Uphill/downhill nystagmus.

Related Articles

Uphill/downhill nystagmus.

Acta Otorhinolaryngol Ital. 2017 Dec;37(6):513-518

Authors: Gufoni M

Abstract
Differential diagnosis between peripheral and central spontaneous nystagmus can be difficult to classify (as peripheral or central) even on the basis of criteria recommended in the recent literature. The aim of this paper is to use the combination of spontaneous nystagmus and ocular tilt reaction to determine the site of origin of the disease that causes nystagmus. We propose to classify the nystagmus in: 1) "Uphill" nystagmus in which the nystagmus takes on an inclined plane and the direction of the fast phase is towards the hypertropic eye (this type of nystagmus is likely peripheral); 2) "Downhill" nystagmus when the nystagmus beats toward the hypotropic eye (this type of nystagmus is likely central); 3) "Flat" nystagmus when the plane on which nystagmus beats is perfectly horizontal: in this case, we cannot say anything about the site of lesion (it was only detected in 15% of cases). The spatial position of nystagmus vector has to be considered as an intrinsic characteristic of the nystagmus itself (as direction, frequency, angular velocity etc.) and must be reported in the description, possibly giving an indication of the site of damage (peripheral or central). In particular, similar results are obtained by comparing the inclination of the nystagmus with the head impulse test (HIT, considered the best bedside test now available). It seems that this sign may confirm HIT for safer diagnosis or replace it in case of doubt. In contrast, in case of "Flat" nystagmus (probably attributable to the fact that the utricular maculae are spared), HIT can replace observation of the plane of the nystagmus. Thus, the two signs confirm and integrate each other. The test does not require additional time and is not tedious for the patient. It is proposed that it be included in the evaluation of spontaneous nystagmus in everyday clinical practice.

PMID: 29327737 [PubMed - in process]

http://ift.tt/2DbYRRx

Balloon dilation of the Eustachian tube: clinical experience in the management of 126 children.

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Balloon dilation of the Eustachian tube: clinical experience in the management of 126 children.

Acta Otorhinolaryngol Ital. 2017 Dec;37(6):509-512

Authors: Tisch M, Maier H, Sudhoff H

Abstract
Balloon dilation of the Eustachian tube has been recently introduced as a novel and minimally invasive method for treating chronic obstructive Eustachian tube dysfunction. For the first time worldwide, we assessed the role of this technique in the treatment of children with Eustachian tube dysfunction who did not respond to other treatments. We retrospectively analysed the medical records of 60 children (mean age: 6.3 years, range: 28 months to 12 years) who underwent balloon dilation of the Eustachian tube using the Bielefeld balloon catheter. In addition, the parents of a further 66 children who underwent balloon dilation (mean age: 8 years, range: 4 to 13 years) were asked to complete a standardised written questionnaire and were interviewed by telephone about the postoperative course of their children. There were no complications during surgery. Clinical symptoms improved in more than 80% of patients. No patient reported a deterioration of symptoms. Of the participating parents, 81.3% were very satisfied or satisfied with the outcome of treatment. Balloon dilation is a rapid, simple and safe method for the treatment of both adults and children with Eustachian tube dysfunction that does not respond to other treatments. Further studies, ideally multicentre studies, are required in order to optimise the definition of existing and potential new indications for this treatment approach and to establish this treatment in the management of children with refractory chronic Eustachian tube dysfunction.

PMID: 29327736 [PubMed - in process]

http://ift.tt/2DaBR5z

Acquired sensorineural hearing loss in children: current research and therapeutic perspectives.

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Acquired sensorineural hearing loss in children: current research and therapeutic perspectives.

Acta Otorhinolaryngol Ital. 2017 Dec;37(6):500-508

Authors: Ralli M, Rolesi R, Anzivino R, Turchetta R, Fetoni AR

Abstract
The knowledge of mechanisms responsible for acquired sensorineural hearing loss in children, such as viral and bacterial infections, noise exposure, aminoglycoside and cisplatin ototoxicity, is increasing and progressively changing the clinical management of affected patients. Viral infections are by far the most relevant cause of acquired hearing loss, followed by aminoglycoside and platinum derivative ototoxicity; moreover, cochlear damage induced by noise overexposure, mainly in adolescents, is an emerging topic. Pharmacological approaches are still challenging to develop a truly effective cochlear protection; however, the use of steroids, antioxidants, antiviral drugs and other small molecules is encouraging for clinical practice. Most of evidence on the effectiveness of antioxidants is still limited to experimental models, while the use of corticosteroids and antiviral drugs has a wide correspondence in literature but with controversial safety. Future therapeutic perspectives include innovative strategies to transport drugs into the cochlea, such as molecules incorporated in nanoparticles that can be delivered to a specific target. Innovative approaches also include the gene therapy designed to compensate for abnormal genes or to make proteins by introducing genetic material into cells; finally, regenerative medicine (including stem cell approaches) may play a central role in the upcoming years in hearing preservation and restoration even if its role in the inner ear is still debated.

PMID: 29327735 [PubMed - in process]

http://ift.tt/2DbYQgr

Clinical study of extrapulmonary head and neck tuberculosis in an urban setting.

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Clinical study of extrapulmonary head and neck tuberculosis in an urban setting.

Acta Otorhinolaryngol Ital. 2017 Dec;37(6):493-499

Authors: Monga S, Malik JN, Jan S, Bahadur S, Jetley S, Kaur H

Abstract
Tuberculosis (TB) of the head and neck region is quite common in endemic countries, but is still misdiagnosed due to its varied presentation and different sites of involvement. The aims of the present study were to present the diversities of presentation of head and neck tuberculosis with the diagnostic predicaments faced during evaluation and to assess treatment response to anti-tubercular treatment (ATT). We analysed 48 patients with head and neck tuberculosis who presented to the Department of Otorhinolaryngology in our tertiary care urban hospital over a period of two years from 2013 to 2015 and recorded their data, which included presenting complaints, local and systemic examination findings, investigation results and treatment outcomes. The results showed that majority (64.5%) of cases were female and none of the patients were HIV positive. The most common manifestation was cervical lymphadenopathy (81.25%) with level II being the most commonly affected (31.3%). Three of the 48 patients had coexisting pulmonary TB. Fine needle aspiration cytology (FNAC), histopathological diagnosis and acid fast bacilli (AFB) staining were used to confirm diagnosis. All patients were treated with Category I ATT, which achieved cure in 96.8% of cases. Though cervical lymphadenitis is the most common presentation of head and neck TB, isolated involvement of the sinonasal region, larynx, oral cavity and other sub-sites are not solely unknown entities. It is, therefore, important for clinicians to be aware of atypical and misleading presentations and consider TB as a major differential diagnosis in the head and neck region, even in non-immunocompromised individuals.

PMID: 29327734 [PubMed - in process]

http://ift.tt/2mDoYYn

Orthopaedic treatment effects of functional therapy on the sagittal pharyngeal dimensions in subjects with sleep-disordered breathing and Class II malocclusion.

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Orthopaedic treatment effects of functional therapy on the sagittal pharyngeal dimensions in subjects with sleep-disordered breathing and Class II malocclusion.

Acta Otorhinolaryngol Ital. 2017 Dec;37(6):479-485

Authors: Pavoni C, Cretella Lombardo E, Lione R, Bollero P, Ottaviani F, Cozza P

Abstract
The purpose of this cephalometric study was to evaluate the craniofacial changes induced by functional treatment of mandibular advancement with special regard to pharyngeal sagittal airway dimensions, tongue and hyoid bone position in subjects with sleep-disordered breathing (SDB) and dentoskeletal Class II malocclusions compared with an untreated Class II control group. 51 subjects (24 female, 27 male; mean age 9.9 ± 1.3 years) with Class II malocclusion and SDB consecutively treated with a functional appliance (Modify Monobloc, MM) were compared with a control group of 31 subjects (15 males, 16 females; mean age 10.1 ± 1.1) with untreated Class II malocclusion. For the study group, mode of breathing was defined by an otorhinolaryngologist according to complete physical examination. The parents of all participants completed a modified version of the paediatric sleep questionnaire, PSQ-SRBD Scale, by Ronald Chervin (the Italian version in 22 items form) before and after the trial. Lateral cephalograms were available at the start and end of treatment with the MM. Descriptive statistics were used for all cephalometric measurements in the two groups for active treatment changes. Significant, favourable skeletal changes in the mandible were observed in the treated group after T2. Significant short-term changes in sagittal airway dimensions, hyoid position and tongue position were induced by functional therapy of mandibular advancement in subjects with Class II malocclusion and SDB compared with untreated controls. After orthodontic treatment, a significant reduction in diurnal symptoms was observed in 45 of the 51 participants who had received an oral appliance. Orthodontic treatment is considered to be a potential therapeutic approach for SDB in children. Orthodontists are playing an increasingly important role in managing snoring and respiratory problems by oral mandibular advancement devices and rapid maxillary expansion.

