Diagnosing diabetes mellitus in patients with porphyria cutanea tarda

Abstract

The prevalence of diabetes mellitus is increased in patients with porphyria cutanea tarda. Different tests are available for diagnosing and screening for type II diabetes mellitus, however choosing the most suitable test is challenging. The pitfalls in the different tests along with the interfering comorbidities and treatments concerning patients with porphyria cutanea tarda complicate diagnosing these patients with diabetes mellitus. HbA1c, fasting glucose, or oral glucose tolerance are the current available tests, with HbA1c as first choice. Measuring HbA1c requires no fasting, however HbA1c can be false low if the patient is treated with phlebotomy or has liver cirrhosis or chronic hepatitis. Instead fasting glucose and oral glucose tolerance tests can be used if the patient is not acutely ill. If either of the tests give a result in the diagnostic range, the test should be repeated if the patient has no clinical symptoms of diabetes. Diagnosing diabetes mellitus is important for the purpose of early intervention, and this review provides the knowledge needed to diagnose this special patient group properly.

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Mycobacterium gordonae-associated skin infection in an immunocompetent patient

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Psoriasis and subclinical atherosclerosis in a Chinese population

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Malignant atrophic papulosis with motor aphasia and intestinal perforation: A case report and review of published works

Abstract

Malignant atrophic papulosis (MAP) is a rare type of obliterating vasculopathy that can present as pure cutaneous lesions or a systemic entity affecting multiple organs. Systemic disease, such as gastrointestinal or central nervous system involvement, may predispose the patients to poorer or even fatal outcomes. We present a 30-year-old female patient with systemic manifestation of MAP 10 days after delivery of a full-term pregnancy who subsequently developed motor aphasia and intestinal perforation. The patient was administrated empirical treatment with an antiplatelet, anticoagulant, methylprednisolone sodium succinate and alprostadil. Antibiotics were administrated due to intestinal perforation and secondary sepsis. Despite all treatment, the patient died a week later. We summarized all the previous reports of MAP based on thorough review of previous published work. Overall, this is the first patient with MAP combined with motor aphasia and intestinal perforation and may provide insights for future studies on the treatment of this disease.

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Obstructive Sleep Apnea: an Ill Eye in the Wind

Publication date: Available online 8 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Arthur H. Friedlander, JoAnn A. Giaconi, Urie K. Lee, Tina I. Chang, Michelle R. Zeidler




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Association of the preoperative body mass index with postoperative complications after treatment of oral squamous cell carcinoma

Publication date: Available online 8 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Susanne Wolfer, Annika Kunzler, Stefan Schultze-Mosgau
PurposeNutritional status is believed to influence surgical outcome. Because of a lack of actual reports in literature, the purpose of this study is to evaluate the surgical outcome of patients after treatment for oral squamous cell carcinoma (OSCC), with special focus on the preoperative body mass index (BMI).Patients and methodsThis retrospective cohort study investigates the association of the preoperative BMI with the surgical outcome for OSCC patients, focusing on local and medical complications. This research also analyzes common clinical and demographic parameters such as age, sex, TNM stage, tumor differentiation, risk behavior, Karnofsky Index, duration of operation, and length of hospital stay. Statistics were performed using the Chi-square test or Fisher's exact test for categorical analysis and with the t-test or ANOVA test and Pearson correlation test for continuous variables. Multivariate analysis was computed for BMI with a multivariate linear regression model and for local and medical complications with the multivariate Poisson regression.ResultsIn the sample of 419 OSCC patients, 8.6% were underweight, 54.7% were normal weight, and 36.8% were overweight patients with an overall mean BMI of 24.28 kg/m². BMI was significantly associated with age (p = 0.0017), consumption of nicotine (p = 0.0178) and alcohol (p = 0.0008), dental status (p = 0.0163), tumor differentiation (p = 0.0288), and T-status (p = 0.0005). Underweight patients in particular are negatively correlated with local postoperative complications (p = 0.0047). Local complications are associated with the need for operative revisions (p < 0.0001) and with an increase of the length of hospital stay (p < 0.0001) after multivariable analysis.ConclusionOur results indicate that evaluation of preoperative morbidity and nutritional status, especially in underweight patients, is worthwhile to improve the postoperative outcome after surgical therapy of OSCC patients for medical and economic aspects.



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Evaluating the Effect of Resveratrol on the Healing of Extraction Sockets in Cyclosporine A-treated rats

Publication date: Available online 8 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Ayse Ozcan Kucuk, Hilal Alan, Mehmet Gul, Umit Yolcu
PurposeThe objective of this study was to investigate the effects of resveratrol on alveolar socket healing after tooth extraction in normal and cyclosporin A (CsA)-treated rats.Materials and MethodsSeventy-two female Sprague Dawley rats were separated into four groups of 18. Group 1 was injected with a placebo solution intraperitoneally. Group 2 was injected with resveratrol (10 μmol/kg) intraperitoneally. Groups 3 and 4 were injected with CsA (10 mg/kg) subcutaneously for 8 days once daily before the tooth extraction. Next, the teeth were extracted and continued to CsA injection until the animals were sacrificed. Eight days after commencing the CsA injections, Group 4 was injected with resveratrol while continuing with CsA injections. Nine rats from each group were sacrificed on days 14 and 28, and sections were examined to assess the degree of inflammation, the formation of connective tissue, and new bone formation. Immunohistochemical analysis was employed to evaluate the alveolar socket healing process using osteocalcin and osteopontin markers; p<0.05 was considered significant.ResultsThere was more new bone formation in Group 2 than in the other three groups on day 14 after the tooth extraction (p<0.05), and there was more new bone formation in Group 2 than in Groups 3 and 4 on day 28 after the extraction (p<0.05). Based on the immunohistochemical assessment, the amount of osteocalcin and osteopontin labelling was higher in Group 2 compared to the other three groups on day 14 (p<0.05); however, on day 28 after the extraction it was higher in Group 4 compared to Group 3 (p<0.05).ConclusionsResveratrol improves alveolar socket healing in normal and CsA-treated rats. Resveratrol also increases the levels of osteocalcin and osteopontin in normal and CsA-treated rats. These results suggest that the use of this natural compound is useful for alveolar socket healing after tooth extraction.



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Comparative Evaluation Of Healing Pattern After Surgical Excision Of Oral Mucosal Lesions By Using Platelet Rich Fibrin (Prf) Membrane And Collagen Membrane As Grafting Materials- A Randomized Clinical Trial

Publication date: Available online 8 March 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Monica Mahajan, Mithilesh Kumar Gupta, Chandrashekhar Bande, Vikas Meshram
PurposeTo compare the healing potential of platelet rich fibrin membrane (PRF) and collagen membrane in oral mucosal healing.Patients and MethodsThirty patients having oral premalignant lesions were randomly included in the study and divided in two Groups A and B. After excising lesions under local anesthesia, Group A and B patients were grafted with PRF membrane and collagen membrane, respectively. Patients were evaluated at 7^th, 15^th, 30^th and 60^th days postoperatively for pain, healing and complications such as recurrence, fibrosis, scar hypertrophy and loss of vestibular depth.ResultsIn Group A, 66.66% of patients reported significantly less pain postoperatively at 15^th day follow-up than those treated in Group B. 30^th day follow-up showed 86.66% cases in Group A showing no pain as compared to 60% in Group B. Pain scores were similar at the 7^th and 60^th follow-up days. Healing was accelerated in Group A on 15^th and 30^th day follow-up, but it was the same on the 60^th day. Complications like fibrosis, loss of vestibular depth and scar hypertrophy was seen in Group B. Recurrence were seen in 1 patient from Group A at the 60^th day follow-up.ConclusionPRF proved to be a better alternative to collagen membrane for grafting of the oral mucosal surgical defects. However, further study with larger sample size is required to prove its efficacy.



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Pain after root canal treatment with different instruments: A systematic review and meta-analysis

Abstract

Objectives

The aims of this systematic review were to compare the incidence and intensity of postoperative pain after single-visit root canal treatment using manual, rotary and reciprocating instruments.

Methods

An extensive literature search in PubMed, EMBASE, Cochrane Library, and Web of Science was performed to identify investigations that evaluated the effects of different instruments on post-endodontic pain. Meta-analyses and additional analyses, including subgroup and sensitivity analyses, were conducted.

Results

We included seventeen trials in this study. Pooled results showed that patients treated with rotary instruments experienced a significantly lower incidence of postoperative pain (RR, 0.32, P = 0.0005) and reduced pain intensity than did patients treated with manual instruments. In addition, patients treated with multiple rotary-file systems experienced a significantly lower incidence of postoperative pain than did those treated with reciprocating systems (RR, 0.73; P < 0.0001).

Conclusion

The use of rotary instruments contributed to a lower incidence and intensity of postoperative pain than did the use of hand files in patients who received single-visit root canal treatment. In addition, the use of multiple rotary-file systems contributed to a lower incidence of postoperative pain than did the use of reciprocating systems.

This article is protected by copyright. All rights reserved.

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Editorial Board/Reviewing Committee

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Immune-Mediated Inner Ear Disease: Diagnostic and therapeutic approaches

Publication date: Available online 7 March 2018
Source:Acta Otorrinolaringológica Española
Author(s): José Ferreira Penêda, Nuno Barros Lima, Francisco Monteiro, Joana Vilela Silva, Rita Gama, Artur Condé
IntroductionImmune Mediated Inner Ear Disease (IMIED) is a rare form of sensorineural bilateral hearing loss, usually progressing in weeks to months and responsive to immunosuppressive treatment. Despite recent advances, there is no consensus on diagnosis and optimal treatment.MethodsA review of articles on IMIED from the last 10 years was conducted using PubMed^® database.ResultsIMIED is a rare disease, mostly affecting middle aged women. It may be a primary ear disease or secondary to autoimmune systemic disease. A dual immune response (both cellular and humoral) seems to be involved. Cochlin may be the inner ear protein targeted in this disease. Distinction from other (core common) forms of neurosensory hearing loss is a challenge. Physical examination is mandatory for exclusion of other causes of hearing loss; audiometry identifies characteristic hearing curves. Laboratory and imaging studies are controversial since no diagnostic marker is available.ConclusionDespite recent research, IMIED diagnosis remains exclusive. Steroids are the mainstay treatment; other therapies need further investigation. For refractory cases, cochlear implantation is an option and with good relative outcome.



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Flexible gastroendoscope as a rescue device for an anaesthetist

Managing the airway of a patient with temporo-mandibular joint (TMJ) ankylosis is very challenging. Securing the airway by awake fiberoptic bronchoscopy is considered as a gold standard [1]. Easy and ubiquitous availability of the gastroendoscopes in the endoscopy room makes them a good alternative to fiberoptic bronchoscope. So we present a unique case of TMJ ankylosis posted for upper gastrointestinal endoscopy, wherein anaesthesia was given to the patient while the flexible gastroendoscope was also used as a rescue device for emergency airway management.

