Is dipyrone effective as a preemptive analgesic in third molar surgery? A pilot study

Abstract

Purpose

Studies on preemptive analgesia in maxillofacial surgery have shown several controversial clinical results, mainly due to the absence of a methodological standard, besides a wide variety of studied drugs. This study intended to answer the following hypothesis: Is the administration of dipyrone preemptively capable of decreasing trans- and postoperative pain in the third molar surgical extraction?

Methods

A pilot prospective double-blind placebo-controlled study was carried out with 25 patients submitted to the third molar surgical extraction at two moments, one side in each intervention. Dipyrone (1 g) was preemptively administered (study group) for the extraction of two third molars on the same side and, in a second surgical procedure, dipyrone (1 g) was administered in the immediate postoperative period (control group). Evaluated variables were the amount of anesthetic, pain perceived through the visual analogue scale (VAS) in transoperative and immediate postoperative periods, and over 12-h investigation period, analgesic consumption, duration of surgery, and time to rescue analgesia.

Results

The results were submitted to Student's t test and statistical differences were observed in transoperative (p < 0.05) and immediate postoperative (p < 0.01) periods, while the other studied variables did not present statistical differences.

Conclusion

The preemptive administration of dipyrone decreased the perception of transoperative and immediate postoperative pain when compared to its use after surgery only.

http://ift.tt/2DnOwin

Is dipyrone effective as a preemptive analgesic in third molar surgery? A pilot study

Abstract

Purpose

Studies on preemptive analgesia in maxillofacial surgery have shown several controversial clinical results, mainly due to the absence of a methodological standard, besides a wide variety of studied drugs. This study intended to answer the following hypothesis: Is the administration of dipyrone preemptively capable of decreasing trans- and postoperative pain in the third molar surgical extraction?

Methods

A pilot prospective double-blind placebo-controlled study was carried out with 25 patients submitted to the third molar surgical extraction at two moments, one side in each intervention. Dipyrone (1 g) was preemptively administered (study group) for the extraction of two third molars on the same side and, in a second surgical procedure, dipyrone (1 g) was administered in the immediate postoperative period (control group). Evaluated variables were the amount of anesthetic, pain perceived through the visual analogue scale (VAS) in transoperative and immediate postoperative periods, and over 12-h investigation period, analgesic consumption, duration of surgery, and time to rescue analgesia.

Results

The results were submitted to Student's t test and statistical differences were observed in transoperative (p < 0.05) and immediate postoperative (p < 0.01) periods, while the other studied variables did not present statistical differences.

Conclusion

The preemptive administration of dipyrone decreased the perception of transoperative and immediate postoperative pain when compared to its use after surgery only.

http://ift.tt/2DnOwin

Aprepitant did not modify global disease activity in cutaneous T cell lymphomas

Abstract

Recent investigations are focused on the potential antitumor effect of neurokinin-1 receptor (NK1R) antagonists in different neoplastic diseases¹. Consequently, Kwatra et al. raised an interesting observation about the possible influence of aprepitant on CTCL outcome².

This article is protected by copyright. All rights reserved.

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Effects of neuroimmune axis modulation by aprepitant on anti-pruritic and global disease severity in patients with cutaneous T-cell lymphoma

Abstract

Itch pathogenesis involves modulation of the neuroimmune axis, with several immunosuppressants such as azathioprine¹ and mycophenolate mofetil² demonstrating significant anti-pruritic activity in subsets of patients with pruritus. These immunosuppressive agents are contraindicated in patients with malignancy, and thus there is a need for novel anti-pruritic agents without significant immunosuppressive effects in neoplastic conditions such as cutaneous T cell lymphoma (CTCL).

This article is protected by copyright. All rights reserved.

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From Foundation to Demolition: The Influence of Perioperative Tranexamic Acid

No abstract available

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The Impact of Prehospital Tranexamic Acid on Blood Coagulation in Trauma Patients

BACKGROUND: There is limited data on prehospital administration of tranexamic acid (TXA) in civilian trauma. The aim of this study was to evaluate changes in coagulation after severe trauma from on-scene to the hospital after TXA application in comparison to a previous study without TXA. METHODS: The study protocol was registered at ClinicalTrials.gov (NCT02354885). A prospective, multicenter, observational study investigating coagulation status in 70 trauma patients receiving TXA (1 g intravenously) on-scene versus a control group of 38 patients previously published without TXA. To account for potential differences in patient and trauma epidemiology, crystalloid and colloidal resuscitation fluid, 2 propensity score matched groups (n = 24 per group) were created. Measurements included ROTEM, standard coagulation tests and blood gas analyses on-scene and emergency department admission. Presented values are mean and [standard deviation], and difference in means and 95% confidence intervals. RESULTS: Patient epidemiology was not different between groups. Coagulation assays on-scene were comparable between the TXA and C. Prehospital hyperfibrinolysis was blunted in all 4 patients in the TXA group. Viscoelastic FIBTEM maximum clot firmness (MCF), representing functional fibrinogen levels, did not change from on-scene to the emergency department in the TXA group, whereas MCF decreased −3.7 [1.8] mm in the control group. Decrease of MCF was significantly reduced in the TXA group in EXTEM by 9.2 (7.2–11.2) mm (P

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A Tale of Two Solutions: High vs Low-Chloride Intravenous Fluids

No abstract available

http://ift.tt/2DQiOLv

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

BACKGROUND: To assess whether use of low-chloride solutions in unselected critically ill or perioperative adult patients for maintenance or resuscitation reduces mortality and renal replacement therapy (RRT) use when compared to high-chloride fluids. METHODS: Systematic review and meta-analysis with random-effects inverse variance model. PubMed, Cochrane library, EMBASE, LILACS, and Web of Science were searched from inception to October 2016. Published and unpublished randomized controlled trials in any language that enrolled critically ill and/or perioperative adult patients and compared a low- to a highchloride solution for volume maintenance or resuscitation. The primary outcomes were mortality and RRT use. We conducted trial sequential analyses and assessed risk of bias of individual trials and the overall quality of evidence. Fifteen trials with 4067 patients, most at low risk of bias, were identified. Of those, only 11 and 10 trials had data on mortality and RRT use, respectively. A total of 3710 patients were included in the mortality analysis and 3724 in the RRT analysis. RESULTS: No statistically significant impact on mortality (odds ratio, 0.90; 95% confidence interval, 0.69–1.17; P = .44; I2 = 0%) or RRT use (odds ratio, 1.12; 95% confidence interval, 0.80–1.58; P = .52; I2 = 0%) was found. Overall quality of evidence was low for both primary outcomes. Trial sequential analyses highlighted that the sample size needed was much larger than that available for properly powered outcome assessment. CONCLUSIONS: The current evidence on low- versus high-chloride solutions for unselected critically ill or perioperative adult patients demonstrates no benefit, but suffers from considerable imprecision. We noted a limited exposure volume for study fluids and a relatively low risk of the populations in each study. Together with the relatively small pooled sample size, these data leave us underpowered to detect potentially important differences. Results from well-conducted, adequately powered randomized controlled trials examining sufficiently large fluid exposure are necessary.

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Brain Monitoring and the Depth of Anesthesia: Another Goldilocks Dilemma

No abstract available

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Characterization of skin blister fluids from children with Epstein–Barr virus-associated lymphoproliferative disease

Abstract

Epstein–Barr virus (EBV)-associated T- or natural killer (NK)-cell lymphoproliferative disease (LPD) is a heterogeneous group of disorders characterized by chronic proliferation of EBV-infected lymphocytes. Patients may present with severe skin manifestations, including hypersensitivity to mosquito bites (HMB) and hydroa vacciniforme (HV)-like eruption, which are characterized by blister formation and necrotic ulceration. Skin biopsy specimens show inflammatory reactions comprising EBV-infected lymphocytes. However, blister fluids have not been fully assessed in patients with this disease. Blister fluids were collected from three patients with EBV-associated LPD: two with HMB and one with HV. Immunophenotyping of blister lymphocytes and measurement of tumor necrosis factor (TNF)-α in blister fluids were performed. The patients with HMB and HV exhibited markedly increased percentages of NK and γδ T cells, respectively, in both peripheral blood and blister fluids. These NK and γδ T cells strongly expressed the activation marker human leukocyte antigen-DR and were considered to be cellular targets of EBV infections. TNF-α was highly elevated in all blister fluids. Severe local skin reactions of EBV-associated LPD may be associated with infiltrating EBV-infected lymphocytes and a high TNF-α concentration in blister fluids.