PMID: 29327733 [PubMed - in process]

http://ift.tt/2D6IOW2

A miRNA signature suggestive of nodal metastases from laryngeal carcinoma.

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A miRNA signature suggestive of nodal metastases from laryngeal carcinoma.

Acta Otorhinolaryngol Ital. 2017 Dec;37(6):467-474

Authors: Ricciardiello F, Capasso R, Kawasaki H, Abate T, Oliva F, Lombardi A, Misso G, Ingrosso D, Leone CA, Iengo M, Caraglia M

Abstract
The discovery that miRNAs are frequently deregulated in tumours offers the opportunity to identify them as prognostic and diagnostic markers. The aim of this multicentric study is to identify a miRNA expression profile specific for laryngeal cancer. The secondary endpoint was to identify specific deregulated miRNAs with potential as prognostic biomarkers for tumour spread and nodal involvement, and specifically to search for a miRNA pattern pathognomonic for N+ laryngeal cancer and for N- tissues. We identified 20 miRNAs specific for laryngeal cancer and a tissue-specific miRNA signature that is predictive of lymph node metastases in laryngeal carcinoma characterised by 11 miRNAs, seven of which are overexpressed (upregulated) and four downregulated. These results allow the identification of a group of potential specific tumour biomarkers for laryngeal carcinoma that can be used to improve its diagnosis, particularly in early stages, as well as its prognosis.

PMID: 29327732 [PubMed - in process]

http://ift.tt/2mt3wEl

Transoral robotic surgery in Eagle's syndrome: our experience on four patients.

Related Articles

Transoral robotic surgery in Eagle's syndrome: our experience on four patients.

Acta Otorhinolaryngol Ital. 2017 Dec;37(6):454-457

Authors: Kim DH, Lee YH, Cha D, Kim SH

Abstract
Eagle's syndrome is characterised by focal pain in the tonsillar fossa on wide mouth opening or head rotation and various accompanying symptoms. While the syndrome is difficult to diagnose, shortening the styloid process via a transoral or transcervical surgical approach has been shown to be the most effective treatment. The aim of this article was to document our experience with a transoral robotic approach to treat Eagle's syndrome and to present the outcomes of four patients. We reviewed the cases of four patients with Eagle's syndrome who underwent transoral robotic surgery (TORS). The average age of patients was 53.75 years, and there were equal numbers of males and females. The styloid processes were reconstructed in 3D from the preoperative CT scans and were measured as an average of 4.18 cm (range 3.3-5.1). The mean set-up time and operation times were less than 10 minutes and 30 minutes, respectively. All patients were completely relieved of symptoms, and were able to restart an oral diet on post-operative day 1. No patient suffered intraoperative or postoperative complication, including cranial nerve injury, haemorrhage, or deep neck infection. In our experience, transoral excision of the styloid process via a robotic approach can be considered as a feasible treatment option for Eagle's syndrome.

PMID: 29327731 [PubMed - in process]

http://ift.tt/2mtqYl3

Human bite injuries to the head and neck: current trends and management protocols in England and Wales

Abstract

Introduction

Human bite injuries can be challenging in their presentation to the examining physician. In a study by Merchant et al., 18% of patients presenting with a human bite injury had suffered wounds to the head and neck region. Current trends in their initial management at presentation to emergency departments throughout England and Wales will be discussed in this paper.

Materials and method

A postal survey was sent out to 100 A&E lead clinicians. This was followed up by telephone enquiries to improve the response rate. The collated results of the survey were entered onto a spreadsheet (Microsoft Excel©) for the purpose of statistical review.

Results

A 68% response rate from A&E departments throughout England and Wales demonstrated a lack of consensus in the initial management and subsequent treatment of human bite injuries. Written protocols are in place for human bite injuries in 54.4% of units. In 100% of units, initial management involves irrigation +/− debridement of the wound, though there is a lack of agreement on the surgical management of the wound. 77.9% of units follow 'needle stick protocols' when stratifying risk for blood-borne viruses.

Conclusion

Human bites pose a number of unique problems, ranging from cellulitis to the transmission of communicable diseases. The maxillofacial surgeon has the added dilemmas surrounding subsequent repair and reconstruction. Appreciation of the complexity of human bite injuries will ensure optimal care for the patient. We propose a set of guidelines developed 'in-house' to assist in the management of human bite injuries.

http://ift.tt/2r3GlWF

Human bite injuries to the head and neck: current trends and management protocols in England and Wales

Abstract

Introduction

Human bite injuries can be challenging in their presentation to the examining physician. In a study by Merchant et al., 18% of patients presenting with a human bite injury had suffered wounds to the head and neck region. Current trends in their initial management at presentation to emergency departments throughout England and Wales will be discussed in this paper.

Materials and method

A postal survey was sent out to 100 A&E lead clinicians. This was followed up by telephone enquiries to improve the response rate. The collated results of the survey were entered onto a spreadsheet (Microsoft Excel©) for the purpose of statistical review.

Results

A 68% response rate from A&E departments throughout England and Wales demonstrated a lack of consensus in the initial management and subsequent treatment of human bite injuries. Written protocols are in place for human bite injuries in 54.4% of units. In 100% of units, initial management involves irrigation +/− debridement of the wound, though there is a lack of agreement on the surgical management of the wound. 77.9% of units follow 'needle stick protocols' when stratifying risk for blood-borne viruses.

Conclusion

Human bites pose a number of unique problems, ranging from cellulitis to the transmission of communicable diseases. The maxillofacial surgeon has the added dilemmas surrounding subsequent repair and reconstruction. Appreciation of the complexity of human bite injuries will ensure optimal care for the patient. We propose a set of guidelines developed 'in-house' to assist in the management of human bite injuries.

http://ift.tt/2r3GlWF

Gallbladder ascariasis in Kosovo – focus on ultrasound and conservative therapy: a case series

Ascaris lumbricoides is one of the most common intestinal infections in developing countries, including Kosovo. In contrast to migration to the bile duct, migration of the worm to the gallbladder, due to the narr...

http://ift.tt/2D9UoQd

Outdoor pollen is a trigger of child and adolescent asthma ED presentations: a systematic review and meta-analysis

Abstract

Background

In the context of increased asthma exacerbations associated with climatic changes such as thunderstorm asthma, interest in establishing the link between pollen exposure and asthma hospital admissions has intensified. Here, we systematically reviewed and performed a meta-analysis of studies on pollen and ED attendance.

Methods

A search for studies with appropriate search strategy in Medline, Embase, Web of Science and CINAHL was conducted. Each study was assessed for quality and risk of bias. The available evidence was summarised both qualitatively and meta-analysed using random effects models when moderate heterogeneity was observed.

Results

Fourteen studies were included. The pollen taxa investigated differed between studies, allowing meta-analysis only of the effect of grass pollen. A statistically significant increase in the percentage change in the mean number of asthma ED presentations (MPC) (pooled results from three studies) was observed for an increase in 10 grass pollen grains per cubic meter of exposure 1.88% (95%CI = 0.94%, 2.82%). Time series studies showed positive correlations between pollen concentrations and ED presentations. Age stratified studies found strongest associations in children aged 5 to 17 years old.

Conclusion

Exposure to ambient grass pollen is an important trigger for childhood asthma exacerbations requiring ED attendance. As pollen exposure is increasingly a problem especially in relation to thunderstorm asthma, studies with uniform measures of pollen and similar analytical methods are necessary to fully understand its impact on human health.

This article is protected by copyright. All rights reserved.

http://ift.tt/2DtRJh0

How does dose impact on the severity of food-induced allergic reactions, and can this improve risk assessment for allergenic foods?

Abstract

Quantitative risk assessment for food allergens has made considerable progress in recent years, yet acceptability of its outcomes remains stymied because of the limited extent to which it has been possible to incorporate severity as a variable. Reaction severity, particularly following accidental exposure, depends on multiple factors, related to the allergen, the host and any treatments which might be administered. Some of these factors are plausibly still unknown. Quantitative risk assessment shows that limiting exposure through control of dose reduces the rates of reactions in allergic populations, but its impact on the relative frequency of severe reactions at different doses is unclear. Food challenge studies suggest that the relationship between dose of allergenic food and reaction severity is complex even under relatively controlled conditions. Because of these complexities, epidemiological studies provide very limited insight into this aspect of the dose-response relationship. Emerging data from single-dose challenges suggest that graded food challenges may overestimate the rate of severe reactions. It may be necessary to generate new data (such as those from single dose-challenges) to reliably identify the effect of dose on severity for use in quantitative risk assessment. Success will reduce uncertainty in the susceptible population and improve consumer choice.