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Can lateral decubitus cause uvular necrosis after general anesthesia?

Uvular necrosis or ulceration is a rare cause of post-operative sore throat after endotracheal intubation (40%) or Laryngeal Mask Airway (7–12%) insertion. Till date, only 17 cases of uvular necrosis have been reported. According to literature, overzealous suctioning, upper GI endoscopy, bronchoscopy via nasal approach, long-term intubation and trans-esophageal echocardiography can cause uvular necrosis (2, 3). Patients present with post-operative severe pain and swollen, elongated, erythematous uvula with odynophagia and dysphagia which require urgent attention and treatment.

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Table of Contents

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Editorial Board w/barcode

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Laparoscope surgical Instrument usage to manage an extremely difficult airway

Airway management is an integral part of anaesthesia practice. Technical difficulty to intubate the patient may pose some critical challenges. We encountered one such case, a smiling girl of 6years posted for 2nd stage palatal fistula repair. Her tongue was attached to the palate (Fig. 1) four weeks back. After explaining the procedure, informed consent and permission to publication was obtained from the parent (mother), patient was prepared for anaesthesia. Surgeon requested for nasal intubation in view of better exposure.

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Ultrasound guided distal adductor canal block provides effective postoperative analgesia in lower leg surgery

In order to provide adequate postoperative analgesia in patients undergoing lower extremity surgeries, blockage of both lumbar and sacral plexus originating nerves are required as part of multimodal analgesia regimens. Block of the sciatic nerve from the popliteal region is a frequently used regional anesthesia/analgesia technique in lower leg surgery. Additionally, saphenous nerve block at the adductor canal level or femoral nerve block may also be included. Runge et al. reported that local anesthetic injected at the distal of the adductor canal around the femoral artery spread both proximally to the saphenous nerve and distally to the popliteal area, around the sciatic nerve in a cadaver model [1].

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Serratus plane block in thoracoscopic sympathectomy surgery

Video-assisted thoracic surgery (VATS), a minimally invasive procedure, has allowed less impairment of pulmonary function compared with thoracotomy. Besides that, there have been reports of significant acute and chronic pain following it [1].

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Anesthesia management of a newborn with Pena-Shokeir Syndrome

Perinatal diagnosis of Pena-Shokeir Syndrome (PSS) characterized by multiple joint contractures, intrauterine growth retardation, craniofacial deformities, multiple ankyloses, camptodactilia, short umbilical cord, polyhydramnios, and pulmonary hypoplasia is possible up to 14th week of pregnancy with abnormal position of fetal organs, abnormal fetal movements or fetal akinesia and those anomalies which may lead to mortality are considered to provide reasonable criteria for decision of termination of pregnancy [1].

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Efficacy of ultrasound imaging for differential diagnosis of cervical swelling after brachial plexus block for shoulder arthroscopy

Various complications associated with peripheral brachial plexus nerve block have been reported, such as pneumothorax, hemodynamic collapse, and hematoma leading to airway obstruction [1]. Here, we report the successful use of ultrasound imaging in the differential diagnosis of cervical swelling after brachial plexus block for shoulder arthroscopy.

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Supraglottic airway for upper gastrointestinal endoscopy in children: A review of 10years' experience

Children undergoing diagnostic EGD require deep sedation or general anesthesia [1] [2]. The anesthesiologist may choose to protect the airway with an endotracheal tube, or use sedation using a variety or combinations of sedatives and analgesics, while relying on the patient's native airway, and without airway protection [2] [3]. There can, in these instances, however, be serious cardiorespiratory complications; specifically, apnea, hypoventilation and oxygen desaturation; and hypercarbia from periods of apnea during deep sedation go unmeasured.

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Diagnostic accuracy of radiology (CT, X-ray, US) for predicting difficult intubation in adults: A meta-analysis

The aim of this study was to evaluate the overall accuracy of radiological measurements in prediction of difficult airway and compare the diagnostic value between the radiological measurements and the modified Mallampati score through a meta-analysis of published studies.

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Epidural management for obstetric patient with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) undergoing emergent cesarean section

Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a rare, autosomal dominant disorder that results from mutations of the NOTCH 3 gene on chromosome 19. The resultant dysfunctional NOTCH 3 protein leads to impaired cerebrovascular autoregulation. CADASIL is characterized by recurrent subcortical ischemic infarcts that can lead to migraine, with or without aura; cognitive problems; seizures; psychiatric symptoms; dementia; walking difficulties; and urinary incontinence [1].

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Obstructive sleep apnea as a risk factor associated with difficult airway management - A narrative review

The association between obstructive sleep apnea (OSA) and difficult airway had been studied in various clinical trials but the relationship between the two conditions has not been clearly established. The objective of this narrative review is to determine if OSA is a risk factor associated with difficult airway.

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Is CPAP treatment not effective after supratentorial craniotomy? Author's reply

We thank the authors for their comments [1] on our study "Efficacy of continuous positive airway pressure and incentive spirometry on respiratory functions during the postoperative period following supratentorial craniotomy: A prospective randomized controlled study" [2], which was published in your journal.

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Intraoperative clevidipine use to manage an acute hypertensive episode in a patient with a simultaneous kidney-pancreatic transplant

Arterial hypertension represents one of the most common diagnoses pathology in general population and usually is associated with a high appearance of complications and an increase in the mortality and morbidity during the perioperative period [1]. Refractory hypertension episodes following a simultaneous kidney-pancreatic transplant (SKPT) are not described by the current literature, and usually are associated with a multifactorial pathogenesis (immunosuppressive drugs use, chronic allograft dysfunction, genetic susceptibility or vascular complications) [2].

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The correlation of the depth of anesthesia and postoperative cognitive impairment: A meta-analysis based on randomized controlled trials

To comprehensively evaluate the associations between the depth of anesthesia and postoperative delirium (POD) or postoperative cognitive dysfunction (POCD).

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Ultrasound guided low thoracic erector spinae plane block for management of acute herpes zoster

Interfascial plane blocks have become very popular in recent years. A novel interfascial plane block, erector spinae plane (ESP) block can target the dorsal and ventral rami of the thoracic spinal nerves but its effect in neuropathic pain is unclear [1]. If acute pain management for herpes zoster is not done aggressively, it can turn into chronic pain. However; ESP block is first described as inject local anesthetics around the erector spinae muscle at the level of T5 spinous process for thoracic region, if the block is performed at lower levels it could be effective for abdominal and lumbar region [2].

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Anesthetic and pharmacologic considerations in perioperative care of obese children

Anesthetic management of obese pediatric patients is challenging. With increasing prevalence of childhood obesity, more severely obese children with comorbidities present for surgery every day. The purpose of this review is to provide an up-to-date comprehensive narrative review on the impact of pathophysiological changes imposed by pediatric obesity on the perioperative management of obese children, especially drug dosing. This knowledge is necessary to provide safe delivery of anesthesia for severely obese children.

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Anesthetic management of an adult patient with Cor Triatriatum Sinistrum: Utility of transesophageal echocardiography

Cor Triatriatum Sinistrum (CTS) is an uncommon congenital cardiac defect, reported in 0.1% to 0.4% of patients with congenital heart disease, and which results from the division of the left atrium into two chambers by a perforated fibromuscular septum [1]. CTS is commonly diagnosed in childhood, though cases with incomplete or fenestrated membranes may remain asymptomatic throughout adulthood.

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Ultrasound guided erector spinae block for postoperative analgesia in pediatric nephrectomy surgeries

Erector spinae block (ESB) is a newly identified regional anesthesia technique, which became popular between the clinicians for its ease and relatively safer administration [1]. There were quite many cases reporting its use for many different indications in adults. By far its use in pediatric cases was just defined for thoracic surgery [2,3]. We would like to share our experience about the use of ESB for postoperative analgesia in two pediatric cases undergoing nephrectomy for Wilms tumor. Written informed consent of all patients' parents was provided for using data of the children in this report.

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P2X receptor-ion channels in the inflammatory response in adipose tissue and pancreas—potential triggers in onset of type 2 diabetes?

Ivana Novak | Anna Solini

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Minimally-invasive operations on the temporomandibular joint with a new retractor: technical note

Our aim was to introduce a new approach to the temporomandibular joint (TMJ) that would provide a short access route (Fig. 1); expose the intra-articular anatomy; minimise morbidity of the treatment of intracapsular condylar fractures and open arthroplasty (Fig. 2); and allow percutaneous endoscopically-assisted arthroplasty (Fig. 3).

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Research in oral and maxillofacial surgery: infrastructure and innovation

It is a damning indictment of surgery in general that, despite our reliance on complex interventions, many aspects of our practice, including those of oral and maxillofacial surgery (OMFS) are not evidence based.

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Bifurcation of the inferior dental nerve canal: an anatomical study

The aims of this study were to find the incidence of bifurcation of the inferior dental nerve (IDN) canal, to describe the characteristics of this variant, and to examine the sensitivity and specificity of dental panoramic tomography to identify it. We classified bifurcations by size and position relative to the main canal and the lower third molar using cone-beam computed tomography (CT) and dental panoramic tomography. In our study of 281 patients, 106 (38%) had bifurcations, and in one quarter, these were classified as large accessory canals.

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The association between otogenic lateral sinus thrombosis and thrombophilia – A long-term follow-up

Otogenic lateral sinus thrombosis (OLST) is an intracranial, potentially life-threatening complication of acute and chronic otitis media. Since congenital thrombophilic disorders are risk factors for cerebral venous thrombosis, OLST may be related to thrombophilia. The aim of our study was twofold: to evaluate whether patients who suffered from OLST in childhood also have thrombophilia, and whether these patients experienced thromboembolic episodes in future years.

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Nasal polyposis pathophysiology: Endotype and phenotype open issues

Endotyping chronic rhinosinusitis with nasal polyps (CRSwNP) poses a challenge for rhinologists nowadays. Phenotyping CRSwNP proved inappropriate as an approach to their classification because of their common clinical features. Endotyping, being based on the pathogenic mechanism, provides a precise picture more appropriate for use in clinical practice. Patients' treatment and follow-up can thus be tailored to cope with the degree of aggressiveness of a specific CRSwNP endotype.The aim of this study was to analyze the available information about the main currently accepted endotypes of CRSwNP; furthermore, we reported and commented evidence regarding some clinical conditions associated with nasal polyposis which could be related with new endotypes.