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2016 measles outbreak in Japan: A report of two cases with reappraisal of histological features

http://ift.tt/2Bg7shh

Epidermal aspects of type VII collagen: Implications for dystrophic epidermolysis bullosa and epidermolysis bullosa acquisita

Abstract

Type VII collagen (COL7), a major component of anchoring fibrils in the epidermal basement membrane zone, has been characterized as a defective protein in dystrophic epidermolysis bullosa and as an autoantigen in epidermolysis bullosa acquisita. Although COL7 is produced and secreted by both epidermal keratinocytes and dermal fibroblasts, the role of COL7 with regard to the epidermis is rarely discussed. This review focuses on COL7 physiology and pathology as it pertains to epidermal keratinocytes. We summarize the current knowledge of COL7 production and trafficking, its involvement in keratinocyte dynamics, and epidermal carcinogenesis in COL7 deficiency and propose possible solutions to unsolved issues in this field.

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Case of relapsing remitting neuro-Sweet disease mimicking immunoglobulin G4-related disease

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Oral lichenoid reaction showing multiple ulcers associated with anti-programmed death cell receptor-1 treatment: A report of two cases and published work review

Abstract

Anti-programmed cell death receptor-1 (PD-1) antibodies represent an effective treatment opinion for advanced melanoma and non-small-cell lung cancer, as well as other cancerous entities. Immune checkpoint inhibitors such as anti-PD-1 antibody result in a unique side-effect profile, commonly described as immune-related adverse events (irAE). These irAE affect the skin, gastrointestinal tract, liver, endocrine system and other organ systems. We report two cases of oral lichenoid reaction showing multiple ulcers associated with nivolumab treatment. Both patients presented with multiple ulcers covered with fibrinous plaque over the entire oral mucosa, lips and tongue. Histopathological examination of ulceration showed epithelial necrosis and subepidermal clefts with dense band-like layers of lymphohistiocytic infiltrate within the upper dermis. Nivolumab was interrupted in both cases. Case 1 responded well to topical corticosteroids. Case 2 required oral corticosteroids, however, nivolumab could be restarted without recurrence of oral ulcers. We provide a comprehensive review of reported cases of lichenoid reaction showing multiple oral ulcers associated with anti-PD-1 therapy to date. Early recognition and management may improve treatment, avoid discontinuation of life-saving therapy and maintain quality of life in these patients.

http://ift.tt/2mWuuFr

Who Are the Online Extremists Among Us? Sociodemographic Characteristics, Social Networking, and Online Experiences of Those Who Produce Online Hate Materials

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


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A Short Review of the Non-invasive Transcutaneous Pericranial Electrical Stimulation Techniques and their Application in Headache

Abstract

Purpose of Review

In this short review, the most common non-invasive neuromodulatory techniques will be described, along with their advantages and disadvantages and their application in headache. Available preventive treatments can be unhelpful or may have unpleasant side effects; moreover, the rate of response to preventive drugs does not exceed 50%, lower in chronic migraine; alternative options would be welcome. Though the concept of neuromodulation was originally developed with invasive methods, newer non-invasive techniques are appearing.

Recent Findings

The novel neuromodulatory techniques have been developed with encouraging results: compared with traditional pharmacotherapy, advantages of non-invasive neuromodulation include reduced incidence of adverse effects, improved adherence, and safety and ease of use. The results are encouraging for acute or preventive treatment of different kinds of headache.

Summary

A variety of neuromodulatory approaches is expanding fastly and has opened new possibilities for treatment of patients suffering from many forms of headache, especially those who have failed traditional pharmacotherapy. The non-invasive treatments can be seen as supplementing traditional management in refractory patients. Current study results are encouraging but preliminary and larger and more rigorous trials are needed to clarify benefit and mode of action.

http://ift.tt/2mQNZhS

Progestogen Hypersensitivity

Abstract

Purpose of Review

Progestogen hypersensitivity (PH) is a rare disorder which usually occurs in women of childbearing age with symptoms ranging from urticaria with or without angioedema, multiple organ involvement consistent with allergic anaphylaxis, to a spectrum of other non-evanescent skin eruptions. In this review, we present a clinical vignette of PH and discuss the clinical presentation and proposed pathomechanisms, diagnosis, and treatment of PH.

Recent Findings

The hypersensitivity symptoms are associated with exogenous progestin exposure (e.g., contraceptive medicines, in vitro fertilization therapy) or endogenous progesterone from progesterone surges during the luteal phase of the menstrual cycle and pregnancy. Recognition of this condition can be challenging to the clinician due to its heterogeneous clinical presentation. It has been recently proposed to use the new term "progestogen hypersensitivity" to replace "autoimmune progesterone dermatitis" due to the lack of evidence supporting an autoimmune mechanism for this disorder. In addition, diagnostic and treatment algorithms are now available that can lead to successful management of this condition. More new developments of Progesterone desensitization protocols are now available which appear to be the safest and most effective long-term treatment option for PH.

Summary

With the extensive use of oral contraceptives and increased use of supra-physiologic doses of progesterone to support pregnancy in in vitro fertilization, there is likely to be a higher prevalence of PH in the future than currently recognized. Therefore, the allergist-immunologist will be required to collaborate with gynecologists and reproductive endocrinologists to diagnose and treat this condition.

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Regarding “Tube Decompression for Staged Treatment of a Calcifying Odontogenic Cyst—A Case Report”

Publication date: Available online 19 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Leandro Napier Souza, Ana Cristina Rodrigues Antunes Souza




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Males with Rheumatoid Arthritis Often Evidence Carotid Atheromas on Panoramic Imaging: A Risk Indicator of Future Cardiovascular Events

Publication date: Available online 16 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Urie K. Lee, Tina I. Chang, Neal Garrett, Arthur H. Friedlander
PurposeMales with rheumatoid arthritis (RA) are at exceedingly high risk of adverse intraoperative ischemic events given the role of systemic inflammation in the atherogenic process. We hypothesized that their panoramic images would demonstrate calcified carotid artery atheromas (CCAP) significantly more often than a general popular of similarly aged males.MethodsThe investigators implemented a retrospective observational study. The sample was composed of male patients over age 55 having a panoramic image. The predictor variable was a diagnosis of RA confirmed by a positive rheumatoid factor (RF) titer and the outcome variable was the prevalence rate of CCAP. The other major study variable was the level of (RF) among patients evidencing CCAP. The prevalence of CCAP among the patients with RA was then compared to that of a historic general population comprised of similarly aged males. Descriptive and bivariate statistics were computed and the p value was set at .05ResultsOf the 100 males (mean age 69.89 ± 8.927) with RA, 29 (29%); (mean age 72.10 ± 7.68) had atheromas (CCAP+), and of these (n = 25) 86% (mean age 71.88 ± 7.43) had RF titer value of ≥ 41 IU/mL which is twice normal. There was a statistically significant (p < .05) association between a diagnosis of RA and the presence of an atheroma on the panoramic image in comparison to the 3% rate manifested by the historic cohort.ConclusionThe results of this study suggest that calcified carotid artery plaque, a risk indicator of future adverse cardiovascular events is frequently seen on the panoramic images of male patients with RA and that these individuals routinely manifest with high titer levels of RF, a biologic marker of inflammation. Oral and maxillofacial surgeons planning surgery for male patients with RA must be uniquely vigilant for the presence of these lesions.



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A Modified Periangular Approach for Exposure of Condylar Fractures

Publication date: Available online 12 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Adarsh Kudva, Abhay T. Kamath, Jyotsna Rajan, Charlene D'souza
ObjectiveTo describe a modified periangular approach to address subcondylar and condylar neck fractures.MethodA modified periangular incision is used to approach a fractured condyle via anteroparotid transmasseteric approach.ResultThis method provided a quick and clean exposure to fractured condylar base and neck fractures for open reduction and internal fixation, as per the authors' experience.DiscussionAlthough periangular approach has been discussed in literature, this modification as per authors' experience reduces the chance of occurrence of complications such as marginal nerve injury and parotid fistula formation, as the nerve is visualised and kept isolated throughout.