This article is protected by copyright. All rights reserved.

http://ift.tt/2D0ktgi

Submental artery island flap with simultaneous level I neck dissection

Abstract

Background

The purpose of this study was to illustrate the submental island flap elevation technique with simultaneous level I neck dissection followed by the inset and reconstruction of an oropharyngeal defect.

Methods

A 63-year-old patient with a T2N1M0 human papillomavirus-positive squamous cell carcinoma of the tonsil was treated with concurrent chemoradiotherapy (cisplatin + 66 Gy). A local recurrence 2.5 years after treatment was treated surgically and reconstructed with a submental island flap.

Results

There were no complications and oral diet was initiated at 2 weeks and the gastrostomy tube was removed 1 month postoperatively. A video demonstration of the submental island flap elevation is included with a focus on how levels 1A and 1B can be dissected safely and this can be viewed online on Head & Neck's home page at http://ift.tt/13H5MtY.

Conclusion

The submental island flap can be performed safely with a level I neck dissection for head and neck reconstruction.

http://ift.tt/2mzvuiu

The complement system in the airway epithelium – an overlooked host defense mechanism and therapeutic target?

Publication date: Available online 12 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Hrishikesh S. Kulkarni, M. Kathryn Liszewski, Steven L. Brody, John P. Atkinson




http://ift.tt/2D7xYyR

Mumps infection but not childhood vaccination induces persistent polyfunctional CD8+ T-cell memory

Publication date: Available online 12 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Jelle de Wit, Maarten E. Emmelot, Martien C.M. Poelen, Rob S. van Binnendijk, Saskia van der Lee, Debbie van Baarle, Wanda G.H. Han, Cécile A.C.M. van Els, Patricia Kaaijk




http://ift.tt/2AWoYXy

Assessment of oral cancer pain, anxiety, and quality of life of oral squamous cell carcinoma patients with invasive treatment procedure

Abstract

Purpose

Depending on its stage on diagnosis, oral squamous cell carcinoma (OSCC) might cause excruciating pain and decreased quality of life. As for treatment, the treatment of OSCC might vary from chemotherapy to surgery. The objective of the current study was to assess the preoperative and postoperative oral cancer pain, anxiety, and quality of life of OSCC patients with invasive treatment procedure.

Methods

The current study was conducted by interviewing 21 (10 males; 11 females) patients who had been diagnosed with stage 3 and stage 4 OSCC and about to go through surgery at the inpatient ward of Surgical Oncology Department, Hasan Sadikin Hospital, Bandung, Indonesia. A preoperative and interview was conducted by using the Hospital Anxiety and Depression Scale (HADS), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QOL)-C30, the shortened EORTC QOL Questionnaire for Oesophageal Cancer (OES)18, the visual analog scale (VAS), and the University of California San Francisco (UCSF) Oral Cancer Pain Questionnaire. All data were analyzed to evaluate the preoperative and postoperative effect.

Results

The current study showed a significant decrease of the postoperative oral pain (p < 0.01) and anxiety level (p < 0.01), while postoperative patient' quality of life was significantly (p < 0.01) increased.

Conclusion

Despite of the invasive procedure that might cause postoperative effect, OSCC patients in the current study showed a better quality of life after cancer removal.

http://ift.tt/2CYdPHn

Assessment of oral cancer pain, anxiety, and quality of life of oral squamous cell carcinoma patients with invasive treatment procedure

Abstract

Purpose

Depending on its stage on diagnosis, oral squamous cell carcinoma (OSCC) might cause excruciating pain and decreased quality of life. As for treatment, the treatment of OSCC might vary from chemotherapy to surgery. The objective of the current study was to assess the preoperative and postoperative oral cancer pain, anxiety, and quality of life of OSCC patients with invasive treatment procedure.

Methods

The current study was conducted by interviewing 21 (10 males; 11 females) patients who had been diagnosed with stage 3 and stage 4 OSCC and about to go through surgery at the inpatient ward of Surgical Oncology Department, Hasan Sadikin Hospital, Bandung, Indonesia. A preoperative and interview was conducted by using the Hospital Anxiety and Depression Scale (HADS), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QOL)-C30, the shortened EORTC QOL Questionnaire for Oesophageal Cancer (OES)18, the visual analog scale (VAS), and the University of California San Francisco (UCSF) Oral Cancer Pain Questionnaire. All data were analyzed to evaluate the preoperative and postoperative effect.

Results

The current study showed a significant decrease of the postoperative oral pain (p < 0.01) and anxiety level (p < 0.01), while postoperative patient' quality of life was significantly (p < 0.01) increased.

Conclusion

Despite of the invasive procedure that might cause postoperative effect, OSCC patients in the current study showed a better quality of life after cancer removal.

http://ift.tt/2CYdPHn

Characterization of CD34+ hematopoietic cells in systemic mastocytosis: potential role in disease dissemination

Abstract

Background

Recent studies show that most systemic mastocytosis (SM) patients, including indolent SM (ISM) with (ISMs+) and without skin lesions (ISMs-), carry the KIT D816V mutation in PB leukocytes. We investigated the potential association between the degree of involvement of BM hematopoiesis by the KIT D816V mutation and the distribution of different maturation-associated compartments of bone marrow (BM) and peripheral blood (PB) CD34⁺ hematopoietic precursors (HPC) in ISM, and identified the specific PB cell compartments that carry this mutation.

Methods

The distribution of different maturation-associated subsets of BM and PB CD34⁺ HPC from 64 newly-diagnosed (KIT-mutated) ISM patients and 14 healthy controls was analyzed by flow cytometry. In 18 patients distinct FACS-purified PB cell compartments were also investigated for the KIT mutation.

Results

ISM patients showed higher percentages of both BM and PB MC-committed CD34⁺ HPC vs. controls, particularly among ISM cases with MC-restricted KIT mutation (ISM_MC); this was associated with progressive blockade of maturation of CD34⁺ HPC to the neutrophil lineage from ISM_MC to multilineage KIT-mutated cases (ISM_ML). Regarding the frequency of KIT-mutated cases and cell populations in PB, variable patterns were observed, the percentage of KIT-mutated PB CD34⁺ HPC, eosinophils, neutrophils, monocytes and T-cells increasing from ISMs-_MC and ISMs+_MC to ISM_ML patients.

Conclusion

The presence of the KIT D816V mutation in PB of ISM patients is associated with (early) involvement of circulating CD34⁺ HPC and multiple myeloid cell subpopulations, KIT-mutated PB CD34⁺ HPC potentially contributing to early dissemination of the disease.

This article is protected by copyright. All rights reserved.

http://ift.tt/2FxTsCQ

Multidimensional endotypes of chronic rhinosinusitis and their association with treatment outcomes

Abstract

Background

The expression of chronic rhinosinusitis (CRS) is multidimensional. Disease heterogeneity in patients with CRS remains poorly understood. This study aimed to identify endotypes of CRS using cluster analysis by integrating multidimensional characteristics and to explore their association with treatment outcomes.

Methods

A total of 28 clinical variables and 39 mucosal cellular and molecular variables were analyzed using principal component analysis. Cluster analysis was performed on 246 prospectively recruited Chinese CRS patients with at least one-year post-operative follow-up. Difficult-to-treat CRS was characterized in each generated cluster.

Results

Seven subject clusters were identified. Cluster 1 (13.01%) was comparable to the classic well-defined eosinophilic CRS with polyps, having severe disease and the highest proportion of difficult-to-treat CRS. Patients in cluster 2 (16.26%) and cluster 4 (13.82%) had relatively lower proportions of presence of polyps and presented mild inflammation with moderate proportions of difficult-to-treat cases. Subjects in cluster 2 were highly atopic. Cluster 3 (7.31%) and cluster 6 (21.14%) were characterized by severe or moderate neutrophilic inflammation, respectively, and with elevated levels of IL-8 and high proportions of difficult-to-treat CRS. Cluster 5 (4.07%) was a unique group characterized by the highest levels of IL-10 and lacked difficult-to-treat cases. Cluster 7 (24.39%) demonstrated the lowest symptom severity, a low proportion of difficult-to-treat CRS, and low inflammation load. Finally, we found that difficult-to-treat CRS was associated with distinct clinical features and biomarkers in the different clusters.

Conclusions

Distinct clinicopathobiologic clusters of CRS display differences in clinical response to treatments and characteristics of difficult-to-treat CRS.

This article is protected by copyright. All rights reserved.

http://ift.tt/2EE4UeW

The asthma-rhinitis multimorbidity is associated with IgE polysensitization in adolescents and adults

Abstract

Background

Children with multimorbid asthma and rhinitis show IgE polysensitization to several allergen sources. This association remain poorly studied in adolescents and adults using defined allergen molecules. We investigated IgE sensitization patterns towards a broad panel of aeroallergen components in adults and adolescents with a focus on individuals with asthma and rhinitis multimorbidity.

