Association of oxidative stress and dynamic thiol-disulphide homeostasis with atopic dermatitis severity and chronicity in children: a prospective study

Summary

Background

Oxidative stress (OS) has an important effect on the pathogenesis of atopic dermatitis (AD). Thiols are antioxidants that regulate intracellular redox metabolism and protect keratinocytes against OS damage in the stratum corneum.

Aim

To investigate dynamic thiol-disulphide homeostasis (dTDH) as a novel OS parameter in children with AD, and its relationship with disease severity and chronicity.

Methods

Severity of AD was determined by using the instruments SCORing Atopic Dermatitis (SCORAD) and Eczema Area And Severity Index (EASI) upon enrolment in the study (SCORAD₁ and EASI₁) and after 1 year (SCORAD₂ and EASI₂). Native thiol, total thiol and disulphide levels were measured as novel OS parameters, and the ratios of disulphide/native thiol, disulphide/total thiol and native/total thiol were calculated as dTDH.

Results

In the AD group, the serum disulphide level and the ratios of disulphide/native thiol and disulphide/total thiol were significantly lower than in healthy controls (P = 0.01, P < 0.01 and P < 0.01, respectively). There was no significant association between OS parameters and disease severity (P > 0.05). SCORAD₂ and EASI₂ were positively correlated with disulphide/native thiol ratio (r = 0.29, P < 0.03 and r = 0.35, P < 0.01, respectively), whereas they were negatively correlated with the native/total thiol ratio (r = −0.30, P = 0.02 for both).

Conclusions

Both OS and impaired dTDH were found to be related to childhood AD. None of the OS parameters was associated with AD severity. dTDH is a possible diagnostic tool to predict AD chronicity.

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Ischaemic pituitary tumour apoplexy and concurrent meningitis: a diagnostic dilemma

Pituitary tumour apoplexy is a rare but potentially life threatening clinical syndrome that mostly results from haemorrhage in the pre-existent tumour. Pure ischaemic subtype of apoplexy is even rarer. The presentation can be hard to differentiate clinically from bacterial meningitis. Moreover, the presence of one does not necessarily exclude the other and early diagnosis of both conditions is imperative for timely management. We report a case of ischaemic pituitary tumour apoplexy that may have precipitated in the setting of bacterial meningitis.

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Hyperacute leucopenia associated with furosemide

A 72-year-old man presented to the hospital with exacerbation of congestive heart failure. He was given furosemide 40 mg intravenously twice at 4 hours apart. At 4 hours after the second dose of furosemide, his white blood cells (WBC) dropped acutely from 9.8 to 2.4x10⁹/L (reference range 4.1 to 9.3x10⁹/L). With the discontinuation of furosemide, the WBC trended up to 7.1x10⁹/L about 13 hours after the second dose of intravenous furosemide and remained in normal range for the next 3 days. However, when the oral furosemide was started on hospital day 4, there was a mild drop in WBC count, which returned to and maintained at baseline since the next day. The dynamic changes in the patient's WBC were coincident with the use of furosemide. The possible mechanisms of furosemide-associated transient hyperacute leucopenia were discussed.

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Giant insulinoma: an unusual cause of hypoglycaemia

Description 

A 70-year-old non-diabetic man presented to the accident and emergency department with convulsions and symptoms of hunger, anxiety and blurred vision. A non-tender epigastric mass was identified, and he was found to be hypoglycaemic, with plasma glucose levels of 1.5 mmol/L (4.4–6.1 mmol/L). C-peptide and insulin levels were both inappropriately elevated.

After stabilisation with glucose, the patient was investigated with CT, which revealed a 154 mm mass in the pancreas that displaced the stomach and encased the coeliac trunk, the superior mesenteric vein and the splenic vein (figure 1). Collaterals were found at the level of the hepatic hilum, the gastro-oesophageal junction and adjacent to the mass itself. Calcifications typical of insulinomas were evident (figure 2). No metastases were seen. Fine-needle aspiration was then performed, confirming the diagnosis (figure 3).

Figure 1

Multiplanar reconstruction identifying the 154 mm insulinoma.

...

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Severe panniculitis and polyarthritis caused by acinar cell carcinoma arising from an ectopic pancreas

The pancreatitis, panniculitis and polyarthritis (PPP) syndrome is a rare condition caused by pancreatic diseases, such as acute or chronic pancreatitis or pancreatic carcinoma. We report the first case of PPP syndrome caused by metastatic acinar cell carcinoma from an ectopic pancreas. The symptoms were successfully managed by the treatment of the metastatic carcinoma. Pancreatic cytosteatonecrosis should be always considered in a patient who is showing symptoms of panniculitis and polyarthritis.

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Retrobulbar heavy liquid discovered 5 years postvitrectomy

Description

This report of a mass in the upper eyelid resulting from long-term complications of heavy liquid tamponade therapy of retinal detachment is a good example of learning from rare cases.

Retinal detachments may be repaired by scleral buckling, vitrectomy surgery or by a combination of both techniques. Retinal detachments repaired by vitrectomy are typically tamponaded by either gas or silicone oil. In certain complex cases, heavy liquid (perfluorohexyloctane/polydimethylsiloxane) is used as a short-term tamponading agent that is subsequently replaced with gas or silicone oil.1 2

A 16-year-old woman presented with bilateral retinal detachments secondary to giant tears. The patient had no relevant ocular history and denied trauma. The left eye had a macula-sparing detachment and the right eye had a macula-off retinal detachment. Both retinas were reattached sequentially with a combination of scleral buckling and vitrectomy with heavy liquid tamponade. The heavy...

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Sino-Nasal outcome test-22 outcomes after sinus surgery: A systematic review and meta-analysis

Objectives/Hypothesis

The goal of the study was to perform a systematic review with meta-analysis to determine the mean change in the 22-item Sino-Nasal Outcome Test (SNOT-22) across patients who have had endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) in the literature.

Methods

A literature search was performed to identify studies that assessed SNOT-22 scores before and after ESS in adult patients with CRS. A random effects model with inverse variance weighting was used to generate the mean change after surgery, along with the forest plot and 95% confidence interval (CI). The impact of patient-specific factors across studies was assessed using a mixed-effects meta-regression.

Results

The final study list included 40 unique patient cohorts published from 2008 to 2016. All studies showed a statistically significant change in mean SNOT-22 scores between baseline and postoperative time points (P < .001), ranging from 12.7 to 44.8, at an average follow-up of 10.6 months. The summary change in mean SNOT-22 across all studies was 24.4 (95% CI: 22.0-26.8). After forward, step-wise multivariate modeling, studies with higher mean preoperative SNOT-22 score and higher asthma prevalence were associated with greater changes in SNOT-22 score after ESS, whereas studies with longer mean follow-up had smaller changes in SNOT-22 score.

Conclusions

Studies evaluating quality-of-life outcomes after sinus surgery using the SNOT-22 instrument universally show significant improvement after ESS. Across the published literature, the magnitude of change is quite variable and appears to be influenced by a number of factors including baseline SNOT-22 score, asthma prevalence, and length of follow-up. Laryngoscope, 2017

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Determining Candidate Single Nucleotide Polymorphisms in Acquired Laryngotracheal Stenosis

Objectives/Hypothesis

Despite wide adoption of strategies to prevent injury from prolonged intubation and tracheotomy, acquired laryngotracheal stenosis (ALTS) has not disappeared. ALTS' persistence may be due to patient factors that confer unique susceptibility for some. We sought to identify genetic markers in genes associated with wound healing that could be associated with ALTS.

Study Design

Case-control study.

Methods

One hundred thirty-eight patients were recruited, 53 patients with ALTS and 85 control patients who underwent intubation or tracheotomy without evidence of ALTS. The patients' DNA was isolated from whole blood. Custom primers were designed, and the TaqMan assay employing allele-specific polymerase chain reaction was used to interrogate single nucleotide polymorphisms (SNPs) rs1799750, rs522616, rs2276109, rs2569190, rs1800469, and rs1024611 of candidate wound healing genes MMP1, MMP3, MMP12, CD14, TGFβ1, and MCP1, respectively. A logistic regression model was used to examine the association of candidate gene polymorphisms with the presence or absence of ALTS.

