Παρασκευή 25 Μαΐου 2018
Biopsy Examination Validity Based on Narrow Band Imaging Guidance of Nasopharyngeal Carcinoma Suspected Patients
Abstract
The diagnosis of nasopharyngeal carcinoma (NPC) is established based on histopathological examination results of tumor tissue in nasopharynx and narrow band imaging (NBI) which is an imaging technique that utilizes specific displacement and light absorption characteristics of a specific wavelength. It has not known yet the validity of nasopharyngeal biopsy examination results based on NBI guidance and blind biopsy as a golden standard in establishing nasopharyngeal carcinoma diagnosis. Analyzing the validity of the nasopharyngeal biopsy examination results through NBI guidance and blind biopsy as a golden standard in nasopharyngeal carcinoma diagnosis. NPC patients performed biopsy using NBI then performed blind biopsy and the results of both examinations were analyzed. Histopathologic examination results of blind biopsy were 23 samples with NPC positive (52.3%) and 21 samples with NPC negative (47.7%). On histopathology examination using NBI guidance 34 samples (77.3%) were positive malignant cells and 10 samples (22.7%) were negative malignant cells. It was calculated and obtained the following results; sensitivity = 95.7%, specificity = 42.9%, positive predictive value = 64.7%, negative predictive value = 90.0%, and accuracy = 70%. Furthermore, statistical analysis using McNemar comparative test and Kappa association test were performed. In McNemar comparative test obtained p value = 0.003 and in Kappa association test obtained p value = 0.002. Histopathologic biopsy examination results using NBI guidance were only valid in stage IV NPC compared to blind biopsy.
https://ift.tt/2KVUzy4
Enhancing the effects of chemotherapy by combined macrophage-mediated photothermal therapy (PTT) and photochemical internalization (PCI)
Abstract
Light-based treatment modalities such as photothermal therapy (PTT) or photochemical internalization (PCI) have been well documented both experimentally and clinically to enhance the efficacy of chemotherapy. The main purpose of this study was to examine the cytotoxic effects of silica–gold nanoshell (AuNS)-loaded macrophage-mediated (MaNS) PTT and bleomycin BLM-PCI on monolayers of squamous cell carcinoma cells. The two modalities were applied separately and in simultaneous combination. Two different wavelengths of light were employed simultaneously, one to activate a highly efficient PCI photosensitizer, AlPcS2a (670 nm) and the other for the MaNS-mediated PTT (810 nm), to evaluate the combined effects of these modalities. The results clearly demonstrated that macrophages could ingest sufficient numbers of silica–gold nanoshells for efficient near infrared (NIR) activated PTT. A significant synergistic effect of simultaneously applied combined PTT and PCI, compared to each modality applied separately, was achieved. Light-driven therapies have the advantage of site specificity, non-invasive and non-toxic application, require inexpensive equipment and can be given as repetitive treatment protocols.
https://ift.tt/2IP9X2o
Biopsy Examination Validity Based on Narrow Band Imaging Guidance of Nasopharyngeal Carcinoma Suspected Patients
Abstract
The diagnosis of nasopharyngeal carcinoma (NPC) is established based on histopathological examination results of tumor tissue in nasopharynx and narrow band imaging (NBI) which is an imaging technique that utilizes specific displacement and light absorption characteristics of a specific wavelength. It has not known yet the validity of nasopharyngeal biopsy examination results based on NBI guidance and blind biopsy as a golden standard in establishing nasopharyngeal carcinoma diagnosis. Analyzing the validity of the nasopharyngeal biopsy examination results through NBI guidance and blind biopsy as a golden standard in nasopharyngeal carcinoma diagnosis. NPC patients performed biopsy using NBI then performed blind biopsy and the results of both examinations were analyzed. Histopathologic examination results of blind biopsy were 23 samples with NPC positive (52.3%) and 21 samples with NPC negative (47.7%). On histopathology examination using NBI guidance 34 samples (77.3%) were positive malignant cells and 10 samples (22.7%) were negative malignant cells. It was calculated and obtained the following results; sensitivity = 95.7%, specificity = 42.9%, positive predictive value = 64.7%, negative predictive value = 90.0%, and accuracy = 70%. Furthermore, statistical analysis using McNemar comparative test and Kappa association test were performed. In McNemar comparative test obtained p value = 0.003 and in Kappa association test obtained p value = 0.002. Histopathologic biopsy examination results using NBI guidance were only valid in stage IV NPC compared to blind biopsy.