Methods

IgE reactivity to 64 microarrayed aeroallergen molecules was determined with the MeDALL-chip in samples from the French EGEA study (n=840, age=40.7±17.1) and the Swedish population-based birth cohort BAMSE (n=786, age=16±0.26). The age- and sex-adjusted associations between the number of IgE-reactive allergen molecules (≥0.3 ISU) and the asthma-rhinitis phenotypes were assessed using a negative binomial model.

Results

Groups representing four phenotypes were identified: no asthma-no rhinitis (A-R-; 30% in EGEA and 54% in BAMSE), asthma alone (A+R-; 11% and 8%), rhinitis alone (A-R+; 15% and 24%), and asthma-rhinitis (A+R+; 44% and 14%). The numbers of IgE-reactive aeroallergen molecules significantly differed between phenotypes (median in A-R-, A+R-, A-R+ and A+R+: 0, 1, 2 and 7 in EGEA and 0, 0, 3, and 5 in BAMSE). As compared to A-R- subjects, the adjusted ratio of the mean number of IgE-reactive molecules was higher in A+R+ than in A+R- or A-R+ (10.0, 5.4 and 5.0 in EGEA and 7.2, 0.7 and 4.8 in BAMSE).

Conclusion

The A+R+ phenotype combined the sensitization pattern of both the A-R+ and A+R-phenotypes. This multimorbid polysensitized phenotype seems to be generalizable to various ages and allergenic environments and may be associated with specific mechanisms.

This article is protected by copyright. All rights reserved.

http://ift.tt/2FA3mnc

Prevalence, severity, and risk factors for acute exacerbations of nasal and sinus symptoms by chronic rhinosinusitis status

Abstract

Background

Nasal and sinus symptoms (NSS) are common to many health conditions, including chronic rhinosinusitis (CRS). Few studies have investigated the occurrence and severity of, and risk factors for, acute exacerbations of NSS (AENSS) by CRS status (current, past, or never met European Position Paper on Rhinosinusitis [EPOS] criteria for CRS).

Methods

Four seasonal questionnaires were mailed to a stratified random sample of Geisinger primary care patients. Logistic regression was used to identify individual characteristics associated with AENSS occurrence and severity by CRS status (current long-term, current recent, past, never) using EPOS subjective symptoms-only (EPOS_S) CRS criteria. We operationalized three AENSS definitions based on prescribed antibiotics or oral corticosteroids, symptoms, and symptoms with purulence.

Results

Baseline and at least one follow-up questionnaires were available from 4,736 subjects. Self-reported NSS severity with exacerbation was worst in the current long-term CRS group. AENSS was common in all subgroups examined and generally more common among those with current EPOS_S CRS. Seasonal prevalence of AENSS differed by AENSS definition and CRS status. Associations of risk factors with AENSS differed by definition, but CRS status, body mass index, asthma, hay fever, sinus surgery history, and winter season consistently predicted AENSS.

Conclusions

In this first longitudinal, population-based study of three AENSS definitions, NSS and AENSS were both common, sometimes severe, and differed by EPOS_S CRS status. Contrasting associations of risk factors for AENSS by the different definitions suggest a need for a standardized approach to definition of AENSS.

This article is protected by copyright. All rights reserved.

http://ift.tt/2EE4Mfs

The urgent need for a harmonized severity scoring system for acute allergic reactions

Abstract

The accurate assessment and communication of the severity of acute allergic reactions is important to patients, clinicians, researchers, the food industry, public health and regulatory authorities. Severity has different meanings to different stakeholders with patients and clinicians rating the significance of particular symptoms very differently. Many severity scoring systems have been generated, most focusing on the severity of reactions following exposure to a limited group of allergens. They are heterogeneous in format, none has used an accepted developmental approach and none has been validated. Their wide range of outcome formats has led to difficulties with interpretation and application. Therefore there is a persisting need for an appropriately developed and validated severity scoring system for allergic reactions that works across the range of allergenic triggers and addresses the needs of different stakeholder groups. We propose a novel approach to develop and then validate a harmonized scoring system for acute allergic reactions, based on a data-driven method that is informed by clinical and patient experience and other stakeholders' perspectives. We envisage two formats: (i) a numerical score giving a continuum from mild to severe reactions that is clinically meaningful and is useful for allergy healthcare professionals and researchers; and (ii) a three grade based ordinal format that is simple enough to be used and understood by other professionals and patients. Testing of reliability and validity of the new approach in a range of settings and populations will allow eventual implementation of a standardized scoring system in clinical studies and routine practice.

This article is protected by copyright. All rights reserved.

http://ift.tt/2FwKTYK

Allergy - Committed to Progress in Allergy and Immunology

Abstract

After more than 8 years, our terms as Co-Editors-in-Chief have now reached an end. We are thankful for having had the privilege to serve the community in this position. We think that we have reached our original goal of increasing the overall quality of the journal (1). The science which is reported every month in Allergy is of high quality and wide interest, largely contributing to the development of the fields of Allergy and Immunology. The impact of the journal is high, as reflected by its present impact factor of 7.36.

This article is protected by copyright. All rights reserved.

http://ift.tt/2EBtTPZ

Long-term patient-related outcome measures of septoplasty: a systematic review

Abstract

Purpose

Septoplasty is a common rhinological procedure intended to relieve symptoms of chronic nasal obstruction. However, there remains a question as to whether patients obtain symptom improvement and are satisfied with surgical outcomes in the months and years after septoplasty. This review aims to evaluate the long-term efficacy of functional septoplasty for nasal septal deviation.

Methods

A systematic review of the literature was conducted from November 2014 to March 2016 using the Cochrane, EMBASE, and PubMed databases. Prospective trials concerning functional septoplasty, which assessed subjective outcomes and included long-term follow-up data (≥ 9 month post-septoplasty) were included.

Results

2189 articles were screened with seven meeting the criteria for inclusion. Patient satisfaction was assessed in six studies, with rates of satisfaction provided in three of these, ranging from 69 to 100%. Two studies assessed the degree of patient satisfaction, with one study indicating that 88% of patients were moderately satisfied or better at 1 year post-op, and the other reporting that 50% of patients were satisfied. In assessing symptom relief, several methods were used, including validated questionnaires, with varying degrees of improvement in nasal obstruction reported.

Conclusions

Septoplasty appears to be a far from perfect treatment for nasal obstruction due to septal deviation. However, given the heterogeneity of data and lack of randomized controlled trials (RCTs), future RCTs and use of validated questionnaires would enable generation of superior levels of evidence. We suggest future prospective trials evaluating prognostic factors in septoplasty, to better inform patients and facilitate the development of guidelines for surgical intervention.

http://ift.tt/2Db70Wp

Eighty-five-year-old man with mosaic attenuation on chest imaging

Description

An 85-year-old man presented with worsening dyspnea and non-productive cough ongoing for 3 days prior to the admission. The patient denied any fever, chills, chest pain, palpitations, orthopnoea or paroxysmal nocturnal dyspnoea. Physical examination was remarkable for mild respiratory distress without any additional findings on auscultation. Social history was significant for >20 pack-year history of smoking. Vitals on admission: blood pressure 138/85, heart rate 92 bpm, respiratory rate 22, pO₂ 94% on room air. EKG was noticeable for normal sinus rhythm with ventricular rate of 87, without any ST-T wave changes.

A chest X-ray (CXR) was significant for hyperlucent lungs (figure 1). CT of chest without Intravenous contrast was performed to evaluate for possible atypical infection that could have been missed on the CXR.1 Areas of hypoattenuation are visible on the scan (figure 2A).

Figure 1

Chest X-ray showing hyperlucent lungs.

http://ift.tt/2mznZZ9

Torsion and rupture of a non-communicating rudimentary horn in a 17-week gestation in a 16-year-old girl: lessons learnt

A unicornuate uterus with non-communicating rudimentary horn has always been notorious and poses threat to continuation of pregnancy with dismal consequences. We are reporting an interesting case of uterine malformation with a 90° rotation of uterine axis which ultimately ruptured during termination of pregnancy. The rarity in our case was not only conception in non-communicating horn but also the complete twisting of axis which made the pregnant horn come in front of the non-gravid unicornuate uterus, mimicking normal pregnancy. The most important lesson learnt is that if induction does not lead to cervical changes and uterine contractions, one must consider atypical presentations of an anomalous uterus as a possible differential before proceeding further.

http://ift.tt/2qX22ri

Correction: A rare case of dual diagnosis in a 16-year-old girl with shortness of breath

de Vere F, House R, Gokdogan Y. A rare case of dual diagnosis in a 16-year-old girl with shortness of breath. BMJ Case Reports 2017. doi:10.1136/bcr-2017-221939.