Results

All 138 patients were successfully genotyped. No significant association was found between candidate SNPs and development of ALTS in the overall group. However, subgroup analysis within each ethnicity identified SNPs that are associated with ALTS depending upon the ethnic background.

Conclusions

Patient factors such as variations in wound healing due to functional SNPs may shed light on the development of ALTS. There may be a difference in susceptibility to developing ALTS in different ethnic backgrounds. These preliminary findings need to be corroborated in larger population studies.

Level of Evidence

3b Laryngoscope, 2017

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Multilevel lumbar spine infection due to poor dentition in an immunocompetent adult: a case report

Although spinal infections have been reported following dental procedures, development of a spinal infection attributed to poor dentition without a history of a dental procedure in an immunocompetent adult has...

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Detection of Hepatitis C antibodies without viral transmission in Hepatitis C negative recipients receiving kidneys from Hepatitis C positive donors treated with Direct Acting Anti-Viral Therapy

No abstract available

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Use of organs from hepatitis C virus positive donors for uninfected recipients: a potential cost-effective approach to save lives?

Background Organs from hepatitis C virus (HCV) seropositive (HCVpos) individuals are seldom used for transplantation because of the risk of disease transmission. Because transmitted HCV is now amenable to effective treatment we estimated the potential impact of using HCVpos deceased donor organs for transplantation. Methods The Potential Donor Audit (PDA) of patients (

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Analysis of biomarkers within the initial 2 years posttransplant and 5-year kidney transplant outcomes: results from Clinical Trials in Organ Transplantation-17

ABSTRACT Background An early posttransplant biomarker/surrogate marker for kidney allograft loss has the potential to guide targeted interventions. Previously published findings, including results from the Clinical Trials in Organ Transplantation (CTOT)-01 study, showed that elevated urinary chemokine CXCL9 levels and elevated frequencies of donor-reactive interferon gamma-(IFNγ)-producing T cells by enzyme linked immunosorbent spot (ELISPOT) assay associated with acute cellular rejection within the first year and with lower 1-year posttransplant estimated glomerular filtration rate (eGFR). How well these biomarkers correlate with late outcomes, including graft loss, is unclear. Methods In CTOT-17, we obtained 5-year outcomes in the CTOT-01 cohort and correlated them with a) biomarker results and b) changes in eGFR (Chronic Kidney Disease Epidemiology Collaboration formula) over the initial 2 years posttransplant using univariable analysis and multivariable logistic regression. Results Graft loss occurred in 14/184 subjects (7.6%) 2 to 5 years posttransplant. Neither IFNγ ELISPOTs nor urinary CXCL9 were informative. In contrast, a ≥40% decline in eGFR from 6 months to 2 years posttransplant independently correlated with thirteen-fold odds of 5-year graft loss [adjusted odds ratio (aOR) 13.1; 95% CI 3.0-56.6], a result that was validated in the independent Genomics of Chronic Allograft Rejection cohort (n=165, aOR: 11.2). Conclusions We conclude that while pre and early posttransplant ELISPOT and chemokine measurements associate with outcomes within 2-years posttransplant, changes in eGFR between 3 months or 6 months and 24 months are better surrogates for 5-year outcomes, including graft loss. Corresponding author: Peter S Heeger, MD, Translational Transplant Research Center, Icahn School of Medicine at Mount Sinai, New York, USA, Email: peter.heeger@mssm.edu, Phone: 212 241 6324, Fax: 212 987 0389 Authorship Geovani Faddoul, M.D. Participated in data analysis and writing/editing of the manuscript Girish N Nadkarni, M.D. Participated in data analysis and writing/editing of the manuscript Nancy D. Bridges, M.D. Participated in study design and writing/editing of the manuscript Jens Goebel, M.D. Participated in writing/editing of the manuscript Donald E. Hricik, M.D. Participated in study design, data analysis and writing/editing of the manuscript Richard Formica, M.D. Participated in study design and writing/editing of the manuscript Madhav C Menon, M.D. Participated in study design, data analysis and writing/editing of the manuscript Yvonne Morrison, Participated in study design and writing/editing of the manuscript Barbara Murphy, M.D. Participated in study design and writing/editing of the manuscript Kenneth Newell, M.D. Participated in study design and writing/editing of the manuscript Peter Nickerson, M.D. Participated in study design and writing/editing of the manuscript Emilio D. Poggio, M.D. Participated in study design and writing/editing of the manuscript David Rush, M.D. Participated in study design and writing/editing of the manuscript Peter S. Heeger, M.D. Participated in study design, data analysis and writing/editing of the manuscript Disclosure The authors of this manuscript have no conflicts of interest to disclose. Funding The study was supported by National Institutes of Health U01 grant AI63594 awarded to P Heeger and K23DK107908 to G Nadkarni Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Heme Oxygenase 1 Attenuates Hypoxia-Reoxygenation Injury in Mice Liver Sinusoidal Endothelial Cells

ABSTRACT Background Heme oxygenase 1 (HO-1), a heat shock protein, can be involved in the resolution of inflammation by modulating cytokine expression and apoptotic cell death. Based on recent evidence that liver sinusoidal endothelial cells (LSECs) is the critical target in early period of liver ischemia-reperfusion injury (IRI), this study aims to clarify whether overexpression of HO-1 gene provides a protective effect on mice LSECs. Method LSECs were transfected with adenovirus vectors encoding mice HO-1 gene (Ad-HO-1) or green fluorescent protein (Ad-EGFP). Controls were not infected with any vector. LSECs were then treated with hypoxic or normoxic culture. We used low serum culture medium and hypoxia-reoxygenation (H-R) conditions to cause IRI in vitro. The transfection efficiency of HO-1 gene in LSECs, after 48 hours of transfection, and the effect of HO-1 on the model of H-R injury in LSECs were observed. Results Transfection of LSECs with Ad-HO-1 was at an optimal dose (MOI=80) to markedly express HO-1 mRNA and protein. Groups of overexpressed HO-1 showed lower levels of inflammatory factor mediators IL-6 and TNF-α. Survival rate of the cells after H-R injury was higher and attributed to overexpressed HO-1. In contrast, the control adenovirus expressing the EGFP failed to induce HO-1 expression, and stimulated cell apoptosis. HO-1 expression was down-regulated in all H-R groups compared to normoxia groups, which may be related to the disruption of the LSEC structure. Conclusion Up-regulation of HO-1 can attenuate H-R injury in LSECs by inhibiting proinflammatory cytokine release and diminishing apoptotic cell death. Corresponding author: Zhong Zeng, MD, PhD, Organ Transplantation Center, the First Affiliated Hospital of Kunming Medical College, 295 Xichang Road, Kunming 650032, Yunnan Province, China. Telephone: +86-871-65359202; Fax: +86-871-65359202; Email: zzong@medmail.com.cn Authorship: Siming Qu, Bo Yuan, and Zhong Zeng contributed equally to this work; Siming Qu and Bo Yuan performed the majority of experiments; Hongbin Zhang participated in the performance of the research; Hanfei Huang participated in data analysis; Shikun Yang, Jie Lin, Li Jin, and Pu Wu participated in the writing of the paper. Disclosure: The authors declare no conflicts of interest. Funding: National Nature Science Foundation of China, No. 81660113 Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Comparison of BQ123, Epoprostenol, and Verapamil as Vasodilators During Normothermic Ex Vivo Liver Machine Perfusion