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Progressive functional improvement in hemiglossectomy defects reconstructed with radial forearm free flap at 6-months

The purposes of the study was to evaluate for the functional improvement of outcomes of patients undergoing surgical management for tongue cancer at varying periods after surgery.

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Analysis of non-posterior canal benign paroxysmal positional vertigo in patients treated using the particle repositioning chair: A large, single-institution series

Benign paroxysmal positional vertigo (BPPV) involving the horizontal and superior semicircular canals is difficult to study due to variability in diagnosis. We aim to compare disease, treatment, and outcome characteristics between patients with BPPV of non-posterior semicircular canals (NP-BPPV) and BPPV involving the posterior canal only (P-BPPV) using the particle repositioning chair as a diagnostic and therapeutic tool.

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Parotid adenoid cystic carcinoma: Retrospective single institute analysis

I have read with interest the recently published article "Mannelli G, et al, Parotid adenoid cystic carcinoma: Retrospective single institute analysis" after one of my students has made reference to the 7th paragraph from this article discussion saying "Adjuvant radiotherapy resulted to negatively affect prognosis of ACC in terms of local relapse incidence, DM appearance and cancer specific mortality. Its role has been debated, so far [26–28]; in our study, patients who received it accordingly to standard treatment concept of radical resection followed by high radiotherapy dose [29], showed a worse prognosis."

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Triple innervation for re-animation of recent facial paralysis

Recent facial palsies are those in which fibrillations of the mimetic musculature remain detectable by electromyography (EMG). Such fibrillations generally cease 18 to 24 months after palsy onset. During this period, facial re-animation surgery seeks to supply new neural inputs to the facial nerve.Neural usable sources were divided into qualitative (contralateral facial nerve) and quantitative (hypoglossus and masseteric nerve), depending on the type of stimulus provided.To further improve the extent and quality of facial re-animation, we here describe a new surgical technique featuring triple neural inputs: the use of the masseteric nerve and 30% of the hypoglossus nerve fibres as quantitative sources was associated with the contralateral facial nerve (incorporated via two cross-face nerve grafts) as a qualitative source in order to restore facial movements in 24 consecutive patients.

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3D Computer Simulation Analysis of the Flap Volume Change in Total Tongue Reconstruction Flaps

A decreased flap volume can be an obstacle to proper phonation and swallowing. In this study we verified the proportion of volume decrease using 3D reconstructed images and identified the contributors to flap volume loss.

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Spheroid formation and stemness preservation of human periodontal ligament cells on chitosan films

Abstract

Objective

The therapeutic potential of periodontal ligament cells for periodontal regeneration gradually decreases when cultured as a monolayer in vitro. Three-dimensional cell culture models provide an alternative to traditional monolayer cell culture. This study aimed to comparatively evaluate the influence of spheroid culture on periodontal ligament cells.

Materials and Methods

Chitosan films were used to culture three-dimensional periodontal ligament cell spheroids. The proliferation, self-renewal, and osteogenic capacity of periodontal ligament cells derived from spheroids were evaluated and compared to cells cultured on a monolayer.

Results

Viable spheroids of periodontal ligament cells were formed on chitosan films. Compared to monolayer cell culture, periodontal ligament cells exhibited decreased proliferation upon spheroid formation. In contrast, their expression of genes related to self-renewal was significantly higher comparison to cells cultured in a monolayer. Moreover, the formation of periodontal ligament cell spheroids increased their colony forming unit ability and osteogenic differentiation capacity.

Conclusion

The results demonstrate the successful use of chitosan films for the culture of periodontal ligament cell spheroids. Compared to cells cultured in monolayer, periodontal ligament cells in spheroids did not proliferate, but exhibited higher self-renewal gene expression, colony forming unit and osteogenic capacity.

This article is protected by copyright. All rights reserved.

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Caregiver and expecting caregiver support for early peanut introduction guidelines

Recent guidelines recommend early peanut introduction (EPI) beginning around 4-6 months in infants with either severe eczema and/or egg allergy, and around 6 months for all other infants. Caregiver preferences for such practices are unkown.

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Surgical Site Identification with Personal Digital Device: A Prospective Pilot Study

Many novel means of biopsy site identification have been proposed., This is a pilot study comparing the accuracy of biopsy site identification with personal digital device photography to professional medical photography., Personal digital device photography is a cost-effective, HIPPA complaint, and readily available means to accurately identify biopsy sites.

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Pathologist Characteristics Associated with Accuracy and Reproducibility of Melanocytic Skin Lesion Interpretation

Diagnostic interpretations of melanocytic skin lesions vary widely among pathologists, yet the underlying reasons remain unclear.

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Educational Resources for Global Health in Otolaryngology

Advances in modern communications and information technology have helped to improve access to, and quality of, health care and education. These enhancements include a variety of World Wide Web–based and mobile learning platforms, such as eLearning, mLearning, and open education resources. This article highlights the innovative approaches that have fostered improved collaboration and coordination of global health efforts in otolaryngology.

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Management of Chronic Suppurative Otitis Media and Otosclerosis in Developing Countries

Chronic ear disease is a major cause of acquired hearing loss in the developing world. It is prevalent on every continent, but occurs more commonly in poorer nations owing to a lack of preventative measures. This article outlines the particular challenges in treating this disease in the developing world, including a discussion of surgical management and special situations. Otosclerosis is another surgically treatable cause of hearing loss that is found throughout the developing world. Surgeons working in these environments should be prepared to deal with advanced otosclerotic disease.

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Global Hearing Loss Prevention

Hearing loss is the fourth leading contributor to years lived with a disability worldwide. Most recent estimates indicate that one-half of a billion people suffer from disabling hearing loss worldwide. The social and economic burden is significant. When attributing monetary value to years lived with disability owing to hearing loss, there is greater than $US750 billion lost each year globally. There are numerous contributors to hearing loss, including congenital, infectious, noise exposure, age-related, traumatic, and immune-mediated causes. Understanding the pathophysiology of these factors allows for the development of preventative and treatment strategies specific to the underlying cause.

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Workforce Considerations, Training, and Certification of Physicians in Europe

Following recent geopolitical events and unification of Europe, the European Union (EU) is currently confronted with health care workforce shortage and insufficient uniform access to quality care. Aging population, difficulties with physician retention, and mobility of health care professionals are thought to contribute to this problem. Because of the differences in medical education and residency curriculum across the European countries, there is a need for a standardized training and certification. Current government initiatives are geared toward developing common policies and programs across the EU countries to address health care access.

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An Evidence-Based Practical Approach to Pediatric Otolaryngology in the Developing World

Despite humanitarian otolaryngology groups traveling in record numbers to resource-limited areas treating pediatric otolaryngology disease processes and training local providers, there remains a large burden of unmet needs. There is a meager amount of published information that comes from the developing world from an otolaryngology standpoint. As would be expected, the little information that does comes involves some of the most common pediatric otolaryngology diseases and surgical burdens including childhood hearing loss, otitis media, adenotonsillectomies, airway obstructions requiring tracheostomies, foreign body aspirations, and craniomaxillofacial surgeries, including cleft lip and palate.

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Light-emitting diode therapy (photobiomodulation) effects on oxygen uptake and cardiac output dynamics during moderate exercise transitions: a randomized, crossover, double-blind, and placebo-controlled study

Abstract

Light-emitting diodes (LEDs) might have a beneficial impact on cytochrome-c oxidase enzyme activity. Thus, it was hypothesized that photobiomodulation by light-emitting diode therapy (LEDT) could influence aerobic metabolism dynamics. Possible LEDT-mediated aerobic improvements were investigated mainly by a precise characterization of the pulmonary O₂ uptake dynamics during moderate exercise transitions. Eight healthy young adults were enrolled in this randomized, double-blind, placebo-controlled, crossover study. A multi-diode array of LEDs was used for muscular pre-conditioning 30 min and 6 h before exercise testing. Pulmonary O₂ uptake, carbon dioxide output, cardiac output, heart rate, stroke volume, and total arteriovenous oxygen difference dynamics were evaluated by frequency domain analysis. Comparisons revealed no statistical (p > 0.05) differences between LEDT and placebo, suggesting no significant changes in aerobic system dynamics. These results challenge earlier publications that reported changes in pulmonary O₂ uptake during incremental exercise until exhaustion after LEDT. Perhaps, increments in peak pulmonary O₂ uptake after LEDT may be a consequence of higher exercise tolerance caused by non-aerobic-related factors as opposed to an improved aerobic response.

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Rituximab as a therapeutic option for patients with advanced melanoma

Abstract

Treatment of metastatic melanoma remains challenging, despite a variety of new and promising immunotherapeutic and targeted approaches to therapy. New treatment options are still needed to improve long-term tumour control. We present a case series of seven patients with metastatic melanoma who were treated individually with the anti-CD20 antibody rituximab between July 2014 and July 2015. Two of the patients were treated in an adjuvant setting. All patients had already received a variety of treatments. During an induction phase, the administration of four cycles of weekly rituximab 375 mg/m² body surface area was planned. After imaging, patients with stable disease continued therapy with rituximab 375 mg/m² body surface area every 4 weeks up to a maximum of 24 weeks. Two patients experienced grade 2 infusion reactions during the first infusion. Otherwise, treatment was well tolerated and there were no grade 3 or 4 side effects. Staging after the induction phase showed stable disease in five patients, and two patients had progressive disease. Median progression-free survival was 6.3 months (95% CI 4.97–7.53), median overall survival was 14.7 months (95% CI 4.52–24.94), and one patient was still alive in December 2016. In conclusion, rituximab might be a therapeutic option for metastatic melanoma. However, further studies on rituximab among larger patient cohorts are warranted. Evaluation of therapy in an adjuvant setting or in combination with other systemic treatment might, therefore, be of particular interest.

http://ift.tt/2FotNMr

Scarring in Patients With PIK3CA -Related Overgrowth Syndromes

This observational study examines the frequency of excessive scarring after surgery in patients with PIK3CA-related overgrowth.

http://ift.tt/2I8Lnpu

Death by Gun Violence—Guns Are Not the Problem—Reply

In Reply We thank Dr Boyd for reading and thinking about our editorial on gun violence. Dr Boyd's argument rests on his belief that rural areas are safer because of more guns. Unfortunately, the data say otherwise. In an analysis of injury deaths in all 3141 US counties, there was no significant difference in the rate of firearm deaths in the most rural counties compared with the most urban counties. Dr Boyd also fails to recognize that over 60% of firearm deaths in the United States are suicides, and that there is a strong linear relationship between the number of guns in a state and the overall suicide rate. Suicide rates are higher in rural than urban areas and for youth, the rural-urban difference is increasing.

