However, the auto-calibrating medical-grade monitors performed better when incipient and recurrent lesions were compared.

http://ift.tt/2yRmlWB

Use of integra in oral reconstruction: a case series

Publication date: Available online 15 November 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): L. Rúa Gonzálvez, L. de Villalaín Álvarez, A. Novoa Gómez, J.C. de Vicente Rodríguez, I. Peña González
Purpose: Small intraoral defects are usually reconstructed using skin autografts. However, the goal of this research was to describe an alternative to the classical techniques using artificial dermis (Integra®) in the reconstruction of these types of injuries. Materials and Methods: Four patients with small intraoral lesions in different locations underwent resection. The created defects were covered with a bilayer of Integra®; then, a chlorhexidine stent cure (Laboratorios Salvat, Barcelona, Spain) was applied. The patients were followed-up daily during the first week to detect any signs of infection, dehiscence or loss of the lamina. Thereafter, they were followed-up once per week for one month. Results: None of the patients presented with infections or a loss of the dermis. When the silicon sheet was detached, granulation tissue was detected, with complete re-epithelialization of the lesion in the postsurgical third through fourth weeks. Conclusion: The use of the Integra® allowed for the rapid reconstruction of slight intraoral defects, while preventing the morbidity associated with classical techniques. In this research, no complications were observed.

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Association between a single-nucleotide polymorphism in the GREM1 gene and nonsyndromic orofacial cleft in the Chinese population

Abstract

Background

Nonsyndromic orofacial cleft (NSOC) is a common craniofacial deformity among newborns. The GREM1 gene is correlated with orofacial development. The aim of our study was to investigate the association between a single-nucleotide polymorphism in the GREM1 gene and this malformation in the Chinese population.

Methods

The SNaPshot mini sequencing technique was used to genotype the locus rs1258763 of the GREM1 gene in 331 patients with NSOC and 271 individuals in a control group.

Results

For GREM1 rs1258763, there was a significant difference between the NSOC case group and control group (P=0.022). Children carrying GA and GA/AA genotypes had an increased risk of NSOC (OR=1.62, 95%CI: 1.15-2.30; OR=1.52, 95%CI: 1.09-2.12). In the cleft subgroup, we found that the GREM1 rs1258763 GA genotype might contribute to the elevated risk of the cleft lip with or without cleft palate (CL/P) (P=0.029). Nonsignificant differences were found between the cleft palate only (CPO) and control groups (P=0.077).

Conclusion

Our findings revealed that the GREM1 polymorphism was significantly associated with the risk of NSOC in the Chinese population.

http://ift.tt/2irr5fL

Psychometric validation of the Center for Epidemiological Studies Depression Scale in Head and Neck Cancer patients

Publication date: December 2017
Source:Oral Oncology, Volume 75
Author(s): K.S. Chhabria, G.D. Carnaby
ObjectiveThe Center for Epidemiological Studies Depression Scale (CES-D) is a 20-item tool developed to screen for depression in the general population. To psychometrically evaluate and validate the CES-D scale for use in head and neck cancer (HNC) patients.MethodsThe CES-D was applied to 130 subjects at onset of radiation treatment and 3-months following treatment. Analysis was conducted via face and content validity using two expert raters, internal consistency was applied using Cronbach's alpha, test retest reliability comparing baseline to 3-month application, concurrent validity was performed against the FACT-H&N and Pain Disability Index, construct validity was conducted via exploratory factor analysis.ResultsThe sample was predominantly male receiving chemo radiation. Face validity was strong (α = 0.85). Significant difference was found in the mean score between depressed (CES-D cut point ≥ 16) vs. non-depressed (t = −15.84, p = .00) (95% CI = −17.18, −13.33). Internal consistency of the scale was high (α = 0.84). Test retest reliability (p < .001) showed moderate-strong correlations (0.51), however was not sensitive to change in this sample across the study time period. Concurrent validity was strong (r = −0.77, 0.51). Factor analysis at baseline explained 54.92% of variance, with 3 distinct factors; depressed affect, somatic/retarded activity, and positive affect. In contrast to general populations, the factor 'disturbed interpersonal skill' was not retained.ConclusionResults confirm the reliability and validity of the CES-D as a measure of depression in HNC populations. Proposed cut off scores remain stable but scale responsiveness suggests caution when evaluating change over time in this population.

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Vorbereitung zur Facharztprüfung HNO

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Patients with atopic dermatitis and history of eczema herpeticum elicit HSV-specific type 2 immune responses

Publication date: Available online 16 November 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Stephan Traidl, Petra Kienlin, Gabriele Begemann, Lichen Jing, David M. Koelle, Thomas Werfel, Lennart M. Roesner

Teaser

An increased type 2 and in parallel decreased type 1 T cell immune response to herpes simplex virus 1 may lead to the clinical phenotype of eczema herpeticum.

http://ift.tt/2zaBwyJ

Αρχειοθήκη ιστολογίου

Παρασκευή 17 Νοεμβρίου 2017

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