Background The optimal vasodilator to avoid hepatic artery (HA) vasospasm during normothermic ex vivo liver perfusion (NEVLP) is yet to be determined. We compared safety and efficacy of BQ123 (endothelin1 antagonist), Epoprostenol (prostacyclin analogue), and Verapamil (calcium channel antagonist). Methods Livers from porcine heart beating donors were perfused for 3 hours and transplanted into recipient pigs. Four groups were compared: Group 1: livers perfused with a dose of 1.25 mg of BQ123 at baseline and at 2 hours of perfusion, Group 2: Epoprostenol at a continuous infusion of 4mg/hr, Group 3: Verapamil 2.5mg at baseline and at 2 hours of perfusion, Group 4: No vasodilator used during ex vivo perfusion. Liver injury and function were assessed during perfusion, and daily post transplantation until postoperative day 3. All groups were compared to a cold storage group for post operative graft function. Results Hepatic artery flow during NEVLP was significantly higher in BQ123 compared to Verapamil, Epopostenol, and no vasodilator treated livers. AST levels were significantly lower with BQ123 and Verapamil compared to Epoprostenol and control group during perfusion. Peak AST levels were lower in pigs receiving BQ123 and Verapamil perfused grafts compared to Epoprostenol and control group. INR, alkaline phosphatase, and total bilirubin levels were lower in the BQ123 and Verapamil groups compared to Epoprostenol group. Cold storage group had increased markers of ischemia reperfusion injury and slower graft function recovery compared to machine perfused grafts. Conclusion The use of BQ123, Epoprostenol, and Verapamil during NEVLP is safe. Livers perfused with BQ123 and Verapamil have higher HA flow and reduced hepatocyte injury during perfusion compared to Epoprostenol. Hepatic artery flow is significantly reduced in the absence of vasodilators during NEVLP. Authors Contributions. Juan Echeverri: Conception and design of the study, completion of experiments, acquisition of data, data analysis and interpretation, drafted manuscript, final approval for publication, and agreement to be accountable for all aspects of the work. Nicolas Goldaracena: Completion of experiments, acquisition of data, data analysis and interpretation, revised manuscript critically for important intellectual content, final approval for publication, and agreement to be accountable for all aspects of the work. Johan Moritz Kaths: Completion of experiments, acquisition of data, data analysis and interpretation, revised manuscript critically for important intellectual content, final approval for publication, and agreement to be accountable for all aspects of the work. Ivan Linares: Completion of experiments, acquisition of data, data analysis and interpretation final approval for publication, and agreement to be accountable for all aspects of the work. Roizar Rosales: Completion of experiments, acquisition of data, data analysis and interpretation final approval for publication, and agreement to be accountable for all aspects of the work. Dagmar Kollmann: Completion of experiments, acquisition of data, data analysis and interpretation final approval for publication, and agreement to be accountable for all aspects of the work. Matyas Hamar: Acquisition of data, data analysis and interpretation final approval for publication, and agreement to be accountable for all aspects of the work. Peter Urbanellis: Analysis and interpretation of data, revised manuscript critically for important intellectual content, final approval for publication, and agreement to be accountable for all aspects of the work. Sujani Ganesh: Acquisition of data, analysis and interpretation of data, revised manuscript critically for important intellectual content, final approval for publication, and agreement to be accountable for all aspects of the work. Oyedele Adeyi: Analysis and interpretation of data, revised manuscript critically for important intellectual content, final approval for publication, and agreement to be accountable for all aspects of the work. Mahmood Tazari: Statistical analysis and interpretation of data, revised manuscript critically, final approval for publication, and agreement to be accountable for all aspects of the work. Markus Selzner: Conception and design of the study, completion of experiments, acquisition of data, data analysis and interpretation, drafted manuscript, final approval for publication, and agreement to be accountable for all aspects of the work. Nazia Selzner: Conception and design of the study, acquisition of data, data analysis and interpretation, drafted manuscript, final approval for publication, and agreement to be accountable for all aspects of the work. Disclosure: The authors declare no conflicts of interest. Correspondence: Nazia Selzner, MD, PhD, Toronto General Hospital, NCSB 11C-1244, 585 University Avenue, Toronto, ON M5G2N2, Phone: 1-416-340-5230, Fax: 1-416-340-5242, e-mail: nazia.selzner@uhn Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Myeloid-Derived Suppressor Cells and their Potential Application in Transplantation

Abstract Myeloid-derived suppressor cells (MDSCs) are a heterogeneous population of immunosuppressive cells of the myeloid lineage upregulated by mediators of inflammation such as IL-2, GCSF, and S100A8/A9. These cells have been studied extensively by tumor biologists. Because of their robust immunosuppressive potential, MDSCs have stirred recent interest among transplant immunologists as well. MDSCs inhibit T cell responses through, among other mechanisms, the activity of arginase-1 and iNOS, and the expansion of T regulatory (Treg) cells. In the context of transplantation, MDSCs have been studied in several animal models, and to a lesser degree in humans. Here, we will review the immunosuppressive qualities of this important cell type and discuss the relevant studies of MDSCs in transplantation. It may be possible to exploit the immunosuppressive capacity of MDSCs for the benefit of transplant patients. Disclosure: The authors have no financial disclosures. Grant support: This work was supported by a grant (to JRS) from the American Surgical Association Foundation and by the Living Legacy Foundation of Maryland. Author contributions: JRS – read the literature, developed the concept/hypotheses, wrote the manuscript, lead the project, revised the paper YSL – read the literature, contributed to hypotheses, edited the paper ED – read the literature, edited the paper, contributed to manuscript's structure JSB – read the literature, edited the paper, contributed to manuscript's structure, mentored the project Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Association of Cardiac Abnormalities to the Frail Phenotype in Cirrhotic Patients on the Waitlist: From the Functional Assessment in Liver Transplantation (FrAILT) Study.

ABSTRACT Background Frailty is a syndrome of decreased physiologic reserve that results from compromise of multiple physiologic systems including cardiovascular. We aimed to determine the association between the frail phenotype and cardiac abnormalities in liver transplant (LT) candidates through evaluation of transthoracic echocardiography (TTE) indices. Methods Included were consecutive outpatients listed for LT who underwent a frailty assessment from 1/1/14-6/30/16 (using the Liver Frailty Index) and a 2-dimensional/doppler TTE exam. Patients were categorized as robust, intermediate frail, or frail by the Liver Frailty Index based on scores of 34cc/m2 (p= 0.001). In linear regression adjusted for age, sex, hypertension and diabetes, the Liver Frailty Index was positively associated with LA dimension (coeff 0.20, 95%CI 0.07-0.34), LAVIcc/m2 (coeff 0.01, 95%CI 0.005-0.02), ejection fraction (coeff 1.59, 95%CI 0.32-2.85) and pulmonary artery systolic pressure (coeff 0.01, 95%CI 0.003-0.02) and negatively associated with LV hypertrophy (coeff -0.22, 95%CI -0.37, -0.06). Conclusion In LT candidates, frailty is associated with cardiac structural and functional changes, independent of known risk factors. Our study provides evidence to support that measures of frailty in cirrhotic patients encompass abnormalities of the cardiovascular system and may inform assessments of cardiovascular reserve in this population. CORRESPONDENCE INFORMATION: Jennifer C. Lai, MD, MBA, Department of Medicine, Division of Gastroenterology and Hepatology, University of California-San Francisco, San Francisco, CA, 513 Parnassus Avenue, UCSF Box 0538, San Francisco, CA 94143, Email: Jennifer.lai@ucsf.edu, Academic office: (415) 476-2777 AUTHORSHIP Puchades:Study concept and design; acquisition of data; analysis and interpretation of data; drafting of manuscript; critical revision of the manuscript for important intellectual content. Chau: Study design; acquisition of data, interpretation of data; critical revision of the manuscript for important intellectual content. Dodson: Study design; interpretation of data; drafting of manuscript; critical revision of the manuscript for important intellectual content. Mohamad: Study design; interpretation of data; critical revision of the manuscript for important intellectual content. Mustain: Study design; interpretation of data; critical revision of the manuscript for important intellectual content. Lebsack: Study design; analysis and interpretation of data; critical revision of the manuscript for important intellectual content. Aguilera: Study design; interpretation of data; critical revision of the manuscript for important intellectual content. Prieto: Study design; interpretation of data; critical revision of the manuscript for important intellectual content. Lai: Study concept and design; analysis and interpretation of data; drafting of manuscript; critical revision of the manuscript for important intellectual content; statistical analysis and study supervision. DISCLOSURE: The authors of this manuscript have no conflicts of interest to disclose. FUNDING: This study was funded by the Spanish Transplantation Society (Puchades), an American College of Gastroenterology Junior Faculty Development Award (Lai), P30AG044281 (UCSF Older Americans Independence Center; Lai), and K23AG048337 (Paul B. Beeson Career Development Award in Aging Research; Lai). These funding agencies played no role in the analysis of the data or the preparation of this manuscript. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Rituximab and Therapeutic Plasma Exchange in Recurrent Focal Segmental Glomerulosclerosis Postkidney Transplantation