http://ift.tt/2oWBi6g

Health-Related Quality of Life in Frontal Fibrosing Alopecia

This cohort study evaluates the association between frontal fibrosing alopecia and health-related quality of life.

http://ift.tt/2I8LlxS

Facial Neutrophilic Dermatosis Mimicking Iododerma Associated With IBD

This case report describes a patient with facial neutrophilic dermatosis mimicking iododerma and associated with inflammatory bowel disease.

http://ift.tt/2oWBOBe

Death by Gun Violence—Guns Are Not the Problem

To the Editor I read with interest the editorial by Bauchner et al regarding gun violence and wish to offer a different opinion. My family and I live on a farm in a rural area near Nashville, Tennessee. Crime, including violent crime, is essentially unheard of in our part of the county. I believe that this stems, in part, from the well-known fact that those of us living here are armed. We have rifles and shotguns in our homes and pistols in our vehicles and/or on our persons.

http://ift.tt/2I8LhOE

Four Staging Systems for Cutaneous Squamous Cell Carcinoma

This nested case-control study assesses the validity and usefulness of 4 staging systems for cutaneous squamous cell carcinoma using population-based data.

http://ift.tt/2oYOl75

Revised Mohs Surgery Appropriate Use Criteria for Superficial BCC

This Viewpoint discusses the process of reevaluating Mohs surgery appropriate use criteria for primary superficial basal cell carcinoma.

http://ift.tt/2I8LOQE

Issue Information

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Immune modulation by neuronal electric shock waves

Publication date: Available online 6 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Kazuhiro Suzuki, Akiko Nakai




http://ift.tt/2FmWqtm

Dietary therapy for eosinophilic esophagitis

Publication date: Available online 6 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Javier Molina-Infante, Alfredo J. Lucendo
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated, esophageal disease triggered predominantly, but not excusively, by food antigens. Presently, available food allergy tests are suboptimal to predict food triggers for EoE, especially in adults. Elemental diet (exclusive feeding with aminoacid-based formulas) and empiric six-food elimination diet (6-FED; withdrawing milk, wheat, egg, soy, nuts and fish/seafood for 6 weeks), have consistently shown the best efficacy rates. However, their high level of restriction and need for multiple endoscopies have hampered their implementation in clinical practice. Currently, milk, wheat/gluten and egg are the most common food triggers in children and adults from US, Spain and Australia. Hence, less restrictive empiric schemes, like a four-food (4-FED; dairy, gluten-containing cereals, egg, and legumes) or a two-food (2-FED; dairy and gluten-containing cereals) have been lately developed with good efficacy rates (2-FED 43%; 4-FED adults 54%, children 64%). A step-up approach (2-4-6) may result in prompt recognition of a majority of responders with few food triggers, reducing the number of endoscopies and costs, and shortening the diagnostic process. Standardization of food reintroduction, novel food allergy testing and studies evaluating milk elimination diet in children and the long-term outcomes of dietary interventions are warranted.



http://ift.tt/2G3NYjS

Nasal epithelium as a proxy for bronchial epithelium for smoking-induced gene expression and eQTLs

Publication date: Available online 6 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Kai Imkamp, Marijn Berg, Cornelis J. Vermeulen, Irene H. Heijink, Victor Guryev, Huib AM. Kerstjens, Gerard H. Koppelman, Maarten van den Berge, Alen Faiz




http://ift.tt/2D9mWo0

A Type III Complement Factor D Deficiency: Structural insights for inhibition of the alternative pathway

Publication date: Available online 6 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Christopher C.T. Sng, Sorcha O'Byrne, Daniil M. Prigozhin, Matthias R. Bauer, Jennifer C. Harvey, Michelle Ruhle, Ben G. Challis, Sara Lear, Lee D. Roberts, Sarita Workman, Tobias Janowitz, Lukasz Magiera, Rainer Doffinger, Matthew S. Buckland, Duncan J. Jodrell, Robert K. Semple, Timothy J. Wilson, Yorgo Modis, James E.D. Thaventhiran




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Are both early egg introduction and eczema treatment necessary for primary prevention of egg allergy?

Publication date: Available online 6 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Kenji Matsumoto, Rintaro Mori, Celine Miyazaki, Yukihiro Ohya, Hirohisa Saito




http://ift.tt/2Fo6KRQ

Regulation of type 2 innate lymphoid cell-dependent airway hyperreactivity by butyrate

Publication date: Available online 6 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Christina Li-Ping Thio, Po-Yu Chi, Alan Chuan-Ying Lai, Ya-Jen Chang
BackgroundAllergic asthma is characterized airway hyperreactivity (AHR) and inflammation driven by aberrant TH2 response. Type 2 innate lymphoid cells (ILC2s) are a critical source of TH2 cytokines IL-5 and IL-13 which promote acute asthma exacerbation. Short chain fatty acids (SCFAs) have been shown to attenuate T cell-mediated allergic airway inflammation. Their role in the regulation of ILC2-driven AHR and lung inflammation, however, remains unknown.ObjectiveWe investigated the immunomodulatory role of SCFAs in the regulation of ILC2-induced AHR and airway inflammation and delineated the mechanism involved.MethodsWe assessed the role of SCFAs in regulating the survival, proliferation, and cytokine production in lung sorted ILC2s. The SCFA butyrate was administered through drinking water or intranasally in BALB/c mice to evaluate its role in ILC2-driven inflammatory response in IL-33 and Alternaria alternata models of allergic inflammation. We further confirmed our findings in human ILC2s.ResultsWe show that butyrate, but not acetate or propionate, inhibited IL-13 and IL-5 production by murine ILC2s. Systemic and local administration of butyrate significantly ameliorated ILC2-driven AHR and airway inflammation. We further demonstrate that butyrate inhibited ILC2 proliferation and GATA3 expression but did not induce cell apoptosis, likely through histone deacetylase (HDAC) inhibition as TSA, a pan-HDAC inhibitor, exerted similar effects on ILC2s. Importantly, co-treatment of TSA and butyrate did not result in additive effect. Finally, we show that butyrate reduces cytokine production in human ILC2s.ConclusionOur findings identify butyrate as a critical regulator of ILC2 proliferation and function through its HDAC inhibitory activity, and may serve as a potential therapeutic target for asthma.

Graphical abstract

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The Parasitic 68-mer Peptide FhHDM-1 inhibits mixed granulocytic inflammation and airway hyperreactivity in experimental asthma

Publication date: Available online 6 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Akane Tanaka, Venkata Sita Rama Raju Allam, Jennifer Simpson, Natalia Tiberti, Jenna Shiels, Joyce To, Maria Lund, Valery Combes, Sinead Weldon, Cliff Taggart, John P. Dalton, Simon Phipps, Maria B. Sukkar, Sheila Donnelly




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IL-25 enhances Th17 cell-mediated contact dermatitis by promoting IL-1β production by dermal dendritic cells

Publication date: Available online 6 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Hajime Suto, Aya Nambu, Hideaki Morita, Sachiko Yamaguchi, Takafumi Numata, Takamichi Yoshizaki, Eri Shimura, Ken Arae, Yousuke Asada, Kenichiro Motomura, Mari Kaneko, Takaya Abe, Akira Matsuda, Yoichiro Iwakura, Ko Okumura, Hirohisa Saito, Kenji Matsumoto, Katsuko Sudo, Susumu Nakae
BackgroundAs well as thymic stromal lymphopoietin (TSLP) and IL-33, IL-25 is known to induce Th2 cytokine production by various cell types—including Th2 cells, Th9 cells, invariant NKT cells and group 2 innate lymphoid cells—involved in Th2-type immune responses. Since both Th2-type and Th17-type cells/cytokines are crucial for contact hypersensitivity (CHS), IL-25 may contribute to this by enhancing Th2-type immune responses. However, the precise role of IL-25 in the pathogenesis of FITC-induced CHS is poorly understood.ObjectiveWe investigated the contribution of IL-25 to CHS using Il25^-/- mice.MethodsCHS was evaluated by measurement of ear skin thickness in mice after FITC-painting. Skin dendritic cell (DC) migration, hapten-specific Th cell differentiation and detection of IL-1β-producing cells were determined by flow cytometry, ELISA and immunohistochemistry, respectively.ResultsIn contrast to TSLP, we found that IL-25 was not essential for skin DC migration or hapten-specific Th cell differentiation in the sensitization phase of CHS. Unexpectedly, mast cell- and non-immune cell-derived IL-25 was important for hapten-specific Th17 cell-, rather than Th2 cell-, mediated inflammation in the elicitation phase of CHS by enhancing Th17-related, but not Th2-related, cytokines in the skin. In particular, IL-1β produced by dermal DCs in response to IL-25 was crucial for hapten-specific Th17 cell activation, contributing to induction of local inflammation in the elicitation phase of CHS.ConclusionOur results identify a novel IL-25 inflammatory pathway involved in induction of Th17, but not Th2, cell-mediated CHS. IL-25 neutralization may be a potential approach for treatment of CHS.

Graphical abstract

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Lipid regulation of ILC2 function: moving beyond epithelial cytokines

Publication date: Available online 6 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Taylor A. Doherty, David H. Broide




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Electronic Cigarettes: One Size Does Not Fit All

Publication date: Available online 6 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Amika K. Sood, Matthew J. Kesic, Michelle L. Hernandez
Electronic cigarettes (EC) have been rapidly growing in popularity among youth and adults in the US over the last decade. This increasing prevalence is partially driven by the ability to customize devices, flavors, and nicotine content and the general notion that EC are harmless, particularly in comparison to conventional cigarettes (CC). In vitro and in vivo murine models have demonstrated a number of harmful biological effects of e-liquids (EL) and their aerosols. However, limited clinical data exists on whether these effects translate into detrimental long-term outcomes in humans. The short-term harmful respiratory effects of EC use demonstrated in non-smokers argue against their use. Slightly more favorable data, though, exists for the respiratory benefits of substituting CC with EC and the short-term efficacy of EC as smoking cessation tools. Nonetheless, available research is severely limited in regards to long-term outcomes and by study designs fraught with bias, pointing to the need for additional research efforts with well-designed longitudinal studies to guide FDA regulatory efforts. The hurdle presented by diverse device designs and EL permutations, which contribute to inconsistency of available data, also highlights the need for legislative standardization of EC.



