Πέμπτη 7 Δεκεμβρίου 2017
Author Index to Volume 119, 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
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Development of a brief assessment of activity limitations in children with food allergy
Source:Annals of Allergy, Asthma & Immunology
Author(s): Catherine C. Peterson, Lauren E. Harrison
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IgG4-related disease presenting as hoarseness and postcricoid ulcer
Source:Annals of Allergy, Asthma & Immunology
Author(s): Syeda Hamadani, Beverly Wang, Sudhir Gupta
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Effect of inhaled allergens and air pollutants on childhood rhinitis development
Source:Annals of Allergy, Asthma & Immunology
Author(s): Hui Zhou, Xia (Iona) Li, Jeong Hee Kim, Muhammad T. Salam, Hyo Bin Kim, Rob S. McConnell, Rima Habre, Tracy Bastain, Shohreh F. Farzan, Jill Johnston, Frank D. Gilliland
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Information for Readers
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
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Table of Contents
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
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rAsp f 3 and rAsp f 4 are associated with bronchiectasis in allergic fungal airways disease
Source:Annals of Allergy, Asthma & Immunology
Author(s): Kerry Woolnough, Michelle Craner, Catherine H. Pashley, Andrew J. Wardlaw
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Instructions for Authors
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
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Toxocara species exposure, symptoms of asthma, and fractional exhaled nitric oxide in the US population
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): Funmilola Ogundipe, Edward Christian Anselm Hennis, Alem Mehari, Richard F. Gillum
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Editorial Board
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
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Could calcium channel blockers treat 2 illnesses with 1 pill?
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): John Oppenheimer, H. William Kelly
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Baseline asthma burden, comorbidities, and biomarkers in omalizumab-treated patients in PROSPERO
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): John J. Oppenheimer, Paul A. Greenberger
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Increasing our knowledge base of asthma
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): John J. Oppenheimer, Gailen D. Marshall
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Innate lymphoid cells and allergic disease
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): Matthew T. Stier, R. Stokes Peebles
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Rare cause of periorbital and eyelids lesions: Discoid lupus erythematosus misdiagnosed as allergy
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): Anzelika Chomiciene, Ruta Stankeviciute, Laura Malinauskiene, Jurate Grigaitiene, Audra Blaziene
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Spectrum and prevalence of reactions to marijuana in a Colorado allergy practice
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): William S. Silvers, Tiana Bernard
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Baseline asthma burden, comorbidities, and biomarkers in omalizumab-treated patients in PROSPERO
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): Bradley E. Chipps, Robert S. Zeiger, Allan T. Luskin, William W. Busse, Benjamin L. Trzaskoma, Evgeniya N. Antonova, Hooman Pazwash, Susan L. Limb, Paul G. Solari, Noelle M. Griffin, Thomas B. Casale
BackgroundPatients included in clinical trials do not necessarily reflect the real-world population.ObjectiveTo understand the characteristics, including disease and comorbidity burden, of patients with asthma receiving omalizumab in a real-world setting.MethodsThe Prospective Observational Study to Evaluate Predictors of Clinical Effectiveness in Response to Omalizumab (PROSPERO) was a US-based, multicenter, single-arm, and prospective study. Patients (≥12 years of age) with allergic asthma initiating omalizumab treatment based on physician-assessed need were included and followed for 12 months. Exacerbations, health care use, adverse events, and Asthma Control Test (ACT) scores were assessed monthly. Biomarkers (blood eosinophils, fractional exhaled nitric oxide, and periostin) were evaluated and patient-reported outcomes (Asthma Quality of Life Questionnaire for 12 Years and Older [AQLQ+12] and Work Productivity and Activity Impairment: Asthma questionnaire [WPAI:Asthma]) were completed at baseline and months 6 and 12. The Mini Rhinoconjunctivitis Quality of Life Questionnaire (MiniRQLQ) was completed at baseline and 12 months.ResultsMost of the 806 enrollees (91.4%) were adults (mean age 47.3 years, SD 17.4), white (70.3%), and female (63.5%). Allergic comorbidity was frequently reported (84.2%), as were hypertension (35.5%) and depression (22.1%). In the 12 months before study entry, 22.1% of patients reported at least 1 asthma-related hospitalization, 60.7% reported at least 2 exacerbations, and 83.3% reported ACT scores no higher than 19 (uncontrolled asthma). Most patients had low biomarker levels based on prespecified cut-points. Baseline mean patient-reported outcome scores were 4.0 (SD 1.4) for AQLQ+12, 2.7 (SD 1.4) for MiniRQLQ, and 47.7 (SD 28.9) for WPAI:Asthma percentage of activity impairment and 33.5 (SD 28.7) for percentage of overall work impairment.ConclusionThe population initiating omalizumab in PROSPERO reported poorly controlled asthma and a substantial disease burden.Trial RegistrationClinicalTrials.gov Identifier: NCT01922037.
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The clinical role of fractional exhaled nitric oxide in asthma control
Publication date: December 2017
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): Suguru Sato, Junpei Saito, Atsuro Fukuhara, Manabu Uematsu, Yasuhito Suzuki, Ryuichi Togawa, Yuki Sato, Takefumi Nikaido, Xintao Wang, Yoshinori Tanino, Mitsuru Munakata
BackgroundThe potential role and characteristics of fractional exhaled nitric oxide (FeNO) remain unclear in the treatment of asthma.ObjectiveTo explore the clinical role of FeNO in asthmatic treatment.MethodsWe evaluated whether the mean or change of FeNO levels in the treatment period is associated with other conventional control parameters and predicted some clinical outcomes of asthma. We retrospectively analyzed the mean and percentage change of FeNO levels in the first 5 measurements at our hospital.ResultsThe study found a significantly strong correlation between FeNO level at diagnosis and the largest changes of FeNO values from diagnosis. No significant correlations were observed between FeNO levels and other parameters (Asthma Control Test [ACT] score or forced expiratory volume in one second [FEV1]) in mean and percentage change of values under treatment of asthma; however, significant positive correlations were found between ACT scores and FEV1. The mean FeNO level revealed a significant negative correlation with an annual change in FEV1 in individuals with asthma who were followed up for more than 2 years. Both the mean ACT score and percent predicted FEV1 revealed a significant negative correlation with occasional use of systemic corticosteroids.ConclusionDuring conventional treatment of asthma, the largest changes of FeNO values from diagnosis were strongly correlated with FeNO levels at diagnosis. As for the unlikely conventional parameters, no significant associations were observed between FeNO levels and deterioration of asthma during the treatment periods. An elevated mean FeNO level may be a marker of decreased lung function in individuals with asthma.
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Burden of skin pain in atopic dermatitis
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): Paras P. Vakharia, Rishi Chopra, Ryan Sacotte, Kevin R. Patel, Vivek Singam, Neha Patel, Supriya Immaneni, Takeshia White, Robert Kantor, Derek Y. Hsu, Jonathan I. Silverberg
BackgroundAtopic dermatitis (AD) is associated with itch, skin inflammation and barrier disruption, and scratching, all of which may be associated with skin pain.ObjectiveTo characterize the patient burden of skin pain in AD.MethodsWe performed a prospective dermatology practice–based study using questionnaires and evaluation by a dermatologist.ResultsOverall, 305 patients (age range, 13–97 years) were included in the study, with 564 encounters. The cohort included 195 females (63.9%) and 193 whites (63.7%). The mean (SD) age at enrollment was 42.3 (18.1) years, and the mean (SD) age of patient-reported AD onset was 29.6 (31.9) years. At baseline, 144 patients (42.7%) reported skin pain in the past week, with 42 (13.8%) reporting severe or very severe pain. Twenty-four (16.8%) thought the skin pain was part of their itch, 16 (11.2%) from scratching, and 77 (72.0%) from both. Patients with skin pain were more likely to describe their itch using terms that resembled neuropathic pain. Prevalence of skin pain was increased in patients with vs without excoriations (72.6% vs 57.6%; χ2 test P = .02) but not other morphologic characteristics. Skin pain severity was most strongly correlated with the Patient-Oriented Eczema Measure (Spearman ρ = 0.54), followed by ItchyQOL (ρ = 0.52), 5-dimensions of itch scale (ρ = 0.47), Dermatology Life Quality Index (ρ = 0.45), numeric rating scale for itch (ρ = 0.43) and sleep (ρ = 0.36), Patient Health Questionnaire 9 (ρ = 0.36), patient-reported global AD severity (ρ = 0.34), Eczema Area and Severity Index (ρ = 0.23), and objective Scoring AD index (ρ = 0.20) (P < .001 for all). Patients with both severe itch and pain vs those with only one or neither symptom being severe had significant increases in all these measures.ConclusionSkin pain is a common and burdensome symptom in AD. Skin pain severity should be assessed with itch severity in AD patients and may be an important end point for monitoring treatment response.
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Intraoperative anaphylaxis to bacitracin during scleral buckle surgery
Source:Annals of Allergy, Asthma & Immunology, Volume 119, Issue 6
Author(s): Juline Caraballo, Elaine Binkley, Ian Han, Amy Dowden
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Dengue hemorrhagic fever complicated with acute liver failure: a case report
Dengue is a common arboviral infection with a clinically diverse spectrum of presentations. Although hepatic dysfunction is commonly identified in patients will dengue illness, acute liver failure is rare. The...