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The Effect of Exercise on Range of Movement and Pain After Temporomandibular Joint Arthrocentesis

Publication date: Available online 12 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Burcu Bas, Dilara Kazan, Nukhet Kutuk, Vugar Gurbanov
PurposeArthrocentesis is an effective treatment modality for temporomandibular disorders, especially in patients who suffer from pain and limited mouth opening. Surgeons generally suggest physical exercises after arthrocentesis and arthroscopy procedures; however, there has been no study in the literature evaluating its effects on clinical outcomes . The aim of this study was to investigate whether physical exercises given after arthrocentesis result in early improvements in the clinical symptoms in patients with temporomandibular joint disc displacement without reduction (TMJ DDw/oR)Materials and methodsThe study group comprised 27 patients with TMJ DDw/oR. Patients who needed arthrocentesis after failed conservative, non-surgical treatment were enrolled in the study. Group 1 consists of 14 patients who were not started on a physiotherapy program following the arthrocentesis procedure. Group 2 consists of 13 patients who were started on a self-administered physiotherapy program immediately following the arthrocentesis procedure. The physiotherapy includes an exercises program for a period of 6 weeks. Patients were followed for 3 months. The range of maximal mouth opening (MMO) and joint pain as measured by the visual analogue scale (VAS) were examined to determine the clinical efficiency before and after treatment.ResultsIn both groups mouth opening increased and pain scores decreased at 1week, 1 and 3 month follow-ups (P < 0.05). No significant relationship was found between the two group according to MMO for all time points and VAS scores at 1 week. A significant relationship was found between the two groups according to VAS scores at 1^th and 3^rd months.ConclusionPhysical exercises are given after arthrocentesis has no effect on the range of mouth opening but reduces pain.



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Accuracy of orthognathic surgical outcomes using 2d and 3d landmarks – the case for apples and oranges?

Publication date: Available online 12 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Alexandre Meireles Borba, Everton José da Silva, André Luis Fernandes da Silva, Michael D. Han, Maria da Graça Naclério-Homem, Michael Miloro
PurposeTo verify predicted versus obtained surgical movements in 2D and 3D measurements and compare the equivalence between these methods.MethodsA retrospective observational study of bimaxillary orthognathic surgeries was performed. Postoperative CBCT scans were superimposed to preoperative scans, and a lateral cephalometric radiograph was generated from each CBCT. After identification of landmarks Sella, Nasion and upper central incisor tip on 2D and 3D images, actual to planned movements were compared on cephalometric measurements. One sample t-test was used to statistically evaluate results to expected means varying from 0 to 2 mm of discrepancy. Equivalence from 2D and 3D values were compared using a paired t test.ResultsFinal sample of 46 cases demonstrated on 2D cephalometry that the differences between actual versus planned movements on the horizontal axis were statistically significant for expected means of 0, 0.5 and 2 mm, and without significance for expected means of 1 and 1.5 mm; vertical movements were statistically significant for expected means of 0 and 0.5 mm, without significance for expected means of 1, 1.5 and 2 mm. For 3D cephalometry on the horizontal axis, there were statistically significant differences for expected means of 0, 1.5 and 2 mm, without significance for expected means of 0.5 and 1 mm; vertical movements showed statistically significant differences for expected means of 0, 0.5, 1.5 and 2 mm, without significance for expected mean of 1 mm. Comparison of 2D and 3D values displayed statistical differences for both horizontal and vertical axes.ConclusionsComparison of 2D and 3D surgical outcomes assessments should be performed with caution since it seems that there is a difference on acceptable levels of accuracy between both methods of evaluation. Moreover, 3D accuracy studies should no longer rely on a 2 mm level discrepancy level but on a 1 mm level.



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In Reply

Publication date: Available online 19 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Hany A. Emam, Courtney A. Jatana




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High Expression of Prospero-Related Homeobox1(PROX1) is Associated With Poor Prognosis in Patients with Salivary Adenoid Cystic Carcinoma

Publication date: Available online 11 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Tao Gao, Chao Ma, Yun Li, Jun Ju, Xiangfeng Kang, Yuanlin Cai, Moyi Sun
PurposeProspero-related homeobox1 (PROX1) plays an important role in the invasion and metastasis of many human cancers. However, the expression pattern of PROX1 in salivary adenoid cystic carcinoma (SACC) remains unclear. The aim of this study was to investigate PROX1 expression and its prognostic value in SACC.MethodsThe PROX1 expression was determined by immunohistochemistry (IHC) in SACC tissue specimens. The correlations between PROX1 expression and clinicopathological features were investigated. The Kaplan-Meier method was used to analyze the correlation between PROX1 expression and survival. Independent prognostic factors associated with overall survival (OS) was analyzed using the Cox regression analysis.ResultsThe IHC data revealed that the PROX1 positivity rate in SACC tissue specimens was significantly higher than that in normal salivary gland tissues (71.1% vs. 13.3%, P < 0.05) . The PROX1 expression was detected mainly in the nucleolus. In addition, PROX1 expression was correlated with perineural invasion, local regional recurrence, and distant metastasis of patients with SACC (P<0.05), and no significant association was found between PROX1 expression and other clinicopathological parameters. Our data indicated that patients with positive PROX1 expression had poor OS compared with those with negative PROX1 expression (P=0.0005). Multivariate analysis showed that PROX1 expression, local regional recurrence, and distant metastasis were independent prognostic factor for OS.ConclusionsThese findings demonstrated that PROX1 expression was significantly higher in SACC specimens. Positive expression of PROX1 might serve as a potential predictor of prognosis in SACC.



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A three-dimensional analysis of nasal cavity volume after maxillary LeFort I osteotomy

Publication date: Available online 10 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Yong-Chan Ha, Se Jin Han
PurposeTwo- and three- dimensional studies on the changes of pharyngeal airway after LeFort I osteotomy have been conducted, but there are few studies on the change of nasal structure. The nasal cavity is the first passage through which air enters during respiration. The movement of the maxilla by LeFort I osteotomy affects the shape of the nasal cavity as well as the shape of other parts of the airway. In this study, we compared the preoperative and postoperative changes of the nasal cavity volume after a maxillary LeFort I osteotomy.Materials and MethodsPre- and post-OP CT of 32 patients were assessed for nasal cavity volume according to the direction of maxilla movement.ResultsA total of 32 patients(22 males, 10 females) were classified according to the direction of maxilla movement.- Group 1 : Maxillary impaction, 8 males, 6 females- Group 2 : Maxillary impaction & advancement, 14 males, 4 femalesThe volume of nasal cavity was significantly decreased after Lefort I osteotomy in both groups. Maxillary impaction group(Group I) represented positive correlation between ratio of impaction and ratio of volume difference. Maxillary impaction and advancement group(Group II) represented no correlation between ratio of impaction or advancement and ratio of volume difference.ConclusionWe concluded that impaction and advancement of the maxilla caused decreasing nasal volume.



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A Consensus Has Not Been Reached for Pathology Reporting of Tall-Cell Variant of Papillary Thyroid Carcinoma

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 25-29.


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Should a Young Patient in Whom a Multinodular Goiter Develops Be Assessed for DICER1 Mutations?

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 3-6.


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Levothyroxine Treatment Does Not Reduce Risk for Premature Delivery Among TPO-Negative Pregnant Women with a TSH of 2.5 to 10.0 mIU/L

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 7-9.


http://ift.tt/2EYlrdR

Harmonized Guidelines Developed, but Lack of Evidence Illustrates the Need for Further Research to Determine the Best Method of Surveillance for Thyroid Cancer in Survivors of Childhood Cancer

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 33-35.


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Adding the Immunosuppressant Mycophenolate Mofetil to Medium-Dose Infusions of Methylprednisolone Improves the Treatment of Graves’ Orbitopathy

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 10-14.


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Selenium Supplementation May Help Protect Salivary Glands After Iodine-131 Therapy for Differentiated Thyroid Cancer

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 21-24.


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Surgery for Hyperthyroidism Lowers Cardiovascular Mortality Compared with Radioactive Iodine

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 15-17.