Background Focal segmental glomerulosclerosis (FSGS) is a common cause of end stage renal disease (ESRD) with a high rate of recurrence after kidney transplantation. Several factors such as white race, rapid progression, and previous allograft failure due to recurrence were found to be risks of recurrence. Data are limited on the benefits of rituximab and/or therapeutic plasma exchange (TPE) in preventing recurrence. In this study, we sought to assess the efficacy of rituximab and TPE for the prevention and treatment of recurrent FSGS post kidney transplantation. Methods We enrolled 66 patients with FSGS in this prospective observational study and followed their outcomes. Patients with high risk for recurrence received preventative therapy with TPE and/or rituximab. Results Twenty three of the thirty seven (62%) who received preventative therapy developed recurrence compared to fourteen recurrences out of the twenty seven (51%) who did not receive any therapy (p=0.21). There was a trend for less relapse when rituximab was used as a therapy for recurrent FSGS, (6/22 versus 9/18, p=0.066). We utilized a clinical score of 5 values to assess the prediction of FSGS recurrence. A score of 3 or more had a predictive Receiver Operating Characteristic (ROC) curve of 0.72. Treatment with TPE and/or rituximab resulted in better allograft survival than historical studies. Allograft failure due to recurrent FSGS occurred in only 6 patients (9%). Conclusion Preventative therapies do not decrease the recurrence rate of recurrent FSGS. However, prompt treatment of recurrence with these therapies may result in improved outcomes. Corresponding Author: Nada Alachkar, MD, 600 Wolfe St. Brady 502, Baltimore, MD. Email: nalachk1@jhmi.edu Authorship Page: Sami Alasfar: data collection, data analysis and interpretation, drafting the article Dany Matar: data collection Robert A Montgomery: critical revision of the article Niraj Desai: critical revision of the article Bonnie Lonze: critical revision of the article Vikas Vujjini: data collection Michelle M. Estrella: critical revision of the article John Manllo Dieck: data collection, critical revision of the article Gebran Khneizer: data collection Sanja Sever: critical revision of the article Jochen Reiser: critical revision of the article Nada Alachkar: design of the work, data collection, data analysis and interpretation, drafting the article, final approval of the version to be published Disclosures: JR and SS are cofounders and stock holders of Trisaq, a biotechnological company developing novel therapeutics for chronic kidney diseases and FSGS, and have pending and issued patents in the therapeutic and diagnostic space regarding kidney diseases. Sources of support: NIH R01DK101350-04, Nada Alachkar Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Valganciclovir prophylaxis versus preemptive therapy in cytomegalovirus-positive renal allograft recipients: Long-term results after 7 years of a randomized clinical trial

Background The VIPP study compared valganciclovir prophylaxis with preemptive treatment regarding efficacy, safety and long-term graft outcome in CMV-positive (R+) renal transplant recipients. Methods Multicenter, open-label, randomized clinical study with a 12-month study phase and a follow-up of up to 84 months. Patients in the prophylaxis group received 2x450 mg/day oral valganciclovir for 100 days adjusted to renal function. Preemptive treatment with 2x900 mg/day valganciclovir was initiated at a viral load of ≥400 CMV copies/mL (PCR) and maintained over ≥14 days, followed by secondary prophylaxis. Patients were stratified by donor CMV IgG serostatus (D+/R+, D-/R+). Results The 12-month-results were reported previously (Witzke et al Transplantation 2012). The intent-to-treat/safety population comprised 148 patients in the prophylaxis (61.5% D+/R+) and 151 patients in the preemptive group (52.3% D+/R+). Overall, 47% patients completed the follow-up. Significantly fewer patients in the prophylaxis compared to preemptive group experienced a CMV infection or disease up to month 84 (11.5% [95% CI: 6.8%,17.8%] vs. 39.7% [31.9%,48.0%], p

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Procedural sedation and analgesia for adults in Europe: Safety first

No abstract available

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Neostigmine-based reversal of intermediate acting neuromuscular blocking agents to prevent postoperative residual paralysis: A systematic review

BACKGROUND Neostigmine is widely used to antagonise residual paralysis. Over the last decades, the benchmark of acceptable neuromuscular recovery has increased progressively to a train-of-four (TOF) ratio of at least 0.9. Raising this benchmark may impact on the efficacy of neostigmine. OBJECTIVE(S) The systematic review evaluates the efficacy of neostigmine to antagonise neuromuscular block to attain a TOF ratio of at least 0.9. DESIGN We performed a systematic search of the literature from January 1992 to December 2015. DATA SOURCES OR SETTING PubMed, EMBASE and the Cochrane Controlled Clinical Trials database were searched for randomised controlled human studies. Search was performed without language restrictions, using the following free text terms: 'neostigmine', 'sugammadex', 'edrophonium' or 'pyridostigmine' AND 'neuromuscular block', 'reversal' or 'reverse'. ELIGIBILITY CRITERIA Studies were accepted for inclusion if they used quantitative neuromuscular monitoring and neostigmine as the reversal agent. Selected trials were checked by two of the authors for data integrity. Trials relevant for inclusion had to report the number of patients included, the type of anaesthetic maintenance, the type of neuromuscular blocking agent used, the reversal agent and dose used, the depth of neuromuscular block when neostigmine was administered and the reversal time (time from injection of neostigmine until a TOF ratio ≥0.9 was attained). RESULTS 19 trials were eligible for quantitative analysis. In patients with deep residual block [T1 (first twitch height) 25% of baseline), or that a recovery time longer than 15 min be accepted. Correspondence to Thomas Fuchs-Buder, MD, Department of Anaesthesia and Critical Care, University Hospital of Nancy, Rue du Morvan, F-54511 Vandoeuvre-Les-Nancy, France. Cedex E-mail: t.fuchs-buder@chru-nancy.fr © 2017 European Society of Anaesthesiology

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Open-label study assessing the efficacy and tolerability of topical skincare and sun protection products following intense pulsed light treatment

Summary

Background

The visible signs of photodamage can be improved by intense pulsed light (IPL). Active ingredients in cosmeceuticals also have effects on skin quality and pigmentation, and can camouflage post-treatment side effects. Combination therapies utilizing different treatment modalities have been shown to optimize clinical outcomes for skin rejuvenation and patient satisfaction.

Aim

To evaluate the efficacy of a combination of IPL with a daily topical skincare and sunscreen regimen for the treatment of facial photodamage and for the improvement of IPL treatment tolerability.

Patients/Methods

Twenty female subjects with moderate-to-severe facial photodamage, with past history of IPL treatments, received one IPL treatment followed by the use of the topical skincare regimen for 8 weeks. An investigator assessed facial photodamage and hyperpigmentation at baseline, week 4, and week 8, and postprocedure erythema. Subject questionnaires were also administered at each visit.

Results

Compared to baseline, there was a significant improvement in photodamage and hyperpigmentation of bare facial skin. The application of the skincare regimen resulted in a significant reduction in post-IPL erythema, stinging/burning, and itching. The majority of patients were very satisfied or satisfied and felt the treatment regimen improved various aspects of skin quality and the tolerability of the procedure.

Conclusions

The addition of a topical skincare regimen after IPL treatment to the face resulted in significant improvements in facial photodamage and pigmentation, decreased post-treatment side effects, and increased tolerability.

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Comparative study of buffered 50% glycolic acid (pH 3.0) + 0.5% salicylic acid solution vs Jessner's solution in patients with acne vulgaris

Summary

Background

Superficial chemical peels are frequently used in acne vulgaris treatment. Although glycolic acid (GA) has been widely used in clinical practice, its pH ranges from 0.08-2.75 and thus should be neutralized after application to avoid burns.

Objective

To evaluate treatment efficacy and safety of chemical peeling using buffered 50% GA (pH 3.0) + 0.5% salicylic acid (SA) solution that does not need to be neutralized in the treatment of acne vulgaris compared to the conventional peeling using Jessner's solution.

Methods

We performed a prospective, randomized, evaluator-blind, split-face clinical trial. Twenty patients were randomized by assigning one side of each patient's face to receive a 50% GA (pH 3.0) + 0.5% SA peel (GA side) and the other side to receive the Jessner's solution (Jessner's solution side). All patients underwent 2 sessions of treatment spaced 2 weeks apart. Lesion count, acne severity, subjective efficacy assessment, and side effects were evaluated.