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Knob protein enhances epithelial barrier integrity and attenuates airway inflammation

Publication date: Available online 6 March 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Sung Gil Ha, Mythili Dileepan, Xiao Na Ge, Bit Na Kang, Yana G. Greenberg, Amrita Rao, Girija Muralidhar, Lali Medina-Kauwe, Michael A. Thompson, Christina M. Pabelick, Scott M. O'Grady, Savita P. Rao, P. Sriramarao
BackgroundAltered epithelial physical and functional barrier properties along with Th1/Th2 immune dysregulation are features of allergic asthma. Regulation of junction proteins to improve barrier function of airway epithelial cells has the potential for alleviation of allergic airway inflammation.ObjectiveTo determine the immunomodulatory effect of knob protein of the adenoviral capsid on allergic asthma and investigate its mechanism of action on airway epithelial junction proteins and barrier function.MethodsAirway inflammation including junction protein expression was evaluated in allergen-challenged mice with and without treatment with knob. Human bronchial epithelial cells (Hu-BEC) were exposed to knob and its effect on expression of junction proteins and barrier integrity were determined.ResultsAdministration of knob to allergen-challenged mice suppressed airway inflammation (eosinophilia, airway hyperresponsiveness, IL-5 levels) and prevented allergen-induced loss of airway epithelial occludin and E-cadherin expression. Additionally, knob decreased expression of Th2-promoting inflammatory mediators, specifically IL-33, by murine lung epithelial cells. At a cellular level, treatment of Hu-BEC with knob activated JNK, increased expression of occludin and E-cadherin and enhanced epithelial barrier integrity.ConclusionIncreased expression of junction proteins mediated by knob leading to enhanced epithelial barrier function may mitigate allergen-induced airway inflammatory response including asthma.



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Novel innate and adaptive lymphocytes: the new players in the pathogenesis of inflammatory upper airway diseases

Summary

Host immunity (innate and adaptive immunity) plays essential roles in the pathogenesis of inflammatory upper airway diseases including allergic rhinitis and chronic rhinosinusitis. Recently, the discovery of novel innate immune cells, particularly innate lymphoid cells, has renewed our view on the role of innate immunity in inflammatory upper airway diseases. Meanwhile, the identification of new subsets of T helper (Th) cells including Th22, Th9 and follicular Th cells, and regulatory B cells in the adaptive immunity has broadened our knowledge on the complex immune networks in inflammatory upper airway diseases. In this review, we focus on these newly identified innate and adaptive lymphocytes with their contributions to the immunological disturbance in allergic rhinitis and chronic rhinosinusitis. We further discuss the perspective for future research and potential clinical utility of regulating these novel lymphocytes for the treatment of allergic rhinitis and chronic rhinosinusitis.

This article is protected by copyright. All rights reserved.

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The familial aggregation of atopic diseases and depression or anxiety in children

Abstract

Background

Children with asthma and atopic diseases have an increased risk of depression or anxiety. Each of these diseases have strong genetic and environmental components, therefore it seems likely that there is a shared liability rather than causative risk.

Objective

To investigate the existence and nature of familial aggregation for the comorbidity of atopic diseases and depression or anxiety.

Methods

Participants came from the Childhood and Adolescent Twin Study in Sweden (CATSS), n= 14197. Current and ever asthma, eczema, hayfever and food-allergy were reported by parents. Internalizing disorders were identified using validated questionnaires. Familial co-aggregation analysis compared monozygotic MZ twins and same-sex dizygotic DZ twins for atopic disease in one twin with internalizing disorder in the other to test for genetic liability. Several familial liability candidates were also tested including parental education, recent maternal psychological stress, childhood family trauma and parental country of birth.

Results

Familial co-aggregation analysis found that if one twin had at least one current atopic disease the partner twin was at risk of having an internalizing disorder regardless of their own atopic status (Adjusted OR 1.22 (95% CI 1.08, 1.37). Similar results were found for each atopic disease ever and current. MZ associations were not higher than DZ associations suggesting that the liability is not genetic in nature. Including other familial candidates to the models made little difference to effect estimates.

Conclusions and Clinical Relevance

Atopic diseases and depression or anxiety tend to occur together in families, therefore when treating for one disease the physician should consider comorbidity in both the individual and the individual's siblings. We did not find evidence to support a genetic explanation for comorbidity and further exploration is needed to disentangle the environmental and epigenetic reasons for familial aggregation.

This article is protected by copyright. All rights reserved.

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The non-small cell lung cancer immune landscape: emerging complexity, prognostic relevance and prospective significance in the context of immunotherapy

Abstract

Immunotherapy of non-small cell lung cancer (NSCLC), by immune checkpoint inhibitors, has profoundly improved the clinical management of advanced disease. However, only a fraction of patients respond and no effective predictive factors have been defined. Here, we discuss the prospects for identification of such predictors of response to immunotherapy, by fostering an in-depth analysis of the immune landscape of NSCLC. The emerging picture, from several recent studies, is that the immune contexture of NSCLC lesions is a complex and heterogeneous feature, as documented by analysis for frequency, phenotype and spatial distribution of innate and adaptive immune cells, and by characterization of functional status of inhibitory receptor⁺ T cells. The complexity of the immune landscape of NSCLC stems from the interaction of several factors, including tumor histology, molecular subtype, main oncogenic drivers, nonsynonymous mutational load, tumor aneuploidy, clonal heterogeneity and tumor evolution, as well as the process of epithelial–mesenchymal transition. All these factors contribute to shape NSCLC immune profiles that have clear prognostic significance. An integrated analysis of the immune and molecular profile of the neoplastic lesions may allow to define the potential predictive role of the immune landscape for response to immunotherapy.

http://ift.tt/2I9qdHV

Quality-of-Life Metrics Correlate With Disease Severity in Idiopathic Subglottic Stenosis

Objectives

Idiopathic subglottic stenosis (ISGS) can have significant impacts on quality of life (QOL), but it remains unclear how patients' subjective responses correlate with objective measurement of disease severity. Peak expiratory flow percentage (PEF%) has been shown to be an effective measure of disease severity in subglottic stenosis. This study aims to identify the key QOL questions correlated with PEF% and proposes a statistical model for prediction of disease severity.

Methods

Patients with ISGS presenting to an academic laryngologist were included retrospectively from 2012 to 2016. Peak expiratory flow percentage (age, sex, and height adjusted) was recorded for each visit, along with four validated QOL instruments (European QOL–Five Dimensions; RAND 36-Item Health Survey; Clinical COPD [Chronic Obstructive Pulmonary Disease] Questionnaire; and the Airway, Dyspnea, Voice, and Swallowing Summary Assessment). A stepwise multiple linear regression was used to identify statistically significant independent variables correlated with PEF%, and a model was built with these variables.

Results

Thirty-two patients were included, with a total of 271 patient encounters. Overall scores from each of the four QOL instruments were correlated with PEF% values recorded each visit (P < 0.05). Question responses correlating most positively included overall breathlessness, difficulty catching breath, cough within the past week, dyspnea with moderate activity, perception that voice changes are restricting social life, and overall general health (all P < 0.01). A model constructed using six nonoverlapping questions yielded an adjusted R² of 0.58.

Conclusion

Quality of life is correlated to PEF% in ISGS. Using a limited number of QOL questions, clinicians can predict objective worsening or improvement of disease severity, as measured by spirometry.

Level of Evidence

2b. Laryngoscope, 2017

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Facial sinus endoscopic evaluation, radiologic assessment, and classification

Objectives

To describe facial sinus anatomy from an endoscopic perspective and present a radiologic classification.

Methods

Facial sinus was studied by endoscopy and high-resolution computed tomography (HRCT) scan in 39 temporal bones that underwent exclusive transcanal endoscopic approach. A radiomorphologic classification based on the relationship between the facial sinus and the mastoid portion of the facial nerve is created as follows. In type A facial sinus, the pneumatization of the facial sinus did not extend medially or posteriorly to the mastoid portion of the facial nerve. In type B facial sinus, the pneumatization extended posteriorly to the mastoid portion of the facial nerve. In type C facial sinus, the pneumatization extended posteriorly and medially to the mastoid portion of the facial nerve.

Results

In all the specimens that underwent HRCT (n = 31), facial sinus could be identified, and its depth classified, in relation to the facial nerve. In this group, 58% type A, 29% type B, and 13% type C facial sinuses were identified. In all the specimens (n = 39), the facial sinus could be assessed by means of an exclusive endoscopic transcanal approach, and anatomical variants of the chordiculus, previously known as chordal ridge, could be described: ridge (39%), bridge (18%), incomplete (15%), and absent (28%).

Conclusion

Endoscopic exploration of the retrotympanum guarantees a very good exposure of the facial sinus, allowing detailed anatomic descriptions of its conformation and relationships with other structures. Improvement in our knowledge of its anatomy might decrease the possibility of residual disease during cholesteatoma surgery. Angled endoscopes (e.g. 45 °, 70 °) can guarantee a better view of the facial sinus.

Level of Evidence

NA. Laryngoscope, 2018

http://ift.tt/2trESKS

Infant with a skin lesion and respiratory distress

Description

A 2-month-old full-term male infant presented with worsening tachypnoea and a rapidly enlarging, smooth-topped, infiltrative, bronze-yellow nodule with overlying telangiectasias on the mid-sternum (figure 1A). CT imaging demonstrated multiple pulmonary nodules, and enhancing extradural masses compressing the L4–L5 vertebral neural foramina. Immunohistochemical staining of biopsies from skin and pulmonary lesions demonstrated a highly proliferative histiocytosis (figure 1B), which was positively immunoreactive for ALK (anaplastic lymphoma kinase) (figure 1C), CD33 and factor XIIIa, weakly positive for CD68, and negative for CD1a, Langerin, CD34, CD20, CD3, CD43, SOX10, S100, C-KIT, lysozyme and myeloperoxidase. These findings were consistent with a diagnosis of ALK+ histiocytosis with pathological features of juvenile xanthogranulomatosis (JXG). Whole body MRI and positron emission tomography (PET)/CT imaging (figure 2) confirmed that the extensive pulmonary and compressing spinal cord lesions were fluorodeoxyglucose (FDG)-avid, and further revealed an additional, metabolically active right meningeal/parietal parenchymal brain tumour...

http://ift.tt/2G70fUR

Rare case of metaplastic breast cancer in a man

Metaplastic breast cancer (MBC) in men is an extremely rare entity. MBC is typically very aggressive with a poor prognosis. In men, it has only been reported three times in the literature. We report a 47-year-old man who presented with right-sided breast erythema and nipple inversion. Mammogram revealed a 2.4 cm spiculated mass. Initial pathology was inconclusive; however, right-sided simple mastectomy showed invasive metaplastic carcinoma with adenosquamous histology. He received adjuvant chemotherapy with 4 cycles of dose dense Adriamycin and cyclophosphamide followed by 12 weeks of paclitaxel and chest wall radiation. Although oestrogen receptor status was 1%, tamoxifen was not given due to recent diagnosis of pulmonary embolism. Two years after treatment, he is currently living with no signs of recurrence. This case will serve as a useful addition to the current literature discussing successful diagnosis, treatment and prognosis of a man with MBC.