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Probiotic Substances Do Not Impair Oral Levothyroxine Intestinal Absorption

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 30-32.


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Primary Thyroid MALT Lymphoma is Cured by Either Radiation Therapy or Chemotherapy

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 18-20.


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Thyroid Sarcoidosis Presenting as Hürthle-Cell Neoplasm: Case Report and Literature Review

Clinical Thyroidology Jan 2018, Vol. 30, No. 1: 36-41.


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Experts Welcome Adjuvant Nivolumab for Melanoma

The PD-1 inhibitor nivolumab was recently approved by the FDA for adjuvant use in completely resected stage III or IV melanoma, a move welcomed by experts in the field.
Medscape Medical News

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A phase 3 trial of mometasone furoate sinus implants for chronic sinusitis with recurrent nasal polyps

Background

Topical intranasal corticosteroid sprays (INCSs) are standard treatment for nasal polyps (NPs), but their efficacy is reduced by poor patient compliance and impaired access of drug to the sinus mucosa. A corticosteroid-eluting sinus implant was designed to address these limitations in patients with recurrent polyposis after sinus surgery by delivering 1350 μg of mometasone furoate (MF) directly to the ethmoid sinus mucosa over approximately 90 days.

Methods

A randomized, sham-controlled, double-blind trial was undertaken in 300 adults with refractory chronic rhinosinusitis with NPs (CRSwNP), who were candidates for repeat surgery. Eligible patients were randomized (2:1) and underwent in-office bilateral placement of 2 implants or a sham procedure. All patients used the MF INCS 200 μg once daily. Co-primary efficacy endpoints were the change from baseline in nasal obstruction/congestion score and bilateral polyp grade, as determined by an independent panel based on centralized, blinded videoendoscopy review.

Results

Patients treated with implants experienced significant reductions in both nasal obstruction/congestion score (p = 0.0074) and bilateral polyp grade (p = 0.0073) compared to controls. At day 90, implants were also associated with significant reductions in 4 of 5 prespecified secondary endpoints compared to control: proportion of patients still indicated for repeat sinus surgery (p = 0.0004), percent ethmoid sinus obstruction (p = 0.0007), nasal obstruction/congestion (p = 0.0248), and decreased sense of smell (p = 0.0470), but not facial pain/pressure (p = 0.9130). One patient experienced an implant-related serious adverse event (epistaxis).

Conclusion

Significant improvements over a range of subjective and objective endpoints, including a reduction in the need for sinus surgery by 61%, suggest that MF sinus implants may play an important role in management of recurrent NP.

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LIMK/cofilin pathway and Slingshot are implicated in human colorectal cancer progression and chemoresistance

Abstract

Cofilin phospho-regulation is important for actin filament turnover and is implicated in cancer. Phosphorylation of cofilin is mediated by LIM kinases (LIMKs) and dephosphorylation by Slingshot phosphatases (SSH). LIMKs and SSH promote cancer cell invasion and metastasis and represent novel anti-cancer targets. However, little is known regarding LIMK/cofilin and SSH in human colorectal cancer (CRC). In this study, we aimed to address their expression and significance in human CRC. We evaluated expression of non-phosphorylated (active) and phosphorylated cofilin, LIMK1, LIMK2, and SSH1 by immunohistochemistry in 143 human CRC samples in relation to clinicopathologic parameters, response of metastatic disease to chemotherapy, and epithelial-mesenchymal transition (EMT) markers β-catenin, E-cadherin, and ZEB. We show that active cofilin, LIMK1, LIMK2, and SSH1 are overexpressed in human CRC and are associated with tumor progression parameters. SSH1 is an independent predictor of lymph node metastasis by multivariate analysis. LIMK1 and SSH1 expression is also higher in non-responders to chemotherapy, and SSH1 is shown by multivariate analysis to independently predict response of metastatic disease to chemotherapy. Active cofilin, LIMK1, LIMK2, and SSH1 also correlated with the EMT markers examined. In addition, immunofluorescence analysis showed increased expression of active cofilin, LIMK1, LIMK2, and SSH1 in HT29 colon cancer cells resistant to 5-fluorouracil compared to parental HT29 cells. Our results suggest that F-actin regulators LIMK/cofilin pathway and SSH1 are associated with CRC progression and chemoresistance representing promising tumor biomarkers and therapeutic targets in CRC.

http://ift.tt/2rmOKVw

Reply

Publication date: Available online 19 January 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Cosby A. Stone, Jonathan A. Hemler, Scott P. Commins, Alexander J. Schuyler, Elizabeth J. Phillips, R. Stokes Peebles, John M. Fahrenholz




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Acquisition, Remission, and Persistence of Eczema, Asthma, and Rhinitis in Children

Abstract

Background

Allergic sensitization is associated with eczema, asthma, and rhinitis. However, it is unknown whether and how allergic sensitization is associated over time with acquisition, remission, and persistence of these diseases and their comorbidity.

Objective

To gain a better understanding of factors including allergic sensitization transitions that influence the temporal pattern of asthma, eczema, and rhinitis and their comorbidity during childhood.

Methods

In the Isle of Wight birth cohort information on allergic sensitization to common allergens was collected at ages 4, 10, and 18 years along with asthma, rhinitis, and eczema status determined by clinical diagnosis. Logistic regressions were used to estimate subsequent and concurrent odds-ratios of diseases transition with allergic sensitization transition status as the main independent variable. Two transition periods were considered, 4 to 10 years of age, and 10 to 18 years of age.

Results

The odds of new diagnosis of allergic disease (no-yes) was increased among subjects with acquired or persistent allergic sensitization to common allergens compared to subjects with no sensitization (acquisition of sensitization odds ratio [OR]=3.22, p <0.0001; persistence of sensitization, OR=6.33, p <0.0001). The odds of remission of allergic diseases (yes-no) was lower among subjects with acquired or sustained allergic sensitization (acquisition, OR=0.18, p =0.0001; persistence, OR=0.085, p <0.0001), compared to subjects not sensitized. Subjects with acquired or persistent allergic sensitization were also had higher odds for persistence of disease (yes-yes) than subjects not sensitized (acquisition, OR=5.49, p =0.0001; persistence, OR=11.79, p <0.0001).

Conclusion

Transition of allergic sensitizations to common allergens is a prognostic factor for subsequent or concurrent transition of eczema, asthma, and rhinitis. Prevention or reduction of allergic sensitization has a potential to lead to remission of these conditions.

This article is protected by copyright. All rights reserved.

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Effects of human rhinovirus on epithelial barrier integrity and function in children with asthma

Abstract

Background

Bronchial epithelial tight junctions (TJ) have been extensively assessed in healthy airway epithelium. However, no studies have yet assessed the effect of human rhinovirus (HRV) infection on the expression and resultant barrier function in epithelial tight junctions (TJ) in childhood asthma.

Objectives

To investigate the impact of HRV infection on airway epithelial TJ expression and barrier function in airway epithelial cells (AEC) of children with and without asthma. Furthermore, to test the hypothesis that barrier integrity and function is compromised to a greater extent by HRV in AECs from asthmatic children.

Methods

Primary AEC were obtained from children with and without asthma, differentiated into Air Liquid Interface (ALI) cultures and infected with rhinovirus. Expression of claudin-1, occludin and zonula occluden-1 (ZO-1) was assessed via qPCR, immunocytochemistry (ICC), in-cell western (ICW) and confocal microscopy. Barrier function was assessed by transepithelial electrical resistance (TER; R_T) and permeability to fluorescent dextran.

Results

Basal TJ gene expression of claudin-1 and occludin was significantly upregulated in asthmatic children compared to non-asthmatics, however no difference was seen with ZO-1. Interestingly, claudin-1, occludin and ZO-1 protein expression was significantly reduced in AEC of asthmatic children compared to non-asthmatic controls suggesting possible post transcriptional inherent differences. HRV infection resulted in a transient dissociation of TJ and airway barrier integrity in non-asthmatic children. Although similar dissociation of TJ was observed in asthmatic children, a significant and sustained reduction of TJ expression concurrent with both a significant decrease in TER and an increase in permeability in asthmatic children was observed.