Results

The total lesion count was significantly reduced for the GA and Jessner's solution sides (P < .001). However, there was no significant difference in the total lesion count, acne severity, or subjective efficacy assessment between the 2 sides (P > .05). The GA side had fewer side effects than the Jessner's solution side.

Conclusion

The results of this study suggest that chemical peeling using the 50% GA (pH 3.0) + 0.5% SA solution can be as effective and convenient as the conventional peeling using Jessner's solution in the treatment of acne vulgaris and may show fewer adverse events than the conventional peeling.

http://ift.tt/2BcHyfq

Speckled acral hypopigmentation in an adolescent

Abstract

We report a case of speckled acral hypopigmentation in a 12-year-old girl. She presented with asymptomatic hypopigmented macules on the hands and feet. This rare entity is a proposed variant of reticulate acropigmentation and of unknown etiology.

http://ift.tt/2jKVGZ8

Urticarial vasculitis after meningococcal serogroup B vaccine in a 6-year-old girl

Abstract

The first vaccine that shows significant potential in providing broad coverage against serogroup B meningococcal disease has recently been approved. Because of its newness, potential adverse events need to be reported. Here we report a case of urticarial vasculitis, a rare disease in children, in probable relationship with the novel vaccine.

http://ift.tt/2hRrBXa

Erythromelanosis follicularis faciei et colli: A clinicoepidemiologic study

Abstract

We describe 25 cases of erythromelanosis follicularis faciei et colli from India. The male:female ratio was 5.25:1 and the average age of onset was 12.3 years. The cheeks, preauricular area, and submandibular region were the sites most commonly affected. Keratosis pilaris was seen in 22 (88%) of the patients.

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Reducing production of fumonisin mycotoxins in Fusarium verticillioides by RNA interference

Abstract

The fungus Fusarium verticillioides is a maize pathogen that can produce fumonisin mycotoxins in ears under certain environmental conditions. Because fumonisins pose health risks to humans and livestock, control strategies with minimal risk to the environment are needed to reduce fumonisin contamination. Host-induced gene silencing is a promising technique in which double-stranded RNA expressed in the plant host is absorbed by an invading fungus and down-regulates genes critical for pathogenicity or mycotoxin production in the fungus. A key preliminary step of this technique is identification of DNA segments within the targeted fungal gene that can effectively silence the gene. Here, we used segments of the fumonisin biosynthetic gene FUM1 to generate double-stranded RNA in F. verticillioides. Several of the resulting transformants exhibited reduced FUM1 gene expression and fumonisin production (24- to 3675-fold reduction in fumonisin FB₁). Similar reductions in fumonisin production resulted from double-stranded RNA constructs with segments of FUM8, another fumonisin biosynthetic gene (3.5- to 2240-fold reduction in fumonisin FB₁). FUM1 or FUM8 silencing constructs were transformed into three isolates of F. verticillioides. Whole genome sequence analysis of seven transformants revealed that reductions in fumonisin production were not due to mutation of the fumonisin biosynthetic gene cluster and revealed a complex pattern of plasmid integration. These results suggest the cloned FUM1 or FUM8 gene segments could be expressed in maize for host-induced gene silencing of fumonisin production.

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Response Regarding Surgical Techniques for Retrograde Parotidectomy

We thank Dr. Tim-Lin Chow and his team for their response to our article and for their contributions to the field.

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Reconstruction of intraoral defects after resection of cancer with two types of submental artery perforator flaps

The submental island flap is a common choice for reconstruction of intraoral defects. To obtain a thinner, more pliable flap and get a better oncological result, the submental artery perforator flap has been proposed, and to assess its feasibility for closure of defects after resection of cancers of the oral cavity we studied 20 patients, each of whom was treated in this way. All the flaps were classified into those with septocutaneous perforators (n=16) and those with musculocutaneous perforators (n=4), and the main veins that drained the flaps were two submental veins (n=17).

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Clinical outcomes of dental implants after use of tenting for bony augmentation: a systematic review

The reconstruction of severely atrophic ridges is often challenging and complicated. We searched the Medline, Embase, and Cochrane databases for articles up to October 2015 that reported the success of all types of tenting for bony regeneration. We extracted data on the size and site of the defect, the number of patients, vertical and horizontal augmentation, survival of dental implants, and complications. Thirteen studies were included, which yielded data on 423 patients with 1111 dental implants.

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Corrigendum to “Craniofacial implants at a single centre 2005–2015: retrospective review of 451 implants” [Br J Oral Maxillofac Surg 2017;55:242-5]

The authors regret an incorrect Fig. 1 published in the above mentioned paper. Please find correct figure below:

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Is a fractured mandible an emergency?

We retrospectively audited the records of 708 patients who presented with the diagnosis of fractured mandible between January 2009 and July 2013 at the Queen Elizabeth Hospital, Birmingham. We assessed the different factors that may have altered their outcomes, and found that delay before definitive fixation caused no harm in either the short or the long term.

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Identification of alpha-gal sensitivity in patients with a diagnosis of idiopathic anaphylaxis

Abstract

IgE antibodies (Ab) specific to galactose-α-1,3-galactose (alpha-gal) are responsible for a delayed form of anaphylaxis that occurs 3 to 6 hours after red meat ingestion. In a unique prospective study of seventy participants referred with a diagnosis of idiopathic anaphylaxis (IA), six (9%) were found to have IgE to alpha-gal. Upon institution of a diet free of red meat, all patients had no further episodes of anaphylaxis. Two of these individuals had indolent systemic mastocytosis (ISM). Those with ISM had more severe clinical reactions but lower specific IgE to alpha-gal and higher serum tryptase levels, reflective of the mast cell burden. The identification of alpha-gal syndrome in patients with IA supports the need for routine screening for this sensitivity as a cause of anaphylaxis, where reactions to alpha-gal are delayed and thus may be overlooked.

This article is protected by copyright. All rights reserved.

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The mycoestrogen zearalenone in Portuguese flowing waters and its potential environmental impact

Abstract

This study provides the first environmental risk assessment (ERA) for zearalenone (ZEN), the only known mycoestrogen, based on a broad-scale investigation on its occurrence in rivers and creeks from Portugal. Water sample filtration and immunoaffinity columns (IAC) clean-up followed by liquid chromatograph with tandem mass spectrometry (LC/MSⁿ ) provided an analytical method with good analytical performance. ZEN levels were determined for seven Portuguese rivers and one creek, during two different seasons, in a total of 38 samples collected upstream wastewater treatment plants (WWTPs). Overall, 23.7% were contaminated with ZEN at levels ranging between 5.6 and 82.6 ng/L. The highest concentration was observed during spring, although no statistically significant differences were observed between spring and autumn sampling campaigns. The potential ecotoxicological risk from ZEN to different trophic levels of aquatic organisms was evaluated by means of risk quotients (RQs) calculation. Although all the RQs obtained were lower than 1, our results confirm that ZEN is a relatively frequent contaminant in flowing waters in Portugal and might contribute to the overall estrogenic activity in the environment.

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The serum leptin level in non-obese patients with obstructive sleep apnea

This study aimed to determine the association between the severity of obstructive sleep apnea (OSA) and the serum leptin level in non-obese OSA patients.

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Sialic Acid-Binding Immunoglobulin-Like Lectin1 as a Novel Predictive Biomarker for Relapse in Graves' Disease: A Multicenter Study

Thyroid , Vol. 0, No. 0.


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Epitope Mapping of Monoclonal Antibody PMab-38 Against Dog Podoplanin

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


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Effect of aging and curing mode on the compressive and indirect tensile strength of resin composite cements

Resin composite cements are used in dentistry to bond ceramic restorations to the tooth structure. In the oral cavity these cements are subjected to aging induced by masticatory and thermal stresses. Thermal c...