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Clinical examination and X-ray: an old approach to a current problem
Description
Ingesting a foreign body is not an uncommon occurrence. Most pass through the gastrointestinal tract uneventfully, and perforation is rare.1 The preoperative diagnosis, in these cases, is always very difficult and the radiological examinations are not always able to resolve the diagnostic. The mortality and the morbidity remain still high first of all for the delay in the diagnosis and the advanced age of patients.2
A 50-year-old man without relevant medical history was admitted to the emergency department with 4 days evolution of abdominal pain. The patient presented continuous abdominal pain at the left lower quadrant. There was no nausea, vomiting, alterations of bowel habits or fever.
On examination, the patient was in painful distress. Vital signs revealed tachycardia at 110 bpm, blood pressure of 120/64 mm Hg but no fever (36.8°C). Abdominal examination revealed diffuse tenderness and pain more intense at the left lower abdomen,...
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Necrotising pneumonia caused by non-PVL Staphylococcus aureus with 2-year follow-up
Necrotising pneumonia (NP) is a rare but life-threatening complication of pulmonary infection. It is characterised by progressive necrosis of lung parenchyma with cavitating foci evident upon radiological investigation. This article reports the case of a 52-year-old woman, immunocompetent healthcare professional presenting to Accident and Emergency with NP and Staphylococcus aureus septicaemia. The cavitating lesion was not identified on initial chest X-ray leading to a delay in antimicrobial optimisation. However, the patient went on to achieve a full symptomatic recovery in 1 month and complete radiological recovery at 2-year follow-up. Long-term prognosis for adult cases of NP currently remains undocumented. This case serves as the first piece of published evidence documenting full physiological and radiological recovery following appropriate treatment of NP in an immunocompetent adult patient.
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Interhemispheric subdural and subarachnoid haemorrhage in a patient with amphetamine-induced vasculitis
Description
A 27-year-old woman with a history of pulmonary embolism presented with confusion and depressed arousal after a night of alcohol and drug use. On examination, she was found to have lack of motivation and right leg weakness but had no other significant neurological findings. Trauma survey did not detect any signs of injury. CT scan of the head revealed interhemispheric subdural and subarachnoid haemorrhage with the highest volume in left frontoparietal region (figure 1). Urine toxicology showed presence of tetrahydrocannabinol and amphetamines. CT angiography demonstrated a small, incidental left supraclinoid internal carotid artery aneurysm but no other significant findings (figure 1). MRI was remarkable only for the haemorrhage and MR venogram confirmed patent venous sinuses (figure 1). Given the patient's history of drug use and the presence of amphetamines in her urine, conventional cerebral angiography was obtained to evaluate for vasculopathy. Cerebral...
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Fat embolism: a rare cause of perioperative renal transplant dysfunction
Fat embolism is a recognised complication of bony injury and orthopaedic surgery, commonly involving the long bones and pelvis. We report on the case of a 68-year-old renal transplant recipient who developed acute kidney injury following surgical stabilisation of metastatic carcinoma of the acetabulum and replacement of the proximal femur. A CT renal angiogram demonstrated a large fat embolus in the inferior vena cava (IVC) and left iliac veins below the level of IVC filter, with impaired renal perfusion. The risks of open or endovascular lipothrombectomy were felt to outweigh the potential benefits. The patient was managed with systemic anticoagulation and prepared for transplant failure. Subsequently, there was spontaneous improvement in urine output and 4 months postoperatively her transplant function had returned to her baseline level and this has remained stable at 1 year postsurgery.
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Perineal aggressive angiomyxoma in a menopausal woman
Aggressive angiomyxoma (AA) is an uncommon mesenchymal tumour that is principally located in the soft tissues of the pelvis and perineum of young women. The primary features of this benign tumour are a local invasion, a high local recurrence rate and non-specific local clinical signs. We describe the case of a 58-year-old woman, initially treated for a Bartholin's cyst. Histological examination indicated the presence of an AA. The MRI showed a 7 cm soft tissue mass extending from the lateral wall of the vagina, into the left buttock and down into the subcutaneous tissue. We performed a radical excision with wide resection, which is considered the standard gold treatment.
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An uncommon diagnosis for a recurrent erythematous patch in a paediatric patient
A 14-year-old girl presented with a circular erythematous patch over the left buttock for approximately 10 years, with ongoing ulceration and papules developing over the last 4 years. Punch biopsies were taken within and above the patch for diagnosis. Both revealed marked inflammatory infiltrates with atypical, irregular lymphocytes and increased mitosis. Immunostaining revealed CD8 positivity and a pan T helper cell phenotype. T cell receptor gene rearrangement analysis showed T cell clonality in both biopsies. These findings were consistent with mycosisfungoides and associated lymphomatoid papulosis. Both are rare conditions but have been associated in 5%–20% of cases. A definitive association has not yet been established; however, T cell monoclonality shows 50%–60% share a common origin. Management options are extensive with no one treatment showing superiority. Our patient received low-dose radiotherapy with good outcomes, but subsequently required further radiotherapy.
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Development of forced normalisation psychosis with ethosuximide
A 50-year-old man with known multidrug resistant coexistent focal and generalised epilepsy was commenced on ethosuximide, with normalisation of his electroencephalogram and cessation of absence seizures. Within 3 weeks, he developed a rapidly worsening paranoid psychosis with visual and olfactory hallucinations. A month after the cessation of ethosuximide and concurrent treatment with olanzapine, his psychosis resolved and permitted reinitiation of ethosuximide at a lower dose without recurrence of psychotic symptoms.
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Pleural lipoma clinically mimicking the presentation of superior sulcus tumour upon initial evaluation
Here we present a case of a large pleural lipoma which presented with paresthesias of the hand. This is an unusual presentation of an uncommon tumour.
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Pulmonary embolism caused by thrombin-based haemostatic matrix
Description
A 38-year-old woman underwent an outpatient L5/S1 discectomy. The procedure was complicated by intraoperative bleeding, and haemostasis was achieved using a thrombin-based haemostatic matrix (TBHM). She presented to our facility on postoperative day 5 with left-sided chest pain and dyspnoea. CT pulmonary angiography (CTPA) showed a heterogeneous filling defect with mixed attenuation and a 'pseudoair pattern' in the left main pulmonary artery (figure 1). Duplex ultrasound of the upper and lower extremities was negative for venous thrombus. An echocardiogram was normal. Pulmonary angiography showed occlusion of the basal branches of the left pulmonary artery (figure 2). Therapeutic anticoagulation with unfractionated heparin was started, and the patient was discharged home on warfarin. Repeat CT angiography 6 months later revealed no filling defect in the pulmonary arteries.
Figure 1
CT chest with contrast demonstrating the 'pseudoair' filling defect (arrow) in the left main pulmonary...
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Acute pancreatitis following oesophagogastroduodenoscopy.
Acute pancreatitis is a well-recognised complication of endoscopic procedures like endoscopic retrograde cholangiopancreatography but not oesophagogastroduodenoscopy (OGD). I report a case of a 33-year-old woman, admitted with severe epigastric pain and vomiting 2 hours after an elective OGD for evaluation of chronic gastrointestinal symptoms. Pancreatitis was diagnosed on the basis of elevated lipase (40 790 U/L; normal 11–82) and findings on imaging studies. Other common causes of acute pancreatitis such as gallstones, alcohol and medications were ruled out. She had an extended hospital course because of severe disease, characterised by systemic inflammatory response syndrome, pleural effusion and ascites but was successfully managed conservatively with bowel rest, hydration and pain management. Acute pancreatitis should be considered a rare complication of OGD and should be considered in differential diagnosis for abdominal pain post OGD. Pathogenesis is likely from direct trauma to pancreas or gas insufflation.
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Hypersomatotropism induced secondary polycythaemia leading to spontaneous pituitary apoplexy resulting in cure of acromegaly and remission of polycythaemia: 'The virtuous circle
A young man with subtle clinical features suggestive of hypersomatotropism presented with acute-onset severe headache. Relevant investigations confirmed polycythaemia and growth hormone (GH)-secreting pituitary macroadenoma with apoplexy. Secondary polycythaemia and myeloproliferative disorders were ruled out. At follow-up after 3 months, resolution of polycythaemia and acromegaly was observed, evident on normal haemoglobin levels, a normocellular marrow, and normal insulin-like growth factor-1 (IGF-1) with glucose-suppressed GH levels. Direct mitogenic properties of GH-IGF-1 axis on bone marrow progenitor cells may very rarely lead to erythroid hyperplasia and subsequent polycythaemia, reversible with successful therapy of acromegaly. In this case, polycythaemia secondary to hypersomatotropism likely resulted in pituitary apoplexy with subsequent remission of both acromegaly and resultant polycythaemia.
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Inguinoscrotal herniation of a caecal adenocarcinoma
An 84-year-old man with multiple comorbidities presented from a residential care home with a 1-month history of asthenia and moderate abdominal pain. On examination, he was found to have an irreducible right-sided inguinoscrotal hernia. Subsequent blood tests revealed a significant anaemia (haemoglobin 48 g/L), for which he was transfused. A CT scan of the abdomen and pelvis revealed a large caecal tumour, herniating through the right inguinal canal into the scrotum. The patient underwent an elective open right hemicolectomy with inguinal hernia defect repair, from which he recovered well. He was discharged from the ward 12 days postoperatively and is awaiting outpatient follow-up.