Conclusion

This study demonstrates novel intrinsic differences in TJ gene and protein expression between AEC of children with and without asthma. Furthermore, it correlates directly the relationship between HRV infection and the resultant dissociation of epithelial TJ that causes a continued altered barrier function in children with asthma.

This article is protected by copyright. All rights reserved.

http://ift.tt/2mWSKHH

Molecular allergen profiling in horses by microarray reveals Fag e 2 from buckwheat as a frequent sensitizer

Abstract

Background

Companion animals are also affected by IgE-mediated allergies, but the eliciting molecules are largely unknown. We aimed at refining an allergen microarray to explore sensitization in horses and compare it to the human IgE reactivity profiles.

Methods

Custom-designed allergen microarray was produced on the basis of the IimmunoCAP ISAC technology containing 131 allergens. Sera from 51 horses derived from Europe or Japan were tested for specific IgE reactivity. The included horse patients were diagnosed for eczema due to insect bite hypersensitivity, chronic coughing, recurrent airway obstruction, urticaria, or were clinically asymptomatic.

Results

Horses showed individual IgE binding patterns irrespective of their health status, indicating sensitization. In contrast to European and Japanese human sensitization patterns, frequently recognized allergens were Aln g 1 from alder and Cyn d 1 from Bermuda grass, likely due to specific respiratory exposure around paddocks and near the ground. The most prevalent allergen for 72.5% of the tested horses (37/51) was the 2S-albumin Fag e 2 from buckwheat, which recently gained importance not only in human but also in horse diet.

Conclusion

In line with the One Health concept, covering human health, animal health and environmental health, allergen microarrays provide novel information on the allergen sensitization patterns of the companion animals around us, which may form a basis for allergen-specific preventive and therapeutic concepts.

This article is protected by copyright. All rights reserved.

http://ift.tt/2rlOTZ4

Panitumumab-IRDye800 Compared to Sentinel Node Biopsy and (Selective) Neck Dissection in Identifying Metastatic Lymph Nodes in Patients With Head and Neck Cancer

Condition:   Head and Neck Squamous Cell Carcinoma
Interventions:   Procedure: Computed Tomography;   Procedure: Lymphoscintigraphy;   Drug: Panitumumab-IRDye800;   Other: Pharmacological Study;   Procedure: Single Photon Emission Computed Tomography;   Radiation: Technetium Tc 99m-labeled Tilmanocept
Sponsors:   Eben Rosenthal;   National Cancer Institute (NCI)
Not yet recruiting

http://ift.tt/2mUw3no

Neck Exercises in Patients With Temporomandibular Disorders

Conditions:   Temporomandibular Disorders;   Temporomandibular Joint Pain
Interventions:   Other: Exercises;   Other: Placebo
Sponsor:   University of Alberta
Recruiting

http://ift.tt/2BfTI5R

Efficacy and Safety of Endoscopic Submucosal Tunnel Dissection for Superficial Esophageal Squamous Cell Carcinoma

Condition:   Esophageal Superficial Mucosal Lesion
Interventions:   Procedure: ESTD;   Procedure: ESD
Sponsors:   Xijing Hospital of Digestive Diseases;   Beijing Cancer Hospital;   Tongji Hospital;   First Affiliated Hospital of Suzhou Medical College;   Shanghai Zhongshan Hospital;   First Affiliated Hospital Xi'an Jiaotong University
Recruiting

http://ift.tt/2mUYZLQ

Maintenance Chemotherapy in High-metastatic Risk Nasopharyngeal Carcinoma Patients of N3 Stage

Condition:   Nasopharyngeal Carcinoma
Interventions:   Drug: Gemcitabine;   Radiation: standard chemoradiotherapy
Sponsor:   Fudan University
Recruiting

http://ift.tt/2BePThe

Correction to: Attenuation of cortical activity triggering descending pain inhibition in chronic low back pain patients: a functional magnetic resonance imaging study

Abstract

Inadvertently, the Fig. 7 was published incorrectly in the original publication of the article. The correct figure should be as below:

http://ift.tt/2DmZPHm

In reply: Is sugammadex alone enough to cause anaphylaxis?

http://ift.tt/2DPipZL

What you should know about alopecia universalis

A look at alopecia universalis, a condition resulting in hair loss across the entire body. Included is detail on diagnosis and the relationship to stress.

http://ift.tt/2DMNRbb

Efficacy of photodynamic therapy in the treatment of symptomatic oral lichen planus: a systematic review

Abstract

Background

The aim of the present study was to systematically review the efficacy of photodynamic therapy (PDT) in the management of symptomatic oral lichen planus (OLP).

Materials and methods

PubMed/MEDLINE, Scopus, and ISI Web of knowledge were searched until July 2017, using the following keywords: oral lichen planus, erosive lichen planus, lichen planus, and photodynamic therapy.

Results

Five clinical studies were included. The risk of bias was considered high in four studies and moderate in one study. The efficacy of PDT was compared with topical corticosteroids in all included studies. Laser wavelengths, duration of irradiation and power density ranged between 420 - 660 nm, 30s - 10 min, and 10-500 mW/cm², respectively. All studies reported PDT to be effective in the management of symptomatic OLP. Two studies reported PDT to be as effective as corticosteroids, one study reported a better efficacy of PDT compared to corticosteroids, whereas two studies found PDT to be inferior to corticosteroids.

Conclusions

The limited available evidence suggests that PDT is an effective treatment option for the management of OLP. However, due to the limited number of studies included in this review and heterogeneity among these studies, more well-designed clinical trials with adequate sample sizes are highly warranted.

This article is protected by copyright. All rights reserved.

http://ift.tt/2Dqms1S

2018: An update on JOPM progress over the last year

http://ift.tt/2mRtXUf

Cover Image

The cover image, by Simone Belobrov et al., is based on the Original Article The role of human papillomavirus in p16-positive oral cancers, DOI 10.1111/jop.12649.

http://ift.tt/2Drk8I3

Comparison of lesional skin c-KIT mutations with clinical phenotype in patients with mastocytosis

Summary

Background

Activating c-KIT mutations cause abnormal mast cell growth and appear to play a role in mastocytosis. However, the correlation of c-KIT mutations with disease phenotypes is poorly characterized.

Aim

To evaluate the correlation of c-KIT mutations with clinical presentations and laboratory findings.

Methods

Total cellular RNA was isolated from the skin lesions of 43 adults and 7 children with mastocytosis, and PCR amplicons of cDNA were sequenced for c-KIT mutations.

Results

The most common activating mutation, KIT-D816V, was identified in 72% of adults and 57% of children. Additional activating mutations, namely, V560G and the internal tandem duplications (ITDs) 502-503dupAY, were detected in 12% of adults and 8% of children. V560G occurred more commonly in our patients than previously reported, and it appeared to be associated with more advanced disease. Otherwise, the presence or absence of activating mutations did not correlate with skin lesion morphology, disease extent or total serum tryptase levels. Four adults had expression only of wild-type KIT, while two others had expression of a truncated KIT lacking tyrosine kinase activity; yet these patients were clinically indistinguishable from those patients with activating c-KIT mutations.

Conclusions

Activating c-KIT mutations exist in a significant portion of patients with mastocytosis, but not all patients showed expression of these mutations. Except for V560G, the presence or absence of activating c-KIT mutations did not predict the extent of disease. These observations suggest that although activating c-KIT mutations are associated with mast cell growth, other genes probably play a role in the cause of mastocytosis.

http://ift.tt/2mWc4EK

Tobacco regulation as a paradigm for advancing regulatory science in dermatology

http://ift.tt/2mQyzdt

Cutaneous hyperpigmentation induced by apremilast

http://ift.tt/2DtdQaA

Acute hemorrhagic lesions in an immunosuppressed patient

http://ift.tt/2mR62Ex

Patientin mit pulsatilem Ohrgeräusch

http://ift.tt/2mVdCz4

In response to “Calculation of indirect costs of associated with postoperative caregiver absences after pediatric tonsil surgery”

http://ift.tt/2Dk2nWM

Maximising Graft Take-Up in Type1 Tympanoplasty Using Peripheral Cartilage Ring and Perichondrium