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The effect of magnesium hydroxide-containing dentifrice using an extrinsic and intrinsic erosion cycling model

Publication date: February 2018
Source:Archives of Oral Biology, Volume 86
Author(s): Vanara Florêncio Passos, Lidiany Karla Azevedo Rodrigues, Sérgio Lima Santiago
ObjectiveTo evaluate, in vitro, the effect of Mg(OH)2 dentifrice, and the influence of the number of experimental days, on the extrinsic (citric acid –CA) and intrinsic (hydrochloric acid –HCl) enamel erosion models.DesignHuman enamel slabs were selected according to surface hardness and randomly assigned to 3 groups (n=9) as follows: non-fluoridated (negative control), NaF (1450ppm F- positive control) and Mg(OH)2 (2%) dentifrices. The slabs were daily submitted to a 2-h period of pellicle formation and, over a period of 5days, submitted to cycles (3×/day) of erosive challenge (CA 0.05M, pH=3.75 or HCl 0.01M, pH=2 for 30s), treatment (1min −1:3w/w of dentifrice/distilled water) and remineralization (artificial saliva/120min). Enamel changes were determined by surface hardness loss (SHL) for each day and mechanical profilometry analysis. Data were analyzed by two-way ANOVA followed by Tukey's test to % SHL and one-way ANOVA to profilometry (p<0.05).ResultsThe number of experimental days influenced the erosion process for the two types of erosion models (p<0.001). Mg(OH)2-containing dentifrices were effective in reducing enamel extrinsic acid erosion as determined by % SHL (p<0.001) when compared to the control group, being better than positive control (p<0.001); however, the dentifrices were not effective for the intrinsic model (p=0.295). With regards to surface wear, no statistically significant differences were found among the groups for CA (p=0.225) and HCl (p=0.526).ConclusionThe findings suggest that Mg(OH)2 dentifrices might protect enamel against slight erosion, but protection was not effective for stronger acid erosion.



http://ift.tt/2z92yCl

The effect of magnesium hydroxide-containing dentifrice using an extrinsic and intrinsic erosion cycling model

Publication date: February 2018
Source:Archives of Oral Biology, Volume 86
Author(s): Vanara Florêncio Passos, Lidiany Karla Azevedo Rodrigues, Sérgio Lima Santiago
ObjectiveTo evaluate, in vitro, the effect of Mg(OH)2 dentifrice, and the influence of the number of experimental days, on the extrinsic (citric acid –CA) and intrinsic (hydrochloric acid –HCl) enamel erosion models.DesignHuman enamel slabs were selected according to surface hardness and randomly assigned to 3 groups (n=9) as follows: non-fluoridated (negative control), NaF (1450ppm F- positive control) and Mg(OH)2 (2%) dentifrices. The slabs were daily submitted to a 2-h period of pellicle formation and, over a period of 5days, submitted to cycles (3×/day) of erosive challenge (CA 0.05M, pH=3.75 or HCl 0.01M, pH=2 for 30s), treatment (1min −1:3w/w of dentifrice/distilled water) and remineralization (artificial saliva/120min). Enamel changes were determined by surface hardness loss (SHL) for each day and mechanical profilometry analysis. Data were analyzed by two-way ANOVA followed by Tukey's test to % SHL and one-way ANOVA to profilometry (p<0.05).ResultsThe number of experimental days influenced the erosion process for the two types of erosion models (p<0.001). Mg(OH)2-containing dentifrices were effective in reducing enamel extrinsic acid erosion as determined by % SHL (p<0.001) when compared to the control group, being better than positive control (p<0.001); however, the dentifrices were not effective for the intrinsic model (p=0.295). With regards to surface wear, no statistically significant differences were found among the groups for CA (p=0.225) and HCl (p=0.526).ConclusionThe findings suggest that Mg(OH)2 dentifrices might protect enamel against slight erosion, but protection was not effective for stronger acid erosion.



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What you need to know about PRP

A look at PRP, a process used to reduce inflammation. Included is detail on costs and the side effects, plus conditions it can help.

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It started from scratch

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Tribute to Reviewers

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Issue Information

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New Zealand Dermatological Society Inc. Annual Scientific meeting Queenstown, New Zealand August 2017 Convener: Dr Paul JM Salmon

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Dermatology Practice Consolidation Fueled by Private Equity Investment

This Viewpoint discusses the consolidation of dermatology practices facilitated by private equity investment and the potential consequences for the specialty and patients.

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Smoking cessation leads to changes in survivin expression in oral mucosa

Abstract

Background

Survivin is an inhibitor protein of apoptosis and play a role in oral carcinogenesis mechanism.

Methods

This aim of this study was to evaluate the effect of smoking in survivin expression of oral mucosa of chronic smokers with and without oral squamous cell carcinoma (OSCC). The study was composed of three groups: Group 1 - 26 patients smoking more than 20 cigarettes/day/10 years without either history of oral malignant neoplasia or visible clinical signs in the examined site; Group 2 - 26 patients with OSCC; Group 3 - 22 patients surgically treated for OSCC for at least 1 month. The immunohistochemistry was performed with 1 smear for each group and analyzed by microscopy regarding extension, intensity of positive cells for survivin, and intracellular location.

Results

The survivin expression was observed in 100% of the cases in Group 1, 88.5% in Group 2, and 100% in Group 3. Concerning to Groups 1 and 3, the survivin expression with cytoplasmic location occurred in 100%, while in Group 2 occurred in 87.5%. The cytoplasmic and nuclear expression was observed only in Group 2, with 7.69%. The results was correlated with clinical-pathological data by Fischer's exact test with significant relation between smoking cessation and intensity (p = 0.015) for Group 2.

Conclusions

The extension and intensity of survivin expression in the cytological smears were related to the smoking cessation in the group with OSCC. However, the smoking history (packs/years) did not influence the survivin expression.

This article is protected by copyright. All rights reserved.

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Epithelial disruptions, but not immune cell invasion, induced secretory dysfunction following innate immune activation in a novel model of acute salivary gland injury

Abstract

Background

Salivary gland (SG) injurious agents are all translated into loss of salivation (xerostomia). An association has been established between activation of innate immunity and salivary gland injury and dysfunction. However, it remains unclear how the secretory epithelia respond by halting saliva production.

Methods

C57BL/6 submandibular glands (SMGs) were acutely challenged using a single dose of the innate immune stimulant: polyinosinic-polycytidylic acid (poly (I:C)). Secretory capacity of the infected SMGs was substantiated by assessing the flow rate in response to pilocarpine stimulation. Depletion of the acute inflammatory cells was achieved by pre-treating mice with RB6-8C5 depletion antibody. Flow cytometry, histology and immunohistochemistry were conducted to verify the immune cell depletion. Epithelial expression of saliva-driving molecules: muscarinic 3 receptor (M3R), aquaporin 5 water channel (AQP5), Na-K- CL-Cotransporter 1 (NKCC1) and transmembrane member 16A (TMEM16A), were characterized using RT-qPCR and immunohistochemistry. Tight junction (TJ) protein; zonula occludens (ZO-1) and basement membrane (BM) protein; laminin were assessed by immunohistochemistry.

Results

Innate immune challenge prompted dysfunction in the exocrine salivary glands (SGs). Dysregulated gene and protein expression of molecules that drive saliva secretion was substantiated. Aberrant expression of TJ and BM proteins followed innate immune activation. Hyposalivation in the current model was independent of myeloperoxidase (MPO)-positive, acute inflammatory cells.

Conclusions

In the present study, we developed a novel injury model of the SGs, featuring acute secretory dysfunction and immediate structural disruptions. Our results ruled out the injurious role of aggressively infiltrating inflammatory cells.

This article is protected by copyright. All rights reserved.

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Psoriasis: Disease Duration and CV Risk

Disease duration joins severity as a factor driving CV risk in patients with psoriasis, but the right therapy can lower this risk.
Medscape Dermatology

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Nivolumab or Nivolumab Plus Cisplatin, in Combination With Radiotherapy in Patients With Cisplatin-ineligible or Eligible Locally Advanced Squamous Cell Head and Neck Cancer

Condition:   Squamous Cell Carcinoma of the Head and Neck
Interventions:   Biological: Nivolumab;   Biological: Cetuximab;   Drug: Placebo;   Drug: Cisplatin
Sponsors:   Bristol-Myers Squibb;   ONO Pharmaceutical Co.
Not yet recruiting

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Local Infusion of Ropivacaine for Post-Op Pain Control After Osseocutaneous Free Flaps

Conditions:   Head and Neck Cancer;   Free Tissue Transfer
Interventions:   Drug: Ropivicaine;   Drug: Local Saline Infusion
Sponsor:   Icahn School of Medicine at Mount Sinai
Recruiting

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Isolated hepatoblastoma arising from the hepatogastric ligament: a case report

Almost all hepatoblastomas are isolated to the liver. Hepatoblastoma arising from and limited to extrahepatic tissue is an extremely rare clinical entity.