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Double duodenal perforation following foreign body ingestion
Intentional ingestion of a foreign body in adults is a rare clinical presentation. This case is one of a 27-year-old Sudanese man who presented having swallowed a ballpoint pen intentionally. Clinical examination and plain chest radiograph exhibited no signs indicative of perforation with only a raised C reactive protein identified on blood tests. Subsequent gastroscopy revealed that the pen had simultaneously perforated the duodenum at both D1 and D3 requiring removal via a laparotomy. The patient fully recovered and was discharged 2 weeks postoperatively following psychiatric input.
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Novel use of a trabecular metal spacer in the treatment of a long-standing ulnar fracture non-union
The use of trabecular metal (TM) implants in spine and joint surgery is well documented. However, their use has yet to be reported as an alternative to either allograft or autograft in the management of fracture non-unions. We present our experience in using a TM implant for treating a patient with a long-standing ulnar fracture non-union. Excision of devitalised bone resulted in a 17 mm defect which the TM implant was used to infill. The defect was then bridged with a locking plate. At 2-year clinical and radiographic review, bony union and a pain-free return to full function was noted. In this case, the use of a TM implant avoided the morbidity associated with an iliac crest autograft.
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One long umbilical cord, four nuchal cord loops and a true knot
Description
A 43-year-old woman G4 P2101 at 36 weeks of gestation presented to the labour floor with non-reactive fetal heart tracing and decreased fetal movement. She had a second-trimester ultrasound showing intrauterine growth retardation (IUGR). Patient had a history of hypothyroidism, two fetal demises at term and a planned preterm delivery at 34 weeks of gestation via caesarean section. Workup was negative for thrombophilia (lupus anticoagulant, anticardiolipin, anti-b2-glycoprotein, factor V Leiden, protein S, protein C, G20210 mutation, antithrombin III, antinuclear antibodies) and infectious diseases. Placental pathology following her second fetal demise revealed chorioamnionitis and necrotising funisitis with negative amniotic fluid cultures. There was no information regarding umbilical cord (UC) length or entanglements in previous pregnancies.
Given her history and the current non-reactive fetal heart tracing, the patient was taken for emergency caesarean delivery. A female infant was born with four loops of nuchal cord and a true knot (
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Catastrophic catheter-induced coronary artery vasospasm successfully rescued using intravascular ultrasound imaging guidance
A 46-year-old man underwent coronary angiography for stable angina. He developed inferior ST-segment myocardial infarction during the angiography. Intravascular ultrasound (IVUS) findings suggested coronary vasospasm. Intracoronary administration of isosorbide dinitrate restored the coronary flow. This case illustrates the essential role IVUS imaging played in establishing the diagnosis of catheter-induced coronary vasospasm.
http://ift.tt/2BUqNWR
Treating patients with brain metastases has evolved: scalp-sparing, hippocampal avoidance whole brain radiotherapy with simultaneous integrated boost
Description
A 43-year-old male with a history of receiving treatment for squamous cell carcinoma (SqCC) of lung 2 years back presented with a complaint of a single episode of self-resolving generalised tonic–clonic seizure 1 day prior. General physical and neurological examinations were unremarkable. An MRI of the brain revealed a well-defined, enhancing, space-occupying lesion (SOL) in the right temporal lobe (figure 1). He was started on oral dexamethasone, oral phenytoin (after an intravenous loading dose) and underwent a whole body 18flourodeoxyglucose positron emission tomography CT (18FDG PET-CT), which revealed increased FDG uptake in the SOL without evidence of metastatic disease elsewhere (figure 1). A diagnosis of oligometastatic SqCC lung (cTx, cNx and cM1b) was made, and the options for management were discussed with the patient.
Figure 1
Pretreatment MRI and positron emission tomography CT (PET-CT) images. (A) T1-weighted contrast-enhanced axial image reveals a well-defined space occupying lesion in...
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Lingual dyskinesia in hyperthyroidism
Description
A 28-year-old female presented to the hospital with a 3-month history of palpitation, weight loss and neck swelling. On examination, she had diffuse soft goitre, warm extremities and fine tremors of hands. In addition, she had an irregular jerky lingual and lip movements suggestive of dyskinesia (see online ). There were no signs of infiltrative ophthalmopathy or dermopathy. Neurological examination was otherwise unremarkable. A clinical diagnosis of Graves' disease was made that was biochemically confirmed by elevated T3 and T4 with suppressed tyroid stimulating hormone (TSH) as well as diffuse increased uptake of technetium in nuclear imaging. Unlike lingual tremors associated with other neurological conditions or adverse effects of drugs, thyrotoxicosis-associated lingual dyskinesia responds very well to beta blockers.1 After 6 months of follow-up on carbimazole and propranolol therapy, her thyrotoxicosis improved, and the abnormal tongue movements had disappeared.
Learning points
Thyrotoxicosis...
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Comparison of transcanal endoscopic tympanoplasty with sterile acellular dermal allograft to conventional endaural microscopic tympanoplasty with tragal perichondrium
Source:American Journal of Otolaryngology
Author(s): Jia Min, Se-Hyung Kim
ObjectivesThis study aimed to compare the outcome of endoscopic tympanoplasty with sterile acellular dermal allograft (ADA) and conventional endaural microscopic tympanoplasty with tragal perichondrium.MethodsThis was a retrospective comparative study of 53 patients (25 males and 28 females) with tympanic membrane perforation who underwent type I tympanoplasty in the department of otorhinolaryngology at a tertiary medical center from March 2011 to April 2017. The subjects were classified into two groups; transcanal endoscopic tympanoplasty with ADA (TET, n=26), conventional endaural microscopic tympanoplasty with autologous tragal perichondrium (EMT, n=27). Demographic data, perforation size of tympanic membrane at preoperative state, pure tone audiometric results preoperatively and 3months postoperatively, operation time, sequential postoperative pain scale, and postoperative graft failure rate were evaluated.ResultsThe perforation size of the tympanic membrane in TET and EMT group was 22.3±10.9% and 23.5±9.7%, respectively (P=0.143). Mean operation time of EMT (92.3±16.5min) was longer than that of the TET (65.3±20.5min) with a statistical significance (P=0.004). Graft success rate in the TET and EMT group were 92.3% and 96.3%, respectively; the values were not significantly different (P=0.610). Pre- and postoperative audiometric results including bone and air conduction thresholds and air-bone gap were not significantly different between the groups. In all groups, the postoperative air-bone gap was significantly improved compared to the preoperative air-bone gap. Pain in the immediate postoperative and day 1 after surgery were significantly less in the TET group.ConclusionWith human cadaveric ADA, minimal invasive endoscopic tympanoplasty can be achieved with similar postoperative results and less pain.
http://ift.tt/2BghseI
Is an endoscopic or a microscopic approach optimal for management of attic cholesteatoma?
Source:American Journal of Otolaryngology
Author(s): Zhengcai-LouZihan-LouZhenqi-Gong
http://ift.tt/2AluTd9
Anti-cytokine autoantibodies in a patient with a heterozygous NFKB2 mutation
Source:Journal of Allergy and Clinical Immunology
Author(s): Kesava A. Ramakrishnan, William Rae, Gabriela Barcenas-Morales, Yifang Gao, Reuben J. Pengelly, Sanjay V. Patel, Dinkantha S. Kumararatne, Sarah Ennis, Rainer Döffinger, Saul N. Faust, Anthony P. Williams
Teaser
We report a family with a heterozygous NFKB2 mutation in which anti-cytokine autoantibodies were identified in one individual. Rituximab therapy for autoantibodies led to a reduction in anti-cytokine autoantibodies and a marked improvement in infectious susceptibility.http://ift.tt/2ACIwDI
Autophagy deficiency in myeloid cells exacerbates eosinophilic inflammation in chronic rhinosinusitis
Publication date: Available online 7 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Go Eun Choi, Seung-Yong Yoon, Ji-Yun Kim, Do-Young Kang, Yong Ju Jang, Hun Sik Kim
BackgroundEosinophilic inflammation is a major pathologic feature of chronic rhinosinusitis and is frequently associated with severe refractory disease. Prostaglandin D2 level is elevated in chronic rhinosinusitis and is an important contributing factor to eosinophilic inflammation. Autophagy has a pleiotropic effect on immune responses and disease pathogenesis. Recent studies suggest the potential involvement of autophagy in chronic rhinosinusitis and the prostaglandin pathway.ObjectiveTo investigate whether altered function of autophagy is associated with eosinophilic inflammation and dysregulated production of prostaglandin D2 in chronic rhinosinusitis.MethodsWe used myeloid cell-specific deletion of Atg7, which is vital for autophagy, and investigated the effects of impaired autophagy on eosinophilic inflammation in a murine model of eosinophilic chronic rhinosinusitis. The effect of autophagy on prostaglandin D2 production and gene expression profiles associated with allergy and the prostaglandin pathway were assessed.ResultsWe found that impaired autophagy in myeloid cells aggravated eosinophilia, epithelial hyperplasia, and mucosal thickening in eosinophilic chronic rhinosinusitis mice. This aggravation was associated with gene expression profiles that favor eosinophilic inflammation, Th2 response, mast cell infiltration, and prostaglandin D2 dysregulation. Supporting this, prostaglandin D2 production was also significantly increased by impaired autophagy. Among other myeloid cells, macrophages were associated with autophagy deficiency, leading to elevated IL-1β levels. Macrophage depletion or blockade of IL-1 receptor led to alleviation of eosinophilic inflammation and sinonasal anatomic abnormalities associated with autophagy deficiency.ConclusionOur results suggest that impaired autophagy in myeloid cells, particularly macrophages, has a causal role in eosinophilic inflammation and eosinophilic chronic rhinosinusitis pathogenesis.