Abstract

The aim of this study is to evaluate the results of closure of big central and subtotal perforation by Tympanoplasty using underlay technique with Composite graft of tragal perichondrium supported by a ring of cartilage peripherally. Our hypothesis was that the cartilage support offers an extremely reliable method for reconstruction of the tympanic membrane in cases of advanced middle ear pathology and Eustachian tube dysfunction and also revision cases. Prospective study of patients undergoing tympanoplasty in big central and subtotal perforation with graft supported by a ring of cartilage peripherally between June 2016 and August 2016. Hearing results were reported using four frequency (500, 1000, 2000 and 3000) pure tone average air–bone gap. During the study period, composite graft comprising of tragal perichondrium and peripheral ring of cartilage prepared from ipsilateral tragus was used for tympanic membrane reconstruction in 30 patients. Overall graft take rate was 93.33%. Complications included residual perforation in 6.67%. Cartilage ring support offers an extremely reliable method for reconstruction of tympanic membrane in cases of high-risk perforation (big central perforation, subtotal perforation, anterior perforation of tympanic membrane, revision cases).

http://ift.tt/2roUy0J

Maximising Graft Take-Up in Type1 Tympanoplasty Using Peripheral Cartilage Ring and Perichondrium

Abstract

The aim of this study is to evaluate the results of closure of big central and subtotal perforation by Tympanoplasty using underlay technique with Composite graft of tragal perichondrium supported by a ring of cartilage peripherally. Our hypothesis was that the cartilage support offers an extremely reliable method for reconstruction of the tympanic membrane in cases of advanced middle ear pathology and Eustachian tube dysfunction and also revision cases. Prospective study of patients undergoing tympanoplasty in big central and subtotal perforation with graft supported by a ring of cartilage peripherally between June 2016 and August 2016. Hearing results were reported using four frequency (500, 1000, 2000 and 3000) pure tone average air–bone gap. During the study period, composite graft comprising of tragal perichondrium and peripheral ring of cartilage prepared from ipsilateral tragus was used for tympanic membrane reconstruction in 30 patients. Overall graft take rate was 93.33%. Complications included residual perforation in 6.67%. Cartilage ring support offers an extremely reliable method for reconstruction of tympanic membrane in cases of high-risk perforation (big central perforation, subtotal perforation, anterior perforation of tympanic membrane, revision cases).

http://ift.tt/2roUy0J

Treatment Outcomes and Adverse Events Following In-Office Angiolytic Laser With or Without Concurrent Polypectomy for Vocal Fold Polyps.

Treatment Outcomes and Adverse Events Following In-Office Angiolytic Laser With or Without Concurrent Polypectomy for Vocal Fold Polyps.

JAMA Otolaryngol Head Neck Surg. 2018 Jan 18;:

Authors: Lin YH, Wang CT, Lin FC, Liao LJ, Lo WC, Cheng PW

Abstract
Importance: In-office angiolytic laser procedures have been used successfully as an alternative treatment for vocal fold polyps; little is known in detail about the treatment outcomes and adverse events.
Objective: To examine the outcomes and incidence rates of adverse events associated with in-office angiolytic laser procedures with or without concurrent polypectomy as an alternative treatment for vocal fold polyps.
Design, Setting, and Participants: Retrospective cohort study at a tertiary medical center. We identified 114 consecutive patients with vocal polyps who underwent in-office angiolytic laser treatments between January 1, 2014, and August 31, 2016. After the exclusion of 17 with missing or incomplete data, 97 were enrolled.
Interventions: In-office 532-nm laser procedures with or without concurrent polypectomy.
Main Outcomes and Measures: Between 1 and 2 months after the surgical procedures, we collected the following outcome data: videolaryngostroboscopy, perceptual rating of voice quality, acoustic analysis, maximal phonation time, and subjective rating of voice quality using a visual analogue scale and 10-item voice handicap index.
Results: This study enrolled 97 patients (mean [SD] age, 45.6 [11.3] years; 48 [49%] male). The mean duration of symptoms was 10.1 months (range, 1-60 months). Twenty-nine patients (30%) had angiolytic laser procedures only, while 68 (70%) received laser with concurrent polypectomy. Both treatment modalities offered significant improvements. Only 1 patient (1%) receiving angiolytic laser with concurrent polypectomy underwent another treatment session, so this group had significantly less need for multiple treatments than those receiving laser treatment alone (6 [21%]; effect size, -1.57; 95% CI, -2.77 to -0.36). We identified 8 adverse events (8% of the cases): vocal fold edema (n = 5), vocal hematoma (n = 2), and vocal ulceration (n = 1). Patients treated with laser plus concurrent polypectomy had significantly fewer adverse events than those treated with angiolytic laser alone (2 [3%] vs 6 [21%]; effect size, 1.20; 95% CI, 0.26 to 2.13).
Conclusions and Relevance: In-office angiolytic laser procedures can be an effective alternative treatment for vocal polyps, although with possible need for multiple treatment sessions and occasional occurrence of minor postoperative adverse events. Concurrent polypectomy following laser coagulation allows less laser energy delivery and reduces the risk of postoperative adverse events and the need for additional treatment sessions.

PMID: 29346486 [PubMed - as supplied by publisher]

http://ift.tt/2FTQAAo

JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngol Head Neck Surg. 2018 Jan 01;144(1):2

Authors:

PMID: 29346482 [PubMed - in process]

http://ift.tt/2Bf1hdd

Errors in Figures 1, 2, and 3.

Errors in Figures 1, 2, and 3.

JAMA Otolaryngol Head Neck Surg. 2018 Jan 18;:

Authors:

PMID: 29346476 [PubMed - as supplied by publisher]

http://ift.tt/2DNVAps

Current Status of Radiology Training in Otolaryngology Residency Programs.

Current Status of Radiology Training in Otolaryngology Residency Programs.

JAMA Otolaryngol Head Neck Surg. 2018 Jan 18;:

Authors: Lozada KN, Bernstein JM

Abstract
Importance: Otolaryngologists use head and neck imaging on a daily basis. However, little is known about the training residents receive on the subject. Understanding the current training environment is important to identify areas of improvement for resident education.
Objective: To assess the current state of radiology training in otolaryngology residency programs.
Design, Setting, and Participants: This was a cross-sectional survey of 106 otolaryngology residency program directors involving multiple academic institutions.
Main Outcomes and Measures: The main outcome of this study is the number of US otolaryngology residency programs that have a radiology curriculum. Measured outcomes were obtained from an anonymous online survey and reported as a percent of total respondents.
Results: Program directors from 39 of 106 (37%) US otolaryngology residency training programs responded to the survey. Twenty-eight of 39 (71%) have a focused radiology curriculum; 18 of 28 (64%) conduct sessions on a monthly basis, 8 of 28 (29%) on a quarterly basis, and 2 of 28 (7%) on a weekly basis. The predominant format (20 of 27 programs [74%]) is a mix of case-based review of inpatient studies and standard lectures. The largest proportion of sessions were run by radiologists (13 of 28 [46%]), with a mix of radiology and otolaryngologists close behind (11 of 28 [39%]). Twenty-two of 39 residency programs (56%) have a dedicated radiology rotation within their educational curriculum, of which 17 of 22 (77%) occur in postgraduate year 1 (PGY-1) of training, 3 of 22 (14%) in PGY-3, and 2 of 22 (9%) in PGY-4. Rotation lengths range from 1 week to 3 months, with most running 1 to 4 weeks. Thirty-two of 38 of US program directors (84%) believe that a formal radiology curriculum would benefit their residents. Thirty-five of 39 believe that this should be a case-based review of images. Twenty-four of 38 believe this should be done on a monthly basis. Fifteen of 39 responding program directors (39%) believe the optimal time is during the PGY-3 of training, 36% (14 of 38) favor the PGY-2, and 23% (9 of 38) in PGY-1.
Conclusions and Relevance: Despite no standardized requirements from the Accreditation Council for Graduate Medical Education (ACGME), 71% of US otolaryngology residency program directors who responded to our survey have a radiology curriculum. Most run didactics sessions at the desired frequency, setting, and format preferred by responding program directors. More than half of programs provide a dedicated radiology rotation, mostly during PGY-1, while identifying PGY-2 and PGY-3 as the optimal time for such an experience. These results highlight the need for a more thorough review of radiology education requirements from the ACGME to improve the training of otolaryngology residents across the country.