There was an error in the published version of this article, in that the following statement was missed from the publication:

FDV and RH are joint first authors and contributed equally to this paper.

http://ift.tt/2mznApE

Relevance of enlarged cardiophrenic lymph nodes in determining prognosis of patients with advanced ovarian cancer

Ovarian cancer often presents at an advanced stage with widespread peritoneal and/or extra-abdominal metastases. Complete cytoreduction is the mainstay of treatment for disease confined to peritoneum. But in patients with distant metastases, the role and rationale is less obvious. One of the the most common sites of extra-abdominal disease is the cardiophrenic lymph node (CPLN). In this paper, we described the management of a patient with International Federation of Gynecology and Obstetrics (FIGO) stage IVB epithelial ovarian carcinoma and widespread peritoneal and extra-abdominal metastases to the CPLN, who underwent complete cytoreduction including excision of enlarged CPLN, following neoadjuvant chemotherapy. We examined the literature to determine the prognostic value of enlarged CPLN and their relevance in managing patients with advanced ovarian cancer and found it as an adverse prognostic factor. Transdiaphragmatic excision of CPLN is feasible without major complications. But as its correlation with overall or progression-free survival is not yet evident, large-scale prospective studies are warranted.

http://ift.tt/2r2KtGj

Combined sublethal irradiation and agonist anti-CD40 enhance donor T cell accumulation and control of autochthonous murine pancreatic tumors

Abstract

Tumor-reactive T lymphocytes can promote the regression of established tumors. However, their efficacy is often limited by immunosuppressive mechanisms that block T cell accumulation or function. ACT provides the opportunity to ameliorate immune suppression prior to transfer of tumor-reactive T cells to improve the therapeutic benefit. We evaluated the combination of lymphodepleting whole body irradiation (WBI) and agonist anti-CD40 (αCD40) antibody on control of established autochthonous murine neuroendocrine pancreatic tumors following the transfer of naïve tumor-specific CD8 T cells. Sublethal WBI had little impact on disease outcome but did promote T cell persistence in the lymphoid organs. Host conditioning with αCD40, an approach known to enhance APC function and T cell expansion, transiently increased donor T cell accumulation in the lymphoid organs and pancreas, but failed to control tumor progression. In contrast, combined WBI and αCD40 prolonged T cell proliferation and dramatically enhanced accumulation of donor T cells in both the lymphoid organs and pancreas. This dual conditioning approach also promoted high levels of inflammation in the pancreas and tumor, induced histological regression of established tumors, and extended the lifespan of treated mice. Prolonged survival was entirely dependent upon adoptive transfer, but only partially dependent upon IFNγ production by donor T cells. Our results identify the novel combination of two clinically relevant host conditioning approaches that synergize to overcome immune suppression and drive strong tumor-specific T cell accumulation within well-established tumors.

http://ift.tt/2D9xuHQ

Histopathological and Inflammatory Features of Chronically Discharging Open Mastoid Cavities: Secondary Analysis of a Randomized Clinical Trial.

Histopathological and Inflammatory Features of Chronically Discharging Open Mastoid Cavities: Secondary Analysis of a Randomized Clinical Trial.

JAMA Otolaryngol Head Neck Surg. 2018 Jan 11;:

Authors: Henatsch D, Alsulami S, Duijvestijn AM, Cleutjens JP, Peutz-Kootstra CJ, Stokroos RJ

Abstract
Importance: Many patients with an open radical mastoid cavity experience therapy-resistant otorrhea. Little is known about the underlying histopathological substrate of unstable cavities and the correlation with treatment failure.
Objective: To study the histopathological and inflammatory features of chronically discharging open radical mastoid cavities and the influence of different treatments.
Design, Setting, and Participants: This secondary analysis of a randomized clinical trial was a histopathology study of tissue samples of a cohort of 30 patients with a chronically discharging open mastoid cavity. Samples were taken from the cavities, which were treated with either honey gel or conventional eardrops in a tertiary center between 2012 and 2013. Tissue staining was performed in May 2014; final computer analysis/correlation studies were performed in June 2016.
Main Outcomes and Measures: Differences of epithelial tissue coverage, infiltration of T cells (CD3, CD4, CD8) and macrophage (CD68, isoenzyme nitric oxide synthase, arginase 1) (sub-)populations, infection status, and the correlation with clinical presentation.
Results: There were 30 patients (24 [80%] male; mean [SD] age, 59 [14] years). Cavities were covered with either stratified squamous (keratinized) epithelium (n = 10), respiratory columnar epithelium (n = 9), or granulation tissue (n = 10). The presence of respiratory epithelium was associated with lower treatment success (posttreatment VAS improvement of 3.1 [95% CI, 0.5 to 5.8] for discomfort and 3.6 [95% CI, 0.2 to 6.9] for otorrhea in the group with granulation tissue coverage vs 4.9 [95% CI, 0.2 to 9.6] and 5.8 [95% CI, -0.1 to 11.6] in the group with squamous [keratinized] epithelium coverage and 1.4 [95% CI, -1.2 to 4.1] and 2.5 [95% CI, -1.3 to 6.2] in the group with respiratory columnar epithelium coverage). In all 3 tissue types of cavity-covering tissues, T-cell infiltrates consisted of helper T cells and cytotoxic T cells, together with a lower number of macrophages. The immunopositivity for isoenzyme nitric oxide synthase and arginase 1 was high and not restricted to a macrophage subpopulation, but seen in various cell types. Inflammatory infiltrations varied strongly in all 3 tissue modalities.
Conclusions and Relevance: Discharging open mastoid cavities can be classified histologically into 3 different types, based on their coverage: squamous epithelium, respiratory epithelium, or granulation tissue. Treatment is less successful in cavities covered with respiratory epithelium, possibly explained by the status of bacterial infection and local immunological differences.

PMID: 29327047 [PubMed - as supplied by publisher]

http://ift.tt/2r0wXmV

Serial In-Office Intralesional Steroid Injections in Airway Stenosis.

Serial In-Office Intralesional Steroid Injections in Airway Stenosis.

JAMA Otolaryngol Head Neck Surg. 2018 Jan 11;:

Authors: Bertelsen C, Shoffel-Havakuk H, O'Dell K, Johns MM, Reder LS

Abstract
Importance: Endoscopic dilation is the mainstay treatment strategy for subglottic and proximal tracheal stenosis (SGS/PTS). Its major limitation is restenosis requiring repeated surgery. Intralesional steroid injection (ISI) is a promising adjunctive treatment aimed at prolonging the effects of dilation.
Objective: To evaluate the association of serial in-office ISI after endoscopic dilation with surgery-free interval (SFI) in adults with SGS/PTS.
Design, Setting, and Participants: A retrospective study of adults with SGS/PTS who underwent at least 2 consecutive in-office ISI at the University of Southern California, Keck School of Medicine, over a 3-year period was conducted.
Exposure: Serial ISI with triamcinolone 40 mg/mL using topical anesthesia, spaced 3 to 6 weeks apart.
Main Outcomes and Measures: Surgery-free interval, number of dilations, need for open airway surgery, decannulation rate, and adverse events. Patients with previous dilations and sufficient follow-up time were included in a comparative analysis of SFI before and after ISI. The Mann-Whitney U test was applied for comparisons.
Results: Twenty-four patients met eligibility criteria. Mean (SD) age was 50.1 (15.1) years; 18 (75%) were female. Ten (42%) patients had idiopathic, 8 (33%) had traumatic, and 6 (25%) had rheumatologic-related SGS/PTS. Mean (SD) follow-up time was 32.3 (33.4) months. Patients underwent mean (SD) 4.08 (1.91) injections. Seventeen (71%) patients have not undergone further surgery after ISI. Mean (SD) SFI was 17.8 (12.8) months overall and was 15.7 (10.6) months for idiopathic, 13.8 (9.9) for traumatic, and 26.7 (16.9) for rheumatologic-related SGS/PTS. Twenty-one (88%) patients underwent dilation(s) prior to ISI. Among patients who fulfilled eligibility criteria for comparison of SFI before and after ISI, SFI improved from 10.1 months before, to 22.6 months after ISI (mean difference, 12.5 months; 95% CI, -2.1 to 27.2 months). Three of 6 patients (all with traumatic SGS/PTS) presenting with a tracheotomy were decannulated. No patients required open airway surgery after ISI. There were no adverse events associated with ISI.
Conclusions and Relevance: Serial in-office ISI are safe and well-tolerated in adults with SGS/PTS. This technique can reduce the surgical burden on these patients and may obviate the need for future airway intervention.

PMID: 29327045 [PubMed - as supplied by publisher]

http://ift.tt/2mAHgsU

Facial Pain and Diplopia in a Young Boy.

Facial Pain and Diplopia in a Young Boy.

JAMA Otolaryngol Head Neck Surg. 2018 Jan 11;:

Authors: Wu D, Ferzli G, Chernichenko N

PMID: 29327036 [PubMed - as supplied by publisher]

http://ift.tt/2r3iuXc

Prenatal maternal psychosocial stress and offspring's asthma and allergic disease: a systematic review and meta-analysis

Abstract

Background

Prenatal maternal stress may influence offspring's atopic risk through sustained cortisol secretion resulting from activation of the hypothalamic-pituitary-axis (HPA), leading to Th2-biased cell differentiation in the fetus. We undertook a systematic review and meta-analysis investigating the relationship between prenatal maternal psychosocial stress and risk of asthma and allergy in the offspring.