Graphical abstract
Teaser
Autophagy deficiency in myeloid cells, particularly macrophages, is linked to augmented production of PGD2 and eosinophilic inflammation in a murine model of ECRS. Thus, autophagy dysfunction has a causal role in the development of ECRS.http://ift.tt/2iCM7Yn
Fatigue in Psoriasis: A Controlled Study
How prevalent is fatigue in patients with psoriasis? Is there a correlation of fatigue to measurements of disease activity and inflammation?
The British Journal of Dermatology
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rAsp f 3 and rAsp f 4 are associated with bronchiectasis in allergic fungal airways disease
Allergy to thermotolerant filamentous fungi, particularly Aspergillus fumigatus, is closely associated with fixed airflow obstruction, bronchiectasis, and other radiologically defined abnormalities, such as mucus plugging.1 However, not all asthma patients who are immunoglobulin E (IgE) sensitized to A fumigatus develop these complications. To identify markers of poor outcomes in fungal allergy with asthma (and cystic fibrosis), the term allergic bronchopulmonary aspergillosis (ABPA) was coined.
http://ift.tt/2Alt93P
Soft palate functional reconstruction with buccinator myomucosal island flaps
Oropharyngeal reconstruction after ablative surgery is a challenge. The results of a retrospective study of 17 patients who underwent total or sub-total soft palate reconstruction with a buccinator myomucosal island flap, between 2008 and 2016, are reported herein. An analysis of flap type and size, harvesting time, and postoperative complications was performed. Patients underwent standardized tests to assess the recovery of sensitivity, deglutition, quality of life (QoL), and donor site morbidity, at >6 months after surgery or the end of adjuvant therapy, if performed.
http://ift.tt/2AniJkg
Clinical Indicators of the Need for Telemetry Postoperative Monitoring in Patients With Suspected Obstructive Sleep Apnea Undergoing Total Knee Arthroplasty
Background and Objectives Obstructive sleep apnea is associated with increased complication rates postoperatively. Current literature does not provide adequate guidance on management of these patients. This study used the STOP-Bang questionnaire to diagnose patients with possible obstructive sleep apnea (score ≥3). We hypothesized that a STOP-Bang score of 3 or greater would significantly correlate with the number of oxygen desaturation episodes during the first 48 hours after total knee arthroscopy. Methods The STOP-Bang questionnaire was administered to 110 patients preoperatively. All patients underwent spinal-epidural anesthesia with a saphenous nerve block and sedation and were connected to the Nellcor OxiMax N-600x pulse oximeter for 48 hours postoperatively. Results Final analysis included 98 patients. There was no significant difference in the total number of desaturation events between STOP-Bang groups (score
http://ift.tt/2k8f3ba
http://ift.tt/2k8f3ba
Intrathecal Morphine for Laparoscopic Segmental Colonic Resection as Part of an Enhanced Recovery Protocol: A Randomized Controlled Trial
http://ift.tt/2BSH2Dw
Anti-mumps IgM antibody positive rate with sudden sensorineural hearing loss using second-generation enzyme immunoassay: A retrospective, multi-institutional investigation in Hokkaido, Japan
Although elevated anti-mumps IgM antibody levels were reported in 5.7%–7.2% of Japanese patients with sudden sensorineural hearing loss (SSNHL), there were several reports of false-positive cases, such as the continually IgM positive case and the IgM positive case in normal adults. To improve specificity, the new enzyme immuno assay (EIA) anti-mumps IgM antibody measurement kit was introduced in December 2009. This study re-examined the frequency of anti-mumps IgM antibody test positivity with SSNHL using the new measurement kit and compared the results with those from a previous report that used old kit.
http://ift.tt/2zZ3YQe
Improving patient safety during procedural sedation via respiratory volume monitoring: A randomized controlled trial
Assess the utility of a respiratory volume monitor (RVM) to reduce the incidence of low minute ventilation events in procedural sedation.
http://ift.tt/2kx8vqj
Is an endoscopic or a microscopic approach optimal for management of attic cholesteatoma?
Dear Editors,
http://ift.tt/2nE05hX
Comparison of transcanal endoscopic tympanoplasty with sterile acellular dermal allograft to conventional endaural microscopic tympanoplasty with tragal perichondrium
This study aimed to compare the outcome of endoscopic tympanoplasty with sterile acellular dermal allograft (ADA) and conventional endaural microscopic tympanoplasty with tragal perichondrium.
http://ift.tt/2A1EBxq
Live cell imaging reveals different modes of cytotoxic action of extracts derived from commonly used luting cements
Publication date: February 2018
Source:Archives of Oral Biology, Volume 86
Author(s): Rita Trumpaitė-Vanagienė, Alina Čebatariūnienė, Virginijus Tunaitis, Alina Pūrienė, Augustas Pivoriūnas
ObjectiveTo compare cytotoxicity of extracts derived from commonly used luting cements: Hoffmann's Zinc Phosphate (ZPC), GC Fuji Plus Resin Modified Glass Ionomer (RMGIC) and 3M ESPE RelyX Unicem Resin Cement (RC) on primary human gingival fibroblasts (HGFs).DesignHGFs were exposed to different concentrations of the ZPC, RMGIC and RC extracts. The cytotoxicity was assessed with the PrestoBlue Cell Viability Reagent and viable cells were counted by a haemocytometer using the trypan blue exclusion test. In order to determine the primary mechanism of the cell death induced by extracts from different luting cements, the real-time monitoring of caspase-3/-7 activity and membrane integrity of cells was employed.ResultsThe extracts from the RMGIC and ZPC decreased the metabolic activity and numbers of viable cells. Unexpectedly, the extracts from the RC evoked only small effects on the metabolic activity of HGFs with a decreasing number of viable cells in a dose-and time-dependent manner. The live cell imaging revealed that the apoptosis was the primary mechanism of a cell death induced by the extracts derived from the RMGIC, whereas the extracts from the RC and ZPC induced a cell death through a necrotic and caspase-independent pathway.ConclusionsThe apoptosis was the primary mechanism of the cell death induced by the extracts derived from the RMGIC, whereas the extracts from the RC and ZPC induced a cell death via a necrotic pathway. We suggest that metabolic assays commonly used to assess the cytotoxicity of luting cements should be validated by alternative methods.
http://ift.tt/2kycwL4
Extensive phenotyping of the orofacial and dental complex in Crouzon syndrome
Source:Archives of Oral Biology, Volume 86
Author(s): Alexander Khominsky, Robin Yong, Sarbin Ranjitkar, Grant Townsend, Peter J. Anderson
ObjectivesFibroblast growth factor receptor 2 (FGFR2) C342Y/+ mutation is a known cause of Crouzon syndrome that is characterised by craniosynostosis and midfacial hypoplasia. Our aim was to conduct extensive phenotyping of the maxillary, mandibular and dental morphology associated with this mutation.Materials and methodsMorphometric data were obtained from 40 mice, representing two genotypes (Crouzon and wild-type) and two sexes (males and females) (n=10 in each group). Dental analysis further categorised the first molars into the two jaws (maxillary and mandibular) (n=20 in each group). Maxillary, mandibular and dental morphology was compared by analysing 23 linear landmark-based dimensions in three-dimensional micro-computed tomography reconstructions.ResultsCompared with wild-type, Crouzon (FGFR2C342Y/+) maxillae were significantly shorter in maximum height, anterior and posterior lengths and middle width, but larger in posterior width (p<0.05 for height; p<0.001 for other comparisons). In the Crouzon mandible, the ascending and descending heights, effective and mandibular lengths, and intercoronoid and intercondylar widths were significantly shorter, whereas intergonial width was larger (p<0.01 for intercondylar width; p<0.001 for other comparisons). Crouzon teeth were significantly smaller mesiodistally, but larger in crown height (p<0.001 for each comparison). All Crouzon mice presented with bifid mandibular condyles and a quarter presented with expansive bone lesions in the mandibular incisor alveolus.ConclusionsOur findings of hypoplasia in all three planes in Crouzon maxillae and mandibles, together with the presence of bifid mandibular condyles and expansive bone lesions, may be relevant to maxillofacial surgery and orthodontics. Beyond skeletal effects, the FGFR2C342Y/+ mutation is now implicated in affecting tooth development. This study's skeletal phenomics data also provides baseline data against which the effect of various treatments can now be assessed.