http://ift.tt/2FqmT9y

Possible anti-VGKC autoimmune limbic encephalitis associated with SIADH

An 80-year-old woman presented with a 5-week history of increasing confusion. Examination was remarkable only for deficits in short-term memory and paranoid thoughts. Blood tests revealed hyponatraemia, and further biochemical testing was consistent with syndrome of inappropriate antidiuretic hormone (SIADH). After an exhaustive diagnostic workup for causes of SIADH, the only abnormal finding was a mildly raised antivoltage-gated potassium channel (VGKC) titre of 185 pmol/L (0–69) consistent with possible anti-VGKC autoimmune limbic encephalitis. However, other diagnostic features were absent. She is currently undergoing outpatient investigation for other causes of memory loss.

http://ift.tt/2G260D2

Pulmonary metastasis from endometrial carcinoma

Description

A woman aged 69 years was referred to our department for the evaluation of a solitary pulmonary nodule. She had undergone total abdominal hysterectomy with bilateral salpingo-oophorectomy on diagnosis of endometrioid endometrial carcinoma (FIGO stage 1B, grade 2) 4 years ago. At that time, she received adjuvant treatment (six cycles of carboplatin and paclitaxel). After 3 years, chest CT scan revealed a nodule of 0.5 cm in diameter with cavitation in the right upper lobe of the lung (figure 1A). One year later, the pulmonary nodule increased in size (1.3 cm; figure 1B), and she underwent CT scan-guided percutaneous transthoracic biopsy, which subsequently revealed potent oestrogen receptor-positive metastatic disease. She underwent wedge resection of the right upper lobe because the primary tumour site was controlled without an uncontrollable extrapulmonary disease. The resection margin was clear, and the nodule was well demarcated with a thin-walled cavity,...

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Acute epiglottitis with intramural oesophageal dissection

Description

A woman aged 31 years with no medical history was admitted to the intensive care unit for acute epiglottitis. For 4 days, she had been complaining of fever, intractable vomiting and increasing cervical pain treated with anti-inflammatory drugs.

The admission CT scan confirmed the diagnosis of acute epiglottitis associated with a parapharyngeal abscess (figure 1A). An intramural oesophageal dissection (IOD) was incidentally diagnosed (figure 1B), extending from the upper oesophageal sphincter to the lesser gastric curvature without any sign of mediastinitis (figure 1C and D). Initial panendoscopy revealed mucosal necrosis on the cervical oesophagus. Neither endoscopy nor an oral contrast-enhanced CT scan revealed any perforation. The parapharyngeal abscess was surgically drained and bacteriological culture revealed Streptococcus anginosus and anaerobic bacteria. A conservative treatment of the oesophagus proved effective with invasive mechanical ventilation, parenteral nutrition and appropriate antibiotherapy for 15 days. The patient...

http://ift.tt/2D8YUti

An uncommon chronic osteochondral defect in the lateral tibial plateau detected after a separate injury

Osteochondral defects (OCD) are rare conditions that usually present in young adolescents. The causes include trauma, inflammation, ischaemia, genetics and changes at secondary ossification centres. The case report presents a 27-year-old man with chronic intermittent left knee pain for about 3 years. He typically develops the symptom after prolonged standing or when rising from a prolonged seated position. An initial MRI scan in 2014 did not identify and report an OCD that was present in his left lateral tibial plateau. It was only after an accidental tibial fracture injury this year that the defect was incidentally detected on a scan. OCD can be staged based on MRI and/or arthroscopic findings. The treatment can be either non-operative or operative, but this largely depends on the age of the patient, the severity of symptoms and the staging of the defect.

http://ift.tt/2FisvGG

Uncommon cause of dysphagia: paraneoplastic achalasia

Achalasia secondary to underlying neoplasm is a rare entity. Early recognition of secondary achalasia is important as its treatment involves management of underlying malignancy, while treatment of primary achalasia mainly involves lowering the lower oesophageal sphincter pressure with pneumatic dilatation or Heller's myotomy. We discuss an interesting case of achalasia secondary to non-Hodgkin's lymphoma.

http://ift.tt/2FmFx1W

Consistency of electronic measurements of endodontic working length when using multiple devices from the same manufacturer—an in vitro study

Abstract

Objectives

To assess the consistency of electronic determination of endodontic working length obtained from four identical electronic root canal length measurement devices (ERCLMD) from five different types of ERCLMD each under various in vitro conditions.

Materials and methods

Eight extracted teeth, seven single-rooted teeth, and one molar were accessed. Root length was measured and instruments were inserted and fixed with the tip placed beyond and short of the apical constriction, in roots with an artificial perforation or an open apex. Devices tested were Root ZX (Morita, Kyoto, Japan), Dentaport ZX (Morita), Apex ID (SybronEndo, Glendora, USA), ProPex II (Dentsply Maillefer, Victoria, Australia), and Raypex 6 (VDW-Antaeos, Munich, Germany). Teeth were irrigated with different solutions (NaOCl, EDTA, CHX). ERCLMDs were connected and measurements were recorded. Consistency was classified by the scores 0–4. Comparisons were carried out using the Kruskal-Wallis test (α = 0.05). For multiple testing, the level of significance was adjusted and analysis was performed using the Mann-Whitney U test.

Results

Among the five types of ERCLMD, Apex ID and Raypex 6 showed the highest consistency. There was no statistically significant difference between the settings and conditions. Raypex 6 showed the highest consistency for measurements in case of a perforation.

Conclusion

Different devices from one type of ERCLMD show a high consistency. Nevertheless, general statements on the accuracy of one type of ERCLMD taken from studies investigating only one device per type should be drawn with caution.

Clinical relevance

The study refers to the reliability and repeatability of determination of endodontic working length by using ERCLMDs.

http://ift.tt/2FuC2db

Intra-individual Comparison of Conventional and Digital PET/CT Scanners

Conditions:   Breast Cancer;   Lung Cancer;   Esophageal Cancer;   Miscellaneous Neoplasm
Intervention:   Diagnostic Test: Digital PET/CT scan
Sponsors:   Isala;   Philips Healthcare
Recruiting

http://ift.tt/2D859h8

Short-course of grass allergen peptides immunotherapy over three weeks reduces seasonal symptoms in allergic rhinoconjunctivitis with/without Asthma: A randomized, multicenter, double-blind, placebo-controlled trial

Abstract

Background

Immunotherapy with peptide hydrolysates from Lolium perenne (LPP) is an alternative treatment for seasonal allergic rhinitis with or without asthma. The aim of this study was to assess the clinical efficacy and safety of a cumulative dose of 170 μg LPP administered subcutaneously over 3 weeks.

Methods

In a randomized, double blind, placebo-controlled trial, 554 adults with grass pollen rhinoconjunctivitis were randomized (1:2 ratio) to receive 8 subcutaneous injections of placebo or 170 μg LPP administered in increasing doses in 4 visits over 3 weeks. The primary outcome was the combined symptom and medication score (CSMS) measured over the peak pollen season. Reactivity to conjunctival provocation test (CPT) and quality of life (QOL) were assessed as secondary endpoints.

Results

The mean reduction in CSMS in the LPP vs. placebo group was −15.5% (p=0.041) during the peak period and −17.9% (p= 0.029) over the entire pollen season. LPP treated group had a reduced reactivity to CPT (p<0.001) and, during the pollen season, a lower rhinoconjunctivitis QOL global score (p=0.005) compared to placebo group. Mostly mild and WAO grade 1 early systemic reaction (ESR) were observed ≤ 30 min in 10.5% of LPP-treated patients, whereas 3 patients with a medical history of asthma (<1%) experienced a serious ESR that resolved with rescue medication.

Conclusion

LPP administered over 3 weeks before the grass pollen season significantly reduced seasonal symptoms, was generally safe and well-tolerated

This article is protected by copyright. All rights reserved.

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Oral spray containing plant-derived compounds is effective against common oral pathogens

Publication date: Available online 6 March 2018
Source:Archives of Oral Biology
Author(s): Wipawee Nittayananta, Surasak Limsuwan, Teerapol Srichana, Chutha Sae-Wong, Thanaporn Amnuaikit
ObjectivesPlant-derived compounds are a good source of therapeutic agents and inhibitors of inflammatory process. Dental caries, periodontal diseases and candidiasis are common oral infections caused by virulent biofilms. The objectives of this study were to develop oral spray containing plant-derived compounds; α-mangostin (α-MG) and/or lawsone methyl ether (2-methoxy-1,4-naphthoquinone) (LME) and determine its antimicrobial, anti-biofilm, and anti-inflammatory activities.DesignOral spray formulations were prepared containing α-MG (5 mg/ml) and/or LME (250 μg/ml). Antimicrobial activity against Candida albicans, Streptococcus mutans, and Porphyromonas gingivalis and anti-biofilm formation activities were determined as well as cytotoxicity and anti-inflammatory effects.ResultsThe oral spray demonstrated antimicrobial activity against all three of the oral pathogens tested with stronger effects on C. albicans and S. mutans than P. gingivalis. The formulation containing α-MG (2.5 mg/ml) and LME (125 ug/ml) reduced growth of the microorganisms about 1-2 Log CFU/ml at 1–3 h and the killing effects were complete at 24 h. Based on biofilm assay, the oral spray containing both α-MG and LME showed greater inhibitory effects than those with α-MG or LME. In addition, the oral spray containing both α-MG and LME demonstrated more inhibition of nitric oxide production than α-MG alone. All the formulations were safe and demonstrated greater anti-inflammatory activity at lower concentration (<6.25 μg/ml) than at a higher concentration.ConclusionOral spray containing α-MG and/or LME is effective against common oral pathogens without significant cytotoxicity. Thus, it has the potential to prevent the infections and may serve as adjunctive treatment to conventional therapy.