Methods

We searched 11 electronic databases from 1960 to 2016, search the grey literature, and contacted experts in the field. Type of stress indicator included mood disorders, anxiety, exposure to violence, bereavement and socio-economic problems occurring during pregnancy, both objectively or subjectively measured. We included all possible asthma and IgE-mediated allergy outcomes. We conducted random-effects meta-analyses to synthesize the data.

Results

We identified 9,779 papers of which 30 studies (enrolling >6 million participants) satisfied inclusion criteria. The quality of 25 studies was moderate, four were strong, and one was weak. Maternal exposure to any type of stressors was associated with an increased risk of offspring atopic eczema/dermatitis (OR 1.34, 95%CI 1.22-1.47), allergic rhinitis (OR 1.30, 95%CI 1.04-1.62), wheeze (OR 1.34, 95%CI 1.16-1.54) and asthma (OR 1.15, 95%CI 1.04-1.27). Exposure to anxiety and depression had strongest effect compared to other stressors. Exposure during the third trimester had the greatest impact compared to first and second trimesters. The increased risk was stronger for early-onset and persistent than for late-onset wheeze. Bereavement of a child (HR 1.28, 95%CI 1.10-1.48) or a spouse (HR 1.40, 95%CI 1.03-1.90) increased the risk of offspring asthma.

Conclusions

Exposure to prenatal maternal psychosocial stress was associated with increased risk, albeit modestly, of asthma and allergy in the offspring. The pronounced risk during the third trimester may represent cumulative stress exposure throughout pregnancy rather than trimester-specific effect. Our findings may represent a causal effect or a result of inherent biases in studies, particularly residual confounding.

This article is protected by copyright. All rights reserved.

http://ift.tt/2D743Ho

Component-resolved diagnostics to direct in venom immunotherapy: important steps towards precision medicine

Abstract

Stings of Hymenoptera can induce IgE-mediated systemic and even fatal allergic reactions. Venom-specific immunotherapy (VIT) is the only disease-modifying and curative treatment of venom allergy. However, choosing the correct venom for VIT represents a necessary prerequisite for efficient protection against further anaphylactic sting reactions after VIT. In the past, therapeutic decisions based on the measurement of specific IgE (sIgE) levels to whole venom extracts were not always straightforward, especially when the patient was not able to identify the culprit insect. In the last years, the increasing knowledge about the molecular structure and relevance of important venom allergens and their availability as recombinant allergens, devoid of cross-reactive carbohydrate determinants, resulted in the development of an advanced component-resolved diagnostics (CRD) approach in venom allergy. Already to date, CRD has increased the sensitivity of sIgE detection and enabled the discrimination between primary sensitization and cross-reactivity, particularly in patients with sensitization to both honeybee and vespid venom. Hence, CRD in many patients improves the selection of the appropriate immunotherapeutic intervention. Moreover, the detailed knowledge about sensitization profiles on a molecular level might open new options to identify patients who are at increased risk for side effects or not to respond to immunotherapy. Therefore, increasing potential of CRD becomes evident, to direct therapeutic decisions in a personalized and patient-tailored manner. Reviewed here are the state of the art options, recent developments and future perspectives of CRD of Hymenoptera venom allergy.

This article is protected by copyright. All rights reserved.

http://ift.tt/2AUAJhk

Photodynamic antimicrobial chemotherapy (PACT) using toluidine blue inhibits both growth and biofilm formation by Candida krusei

Abstract

Among non-albicans Candida species, the opportunistic pathogen Candida krusei emerges because of the high mortality related to infections produced by this yeast. The Candida krusei is an opportunistic pathogen presenting an intrinsic resistance to fluconazol. In spite of the reduced number of infections produced by C. krusei, its occurrence is increasing in some groups of patients submitted to the use of fluconazol for prophylaxis. Photodynamic antimicrobial chemotherapy (PACT) is a potential antimicrobial therapy that combines visible light and a nontoxic dye, known as a photosensitizer, producing reactive oxygen species (ROS) that can kill the treated cells. The objective of this study was to investigate the effects of PACT, using toluidine blue, as a photosensitizer on both growth and biofilm formation by Candida krusei. In this work, we studied the effect of the PACT, using TB on both cell growth and biofilm formation by C. krusei. PACT was performed using a light source with output power of 0.068 W and peak wavelength of 630 nm, resulting in a fluence of 20, 30, or 40 J/cm². In addition, ROS production was determined after PACT. The number of samples used in this study varied from 6 to 8. Statistical differences were evaluated by analysis of variance (ANOVA) and post hoc comparison with Tukey-Kramer test. PACT inhibited both growth and biofilm formation by C. krusei. It was also observed that PACT stimulated ROS production. Comparing to cells not irradiated, irradiation was able to increase ROS production in 11.43, 6.27, and 4.37 times, in the presence of TB 0.01, 0.02, and 0.05 mg/mL, respectively. These results suggest that the inhibition observed in the cell growth after PACT could be related to the ROS production, promoting cellular damage. Taken together, these results demonstrated the ability of PACT reducing both cell growth and biofilm formation by C. krusei.

http://ift.tt/2D9baiw

Mallory–Weiss syndrome diagnosed after tracheal extubation

http://ift.tt/2AWxhmf

Vasoactive-inotropic score as a predictor of morbidity and mortality in adults after cardiac surgery with cardiopulmonary bypass

Abstract

Purpose

The vasoactive-inotropic score (VIS) is a scale showing the amount of vasoactive and inotropic support. Recently, it was suggested that the VIS after cardiac surgery predicts morbidity and mortality in infants. The purpose of this study was to evaluate the VIS at the end of surgery as a predictor of morbidity and mortality in adult cardiac surgery.

Methods

A retrospective cohort study of 129 adult cardiac surgery patients was performed at a university hospital. The primary outcome was termed "poor outcome", which was a composite of morbidity and mortality. The secondary outcomes were the duration of intensive care unit (ICU) stay and time to first extubation. Multivariate logistic regression analysis was performed to evaluate the association between the VIS and poor outcomes. A proportional hazards model was used to evaluate the duration of the ICU stay and time to first extubation.

Results

After adjusting for the EuroSCORE, preoperative ejection fraction, and bypass time, a high VIS at the end of surgery was associated with a poor outcome with an adjusted odds ratio of 4.87 (95% confidence interval 1.51–18.94; p = 0.007). After controlling for the EuroSCORE and bypass time, patients with a high VIS experienced longer ICU stay (hazard ratio 1.62; 95% confidence interval 1.10–2.39; p = 0.015) and needed longer ventilation (hazard ration 1.87; 95% confidence interval 1.28–2.74, p = 0.001).

Conclusions

The amount of cardiovascular support at the end of cardiac surgery may predict morbidity and mortality in adults.

http://ift.tt/2D6Ugkl

Measuring cochlear duct length in Asian population: worth giving a thought!

Abstract

Introduction

The anatomy of the cochlea forms the basis for a successful cochlear implantation. Cochlear duct length (CDL) is defined as the length of the scala media as measured from the middle of the round window to helicotrema. Preoperative measurement of CDL is particularly important when precise intracochlear electrode array placement is desired. It can be done both histologically and radiologically. Preoperative high-resolution computed tomography (HRCT) scan which forms an integral part of cochlear implant workup is a useful tool to calculate CDL using 3D reconstructions.

Method

This study was done in SMS Medical College and Hospital, Jaipur, India, which is a tertiary care hospital and referral centre for cochlear implants. HRCT temporal bones of all children less than 6 years of age, with congenital bilateral severe-to-profound SNHL who were being worked up for cochlear implant were studied and analysed. 124 patients (56 females and 68 males) with hearing loss were evaluated for cochlear implantation. HRCT temporal bone of these patients was analysed and a variable A was measured which is defined as the linear measurement from the round window to the farthest point on the opposite wall of the cochlea on a reformatted CT scan slice.

Results

Mean of distance A for right ear of these patients was 8.10 mm (range 7.7–9.2 mm). Mean for the same in left ear of these patients was 8.14 mm (range 7.7–9.0 mm), giving an overall average of 8.12 mm. Using the formula, CDL = 4.16A−3.98, we calculated the length of cochlear duct. Mean cochlear duct length was 29.8 mm with a range from 28 to 34.3 mm.