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Can overnight stenting be safely eliminated following a pharyngeal flap? A matched comparison study

Objective

Determine if overnight stenting is warranted after pharyngeal flap for management of velopharyngeal insufficiency (VPI) in pediatric patients

Methods

This is a retrospective age-matched cohort study from a single tertiary pediatric facility. Patients who underwent a posterior pharyngeal flap for VPI from January 1, 2013, to December 31, 2016, were included. Two equal groups were constructed based on when their nasal stents were removed, that is, postoperative day (POD) 0 or POD 1. Primary outcome measure was oxygen desaturation after surgery. Secondary outcome measures were total length of stay, need for narcotics, and oral intake based on POD. Additional information was gathered and evaluated as possible prognostic variables.

Results

There were 27 matched pairs included in the study. One patient from each group required supplemental oxygen during the night of surgery. No escalation of care was needed in either case. The group whose stents were removed on POD 0 were discharged earlier than the group whose stents were removed on POD 1, P < 0.0001. The POD 0 group took significantly more oral intake on POD 0 than the POD 1 group, P = 0.03. The POD 0 group had significantly more genetic syndromes than the POD 1 group, P = 0.02.

Conclusion

There was no benefit with overnight stenting. Earlier discharge from the hospital was achieved in the POD 0 group. No patient experienced need for reintubation, escalation of clinical care, postoperative hemorrhage, or death.

Level of Evidence

4 Laryngoscope, 2017

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Vulvar swelling as the first presentation of Crohn's disease in children—A report of three cases

Abstract

Vulvar swelling is a rare manifestation of metastatic Crohn's disease in children. It often predates gastrointestinal symptoms and can be the first presentation of pediatric Crohn's disease. We report three cases of pediatric Crohn's disease presenting with vulvar swelling. We discuss this rare presentation and its treatment and highlight the importance of recognizing it so that prompt investigation and appropriate management can be initiated.

http://ift.tt/2zWdaI7

Bleomycin-induced flagellate erythema after venous malformation sclerosis—Case report and brief review

Abstract

Bleomycin-induced flagellate erythema is a rare but typical skin toxicity of bleomycin. We report the case of a boy with a left foot venous malformation who developed this skin rash after two sessions of bleomycin intralesional injection. We discuss the mechanism and characteristics of this reaction to bleomycin, which is usually benign and self-limited. We conclude that, although rare, flagellate pigmentation can occur when bleomycin is used as a sclerosant in children.

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Prevalence of sun protection behaviors in Hispanic youth residing in a high ultraviolet light environment

Abstract

Although rates of late-stage melanoma are rising in Hispanics, particularly those living in high ultraviolet light environments, little is known about the prevalence of sun protective behaviors in Hispanic children. We analyzed baseline data including frequency of sunburn, sun protective behaviors, level of U.S. acculturation, and skin phototype from a cross-sectional survey of 2003 Hispanic elementary school children in Los Angeles, California, who participated in a skin cancer prevention intervention. Although the Hispanic children reported frequently engaging in some sun protective behaviors, they also had a high rate of sunburn (59%) that exceeded previous national estimates for non-Hispanic white children (43%). Fewer U.S.-acculturated children reported more frequent shade-seeking at home (P = .02), along with less shade-seeking at school (P = .001) and more sunscreen use at school (P = .02). The surprisingly high rate of sunburn in Hispanic children suggests that the way in which they are practicing sun protection is not preventing sunburns. Sun safety interventions should be targeted toward Hispanic youth to provide them with practical methods of effective sun protection, in addition to education on the risks of high sun exposure.

http://ift.tt/2zWiIlM

RCAT reflects symptom control and quality of life in allergic rhinoconjunctivitis patients

Abstract

Background

The Global Allergy and Asthma European Network (GA²LEN) Taskforce has requested more data on correlations between various Patient Reported Outcomes (PROs) in clinical trials on allergy. We compared three tools—the Rhinitis Control Assessment Test (RCAT), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and Rhinitis Total Symptom Score (RTSS)—to determine whether the RCAT alone is a sufficient primary outcome parameter in clinical trials on allergic rhinoconjunctivitis.

Methods

In two double-blind, placebo-controlled immunotherapy studies, 33 patients allergic to grass pollen and 94 to birch pollen completed two questionnaires (RCAT and RQLQ) and kept their own symptom diary from which the RTSS was calculated.

Results

Upon comparing RCAT and RQLQ results, we found strong correlations of r = –0.871 for grass pollen–allergic patients and r = –0.795 for birch pollen–allergic patients. The comparison between RCAT and RTSS results showed a strong correlation of r = –0.811 (grass pollen–allergic patients) and a moderate correlation of r = –0.539 (birch pollen–allergic patients). In the RCAT, 69.7% of grass pollen–allergic patients and 45.7% of birch pollen–allergic patients receiving guideline-concordant therapy were regarded as having insufficiently controlled symptoms.

Conclusion

The strong correlation suggests that the RCAT alone is equivalent to the RQLQ with respect to patients' symptom control and quality of life. Patients with uncontrolled symptoms can be identified using the RCAT. Hence, the physician can decide whether symptomatic therapy can be intensified or allergy immunotherapy should be administered.

This article is protected by copyright. All rights reserved.

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Maternal hypothyroidism in the perinatal period and childhood asthma in the offspring

Abstract

Background

There is increasing interest in the possible link between maternal hypothyroidism in the perinatal period and childhood asthma risk. We explored this in the present study while accounting for the timing of hypothyroidism diagnosis. Further, we evaluated whether the risk was moderated by thyroid hormone treatment during pregnancy.

Methods

We conducted a population-based cohort study using Danish national registers. All liveborn singletons in Denmark from 1998 to 2007 were identified. Maternal hypothyroidism and asthma in the children were defined by data from the Patient Register and Prescription Registry. We estimated incidence rate ratios (IRRs) of asthma among children born to hypothyroid mothers versus children born to mothers with no recorded thyroid dysfunction using Poisson regression models.

Results

Of 595,669 children, 3,524 children were born to mothers with hypothyroidism diagnosed before delivery and 4,664 diagnosed after delivery. Overall 48,990 children received treatment for asthma. The IRRs of asthma was 1.16 (95% confidence interval (CI): 1.03–1.30) and 1.12 (95% CI: 1.02–1.24) for children born to mothers with hypothyroidism diagnosed before and after delivery, compared to children born to mothers with no thyroid dysfunction. The highest risk was observed among children born to mothers with hypothyroidism diagnosed before delivery who did not receive thyroid hormone treatment during pregnancy (IRR=1.37, 95% CI: 1.04–1.80).

Conclusion

Our findings suggest that maternal hypothyroidism, especially when it is untreated, increases childhood asthma risk. Early detection and appropriate treatment of hypothyroidism in pregnant women may be an area for possible prevention of childhood asthma.

This article is protected by copyright. All rights reserved.

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Blocking antibodies induced by allergen-specific immunotherapy ameliorate allergic airway disease in a human/mouse chimeric model

Abstract

Background

Allergen-specific immunotherapy (AIT) induces specific blocking antibodies (Ab) which are claimed to prevent IgE-mediated reactions to allergens. Additionally, AIT modulates cellular responses to allergens, e.g. by desensitizing effector cells, inducing regulatory T and B lymphocytes and immune deviation. It is still enigmatic which of these mechanisms mediate(s) clinical tolerance. We sought to address the role of AIT-induced blocking Ab separately from cellular responses in a chimeric human/mouse model of respiratory allergy.