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Clinical presentation, assessment, and management of inducible laryngeal obstruction

Purpose of review Many aspects of inducible laryngeal obstruction (ILO) are still poorly understood. However, in recent years there have been advances made and an international consensus has achieved a standardized taxonomy. This review will synthesize recent research; specifically, relating to clinical presentation, assessment, and therapeutic interventions. Recent findings The evidence base is growing but still limited for ILO and mostly comprises retrospective reviews, case studies, and anecdotal reports. The proposed relationship between ILO and other manifestations of laryngeal dysfunction via laryngeal hypersensitivity and hyperresponsiveness warrants further investigation. Progress has been made with guidelines published on laryngoscopy reporting procedures and validated symptom questionnaires produced for clinical use, although diagnostic algorithms are yet to be established. Emerging conservative and surgical interventions show promise, although as yet there are no randomized controlled trials investigating treatment efficacy. Summary The field is in an embryonic state and key research priorities, acknowledged in the current literature, need to be addressed to positively impact patient care. Correspondence to Jemma Haines, Department of Respiratory Medicine, North West Lung Centre, Wythenshawe Hospital, Manchester University National Health Service Foundation Trust, Southmoor Road, Manchester M23 9LT, UK. E-mail: jemma.haines@mft.nhs.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Oral spray containing plant-derived compounds is effective against common oral pathogens

Publication date: Available online 6 March 2018
Source:Archives of Oral Biology
Author(s): Wipawee Nittayananta, Surasak Limsuwan, Teerapol Srichana, Chutha Sae-Wong, Thanaporn Amnuaikit
ObjectivesPlant-derived compounds are a good source of therapeutic agents and inhibitors of inflammatory process. Dental caries, periodontal diseases and candidiasis are common oral infections caused by virulent biofilms. The objectives of this study were to develop oral spray containing plant-derived compounds; α-mangostin (α-MG) and/or lawsone methyl ether (2-methoxy-1,4-naphthoquinone) (LME) and determine its antimicrobial, anti-biofilm, and anti-inflammatory activities.DesignOral spray formulations were prepared containing α-MG (5 mg/ml) and/or LME (250 μg/ml). Antimicrobial activity against Candida albicans, Streptococcus mutans, and Porphyromonas gingivalis and anti-biofilm formation activities were determined as well as cytotoxicity and anti-inflammatory effects.ResultsThe oral spray demonstrated antimicrobial activity against all three of the oral pathogens tested with stronger effects on C. albicans and S. mutans than P. gingivalis. The formulation containing α-MG (2.5 mg/ml) and LME (125 ug/ml) reduced growth of the microorganisms about 1-2 Log CFU/ml at 1–3 h and the killing effects were complete at 24 h. Based on biofilm assay, the oral spray containing both α-MG and LME showed greater inhibitory effects than those with α-MG or LME. In addition, the oral spray containing both α-MG and LME demonstrated more inhibition of nitric oxide production than α-MG alone. All the formulations were safe and demonstrated greater anti-inflammatory activity at lower concentration (<6.25 μg/ml) than at a higher concentration.ConclusionOral spray containing α-MG and/or LME is effective against common oral pathogens without significant cytotoxicity. Thus, it has the potential to prevent the infections and may serve as adjunctive treatment to conventional therapy.



http://ift.tt/2D74lJd

Abnormal lung function at preschool age – asthma in adolescence?

Publication date: Available online 6 March 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Katariina Lajunen, Satu Kalliola, Anne Kotaniemi-Syrjänen, Seppo Sarna, L. Pekka Malmberg, Anna S. Pelkonen, Mika J. Mäkelä
BackgroundAsthma often begins early in childhood. However, the risk for persistence is challenging to evaluate.ObjectiveThis longitudinal study relates lung function assessed with impulse oscillometry (IOS) in preschool children to asthma in adolescence.MethodsLung function was measured with IOS in 255 children with asthma-like symptoms aged 4-7 years. Baseline measurements were followed by exercise challenge and bronchodilation tests. At age 12-16 years, 121 children participated in the follow-up visit, when lung function was assessed with spirometry, followed by a bronchodilation test. Asthma symptoms and medication were recorded by a questionnaire and atopy defined by skin prick tests.ResultsAbnormal baseline values in preschool IOS were significantly associated with low lung function, the need for asthma medication, and asthma symptoms in adolescence. Preschool abnormal R5 at baseline (z-score ≥1.645 SD) showed 9.2 odds ratio (95%CI 2.7;31.7) for abnormal FEV1/FVC, use of asthma medication in adolescence, and 9.9 odds ratio (95%CI 2.9;34.4) for asthma symptoms. Positive exercise challenge and modified asthma-predictive index at preschool age predicted asthma symptoms and the need for asthma medication, but not abnormal lung function at teenage.ConclusionAbnormal preschool IOS is associated with asthma and poor lung function in adolescence and might be utilised for identification of asthma persistence.



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Contact dermatitis and patch testing for the allergist

Publication date: Available online 6 March 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Luz Fonacier, Irum Noor
ObjectiveContact dermatitis (CD) is a common disease seen by allergists. Although underutilized, patch testing (PT) remains the gold standard in the diagnosis of allergic CD. It is not difficult to perform, however, the interpretation of the PT, proper classification of the results and determination of their relevance, need an appropriate level of expertise. The objective of this article is to provide a review of CD and its key allergens and provide updates and recommendations for the practicing allergist.Data SourcesThrough the use of various scientific search engines (e.g., PubMed and Medline) we reviewed literature on CD, PT, key allergens, occupational dermatitis and treatment. Study Selections: Studies on CD, important allergens, and PT were considered.ResultsContact induced dermatitis may be due to allergic CD, irritant CD, systemic CD, contact urticaria and protein CD. Key allergens include metals (nickel, gold), topical medicaments (topical corticosteroids), and cosmetics and personal care products (fragrances and preservatives such as methyl- and methylchloro-isothiazolinone). Present relevance of a positive PT is the combination of definite, probable, and possible relevance and should be correlated with the patient's history and physical examination. Treatment of allergic CD includes identification of relevant allergens, patient education, avoidance and provision of alternative products the patient can use.ConclusionCD is a common inflammatory skin disease and should be suspected in patients presenting acute, subacute or chronic dermatitis. The gold standard for diagnosing allergic CD is PT. This article provides practical recommendations for the diagnosis and management of CD commonly seen by the allergist in their practice.



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Involvement of taste receptors in the effectiveness of sublingual immunotherapy

Publication date: Available online 6 March 2018
Source:Allergology International
Author(s): Minoru Gotoh, Osamu Kaminuma, Akihiro Nakaya, Kazufumi Katayama, Nobumasa Watanabe, Mayumi Saeki, Tomoe Nishimura, Noriko Kitamura, Kimihiro Okubo, Takachika Hiroi




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Author Guidelines

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Issue Information

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TIGIT expression levels on CD4+ T cells are correlated with disease severity in patients with psoriasis

Summary

Background

T-cell immunoglobulin and ITIM domain (TIGIT), a co-inhibitory receptor, suppresses CD4+ T-cell responses by triggering CD155. TIGIT shifts the balance of cytokines, including interferon (IFN)-γ, interleukin (IL)-10 and IL-17A, and affects the proliferation of CD4+ T cells.

Aim

To investigate TIGIT expression and its effects on CD4+ T-cell function in psoriasis.

Methods

In total, 28 patients with psoriasis vulgaris PV and 14 healthy controls (HCs) were enrolled. TIGIT expression on CD4+ T cells was evaluated by flow cytometry analysis and quantitative real-time PCR. Production of IFN-γ, IL-10 and IL-17 was measured with cytometry bead arrays, while CD4+ T cell proliferation was measured using a permeable assay.

Results

IGIT expression on CD4+ T cells and mRNA level were significantly lower in patients with PV compared with HCs. TIGIT expression was negatively correlated with Psoriasis Area and Severity Index. Activation of TIGIT with recombinant human CD155/Fc protein significantly inhibited psoriatic CD4+ T-cell proliferation, decreased production of IFN-γ and IL-17A, and increased IL-10. After blockade with a functional anti-human TIGIT antibody, TIGIT produced the opposite effect on IFN-γ and IL-17A, but had no significant effect on IL-10 or cell proliferation. Furthermore, the frequency of TIGIT+CD4+ T cells was significantly increased in patients with PV after 2 months of treatment with acitretin, with associated significant changes in IFN-γ, IL-10and IL-17A plasma levels.

Conclusions

Downregulation of TIGIT on CD4+ T cells may contribute to the pathogenesis of psoriasis, and activation of the TIGIT signalling pathway may be a potential therapeutic target.

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Geniposide prevents H2O2-induced oxidative damage in melanocytes by activating the PI3K–Akt signalling pathway

Summary

Background

Oxidative stress is one possible pathogenic event in vitiligo that induces melanocyte destruction. Geniposide exerts certain antioxidant effects on various cells by activating the phosphoinositol 3-kinase (PI3K)–Akt signalling pathway. However, researchers have not clearly determined whether geniposide protects human melanocytes from oxidative stress or identified the underlying mechanism of such protection.

Aim

To determine whether geniposide protects melanocytes from H₂O₂-induced oxidative damage and to explore the role of the PI3K–Akt signalling pathway in this protective effect.

Methods

The antioxidant effects of geniposide on human melanocytes were examined by measuring cell viability, apoptosis rates, reactive oxygen species (ROS) production and activities of the antioxidant enzymes superoxide dismutase (SOD) and catalase (CAT). We examined expression of Akt, phosphorylated Akt (p-Akt), Bcl-2, Bax, and cleaved caspase 3 and cleaved caspase 9 proteins to determine the involvement of the PI3K–Akt pathway.

Results

Pretreatment with geniposide 5, 25, 125 or 625 μmol/L increased cell viability and decreased the apoptosis rate of H₂O₂-treated melanocytes. In addition, geniposide enhanced the antioxidant activity of SOD and CAT, and decreased intracellular ROS accumulation. Furthermore, geniposide increased the levels of p-Akt and regulated the expression of downstream proteins in the PI3K–Akt pathway, such as Bcl-2, Bax, and cleaved caspase 3 and 9, in H₂O₂-treated melanocytes. Notably, these effects were largely blocked by treatment with LY294002 prior to H₂O₂ treatment.

Conclusions

Based on these results, geniposide protects human melanocytes from H₂O₂-induced oxidative damage, and the PI3K–Akt signalling pathway is involved in its antioxidant effect.

http://ift.tt/2G46UPC

Large gastric intramural hematoma mimicking a visceral artery aneurysm: a case report

Gastric hematoma is a rare disorder. Here we report a case of a large gastric intramural hematoma mimicking an impending rupture of a visceral artery aneurysm.

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Laparoscopic abdominoperineal resection for the treatment of a mucinous adenocarcinoma associated with an anal fistula

Abstract

Mucinous adenocarcinoma associated with an anal fistula is a rare oncologic entity which may pose diagnostic and therapeutic challenges for Surgeons and Medical Oncologists. Few reported cases without definite therapeutic guidelines exist. It represents 2–3% of all gastrointestinal malignancies and arises from chronic anal fistulas, ischiorectal or perianal abscesses. We report a case of perianal mucinous adenocarcinoma in a 65-year-old male initially surgically treated multiple times for a recurrent fistula in ano of 5 years duration. He presented with an ischiorectal and a perianal fistula. Incisional biopsy from fistulotomy revealed mucinous adenocarcinoma. Contrast enhanced computed tomography scan and magnetic resonance imaging showed a localized perianal growth of a tumor which was further evaluated with colonoscopy. With no evidence of metastasis, we performed a laparoscopic abdominoperineal resection (APR). Two years follow-up after APR and without adjuvant chemotherapy there is not any evidence of recurrence or distant metastasis.