PMID: 29346475 [PubMed - as supplied by publisher]

http://ift.tt/2FTQpVK

Proposal for a New Diagnosis for Cochlear Migraine.

Proposal for a New Diagnosis for Cochlear Migraine.

JAMA Otolaryngol Head Neck Surg. 2018 Jan 18;:

Authors: Lai JT, Liu TC

PMID: 29346470 [PubMed - as supplied by publisher]

http://ift.tt/2DhwXAl

In Response

No abstract available

http://ift.tt/2DqfABL

In Response

No abstract available

http://ift.tt/2mRicgD

The Unknown Mechanism of Exogenous Tetrahydrobiopterin in the Renal Protection of Sheep Ischemia and Reperfusion

No abstract available

http://ift.tt/2DqfolY

Surveying the Literature: Synopsis of Recent Key Publications

No abstract available

http://ift.tt/2mRDSt0

New Modalities for the Administration of Inhaled Nitric Oxide in Intensive Care Units After Cardiac Surgery or for Neonatal Indications: A Prospective Observational Study

BACKGROUND: Nitric oxide (NO) has a well-known efficacy in pulmonary hypertension (PH), with wide use for 20 years in many countries. The objective of this study was to describe the current use of NO in real life and the gap with the guidelines. METHODS: This is a multicenter, prospective, observational study on inhaled NO administered through an integrated delivery and monitoring device and indicated for PH according to the market authorizations. The characteristics of NO therapy and ventilation modes were observed. Concomitant pulmonary vasodilator treatments, safety data, and outcome were also collected. Quantitative data are expressed as median (25th, 75th percentile). RESULTS: Over 1 year, 236 patients were included from 14 equipped and trained centers: 117 adults and 81 children with PH associated with cardiac surgery and 38 neonates with persistent PH of the newborn. Inhaled NO was initiated before intensive care unit (ICU) admission in 57%, 12.7%, and 38.9% with an initial dose of 10 (10, 15) ppm, 20 (18, 20) ppm, and 17 (11, 20) ppm, and a median duration of administration of 3.9 (1.9, 6.1) days, 3.8 (1.8, 6.8) days, and 3.1 (1.0, 5.7) days, respectively, for the adult population, pediatric cardiac group, and newborns. The treatment was performed using administration synchronized to the mechanical ventilation. The dose was gradually decreased before withdrawal in 86% of the cases according to the usual procedure of each center. Adverse events included rebound effect for 3.4% (95% confidence interval [CI], 0.9%–8.5%) of adults, 1.2% (95% CI, 0.0%–6.7%) of children, and 2.6% (95% CI, 0.1%–13.8%) of neonates and methemoglobinemia exceeded 2.5% for 5 of 62 monitored patients. Other pulmonary vasodilators were associated with NO in 23% of adults, 95% of children, and 23.7% of neonates. ICU stay was respectively 10 (6, 22) days, 7.5 (5.5, 15) days, and 9 (8, 15) days and ICU mortality was 22.2%, 6.2%, and 7.9% for adults, children, and neonates, respectively. CONCLUSIONS: This study confirms the safety of NO therapy in the 3 populations with a low rate of rebound effect. Gradual withdrawal of NO combined with pulmonary vasodilators are current practices in this population. The use of last-generation NO devices allowed good compliance with recommendations. Accepted for publication November 29, 2017. Funding: This study was funded by Air Liquide Healthcare. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Trial registration: NCT02821156; Clinicaltrials.gov; retrospectively registered May 20, 2016. Reprints will not be available from the authors. Address correspondence to Philippe Pouard, MD, Service Réanimation Chirurgie Pédiatrique, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015 Paris, France. Address e-mail to pp@invivo.edu. © 2018 International Anesthesia Research Society

http://ift.tt/2DnUrI8

Statistical Significance Versus Clinical Importance of Observed Effect Sizes: What Do P Values and Confidence Intervals Really Represent?

Effect size measures are used to quantify treatment effects or associations between variables. Such measures, of which >70 have been described in the literature, include unstandardized and standardized differences in means, risk differences, risk ratios, odds ratios, or correlations. While null hypothesis significance testing is the predominant approach to statistical inference on effect sizes, results of such tests are often misinterpreted, provide no information on the magnitude of the estimate, and tell us nothing about the clinically importance of an effect. Hence, researchers should not merely focus on statistical significance but should also report the observed effect size. However, all samples are to some degree affected by randomness, such that there is a certain uncertainty on how well the observed effect size represents the actual magnitude and direction of the effect in the population. Therefore, point estimates of effect sizes should be accompanied by the entire range of plausible values to quantify this uncertainty. This facilitates assessment of how large or small the observed effect could actually be in the population of interest, and hence how clinically important it could be. This tutorial reviews different effect size measures and describes how confidence intervals can be used to address not only the statistical significance but also the clinical significance of the observed effect or association. Moreover, we discuss what P values actually represent, and how they provide supplemental information about the significant versus nonsignificant dichotomy. This tutorial intentionally focuses on an intuitive explanation of concepts and interpretation of results, rather than on the underlying mathematical theory or concepts. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Accepted for publication November 29, 2017. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Patrick Schober, MD, PhD, MMedStat, Department of Anesthesiology, VU University Medical Center, De Boelelaan 1117, 1081HV Amsterdam, the Netherlands. Address e-mail to p.schober@vumc.nl. © 2018 International Anesthesia Research Society

http://ift.tt/2DplF1d

Bolus Norepinephrine Administration and Fetal Acidosis at Cesarean Delivery Under Spinal Anesthesia

No abstract available

http://ift.tt/2mSrAR4

Nutrition in the ICU: new trends versus old-fashioned standard enteral feeding?

Purpose of review The narrative review aims to summarize the relevant studies from the last 2 years and provide contextual information to understand findings. Recent findings Recent ICU studies have provided insight in the pathophysiology and time course of catabolism, anabolic resistance, and metabolic and endocrine derangements interacting with the provision of calories and proteins. Early provision of high protein intake and caloric overfeeding may confer harm. Refeeding syndrome warrants caloric restriction and to identify patients at risk phosphate monitoring is mandatory. Infectious complications of parenteral nutrition are associated with overfeeding. In recent studies enteral nutrition is no longer superior over parenteral nutrition. Previously reported benefits of glutamine, selenium, and fish oil seem to have vanished in recent studies; however, studies on vitamin C, thiamine, and corticosteroid combinations show promising results. Summary Studies from the last 2 years will have marked impact on future nutritional support strategies and practice guidelines for critical care nutrition as they challenge several old-fashioned concepts. Correspondence to Arthur R.H. van Zanten, M.D., PhD, Department of Intensive Care, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands. Tel: +31 318 43 41 15; e-mail: zantena@zgv.nl Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2BcGreC

Cardiac dysfunction in critical illness

Purpose of review Sepsis and septic shock are prevalent conditions that are likely to increase in prevalence in the future. Given the high mortality and morbidity associated with sepsis and sepsis-induced cardiac dysfunction, we must continue to make advances in knowledge of the complex physiologic interactions and how we may target specific mediators for potential therapeutic options in the future. Recent findings Multiple biomarkers have been discovered, which when assayed in sepsis-induced cardiomyopathy predict morbidity and mortality. With increased sensitivity of echocardiography, we can diagnose subclinical cardiac dysfunction, which may have future implications for slowing or preventing progressive dysfunction. Summary Sepsis-induced cardiomyopathy is the result of complicated interactions between the pathogen, the body's response to infection, and iatrogenic injury. Interplay between inflammatory, metabolic, and adrenergic systems results in direct and indirect myocardial injury leading to decreases in both systolic and diastolic cardiac function. As the interactions are further elucidated with additional research into other proteins and mediators, new treatment options can be researched. Video Abstract http://ift.tt/2mYIq1V Correspondence to Allison Dalton, MD, University of Chicago, 5841 S. Maryland Ave, MC 4028, Chicago, IL 60637, USA. E-mail: adalton@dacc.uchicago.edu Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://ift.tt/1qR4umk). Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2mYIqPt