Conclusion

To the best of our knowledge, this is the first large sample study of cochlear length in population of this part of the world. A smaller cochlear length in this part of the world as compared to the Caucasian cochlear duct is a significant finding in understanding of the cochlear anatomy and physiology. It would also have great implications on the insertion depth in cochlear implantation.

http://ift.tt/2D8PmTU

MiRNA–mRNA crosstalk in laryngeal squamous cell carcinoma based on the TCGA database

Abstract

Background

The functional characterization of non-coding microRNAs (miRNAs) has been shown to be associated with the pathophysiology of the disease, but it is still a challenging task to elucidate the pathogenesis of microRNAs and disease. In addition, the understanding of the role of miRNAs in the development of LSCC still needs further exploration.

Materials and methods

In this study, to identify miRNAs that play a key role in LSCC, we analyzed miRNA and mRNA sequence data from 162 LSCC samples from the TCGA database, and screened specific miRNAs and mRNAs by differential gene expression analysis. And then, construct a differentially expressed miRNAs and mRNAs interaction network.

Results

In our investigation, 23 miRNAs (P < 0.01, log2FoldChange > 2) and 331 mRNAs (P < 0.01, log2FoldChange > 4) were identified differentially expressed in LSCC and reduced the number of loosely linked miRNAs and mRNAs according to appropriate thresholds. Finally, 13 miRNAs and 35 mRNAs were enriched in a network.

Conclusions

Our study provides the most comprehensive information on the expression of miRNAs in LSCC and identifies the known oncogenic miRNAs (such as miR-163a), as well as aberrant expression of novel miRNAs involved in cell regulation and metabolic defects that occur during development of LSCC.

http://ift.tt/2AVLMGS

Stage-specific therapeutic strategies of medication-related osteonecrosis of the jaws: a systematic review and meta-analysis of the drug suspension protocol

Abstract

Objective

The most debated topic about medication-related osteonecrosis of the jaws (MRONJ) is its therapy, as there are no definitive guidelines. The aims of this systematic review were (a) to outline the best therapeutic approach according to the stage at diagnosis and (b) to perform a meta-analysis to assess whether the drug-holiday protocol may be or not an effective method in the management of MRONJ patients.

Materials and methods

The systematic review was performed following the PRISMA principles. Results were screened according to inclusion and exclusion criteria regarding staging before/after treatment, follow-up, and information provided by the authors. For statistical analysis, linear variables are reported as means and standard deviations, medians, and inter-quartile range (IQR); normality of data, according to the distribution of complete healing (primary outcome variable), was assessed with the Kolmogorov-Smirnov test. A p value < 0.05 was considered statistically significant for all tests.

Results

Thirteen studies were selected out of 1480. None of them was case-controlled or randomized. Conservative approach showed good results at early stages, but heterogeneous result at advanced stages (100% stage 0, stage I range 81–97%, stage II range 63.6–100%, stage III 73%). Surgical approach showed heterogeneous results at all stages (stage I range 0–100%, stage II range 52–100%, stage III range 50–100%). Statistical analysis showed a significantly higher prevalence of completely healed sites in patients who followed the drug-holiday protocol.

Conclusions

The results suggest that the current stage-specific approach for MRONJ therapy is based on a sound clinical rationale. Conservative treatment appears to yield better outcomes at early stages, while further investigations are needed to elucidate the best protocols for the management of advanced stages. The drug-holiday protocol statistically promotes complete healing after oral surgery procedures but the application should be dictated by the condition of each patient.

Clinical relevance

At present, early MRONJ stages should be primarily treated by means of a conservative approach while more advanced stages must be carefully evaluated. Individual decisions should be made for every single case even with respect to the drug-holiday protocol.

http://ift.tt/2qYT3WN

Repair of high-grade posterior glottic stenosis: A novel criocarytenoid joint release technique

http://ift.tt/2mytU0y

Hyoepiglottic ligament collagen and elastin fiber composition and changes associated with aging

Objective

The epiglottis may contribute to upper airway obstruction in approximately 10% of patients with obstructive sleep apnea. Clinical experience indicates that older patients may be more likely to have epiglottis-related obstruction. This study was designed to examine tissue characteristics of the hyoepiglottic ligament as a possible factor in epiglottis-related obstruction based on previous research suggesting that older adults have fewer collagen, elastin, and muscle fibers in the hyoepiglottic ligament.

Methods

This is a cross-sectional study of 25 human cadaver hyoepiglottic ligaments. Specimens were stained using Masson's trichrome and Picrosirius red for collagen fibers and with Verhoeff-Van Gieson for elastin fibers. Percentage of collagen and elastin fiber staining for each specimen was calculated and averaged over three regions of each ligament section. Regression analysis was used to determine the association between age, smoking history, and collagen and elastin composition of the hyoepiglottic ligament.

Results

The average age of the specimens was 68.4 ± 15.1 years (range 30–90 years). Increasing age was associated with a lower percentage of collagen and elastin fibers. When accounting for tobacco use, each 1-year increase in age was associated with a 0.53% decrease in Masson's trichrome staining (P = 0.004), a 0.35% decrease in Picrosirius red staining (P = 0.023), and a 0.33% decrease in Verhoeff-Van Gieson staining (P = 0.008).

Conclusion

Increasing age is associated with decreases in the collagen and elastin content of the hyoepiglottic ligament.

Level of Evidence

NA. Laryngoscope, 2017

http://ift.tt/2r0aDtD

Validity evidence as a key marker of quality of technical skill assessment in OTL–HNS

Objective

Quality monitoring of assessment practices should be a priority in all residency programs. Validity evidence is one of the main hallmarks of assessment quality and should be collected to support the interpretation and use of assessment data. Our objective was to identify, synthesize, and present the validity evidence reported supporting different technical skill assessment tools in otolaryngology–head and neck surgery (OTL–HNS).

Methods

We performed a secondary analysis of data generated through a systematic review of all published tools for assessing technical skills in OTL–HNS (n = 16). For each tool, we coded validity evidence according to the five types of evidence described by the American Educational Research Association's interpretation of Messick's validity framework. Descriptive statistical analyses were conducted.

Results

All 16 tools included in our analysis were supported by internal structure and relationship to variables validity evidence. Eleven articles presented evidence supporting content. Response process was discussed only in one article, and no study reported on evidence exploring consequences.

Conclusion

We present the validity evidence reported for 16 rater-based tools that could be used for work-based assessment of OTL–HNS residents in the operating room. The articles included in our review were consistently deficient in evidence for response process and consequences. Rater-based assessment tools that support high-stakes decisions that impact the learner and programs should include several sources of validity evidence. Thus, use of any assessment should be done with careful consideration of the context-specific validity evidence supporting score interpretation, and we encourage deliberate continual assessment quality-monitoring.

Level of Evidence

NA. Laryngoscope, 2018

http://ift.tt/2myHb9n

Insulin resistance and the increased risk for smell dysfunction in US adults

Objective

Over 24% of older American adults (approximately 14 million) are estimated to have reduced olfactory sensitivity. Previous studies have provided evidence that patients with diabetes mellitus (DM) or its complications are at increased risk of olfactory dysfunction. We therefore investigated whether smell dysfunction was associated with DM-related biomarkers, including fasting blood glucose, glycohemoglobin, serum insulin, and homeostasis model assessment of insulin sensitivity (HOMA-IR), in older US adults.

Methods

Data from 9,678 older adults who had participated in the 2013 to 2014 National Health and Nutrition Examination Survey were available for this study. We used the eight-item, self-administered scratch-and-sniff smell test (Sensonics, Inc., Haddon Heights, NJ) for assessing smell. Smell dysfunction was defined as the condition with an odor identification score of ≤ 5.

Results

Of the 978 participants, 20% of older adults (n = 193) were defined as having smell dysfunction. After adjustment for potential confounding variables, participants in the highest HOMA-IR quintile had approximately two-fold increased odds (odds ratio = 2.25; 95% confidence interval: 1.25–4.05) of smell dysfunction compared with those in the lowest HOMA-IR quintile. In contrast, the odds of smell dysfunction were not associated with the quintiles for fasting blood glucose, glycohemoglobin (HbA1c), or serum insulin levels.

Conclusion

We found a significant association between smell dysfunction and severe insulin resistance in older US adults. Our data suggests that insulin resistance may be mechanistically linked to loss of smell function.

Level of Evidence

4. Laryngoscope, 2017

http://ift.tt/2r62NPd

Safety of high-current stimulation for intermittent intraoperative neural monitoring in thyroid surgery: A porcine model

Objectives

During monitored thyroidectomy, displacement of the recurrent laryngeal nerve (RLN) or vagus nerve (VN) in some complicated cases can increase the risk of injury. Although increasing the stimulus current can facilitate nerve mapping and localization, the safety of a high-current stimulus remains unknown. Therefore, this study evaluated the safety of a high-current stimulus in a porcine model.

Methods

Short-duration (1 minute), high-current (3, 5, 10, 15, 20, 25, and 30 mA at 4Hz) stimulus pulses were repeatedly applied to the RLN or VN in six anesthetized piglets. The safety of the high-current stimulus pulses was assessed in terms of hemodynamic stability during VN stimulation and in terms of nerve function integrity after VN and RLN stimulation.