http://ift.tt/2j4UEY3
Live cell imaging reveals different modes of cytotoxic action of extracts derived from commonly used luting cements
Publication date: February 2018
Source:Archives of Oral Biology, Volume 86
Author(s): Rita Trumpaitė-Vanagienė, Alina Čebatariūnienė, Virginijus Tunaitis, Alina Pūrienė, Augustas Pivoriūnas
ObjectiveTo compare cytotoxicity of extracts derived from commonly used luting cements: Hoffmann's Zinc Phosphate (ZPC), GC Fuji Plus Resin Modified Glass Ionomer (RMGIC) and 3M ESPE RelyX Unicem Resin Cement (RC) on primary human gingival fibroblasts (HGFs).DesignHGFs were exposed to different concentrations of the ZPC, RMGIC and RC extracts. The cytotoxicity was assessed with the PrestoBlue Cell Viability Reagent and viable cells were counted by a haemocytometer using the trypan blue exclusion test. In order to determine the primary mechanism of the cell death induced by extracts from different luting cements, the real-time monitoring of caspase-3/-7 activity and membrane integrity of cells was employed.ResultsThe extracts from the RMGIC and ZPC decreased the metabolic activity and numbers of viable cells. Unexpectedly, the extracts from the RC evoked only small effects on the metabolic activity of HGFs with a decreasing number of viable cells in a dose-and time-dependent manner. The live cell imaging revealed that the apoptosis was the primary mechanism of a cell death induced by the extracts derived from the RMGIC, whereas the extracts from the RC and ZPC induced a cell death through a necrotic and caspase-independent pathway.ConclusionsThe apoptosis was the primary mechanism of the cell death induced by the extracts derived from the RMGIC, whereas the extracts from the RC and ZPC induced a cell death via a necrotic pathway. We suggest that metabolic assays commonly used to assess the cytotoxicity of luting cements should be validated by alternative methods.
http://ift.tt/2kycwL4
Extensive phenotyping of the orofacial and dental complex in Crouzon syndrome
Source:Archives of Oral Biology, Volume 86
Author(s): Alexander Khominsky, Robin Yong, Sarbin Ranjitkar, Grant Townsend, Peter J. Anderson
ObjectivesFibroblast growth factor receptor 2 (FGFR2) C342Y/+ mutation is a known cause of Crouzon syndrome that is characterised by craniosynostosis and midfacial hypoplasia. Our aim was to conduct extensive phenotyping of the maxillary, mandibular and dental morphology associated with this mutation.Materials and methodsMorphometric data were obtained from 40 mice, representing two genotypes (Crouzon and wild-type) and two sexes (males and females) (n=10 in each group). Dental analysis further categorised the first molars into the two jaws (maxillary and mandibular) (n=20 in each group). Maxillary, mandibular and dental morphology was compared by analysing 23 linear landmark-based dimensions in three-dimensional micro-computed tomography reconstructions.ResultsCompared with wild-type, Crouzon (FGFR2C342Y/+) maxillae were significantly shorter in maximum height, anterior and posterior lengths and middle width, but larger in posterior width (p<0.05 for height; p<0.001 for other comparisons). In the Crouzon mandible, the ascending and descending heights, effective and mandibular lengths, and intercoronoid and intercondylar widths were significantly shorter, whereas intergonial width was larger (p<0.01 for intercondylar width; p<0.001 for other comparisons). Crouzon teeth were significantly smaller mesiodistally, but larger in crown height (p<0.001 for each comparison). All Crouzon mice presented with bifid mandibular condyles and a quarter presented with expansive bone lesions in the mandibular incisor alveolus.ConclusionsOur findings of hypoplasia in all three planes in Crouzon maxillae and mandibles, together with the presence of bifid mandibular condyles and expansive bone lesions, may be relevant to maxillofacial surgery and orthodontics. Beyond skeletal effects, the FGFR2C342Y/+ mutation is now implicated in affecting tooth development. This study's skeletal phenomics data also provides baseline data against which the effect of various treatments can now be assessed.
http://ift.tt/2j4UEY3
Recent advancement to prevent the development of allergy and allergic diseases and therapeutic strategy in the perspective of barrier dysfunction
Publication date: Available online 7 December 2017
Source:Allergology International
Author(s): Osamu Natsume, Yukihiro Ohya
Therapeutic strategy in late 20th century to prevent allergic diseases was derived from a conceptual framework of allergens elimination which was as same as that of coping with them after their onset. Manifold trials were implemented; however, most of them failed to verify the effectiveness of their preventive measures. Recent advancement of epidemiological studies and cutaneous biology revealed epidermal barrier dysfunction plays a major role of allergen sensitization and development of atopic dermatitis which ignites the inception of allergy march. For this decade, therapeutic strategy to prevent the development of food allergy has been confronted with a paradigm shift from avoidance and delayed introduction of allergenic foods based on the theoretical concept to early introduction of them based on the clinical and epidemiological evidences. Especially, prevention of peanut allergy and egg allergy has been established with the highest evidence verified by randomized controlled trials, although application in clinical practice should be done with attention. This paradigm shift concerning food allergy was also due to the discovery of cutaneous sensitization risk of food allergens for an infant with eczema revealed by prospective studies. Here we have recognized the increased importance of prevention of eczema/atopic dermatitis in infancy. Two randomized controlled trials using emollients showed successful results in prevention of atopic dermatitis in infancy; however, longer term safety and prognosis including allergy march should be pursued. To establish more fundamental strategy for prevention of the development of allergy, further studies clarifying the mechanisms of interaction between barrier dysfunction and microbial milieu are needed with macroscope to understand the relationship between allergic diseases and a diversity of environmental influences.
http://ift.tt/2kuwq9P
Long-term safety of subcutaneous immunotherapy with TO-204 in Japanese patients with house dust mite-induced allergic rhinitis and allergic bronchial asthma: Multicenter, open label clinical trial
Publication date: Available online 7 December 2017
Source:Allergology International
Author(s): Takao Fujisawa, Terufumi Shimoda, Keisuke Masuyama, Kimihiro Okubo, Kohei Honda, Mitsuhiro Okano, Toshio Katsunuma, Atsuo Urisu, Yasuto Kondo, Hiroshi Odajima, Kazuyuki Kurihara, Makoto Nagata, Masami Taniguchi, Shoichiro Taniuchi, Satoru Doi, Tomoshige Matsumoto, Shoji Hashimoto, Akihiko Tanaka, Kensuke Natsui, Nahoko Abe, Hideki Ozaki
BackgroundTo evaluate the long-term safety of subcutaneous immunotherapy with TO-204, a standardized house dust mite (HDM) allergen extracts, we conducted a multicenter, open label clinical trial.MethodsJapanese patients aged 5–65 years were eligible for the study, if they had HDM-induced allergic rhinitis (AR), allergic bronchial asthma (BA), or both. TO-204 was administered in a dose titration scheme, and the maintenance dose was determined according to the predefined criteria. The treatment period was 52 weeks, and patients who were willing to continue the treatment received TO-204 beyond 52 weeks. This clinical trial is registered at the Japan Pharmaceutical Information Center (Japic CTI-121900).ResultsBetween July 2012 and May 2015, 44 patients (28 with AR and 16 with allergic BA) were enrolled into the study. All patients were included in the analysis. The duration of treatment ranged from 23 to 142 weeks and the median maintenance dose was 200 Japanese allergy units (JAU). Adverse events occurred in 22 patients (50%). The most common adverse event was local reactions related to the injection sites. Four patients experienced anaphylactic reactions when they were treated with the dose of 500 JAU. Two patients experienced anaphylactic shock with the doses of 1000 JAU at onset. These 6 patients could continue the study with dose reduction.ConclusionsSafety profile of TO-204 was acceptable in Japanese patients with HDM-induced AR or allergic BA. Higher doses should be administered carefully, because the risk of anaphylaxis increased at doses of 500 or 1000 JAU.
http://ift.tt/2j54PM1
Serum periostin is associated with body mass index and allergic rhinitis in healthy and asthmatic subjects
Publication date: Available online 7 December 2017
Source:Allergology International
Author(s): Hirokazu Kimura, Satoshi Konno, Hironi Makita, Natsuko Taniguchi, Hiroki Kimura, Houman Goudarzi, Kaoruko Shimizu, Masaru Suzuki, Noriharu Shijubo, Katsunori Shigehara, Junya Ono, Kenji Izuhara, Yoichi Minagawa Ito, Masaharu Nishimura
BackgroundMany studies have attempted to clarify the factors associated with serum periostin levels in asthmatic patients. However, these results were based on studies of subjects mainly characterized by high eosinophil counts, which may present as an obstacle for clarification in the identification of other factors associated with serum periostin levels. The aim of this study was to determine the factors associated with serum periostin levels in healthy subjects. We also assessed some factors in asthmatic subjects to confirm their extrapolation for management of asthma.MethodsSerum periostin levels were measured in 230 healthy subjects. Clinical factors of interest included body mass index (BMI) and allergic rhinitis (AR). Additionally, we confirmed whether these factors were associated with serum periostin in 206 asthmatic subjects. We further evaluated several obesity-related parameters, such as abdominal fat distribution and adipocytokine levels.ResultsSmoking status, blood eosinophil count, total immunoglobulin E, and the presence of AR were associated with serum periostin in healthy subjects. There was a negative association between BMI and serum periostin in both healthy and asthmatic subjects, while there was a tendency of a positive association with AR in asthmatic subjects. There were no differential associations observed for subcutaneous and abdominal fat in relation to serum periostin in asthmatic subjects. Serum periostin was significantly associated with serum levels of adiponectin, but not with leptin.ConclusionsOur results provided clarity as to the factors associated with serum periostin levels, which could be helpful in the interpretation of serum periostin levels in clinical practice.
http://ift.tt/2kw1Tsh
Dysphagia and Pharyngeal Obstruction in a Nonsmoker
A man in his 60s presented with a 6-month history of dysphagia and a 3-month history of a 5-pound weight loss and a right neck mass; physical examination, including flexible nasolaryngoscopy, was notable for a large smooth nonulcerated right base of tongue mass. What is your diagnosis?