Methods

Non-obese diabetic severe combined immunodeficient γc^-/- (NSG) mice received intraperitoneally allergen-reactive PBMC from birch pollen-allergic patients together with birch pollen extract and human IL-4. Engraftment was assessed by flow cytometry. Airway hyperresponsiveness (AHR) and bronchial inflammation were analyzed after intranasal challenges with allergen or PBS. Sera collected from patients before and during AIT with birch pollen were added to the allergen prior to intranasal challenge. The IgE-blocking activity of post-AIT sera was assessed in vitro.

Results

Human cells were detected in cell suspensions of murine lungs and spleens indicating successful humanization. Humanized mice displayed a more pronounced AHR and bronchial inflammation when challenged with allergen compared to negative controls. Post-AIT sera excerted IgE-blocking activity. In contrast to pre-AIT sera, the presence of heterologous and autologous post-AIT sera significantly reduced the allergic airway inflammation and matched their IgE-blocking activity determined in vitro.

Conclusion

Our data demonstrate that post-AIT sera with IgE-blocking activity ameliorate allergic airway inflammation in a human/mouse chimeric model of respiratory allergy independently of AIT-induced cellular changes.

This article is protected by copyright. All rights reserved.

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New soft tissue filler derived from autologous keratin and fibroblast for neck wrinkles

Summary

Objective

To assess the effectiveness of injection of autologous keratin gel and fibroblast for neck aging as soft tissue filler.

Materials and methods

Totally 30 volunteers received treatment of autologous keratin and fibroblast for neck wrinkles and 5 of them received hyaluronic acid (HA) treatment as control. Clinical features of the volunteers were collected at 1st, 3rd, 6th, 12th, and 24th months after treatment. The volunteers were independently assessed using Lemperle's methods at different time points.

Results

The neck wrinkles ameliorated observably and no severe complications were reported after treatment. The effect and maintain time of autologous keratin and fibroblast were better than HA control.

Conclusion

Autologous keratin and fibroblast as soft tissue filler is an effective treatment option for neck rejuvenation with long-term efficacy for reversing of skin aging.

http://ift.tt/2A03FW2

Delayed allergic hypersensitivity to hyaluronidase during the treatment of granulomatous hyaluronic acid reactions

Summary

Hyaluronic acid (HA) is now extensively employed for esthetic concerns. In the majority of cases, HA is considered to be safe, but mild-to-severe complications can occur in a few cases. Hyaluronidase is enzymes that degrade HA, also being suggested for the treatment of HA filler-induced complications. However, hyaluronidase has been reported to be a potential cause of allergic responses in some anesthetic and ophthalmic literature. However, there are few reports of allergic reactions to hyaluronidase in cosmetic medicine. We herein report on a 39-year-old Asian woman who developed a delayed allergic hypersensitivity to hyaluronidase in the treatment process of HA-related granulomatous reaction.

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Serum homocysteine levels in acne patients

Summary

Objective

This study was designed to investigate serum homocysteine (HCY) levels in acne patients.

Methods

Acne patients (n = 124) and healthy volunteers (n = 70), matched in terms of both age and sex, were enrolled. Serum HCY levels for all subjects were measured by a clinical laboratory.

Results

Serum HCY levels in male and female patients with severe and moderate acne were significantly higher than in the healthy control group (P < .05). The constituent ratio of male and female acne patients with HCY above the normal range (10 mmol/L) was significantly higher than the healthy control group. The severity of acne patients was positively correlated with serum homocysteine concentration, (P < .01).

Conclusion

Hyperhomocysteinemia may be an independent risk factor for acne vulgaris. Detection of serum HCY is important for acne patients.

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Calcium hydroxide regulates transcription of the bone sialoprotein gene via a calcium-sensing receptor in osteoblast-like ROS 17/2.8 cells

Bone sialoprotein (BSP) is a glycoprotein associated with mineralized tissues. In this study, we investigated the regulation of Bsp transcription by calcium hydroxide [Ca(OH)₂] in rat osteosarcoma-derived osteoblast-like ROS 17/2.8 cells and stromal bone marrow cells. Application of Ca(OH)₂ (0.4 mM) increased the levels of runt-related transcription factor 2 (Runx2) and BspmRNAs at 3 and 6 h and the level of BSP protein at 12 h. Transient transfection analyses were performed using chimeric constructs encompassing different regions of the rat Bsp gene promoter ligated to a luciferase reporter gene. It was found that Ca(OH)₂ increased the luciferase activities of the pLUC3 and pLUC4 constructs. Introduction of 2-bp mutations to the luciferase construct showed that the effects of Ca(OH)₂ were mediated by cAMP response-element (CRE) and fibroblast growth factor 2 (FGF2) response element (FRE). Luciferase activities induced by Ca(OH)₂ were blocked by protein kinase C (PKC), protein kinase A (PKA), phosphoinositide-3-kinase (PI3-K), and extracellular signal-regulated kinase 1/2 (ERK1/2) inhibitors and by calcium-sensing receptor (CASR) antagonists. Gel-shift analyses showed that Ca(OH)₂ increased binding of nuclear protein to CRE and FRE. Dexamethasone-induced mineralization in stromal bone marrow cells was abrogated by CASR antagonists. These studies demonstrate that Ca(OH)₂ regulates Bsp transcription via the CASR by targeting CRE and FRE in the rat Bsp gene promoter.

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Severe Stevens-Johnson syndrome/toxic epidermal necrolysis overlap syndrome—beyond skin involvement

Abstract

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but serious dermatologic diseases with many potential multisystem complications. We describe the case of an 8-year-old girl who developed severe SJS/TEN overlap syndrome (25% of her body surface area was affected) complicated by pancreatitis and bronchiolitis obliterans. These rare complications emphasize the need for careful, intensive monitoring of possible complications and an interdisciplinary team approach to provide optimal treatment and follow-up.

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Demographic characteristics of teenage boys with horizontal striae distensae of the lower back

Abstract

Background

This study examines the clinical characteristics and demographics of teenage boys with horizontal striae distensae of the lower back in an outpatient setting.

Methods

Retrospective medical chart reviews and telephone survey studies were completed on an outpatient cohort of 12 boys 11 to 17 years of age with a clinical diagnosis of transverse striae distensae of the lower back at a single-center, university-based, pediatric dermatology practice. We evaluated the clinical features of the striae, participant demographic characteristics, and past medical history. A review of the literature concerning risk factors was conducted using PubMed and Google Scholar.

Results

Of the 14 patients we contacted, 12 agreed to participate. The average age of onset for the striae was 14.3 years. All boys were above the 50th percentile in height at the time of onset. Eight (66.7%) reported a significant growth spurt before the appearance of the stretch marks. Most were asymptomatic. None of the boys had a history of unmonitored exogenous steroid use or prior infection with Bartonella henselae or Borrelia burgdorferi. Only one (8.3%) had a chronic medical condition. Eleven (91.7%) had at least one first-degree relative with striae distensae.

Conclusion

Our results indicate that horizontal striae distensae of the lower back in adolescent boys is associated with a rapid growth spurt, tall stature, and family history of striae distensae. There is no association between this type of striae distensae and any chronic medical condition, bacterial infection, or exogenous steroid use. Thus a careful review of systems and counseling without further medical testing is reasonable management.

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Juvenile mycosis fungoides with large-cell transformation: Successful treatment with psoralen with ultraviolet A light, interferon-alfa, and localized radiation

Abstract

Mycosis fungoides with large-cell transformation is historically associated with a poor prognosis. Pediatric cases of mycosis fungoides with large-cell transformation are rare, with only three other cases reported in the literature. We present the first case of a child with almost complete remission of his mycosis fungoides with large-cell transformation shortly after administration of psoralen plus ultraviolet A, interferon-alfa, and localized radiation.

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New insights into pemphigoid diseases

Abstract

Pemphigus and pemphigoid diseases are organ-specific autoimmune blistering diseases (AIBD), characterized and caused by autoantibodies to structural components of the skin (1). The autoantigens targeted in pemphigus are desmoglein 1 and 3, two proteins of the desmosomal structure, while the autoantigens in pemphigoid diseases (PD) are components of the basal membrane. For example, bullous pemphigoid (BP), the most frequent PD is characterized by autoantibodies against type XVII collagen (COL17, BP180) and BP230, and epidermolysis bullosa acquisita (EBA) is caused by autoantibodies against type VII collagen (COL7).

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