Results

During VN stimulation with a high-current stimulus pulse, sinus rhythms in all six piglets showed stable heart rates, and mean arterial pressure was unaffected. High-current stimulation of the VN and the RLN did not affect electromyography amplitude or latency.

Conclusion

This porcine study showed that applying a short-duration, high-current stimulus pulse to the VN or RLN during monitored thyroidectomy has no harmful effects. In clinical practice, a short duration of high-current stimulus can be applied to facilitate neural mapping, especially in patients with disoriented nerve positions.

Level of Evidence

NA. Laryngoscope, 2017

http://ift.tt/2mz5J1J

Long-term outcomes of cochlear implantation in patients with high-frequency hearing loss

Objective

To demonstrate the long-term benefits of implantation in patients with high-frequency sensorineural hearing loss, this report provides 5-year follow-up on a group of implant recipients who were subjects of the Cochlear™ Nucleus^® Hybrid™ L24 Implant System pivotal clinical study.

Methods

The results of three related clinical studies were compiled to provide outcome data after 1, 3, and 5 years of implant use in a group of subjects who presented with preoperative high-frequency hearing loss and were implanted with a Nucleus Hybrid L24 (Cochlear Ltd., Sydney, Australia) cochlear implant. A subset of the 50 adult subjects (N = 32) who participated in the Hybrid L24 pivotal Investigational Device Exemption (IDE) completed comprehensive evaluations at 12 months postactivation, 3 years postactivation, and then as part of a postapproval study at 5 years postactivation. Testing included audiometric, speech perception, and subjective satisfaction measures.

Results

Mean unilateral speech perception performance was significantly improved at all postoperative intervals compared to preoperative best-aided results and has remained stable to 5 years postactivation. Ninety-four percent of subjects had measurable hearing, and 72% continued to use electric-acoustic stimulation in the implanted ear after 5 years of implant use. Subjective satisfaction results support objective performance improvements.

Conclusion

Results demonstrate long-term success of patients with high-frequency hearing loss following Hybrid L24 (Cochlear) cochlear implantation. Benefits include speech perception abilities significantly better than those in the preoperative best-aided condition, with additional benefit in those using electric-acoustic stimulation in the implanted ear.

Level of Evidence

2b. Laryngoscope, 2018

http://ift.tt/2r3KEBi

How I Do It: Examining the value of an otology multidisciplinary team meeting

http://ift.tt/2mA2vLu

Clinical value of 4-hour delayed gadolinium-Enhanced 3D FLAIR MR Images in Acute Vestibular Neuritis

Objective

To investigate the clinical significance of 4-hour delayed-enhanced 3.0 Tesla three-dimensional (3D) fluid-attenuated inversion recovery (FLAIR) magnetic resonance (MR) imaging in acute vestibular neuritis.

Study Design

A prospective observational study.

Methods

Twenty-nine vestibular neuritis patients were enrolled between January 2017 and June 2017. Vestibular function tests, comprising the caloric and video head impulse tests and vestibular-evoked myogenic potential measurements, were performed. Precontrast, 10-minute, and 4-hour delayed-enhanced 3D-FLAIR MR images using double-dose IV gadolinium were obtained. After laterality and extent of inner ear enhancement were defined, the patients were divided into groups based on the patterns of enhancement, and clinical parameters were analyzed according to the groups.

Results

Twenty patients (20 of 29, 69.0%) had obviously asymmetric enhancement of the affected inner ear structures on 4-hour delayed images, whereas only three patients (10.3%) had marked enhancement on 10-minute delayed images. The duration of spontaneous nystagmus (DurSN) was significantly longer in the patients with enhancement, especially with enhancement of the whole inner ear, including the vestibule and semicircular canals (P < 0.033). Spontaneous nystagmus resolved within 12 days in patients without laterality of enhancement, and within 16 days in ipsilesional enhancement confined to the inner auditory canal and fundus. Other results of vestibular function tests did not reveal any significant associations with MR enhancement.

Conclusions

Contrast enhancement of the vestibular nerve and inner ear structures can be identified on 4-hour delayed-enhanced 3T 3D-FLAIR MR images in acute vestibular neuritis. The extent of inner ear enhancement may be associated with the DurSN.

Level of Evidence

IV. Laryngoscope, 2017

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A rare case of topical methazolamide ophthalmic solution causing death due to toxic epidermal necrolysis

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Fumarate hydratase (FH) deficiency in uterine leiomyomas: recognition by histological features versus blind immunoscreening

Abstract

Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) syndrome is a rare autosomal dominant disease caused by germline mutations in the fumarate hydratase (FH) gene. Affected individuals develop cutaneous and uterine leiomyomas and aggressive RCC. To date, only few publications described the frequency and morphology of FH-deficient uterine leiomyomas. We reviewed 22 cases collected over 8 years from routine and consultation files based on distinctive histological features. In addition, we screened 580 consecutive uterine leiomyomas from 484 patients, 23 extra-uterine and 8 uterine leiomyosarcomas, and 6 leiomyomas with bizarre nuclei for FH loss using immunohistochemistry (IHC) on tissue microarrays (TMAs). All 22 FH-deficient cases were suspected on H&E sections and confirmed by FH IHC. Patients' ages ranged from 25 to 70 years (median 36). Seventeen patients had multiple nodules (2–14) measuring up to 11.8 cm. None of the patients had stigmata or family history of the HLRCC syndrome. Histologically, all FH-deficient tumors showed consistent and reproducible features as reported previously. FH loss was detected in 2/534 evaluable leiomyomas (0.4%), but in none of leiomyosarcomas. Two of six leiomyomas with bizarre nuclei were FH-deficient. FH-deficient uterine leiomyomas are rare in routine material (= 0.4%). They can be reliably identified or suspected by consistent morphological features. Our data showed predictive morphology to be superior to blind IHC screening for detecting them. The relationship of FH-deficient uterine smooth muscle tumors to the HLRCC syndrome needs further clarification.

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Issue Information

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Influences for gender disparity in dermatology in North America

Abstract

Background

Despite constituting half the population, women represent a minority of active physicians and hold a small proportion of faculty leadership positions in North America. However, dermatology is one of the few specialties where women comprise a substantial portion of the workforce. This study explores extent and contributors to gender disparity in academic dermatology faculty positions, leadership, and research.

Methods

We collected data on academic faculty including leadership from the websites of accredited U.S. and Canadian dermatology faculties. We used PubMed and SCOPUS to collect faculty research information including h-index, number of publications, citations, and years of active research.

Results

Although women constitute almost half of all dermatologists in the U.S. and Canada (47.9%), only one-fourth (26.1%) of all faculty heads are women. Furthermore, the proportion of women in higher faculty ranks (Assistant Professor, Associate Professors, and Professors) is much lower than males. Female dermatologists also have fewer publications, citations, and years of active research. Interestingly, having a female in a leadership position is associated with a higher proportion of female dermatologists in the faculty.

Conclusions

Gender disparity exists in academic dermatology, and the current academics fail to account for the enormous social challenges that women face, which may put them at a disadvantage to career advancement. Among other factors, better representation of female leadership may encourage and inspire women joining academic faculties in the future.

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Teaching & Learning Tips 4: Motivation and emotion in learning

Abstract

Challenge: Trainees' motivational and emotional states can influence their learning and career decisions, but historically these "affective" learning factors have received little attention in medical education. In this "Tips" piece, we outline strategies to positively influence trainees' intrinsic motivation and emotion toward their training to ultimately enhance their overall learning experience.

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Gender-specific risk factors for androgenetic alopecia in the Korean general population: Associations with medical comorbidities and general health behaviors

Abstract

Background

The relationships between androgenetic alopecia (AGA) and various factors related to metabolic syndrome have been demonstrated in previous studies. However, it remains unclear because of inconsistent results. We investigated the associations between AGA and various risk factors related to metabolic syndrome according to gender.

Methods

We conducted a population-based cross-sectional survey of 2028 Koreans (1050 men, 978 women). The basic and specific (BASP) classification was used for diagnosis of AGA. We collected information on risk factors though questionnaires and medical records.

Results

AGA was significantly associated with age, family history of AGA, hypertension, diabetes mellitus, and waist circumference in both genders. Female subjects with AGA were more likely to have cerebrovascular disease, dyslipidemia, and obesity; however, these associations were not observed in the male subjects. When multiple regression analysis was applied, there was a significant relationship between hypertension and AGA in male subjects. However, there was no statistically significant association in female subjects.

Conclusion

The different results according to gender might arise from different mechanisms of AGA. There was a significant relationship between hypertension and AGA in male subjects. Evaluation of blood pressure in male patients with AGA might facilitate interventions for hypertension.

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To avoid a misleading genetic diagnosis of epidermolysis bullosa

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