http://ift.tt/2AlOgmI
http://ift.tt/2AlOgmI
Sensory Changes and the Hearing Loss–Cognition Link
The UK National Institute of Health and Care Excellence (NICE) and the US National Institutes of Health (NIH) identified peripheral age-related hearing loss (ARHL) and social isolation as potentially modifiable dementia risk factors. A growing body of evidence suggested that ARHL and cognition in older age are interrelated and that midlife ARHL may be a risk factor for the development of Alzheimer disease (AD) and dementia in older adults. In a recent meta-analysis of only 3 selected studies with follow-up periods of 9 to 17 years, Livingstone and colleagues found that peripheral ARHL was a significant risk factor for incident dementia, calculating a pooled risk ratio of 1.94. At early stage of ARHL, part of the hearing problems are not related to the peripheral deficit of the auditory system but also to the central auditory processing (CAP) dysfunction, with considerable difficulty in understanding speech in presence of a background noise. Both peripheral and central auditory dysfunctions are therefore relevant to assess a possible influence of ARHL on late-life cognitive disorders.
http://ift.tt/2nEsvZj
http://ift.tt/2nEsvZj
Age-Related Hearing Loss, Cognitive Function, and Dementia
This meta-analysis examines the association between age-related hearing loss and cognitive function, cognitive impairment, and dementia in epidemiologic studies from 12 countries.
http://ift.tt/2AlO7Qc
http://ift.tt/2AlO7Qc
Asymptomatic Septal Mass
A woman in her 40s presented with a 2-month history of an enlarging asymptomatic anterior septal mass; she denied a history of localized trauma, and examination revealed an 8-mm pink-red, soft fleshy growth posterior to the membranous septum near the nostril apex. What is your diagnosis?
http://ift.tt/2BzGhPG
http://ift.tt/2BzGhPG
Association of Hearing Loss and Otologic Outcomes With Fibrous Dysplasia
This study characterizes audiologic and otologic manifestations in a cohort of individuals with fibrous dysplasia and/or McCune-Albright syndrome and investigated potential mechanisms of hearing loss.
http://ift.tt/2Bz3gKL
http://ift.tt/2Bz3gKL
Association of Lymph Node Density With Survival in Papillary Thyroid Cancer
This cohort study assesses the association of lymph node density—the ratio of the number of positive lymph nodes to the total number of nodes excised—with survival in patients with papillary thyroid cancer.
http://ift.tt/2kd5ew5
http://ift.tt/2kd5ew5
Endometriumkarzinom
Zusammenfassung
Das Endometriumkarzinom (EC) ist in Industrienationen die häufigste Karzinomerkrankung der weiblichen Genitalorgane. Es wird histologisch unterteilt in den östrogenabhängigen Typ I (etwa 90 %) und den östrogenunabhängigen Typ II (etwa 10 %), zu dem seröse, klarzellige und auch die dedifferenzierten Karzinome wie Karzinosarkome/maligne Müller-Mischtumoren des Uterus zählen. In der Mehrzahl der Fälle wird das Endometriumkarzinom in einem frühen Stadium diagnostiziert mit einem mittleren Erkrankungsalter von 69 Jahren. Die Therapie erfolgt meist als Hysterektomie mit beidseitiger Adnexexstirpation. Bei höherem Rezidivrisiko werden zusätzlich eine pelvine und paraaortale Lymphonodektomie und ggf. eine adjuvante Chemo- und/oder Strahlentherapie empfohlen. Die Nachsorge umfasst gynäkologische Untersuchungen zur Erkennung von Frührezidiven im Scheiden‑/Beckenbereich und zur Vermeidung von Scheidenverklebungen.
http://ift.tt/2ABdFri
Efficacy of pulsed dye laser treatment for common warts is not influenced by the causative HPV type: a prospective study
Abstract
Verruca vulgaris (VV) is a prevalent skin condition caused by various subtypes of human papilloma virus (HPV). The most common causes of non-genital lesions are HPV types 2 and 4, and to a lesser extent types 1, 3, 26, 29, and 57. Although numerous therapeutic modalities exist, none is universally effective or without adverse events (AE). Pulsed dye laser (PDL) is a favorable option due to its observed efficacy and relatively low AE rate. However, it is not known which verrucae are most likely to respond to PDL, or whether the causative viral subtype influences this response. The objective of this prospective blinded study was to assess whether the HPV subtype was predictive of response to PDL. For that matter, 26 verrucae from 26 immunocompetent patients were biopsied prior to treatment by PDL. HPV coding sequences were isolated and genotyped using PCR analysis. Patients were treated by PDL (595 nm wavelength, 5 mm spot size, 1.5 ms pulse duration, 12 J/cm2 fluence) once a month for up to 6 months, and clinical response was assessed. Binary logistic regression analysis and linear logistic regression analysis were used in order to evaluate statistical significance. Different types of HPV were identified in 22 of 26 tissue samples. Response to treatment did not correlate with HPV type, age, or gender. As no association between HPV type and response to PDL therapy could be established, it is therefore equally effective for all HPV types and remains a favorable treatment option for all VV.
http://ift.tt/2AmYkLZ
Scharfrandige Erosionen und Ulzerationen im Anschluss an ein Arzneimittelexanthem nach Sultamicillin-Gabe
Zusammenfassung
Es wird über den Fall einer Patientin mit neu aufgetretenen Erosionen und Ulzerationen im Anschluss an ein Arzneimittelexanthem durch Sultamicillin berichtet. Die Effloreszenzen traten nach topischer Behandlung mit Clobetasol und Prednicarbat sowie systemischer Gabe von Methylprednisolon auf. Im Hautabstrich wurden massiv Escherichia-coli-Bakterien nachgewiesen. Blutkulturen waren unauffällig. Ursächlich für Ecthymata gangraenosa bei unserer Patientin war eine iatrogene Immunsuppression bei transienter Bakteriämie.
http://ift.tt/2j2yOEr
P16 positivity and regression grade predict survival after neoadjuvant radiotherapy of OSCC
Abstract
Objectives
Survival after preoperative radiotherapy in locally advanced head and neck squamous cell cancer is associated with pathological response. The prognostic importance of p16 expression in these patients has not been established yet.
Materials and methods
Ninety-seven oral squamous cell carcinoma patients, treated preoperatively with radiotherapy in combination with chemotherapy or cetxuximab, were included in this retrospective analysis. Survival rates were estimated by the Kaplan-Meyer method. Pathological response was evaluated by histological analysis and p16 expression by immunohistochemistry.
Results
Overall survival after 2 years was 66% for the entire group, 92% in the p16-positive and 62% in the p16-negative group, respectively. 12.4% of the tumours were p16-positive. P16 expression (HR 6.98, P = 0.05) and regression grade (HR 2.94, P = 0.001) had a statistically significant impact on prognosis. 83.3% of p16 expressing tumours were pathological responders. All p16-positive patients with pathological response were alive within the observation period.
Conclusion
P16 expression is associated with prognosis in preoperatively irradiated OSCC patients. The association between p16-positivity, regression grade, and improved survival, provides a rationale for de-intensification strategies in head and neck cancer patients that respond well to neoadjuvant therapy; a concept that is being tested in prospective clinical trials.
This article is protected by copyright. All rights reserved.
http://ift.tt/2B0t70C
PDR001 Plus LAG525 for Patients With Advanced Solid and Hematologic Malignancies
Conditions: Small Cell Lung Cancer; Gastric Adenocarcinoma; Esophageal Adenocarcinoma; Castration Resistant Prostate Adenocarcinoma; Soft Tissue Sarcoma; Ovarian Adenocarcinoma; Advanced Well-differentiated Neuroendocrine Tumors; Diffuse Large B Cell Lymphoma
Interventions: Biological: PDR001; Biological: LAG525
Sponsor: Novartis Pharmaceuticals
Not yet recruiting
http://ift.tt/2Bccuj0
Interventions: Biological: PDR001; Biological: LAG525
Sponsor: Novartis Pharmaceuticals
Not yet recruiting
http://ift.tt/2Bccuj0
In vivo differentiation of common basal cell carcinoma subtypes by microvascular and structural imaging using dynamic optical coherence tomography
Abstract
Background
The subtype of basal cell carcinoma (BCC) influences the choice of treatment. Optical coherence tomography (OCT) is a non-invasive imaging tool and recent development of angiographic version of OCT has extended the application of OCT to image the cutaneous microvasculature (so called dynamic OCT, D-OCT). This study explores D-OCT's ability to differentiate the common BCC subtypes by microvascular and structural imaging.
Methods
81 patients with 98 BCC lesions, consisting of three subtypes: 27 superficial BCC (sBCC), 55 nodular BCC (nBCC) and 16 infiltrative BCC (iBCC), were D-OCT scanned at three European dermatology centres. Blinded evaluations of microvascular and structural features were performed, followed by extensive statistical analysis of risk ratio (RR) and multiple correspondence analysis (MCA).
Results
nBCC lesions displayed most characteristic structural and vascular features. Serpiginous vessels, branching vessels, vessels creating a circumscribed figure and sharply demarcated hyporeflective ovoid structures in the dermis were all associated with a higher risk of the subtype being nBCC. The presence of highly present lines and dark peripheral borders at the margin of ovoid structures were negatively associated with iBCC. Lastly, the finding of hyporeflective ovoid structures protruding from epidermis correlated with sBCC.
Conclusion
We identified various microvascular and structural D-OCT features that may aid non-invasive identification of BCC subtypes. This would allow clinicians to individualize and optimize BCC treatment as well as aid follow-up of non-surgical treatment.