Worldwide end-of-life practice for patients in ICUs

Purpose of review Published data and practice recommendations on end-of-life (EOL) generally reflect Western practice frameworks. Understanding worldwide practices is important because improving economic conditions are promoting rapid expansion of intensive care services in many previously disadvantaged regions, and increasing migration has promoted a new cultural diversity previously predominantly unicultural societies. This review explores current knowledge of similarities and differences in EOL practice between regions and possible causes and implications of these differences. Recent findings Recent observational and survey data shows a marked variability in the practice of withholding and withdrawing life sustaining therapy worldwide. Some evidence supports the view that culture, religion, and socioeconomic factors influence EOL practice, and individually or together account for differences observed. There are also likely to be commonly desired values and expectations for EOL practice, and recent attempts at establishing where worldwide consensus may lie have improved our understanding of shared values and practices. Summary Awareness of differences, understanding their likely complex causes, and using this knowledge to inform individualized care at EOL is likely to improve the quality of care for patients. Further research should clarify the causes of EOL practice variability, monitor trends, and objectively evaluate the quality of EOL practice worldwide. Correspondence to Professor Gavin M. Joynt, MBBCh, FFA (SA), FRCP, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Room 04D24, 4/F, Shatin, Hong Kong. Tel: +852 35051313; e-mail: gavinmjoynt@cuhk.edu.hk Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2BeE8HN

Recent evidence on early mobilization in critical-Ill patients

Purpose of review To examine the benefits of early mobilization and summarize the results of most recent clinical studies examining early mobilization in critically ill patients followed by a presentation of recent developments in the field. Recent findings Early mobilization of ICU patients, defined as mobilization within 72 h of ICU admission, is still uncommon. In medical and surgical critically ill patients, mobilization is well tolerated even in intubated patients. In neurocritical care, evidence to support early mobilization is either lacking (aneurysmal subarachnoid hemorrhage), or the results are inconsistent (e.g. stroke). Successful implementation of early mobilization requires a cultural change; preferably based on an interprofessional approach with clearly defined responsibilities and including a mobilization scoring system. Although the evidence for the majority of the technical tools is still limited, the use of a bed cycle ergometer and a treadmill with strap system has been promising in smaller trials. Summary Early mobilization is well tolerated and feasible, resulting in improved outcomes in surgical and medical ICU patients. Implementation of early mobilization can be challenging and may need a cultural change anchored in an interprofessional approach and integrated in a patient-centered bundle. Scoring systems should be integrated to define daily goals and used to verify patients' achievements or identify barriers immediately. Correspondence to Dr Stefan J. Schaller, MD, MHBA, Klinik für Anaesthesiologie, Klinikum rechts der Isar der TUM, Ismaningerstr, 22, 81675 Munich, Germany. Tel: +49 89 4140 9635; e-mail: s.schaller@tum.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2mV9jno

Could Botox stop teeth grinding?

If, like me, you grind your teeth when you sleep, you might be interested in this study. It claims that Botox could help to treat bruxism.

http://ift.tt/2mTJ40s

The burden of non-melanoma skin cancers in Auckland, New Zealand

Abstract

Background/Objectives

As the New Zealand Cancer Registry does not require mandatory reporting of non-melanoma skin cancers (NMSC), basal cell carcinomas (BCC) and squamous cell carcinomas (SCC), the clinical burden of these diseases is unknown.

Methods

A retrospective review of all patients with histopathology performed allowed us to estimate invasive BCC and SCC in the Auckland region in 2008 (population 1.44 million).

Results

During this period, a total of 21 236 NMSC were diagnosed among 13 996 patients, consisting of 5611 SCC lesions (26%) and 15 525 (74%) BCC. The Auckland incidence rates per 100 000 were 425 for SCC and 1177 for BCC. The overall rate of NMSC per 100 000 was 1906.5 (standardised to the census data of Australia 2001); 1385 for BCC and 522 for SCC. Using published data on incidence trends and population growth, we estimate that 29 000–33 000 NMSC would have been excised in Auckland in 2016, and 78 000–87 000 in New Zealand.

Conclusion

Auckland has the highest reported incidence of invasive NMSC in the world. We believe that high-risk cutaneous SCC and complex BCC should be recorded. Our study provides information for clinicians and health economists on the scale of the problem.

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Long-term changes in multimodal intensive tinnitus therapy

Abstract

Background

We present 5‑year follow-up data for tinnitus-specific and comorbid depressive symptoms as well as stress-related outcome variables of an intensive multimodal 7‑day tinnitus therapy.

Method

Tinnitus burden (Tinnitus Questionnaire), stress (Perceived Stress Questionnaire), and depressive symptomatology (General Depression Scale) were measured at the 5‑year follow-up after a multimodal intensive 7‑day intervention. In all, 94 patients participated in the study.

Results

All outcome variables showed significant improvement at the end of the 7‑day intensive treatment. These effects remained significant after 5 years.

Conclusion

The results of the present study support the effectiveness of the 7‑day multimodal intensive therapy for tinnitus. Posttreatment improvements were related to both tinnitus burden as well as stress and depressive symptoms and were maintained at the 5‑year follow-up.

http://ift.tt/2FTGak3

Specific cutaneous infiltrates of acute myeloid leukaemia in a venous leg ulcer: an unusual presentation of leukaemia cutis

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Endoscopic endonasal approach for trigeminal schwannomas: our experience of 39 patients in 10 years

Abstract

Background

The anatomical locations involved in trigeminal schwannomas (TSs) are quite complex. The endoscopic endonasal approach provides a minimal damage access corridor to both anterior and middle skull base for surgery. Given the nerve function recovery and postoperative neurological deterioration varied in different reports, the author demonstrates his surgery tips and the functional outcomes under endoscopic surgery in one single institution.

Methods

A retrospective review of patients with TSs was undertaken to assess the outcome of endoscopic surgery from 2006 to 2016. Clinical features, imaging findings, preoperative/postoperative neurological deficits, surgical approaches and followed up data were collected.

Results

Thirty-nine patients with TSs were included in this study. Surgical approaches include endoscopic medial maxillectomy approach (n = 8), endoscopic endonasal-assisted sublabial transmaxillary approach (n = 27) and endoscopic endonasal-assisted sublabial transmaxillary combined with septectomy (n = 4). Gross total resection and sub-total resection were achieved in 27 and 10 patients, respectively. The most common chief complaint was facial numbness, accounting for 41%, with a resolved rate of 62.5% after treatment. Fifteen patients developed new neurologic symptoms, including facial numbness/pain (n = 9 and 2, respectively), dry eye (n = 3) and mastication weakness (n = 1). Eight of these patients had partial improvement except for patients with dry eye.

Conclusion

Endoscopic endonasal approach represents a safe and effective surgical procedure for TSs in pterygopalatine fossa, infratemporal fossa and even Meckel cave. Tumor resection can be achieved by endoscope with few neurologic deficits and complications.

http://ift.tt/2rkWd7p

Progestogen Hypersensitivity

Abstract

Purpose of Review

Progestogen hypersensitivity (PH) is a rare disorder which usually occurs in women of childbearing age with symptoms ranging from urticaria with or without angioedema, multiple organ involvement consistent with allergic anaphylaxis, to a spectrum of other non-evanescent skin eruptions. In this review, we present a clinical vignette of PH and discuss the clinical presentation and proposed pathomechanisms, diagnosis, and treatment of PH.

Recent Findings

The hypersensitivity symptoms are associated with exogenous progestin exposure (e.g., contraceptive medicines, in vitro fertilization therapy) or endogenous progesterone from progesterone surges during the luteal phase of the menstrual cycle and pregnancy. Recognition of this condition can be challenging to the clinician due to its heterogeneous clinical presentation. It has been recently proposed to use the new term "progestogen hypersensitivity" to replace "autoimmune progesterone dermatitis" due to the lack of evidence supporting an autoimmune mechanism for this disorder. In addition, diagnostic and treatment algorithms are now available that can lead to successful management of this condition. More new developments of Progesterone desensitization protocols are now available which appear to be the safest and most effective long-term treatment option for PH.

Summary

With the extensive use of oral contraceptives and increased use of supra-physiologic doses of progesterone to support pregnancy in in vitro fertilization, there is likely to be a higher prevalence of PH in the future than currently recognized. Therefore, the allergist-immunologist will be required to collaborate with gynecologists and reproductive endocrinologists to diagnose and treat this condition.

http://ift.tt/2mQ9nUx