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Peritoneal encapsulation as a cause of chronic recurrent abdominal pain in a young male

Abstract

This case report describes an otherwise well 20-year-old male who presented to hospital with vague, long-standing abdominal symptoms and was found to have peritoneal encapsulation.

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Surgical removal of fibrous axillary seroma pocket and closing of dead space using a lattisimus dorsi flap

Abstract

Seroma formation after axillary dissection is a common problem in breast cancer surgery. We report the case of a 68-year-old female with breast cancer who underwent a wide local excision and axillary clearance due to stage III breast cancer. Patient received post-operative whole breast irradiation therapy and developed a painful, infected seroma one month after surgery. This was treated with antibiotic therapy after which the infection subsided. One year after surgery patient presented with a painful persisting seroma in the left axilla. We decided to surgically treat the seroma by removing the fibrous seroma capsula and closing of the dead space with a latissimus dorsi flap. Six weeks after surgery, patient was pain and seroma free and was happy with the surgical result. Latissimus dorsi flap harvesting is an ideal way to treat persisting fibrous encapsulated seroma pockets after axillary clearance in the treatment of breast cancer.

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Analysis of psoriasis-relevant gene expression and exon usage alterations after silencing of SR-rich splicing regulators

Abstract

In our recent cDNA microarray experiment, three SR-rich splicing factors — SFRS18, PPIG and LUC7L3 — were shown to exert altered responsiveness upon T-lymphokine stimulation of psoriatic non-involved and healthy epidermis samples. We have also demonstrated that double silencing LUC7L3 and SFRS18 efficiently decreased production of the psoriasis-associated EDA+ fibronectin isoform. These findings prompted the further investigation of signaling pathways affected by LUC7L3 and SFRS18.

To detect gene expression and splicing pattern alterations upon double silencing of LUC7L3 and SFRS18 in an HPV-immortalized keratinocyte cell culture, paired-end RNA-Sequencing was carried out. Marked changes in exon usage were revealed, in contrast to the modest alterations detected in gene expression, providing a closer delineation of the potential targets of the examined splicing factors. The most prominent gene expression change was detected for IFI6, an interferon-inducible gene highly expressed in psoriasis. Interacting partners of IFI6 and certain psoriasis-associated transcripts also exhibited significantly increased expression upon silencing.

In addition to elevated abundance of the EDA+ fibronectin interactor ITGA5, we confirmed decreased EDA-domain inclusion, which agrees well with our prior experimental data. Furthermore, differential exon usage was established for the transcription element CREB1, along with HERC6 and CUL1, which are implicated in ubiquitination. Although immortalized keratinocytes express low levels of TINCR, a long non-coding RNA involved in terminal differentiation of keratinocytes, splicing alterations were successfully demonstrated for this RNA as well.

We believe that the targeted investigation of mRNA maturation disturbances may help us gain deeper insight into the molecular pathogenesis of psoriasis.

This article is protected by copyright. All rights reserved.

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Clinical presentation, assessment, and management of inducible laryngeal obstruction

Purpose of review Many aspects of inducible laryngeal obstruction (ILO) are still poorly understood. However, in recent years there have been advances made and an international consensus has achieved a standardized taxonomy. This review will synthesize recent research; specifically, relating to clinical presentation, assessment, and therapeutic interventions. Recent findings The evidence base is growing but still limited for ILO and mostly comprises retrospective reviews, case studies, and anecdotal reports. The proposed relationship between ILO and other manifestations of laryngeal dysfunction via laryngeal hypersensitivity and hyperresponsiveness warrants further investigation. Progress has been made with guidelines published on laryngoscopy reporting procedures and validated symptom questionnaires produced for clinical use, although diagnostic algorithms are yet to be established. Emerging conservative and surgical interventions show promise, although as yet there are no randomized controlled trials investigating treatment efficacy. Summary The field is in an embryonic state and key research priorities, acknowledged in the current literature, need to be addressed to positively impact patient care. Correspondence to Jemma Haines, Department of Respiratory Medicine, North West Lung Centre, Wythenshawe Hospital, Manchester University National Health Service Foundation Trust, Southmoor Road, Manchester M23 9LT, UK. E-mail: jemma.haines@mft.nhs.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Cardiac Arrest in the Operating Room: Part 2—Special Situations in the Perioperative Period Erratum

No abstract available

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Utilizing Patient E-learning in an Intervention Study on Preoperative Smoking Cessation

BACKGROUND: Patients who smoke put themselves at increased risk for serious surgical complications, yet it is not currently routine practice to educate patients about the risk of complications due to smoking. Computer-based smoking cessation programs are increasingly being utilized in the general population and may overcome some of the barriers such as lack of time, knowledge, and training to provide interventions. Our objective was to develop and implement a patient e-learning program designed for surgical patients as part of a multifaceted program aimed at assisting them to quit smoking and to determine the factors cross-sectionally and longitudinally associated with abstinence. METHODS: In this prospective multicenter study, smokers undergoing elective noncardiac surgery participated in a preoperative smoking cessation program consisting of a patient e-learning program, brief advice, educational pamphlet, tobacco quitline referral, letter to the primary care physician, and pharmacotherapy. The patient e-learning program described (1) the benefits of quitting smoking before surgery; (2) how to quit smoking; and (3) how to cope while quitting. The 7-day point prevalence (PP) abstinence on the day of surgery and at 1, 3 and 6 six months after surgery was separately assessed, and factors most associated with abstinence were identified using multivariable logistic regression analysis. Generalized estimating equation methods were used to estimate effect of the factors associated with abstinence longitudinally. The reach of the program was assessed with the number of smokers who participated in the program versus the number of patients who were referred to the program. RESULTS: A total of 459 patients (68.9% of eligible patients) participated. The 7-day PP abstinence at day of surgery, 1 month, 3 months, and 6 months was 22%, 29%, 25%, and 22%, respectively. The variables predicting abstinence at 6 months were use of pharmacotherapy (odds ratio [OR], 7.32; 95% confidence interval [CI], 3.71–14.44; P

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Retraction Notice

No abstract available

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Lack of Translatable Proinflammatory Cytokines in Cerebrospinal Fluid in Rats With Increased Hyperalgesia With or Without Fentanyl Treatment

No abstract available

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In Response

No abstract available

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In Response

No abstract available

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Complications of Regional Anesthesia, 3rd ed

No abstract available

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Perioperative Cardiac Arrest: Focus on Malignant Hyperthermia (MH) Erratum

No abstract available

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Monitoring the Nervous System for Anesthesiologists and Other Health Care Professionals, 2nd ed

No abstract available

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Usefulness of Basophil Activation Tests for Diagnosis of Sugammadex-Induced Anaphylaxis

BACKGROUND: Sugammadex is used to reverse the effects of neuromuscular blocking agents in many cases of general anesthesia. However, there are several reports of anaphylaxis after its use. Skin testing is the gold standard for detecting the causative agent of anaphylaxis. However, due to the lack of validated protocols for skin testing with sugammadex, the diagnostic accuracy might be inadequate. Recently, the basophil activation test (BAT) has been established as a tool to detect the causative agent of anaphylaxis with high sensitivity and specificity. However, few studies have investigated the utility of the BAT for sugammadex-induced anaphylaxis. METHODS: Eight patients who presented with immediate hypersensitivity to sugammadex during general anesthesia were included in this study. We conducted skin tests to confirm the diagnosis of sugammadex-induced anaphylaxis. Twenty-one sugammadex-naive individuals who had a negative skin test for allergy to this drug were enrolled as controls. Basophils were selected on a CD3−/CRTH2+ gate and labeled with CD63 and CD203c. RESULTS: The ratios of activated basophils in the patients were much higher than those in controls: the median values of areas under the curves in the patients and controls for CD203c were 1,265,985 (95% confidence interval [CI], 77,580–5,040,270) and 116,325 (95% CI, −268,605 to 232,690), respectively (Mann-Whitney U test, P

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Perioperative Management May Improve Long-Term Survival in Patients After Lung Cancer Surgery: A Retrospective Cohort Study

BACKGROUND: Surgical resection is the main treatment for patients with non–small–cell lung cancer (NSCLC), but patients' long-term outcome is still challenging. The purpose of this study was to identify predictors of long-term survival in patients after lung cancer surgery. METHODS: Patients who underwent surgery for NSCLC from January 1, 2006, to December 31, 2009, were enrolled into this retrospective cohort study. The primary outcome was the survival length after surgery. Predictors of long-term survival were screened with the multivariable Cox proportional hazard model. RESULTS: Postoperative follow-up was completed in 588 patients with a median follow-up duration of 5.2 years (interquartile range, 2.0–6.8). Two hundred ninety-one patients (49.5%) survived at the end of follow-up with median survival duration of 64.3 months (interquartile range, 28.5–81.6). The overall survival rates were 90.8%, 70.0%, and 57.1% at the end of the first, third, and fifth year after surgery, respectively. Limited resection (hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.08–1.98; P = .013) and large tumor size (HR, 1.29; 95% CI, 1.17–1.42; P

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Variability in Case Durations for Common Surgical Procedures

BACKGROUND: Under the Merit-based Incentive Payment System, physician payment will be adjusted using a composite performance score that has 4 components, one of which is resource use. The objective of this exploratory study is to quantify the facility-level variation in surgical case duration for common surgeries to examine the feasibility of using surgical case duration as a performance metric. METHODS: We used data from the National Anesthesia Clinical Outcomes Registry on 404,987 adult patients undergoing one of 6 general surgical or orthopedic procedures: laparoscopic appendectomy, laparoscopic cholecystectomy, laparoscopic cholecystectomy with intraoperative cholangiogram, knee arthroscopy, laminectomy, and total hip replacement. We constructed separate mixed-effects multivariable time-to-event models (survival analysis) for each of the 6 procedures to model surgical case duration. RESULTS: We identified performance outliers, based on surgical case duration, using 2013 data and then quantified the gap between high- and low-performance outliers using 2014 data. After adjusting for patient risk, patients undergoing surgery at high-performance facilities were between 54% and 79% more likely to exit the operating room (OR) per unit time compared to average-performing facilities, depending on the procedure. For example, patients undergoing a laparoscopic appendectomy at high-performance facilities were 68% more likely to exit the OR per unit time (hazard ratio, 1.68; 95% CI, 1.40–2.02; P

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