This article is protected by copyright. All rights reserved.
http://ift.tt/2jqOK04
How frequent does peri-implantitis occur? A systematic review and meta-analysis
Abstract
Objectives
The objective of this study is to estimate the overall prevalence of peri-implantitis (PI) and the effect of different study designs, function times, and implant surfaces on prevalence rate reported by the studies adhering to the case definition of Sanz & Chapple 2012.
Material and methods
Following electronic and manual searches of the literature published up to February 2016, data were extracted from the studies fitting the study criteria. Meta-analysis was performed for estimation of overall prevalence of PI while the effects of the study design, function time, and implant surface type on prevalence rate were investigated using meta-regression method.
Results
Twenty-nine articles were included in this study. The prevalence rate in all subset meta-analyses was always higher at patient level when compared to the prevalence rate at the implant level. Prevalence of PI was 18.5% at the patient level and 12.8% at the implant level. Meta-regression analysis did not identify any association for different study designs and function times while it was demonstrated the significant association between moderately rough surfaces with lower prevalence rate of PI (p = 0.011).
Conclusions
The prevalence rate of PI remains highly variable even following restriction to the clinical case definition and it seems to be affected by local factors such as implant surface characteristics. The identification of adjuvant diagnostic markers seems necessary for more accurate disease classification.
Clinical relevance
The occurrence of PI is affected by local factors such as implant surface characteristics hence the careful assessment of the local factors should be performed within treatment planning.
http://ift.tt/2BKdTd8
Natural Agents in the Management of Oral Mucositis in Cancer Patients-Systematic Review
Publication date: Available online 6 December 2017
Source:Journal of Oral Biology and Craniofacial Research
Author(s): Ravleen Nagi, Deepa Jatti Patil, N. Rakesh, Supreet Jain, Shashikant Sahu
IntroductionOral mucositis is most severe complication of cancer therapy characterized by ulcerative lesions of oral mucosa causing negative impact on patient's quality of life. Wide variety of therapeutic agents are available to reduce the lesions of mucositis. Currently, natural herbal remedies have become popular in treating this condition due to fewer side effects than synthetic drugs.AimThe aim of this systematic review is to compile evidence based studies to evaluate the effectiveness of natural agents in the management of oral mucositis induced by chemotherapy or radiotherapy in cancer patients.Materials and methodComputerized literature searches were performed to identify all published articles in the subject. The following databases were used: PUBMED [MEDLINE], SCOPUS, COCHRANE DATABASE, EMBASE and SCIENCE DIRECT using specific keywords. The search was for limited articles published in English which were read in full by two authors.ResultsTwenty six randomized controlled trials satisfied our inclusion criteria. Most studies showed statistically significant result demonstrating the efficacy of natural agents with minimal side effects except manuka honey which was not tolerated by few patients.ConclusionNatural agents proved to be promising in healing cancer induced oral mucositis but future demands further randomized controlled clinical trials on these agents which should also be focused on drug interactions of the natural remedies.
http://ift.tt/2nH8uBs
Efficacy of Secukinumab in the Treatment of Moderate to Severe Plaque Psoriasis in the North American Subgroup of Patients: Pooled Analysis of Four Phase 3 Studies
Abstract
Introduction
Demographic and disease characteristics may impact response to psoriasis therapies. The objective of this study is to explore the safety and efficacy profile of secukinumab in North American (NA) versus non-NA patients with moderate to severe psoriasis.
Methods
Data were pooled from four phase 3 studies of secukinumab. Secukinumab (300 and 150 mg) was administered at baseline, weeks 1, 2, and 3, then every 4 weeks from week 4 to 48.
Results
Peak efficacy was observed at week 16 in NA and non-NA patients with secukinumab 300 mg and secukinumab 150 mg, and disease clearance was maintained to week 52. At week 52 with secukinumab 300 mg, Psoriasis Area and Severity Index (PASI) 90/100 response was achieved by 62.9%/37.9% of NA patients, respectively, and 70.2%/42.0% of non-NA patients, respectively. At week 52 with secukinumab 150 mg, PASI 90/100 response was achieved by 30.9%/17.5% of NA patients, respectively, and 53.9%/26.9% of non-NA patients, respectively. Response to secukinumab was rapid, and 50% reduction in mean PASI was achieved in both groups after 2.9 weeks with secukinumab 300 mg and 3.7 weeks with secukinumab 150 mg.
Conclusion
Despite differences in baseline characteristics, the efficacy and safety of secukinumab were similar among NA and non-NA patients.
Funding
Novartis Pharma AG.
Plain Language Summary
Plain language summary available for this article.
http://ift.tt/2A0amXH
Haploidentical natural killer cells induce remissions in non-Hodgkin lymphoma patients with low levels of immune-suppressor cells
Abstract
We report a novel phase 2 clinical trial in patients with poor prognosis refractory non-Hodgkin lymphoma (NHL) testing the efficacy of haploidentical donor natural killer (NK) cell therapy (NK dose 0.5–3.27 × 107 NK cells/kg) with rituximab and IL-2 (clinicaltrials.gov NCT01181258). Therapy was tolerated without graft-versus-host disease, cytokine release syndrome, or neurotoxicity. Of 14 evaluable patients, 4 had objective responses (29%; 95% CI 12–55%) at 2 months: 2 had complete response lasting 3 and 9 months. Circulating donor NK cells persisted for at least 7 days after infusion at the level 0.6–16 donor NK cells/µl or 0.35–90% of total CD56 cells. Responding patients had lower levels of circulating host-derived Tregs (17 ± 4 vs. 307 ± 152 cells/µL; p = 0.008) and myeloid-derived suppressor cells at baseline (6.6 ± 1.4% vs. 13.0 ± 2.7%; p = 0.06) than non-responding patients. Lower circulating Tregs correlated with low serum levels of IL-10 (R 2 = 0.64; p < 0.003; n = 11), suggestive of less immunosuppressive milieu. Low expression of PD-1 on recipient T cells before therapy was associated with response. Endogenous IL-15 levels were higher in responders than non-responding patients at the day of NK cell infusion (mean ± SEM: 30 ± 4; n = 4 vs. 19.0 ± 4.0 pg/ml; n = 8; p = 0.02) and correlated with day 14 NK cytotoxicity as measured by expression of CD107a (R 2 = 0.74; p = 0.0009; n = 12). In summary, our observations support development of donor NK cellular therapies for advanced NHL as a strategy to overcome chemoresistance. Therapeutic efficacy may be further improved through disruption of the immunosuppressive environment and infusion of exogenous IL-15.
http://ift.tt/2AVMOa1
An Unusual Cause of Leg Pain
http://ift.tt/2iBgFd9
Generalized pustular psoriasis in a 92-year-old man with a homozygous nonsense mutation in IL36RN
Abstract
A 92-year-old man developed an erythematous eruption on the trunk and extremities with numerous pustules accompanied by fever. He had never experienced pustular eruption or been diagnosed with psoriasis previously. Skin biopsy revealed Kogoj's spongiform pustule, and he was diagnosed with generalized pustular psoriasis (GPP). Genomic DNA was extracted from his peripheral blood and the sequence of IL36RN gene was analyzed, which revealed a p.Arg10X homozygous mutation. Several cases of elderly-onset GPP have been reported, however, this is the oldest case of GPP. The existence of splice variants of IL36RN was suspected, but we could not detect any splice variants of IL36RN in this case or in a healthy control from peripheral blood samples.
http://ift.tt/2joIfuC
Use of biological drugs in patients with psoriasis and psoriatic arthritis in Italy: Results from the PSONG survey
Abstract
This Italian multicenter retrospective study compared the drug survival and efficacy of different anti-TNF agents in psoriasis (PsO) and psoriatic arthritis (PsA) patients. A database of PsO/PsA patients treated with adalimumab, etanercept, and infliximab from May 2013 to May 2014 was analyzed. PASI 75, 90, and 100 was calculated at each time point to evaluate efficacy. Drug survival rate and probability of maintaining PASI response were evaluated. The impact of dependent variables on probability of PASI 75 loss was evaluated by logistic regression. 1,235 patients were included, 577 with PsO and 658 with PsA. Highest survival rates were observed with adalimumab followed by etanercept and infliximab in PsO and PsA patients. The probability of maintaining PASI response was significantly higher for adalimumab followed by infliximab. For PsO patients, the odds of losing PASI 75 was higher in etanercept-treated patients (OR: 8.1; 95% CI: 4.2–15.6, p < .001) or infliximab (OR: 6.6; 95% CI: 2.6–16.3, p < .001) vs. adalimumab. Likewise, for PsA patients the odds of losing PASI 75 was higher in etanercept-treated patients (OR: 2.3; 95% CI: 1.4–3.8, p = .01) or infliximab (OR: 2.2; 95% CI: 1.1–4.1, p = .018) vs. adalimumab. Adalimumab could be the best therapeutic option over other anti-TNF agents for the treatment of PsO and PsA patients.
http://ift.tt/2Aha1Ux
Psoriasis improvement after gastric bandage in a patient partial responder to infliximab
Abstract
Patients overweight or obese have more severe psoriasis than normal weight patients. Sometimes the excessive weight is related to a lack of efficacy of systemic treatment. We report a case of a psoriatic patient that experienced a dramatic improvement of psoriasis after weight loss surgery by gastric bandage. The great weight loss was accompanied by an effectiveness gain of response to infliximab. The mechanism responsible for this association is not certain, but it is probably multifactorial, involving genetic, environmental and immune-mediated factors. It has been suggested that adipose tissue can dramatically alter the volume of drug distribution and limit drug efficacy. Moreover, a reduction of weight could favour the response to therapy and remission of the disease, inducing an improvement in patient's quality of life. Gastric bandage has a scarce rate of complications, a fast recovery and scarce life-threatening complications. It should be considered in obese patient that not shown effectiveness to therapy.
http://ift.tt/2BbHTlZ
Case of thymoma-associated cutaneous graft-versus-host disease-like disease successfully improved by narrowband ultraviolet B phototherapy
Abstract
Thymoma-associated graft-versus-host disease (GVHD)-like disease is a rare paraneoplastic disease seen in patients with thymoma. Here, we describe the first case of thymoma-associated GVHD-like disease localized to the skin that was successfully improved by a combination of systemic corticosteroids and whole-body narrowband ultraviolet (UV)-B phototherapy. The patient had developed toxic epidermal necrolysis-like erosive skin lesions over the whole body. Although systemic corticosteroids were effective up to a point, we were unable to begin the steroid taper. The addition of systemic narrowband UV-B phototherapy improved the skin manifestation of this disease, allowing corticosteroids to be reduced to a third of the original dose. Histopathologically, it was confirmed that the proportion of Foxp3-positive lymphocytes in the skin increased after narrowband UV-B irradiation. We propose that whole-body narrowband UV-B phototherapy is a good therapeutic option for the skin manifestation of thymoma-associated GVHD-like disease.
http://ift.tt/2AiLVJ2
Attractivité de la carrière hospitalo-universitaire en France : analyse de la perception des jeunes dermatologues en 2016
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A. Soria, B. Dreno, S. Aractingi, M. Beylot-Barry, C. Bodemer, O. Chosidow, B. Cribier, J.-P. Lacour, C. Paul, M.-A. Richard, C. Gaudy-Marqueste, M. Samimi
http://ift.tt/2jocemG
Direct biological effects of fractional ultrapulsed CO 2 laser irradiation on keratinocytes and fibroblasts in human organotypic full-thickness 3D skin models
Abstract
Molecular effects of various ablative and non-ablative laser treatments on human skin cells—especially primary effects on epidermal keratinocytes and dermal fibroblasts—are not yet fully understood. We present the first study addressing molecular effects of fractional non-sequential ultrapulsed CO2 laser treatment using a 3D skin model that allows standardized investigations of time-dependent molecular changes ex vivo. While histological examination was performed to assess morphological changes, we utilized gene expression profiling using microarray and qRT-PCR analyses to identify molecular effects of laser treatment. Irradiated models exhibited dose-dependent morphological changes resulting in an almost complete recovery of the epidermis 5 days after irradiation. On day 5 after laser injury with a laser fluence of 100 mJ/cm2, gene array analysis identified an upregulation of genes associated with tissue remodeling and wound healing (e.g., COL12A1 and FGF7), genes that are involved in the immune response (e.g., CXCL12 and CCL8) as well as members of the heat shock protein family (e.g., HSPB3). On the other hand, we detected a downregulation of matrix metalloproteinases (e.g., MMP3), differentiation markers (e.g., LOR and S100A7), and the pro-inflammatory cytokine IL1α.
Overall, our findings substantiate the understanding of time-dependent molecular changes after CO2 laser treatment. The utilized 3D skin model system proved to be a reliable, accurate, and reproducible tool to explore the effects of various laser settings both on skin morphology and gene expression during wound healing.
http://ift.tt/2AzlrSw
Management of head and neck primary unknown squamous cell carcinoma using combined positron emission tomography-computed tomography and transoral laser microsurgery
Objectives/Hypothesis
The unknown primary of the neck is commonly encountered by the head and neck surgeon. Despite the exhaustive diagnostic tools employed in traditional detection protocols, many unknown primaries are not found, and the patient is subjected to wide-field radiation and chemotherapy during treatment. Localizing the primary tumor has demonstrated therapeutic benefits, improved quality of life, and overall survival. The authors' objective was to determine the efficacy of a new management protocol for unknown primaries of the head and neck.
Study Design
Prospective cohort study.
Methods
Our technique involved a preoperative positron emission tomography-computed tomography (PET-CT) followed by a planned transoral laser microsurgery (TLM) approach. Efficacy was assessed based on survival statistics, disease control, detection rates, the proportion of patients not receiving adjuvant therapy, and the proportion of PET-CT scans helpful for detection of the primary cancer.
Results
The occult primary was located in 25 of the 27 patients (93%), with the majority found in the palatine tonsil (52%). Both overall survival and disease-specific survival was 80% at 36 months. Local control was achieved in 100% of patients. After surgery, 37.0% (n = 10) received adjuvant radiation alone and 33.3% (n = 9) of patients went on to receive adjuvant chemoradiation. On imaging, 72% (n = 18) of PET-CT scans correctly localized the primary tumor.
Conclusions
Occult head and neck primaries present a diagnostic challenge that is not adequately overcome using traditional detection protocols. The current study presents our unique protocol at Dalhousie University, which demonstrates the efficacy of the PET-CT TLM protocol from both a detection and therapeutic perspective.
Level of Evidence
4. Laryngoscope, 2017
http://ift.tt/2Ayx8Jc
Endoscopic sentinel lymph node biopsy using indocyanine green-neomannosyl human serum albumin
Objective
The aim of this study was to determine the possibility of endoscopic sentinel lymph node biopsy of the head and neck region using indocyanine green-neomannosyl human serum albumin (ICG:MSA) and a custom-made intraoperative color-and-fluorescence-merged imaging system (ICFIS).
Methods
Using mouse and rabbit models of tongue cancer, we performed sentinel lymph node biopsy using an ICG:MSA tracer and custom imaging system equipped with an endoscope.
Results
ICG:MSA was localized to the cervical lymph node on the ipsilateral side for up to 30 minutes compared to ICG tracer (ICG n = 3, IGC:MSA n = 3). Detection of sentinel lymph nodes was attempted after injecting ICG:MSA in the mouse tongue cancer model (n = 3). During the operation, lymph nodes were easily identified and resected using ICFIS without the aid of other magnifiers. In the rabbit tongue cancer model (n = 3), the ICFIS equipped with 30-degree endoscopy was used to confirm the feasibility of endoscopic sentinel lymph node biopsy. The entire sentinel lymph node biopsy procedure was performed using the ICFIS with the 30-degree endoscope. We detected and dissected sentinel lymph nodes in the rabbit model without the other sentinel lymph node detection tools.
Conclusion
We confirmed the usefulness of sentinel lymph node biopsy using a near infrared fluorescence technique and endoscopic system. Avoidance of radiation exposure and shine-through phenomena, which are problems of sentinel lymph node biopsy using conventional radioisotopes, are advantages of our surgical technique. By combining the endoscopic system with a sentinel lymph node biopsy procedure, we avoided visible neck scars, which lead to excellent cosmetic outcomes.
Level of Evidence
NA. Laryngoscope, 2017
http://ift.tt/2jo3ME5
A case of hypoglossal nerve stimulator-resistant obstructive sleep apnea cured with the addition of a chin strap
A population of appropriately selected patients does not respond, or does not achieve cure, with hypoglossal nerve stimulation (HGNS). We describe the case of nonresponder whose obstructive sleep apnea (OSA) resolved with the addition of chin strap. After initial placement and titration of HGNS implant, follow-up sleep study demonstrated persistent moderate OSA. Drug-induced sleep endoscopy demonstrated supraglottic collapse with activate neurostimulation. With mouth closure and change of stimulation settings to unipolar from bipolar, the airway collapse and desaturations improved. The follow-up polysomnogram with (HGNS) therapy and chin strap demonstrated resolution of sleep apnea. Laryngoscope, 2017
http://ift.tt/2AywUlk
An app to enhance resident education in otolaryngology
Objective
Technological change is leading to an evolution in medical education. The objective of our study was to assess the impact of a medical knowledge app, called PulseQD, on resident education within our otolaryngology–head and neck surgery department at Montefiore Medical Center, Albert Einstein College of Medicine (Bronx, NY).
Methods
A prospective cohort study was conducted within the Department of Otolaryngology–Head and Neck Surgery from July 2016 to June 2017. All faculty attendings and residents were asked to participate in the study and were included. A Web and mobile-based app, PulseQD, that allowed for collaborative learning was implemented. Questionnaires were given at the beginning and end of the academic year. Otolaryngology Training Exam (OTE) scores were collected
Results
A total of 20 residents and 13 faculty members participated in the study. Residents used online sources of medical information significantly more often than faculty (90% and 54%, respectively, P = 0.0179). Residents and faculty felt that PulseQD offered a valuable perspective on clinically relevant medical information (P = 0.0003), was a great way to test clinical and medical knowledge (P = 0.0001), and improved the sharing and discussing of medical knowledge (P < 0.0001). There was a statistically significant 5.8% improvement in OTE scores (P = 0.0008) at the end of the academic year.
Conclusion
The implementation of a novel mobile app, PulseQD, was well received by residents and faculty in the Department of Otolaryngology–Head and Neck Surgery. Preliminary data suggest that app-based learning may lead to improved performance on knowledge-based assessments.
Level of Evidence
NA. Laryngoscope, 2017
http://ift.tt/2jq8oto
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