https://ift.tt/2KVUzy4
Current status of sublingual immunotherapy for allergic rhinitis in Japan
Publication date: Available online 25 May 2018
Source:Allergology International
Author(s): Keisuke Masuyama, Tomokazu Matsuoka, Atsushi Kamijo
Japanese cedar pollen (JCP) and house dust mite (HDM) are two major allergens that cause allergic rhinitis (AR) in Japan and the prevalence of AR is increasing. Pharmacothearpy is a commonly used treatment, but the level of patient satisfaction is very low. Allergen immunotherapy (AIT) is the only therapeutic modality that provides not only symptom relief but also quality of life improvement that leads to a high rate of satisfaction. In particular, sublingual immunotherapy (SLIT) is a safe and effective treatment for AR. Here we introduce a large-scale double-blind, placebo-controlled trial of SLIT in Japanese patients using JCP droplets or HDM tablets conducted in Japan. The immediate future of SLIT in Japan is also discussed.
https://ift.tt/2LwFW5x
Prospective assessment of diagnostic tests for pediatric penicillin allergy, from clinical history to challenge tests✰,✰✰,✰✰✰
Diagnostic guidelines for penicillin allergy in children recommend cumbersome protocols based partially on data from adults, which may be suboptimal for pediatric use.
https://ift.tt/2J7fKQo
Oral diabetes medications other than dipeptidyl peptidase-4 inhibitors are not associated with bullous pemphigoid: a Finnish nationwide case control study
Dipeptidyl peptidase-4 inhibitor (DPP-4i) medication increases the risk of bullous pemphigoid. In this case control study from a Finnish patient registry, conventional oral anti-diabetic medications were not associated with increased risk of bullous pemphigoid. Diabetes medications other than DDP-4i may be safe to use in patients with bullous pemphigoid.
https://ift.tt/2IQzUuu
Successful ventilation through a Rüsch intubation guide catheter in severe laryngotracheal stenosis
Providing adequate ventilation may remain complex in patients with severe proximal laryngotracheal stenosis, especially when the airway is shared with the surgeon during tracheal resection surgery. We describe...
https://ift.tt/2GNzZ0l
The role of gastrointestinal permeability in food allergy
Source:Annals of Allergy, Asthma & Immunology
Author(s): Nazanin Samadi, Martina Klems, Eva Untersmayr
ObjectiveThe contribution of a dysfunctional intestinal barrier to the onset and progression of a variety of intestinal and extra-intestinal inflammatory diseases is well established. However, the role of the intestinal barrier function in food allergy is less evident.Data SourcesA MEDLINE search identified relevant studies investigating the role of intestinal permeability in food hypersensitivity.Study SelectionsThis review aimed at integrating cutting edge knowledge from different research fields with focus on the gastrointestinal barrier to evaluate its impact on food adverse reactions.ResultsThe different layers of the gastrointestinal barrier are responsible for separation of immunologically active food compounds from immune induction sites in the intestinal tract. In the intestinal lumen, commensals were revealed to induce enterocyte and immune cell maturation and formation of a tight epithelium, while the host immune response shapes microbiota composition. Located directly above the epithelium, the mucus layer forms a physical barrier preventing epithelial contact and mucus proteins were demonstrated to deliver antigen-specific tolerogenic stimuli to subepithelial innate immune cells. Moreover, the multiprotein complex sealing the intercellular space between epithelial cells forming a tight epithelial barrier was found to be influenced by allergic immune responses. However, not only intestinal barrier dysfunction, but also impaired gastric protein degradation was reported to contribute to food allergy. Gastric acid suppression by anti-ulcer medication was repeatedly described to induce food allergy and to facilitate food adverse reactions in already sensitized individuals.ConclusionsA functional gastrointestinal barrier is of paramount importance to prevent immunologically mediated food hypersensitive reactions.
https://ift.tt/2IMipjc
Prospective assessment of diagnostic tests for pediatric penicillin allergy, from clinical history to challenge tests✰,✰✰,✰✰✰
Publication date: Available online 25 May 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): María Dolores Ibáñez, Pablo Rodríguez del Río, Eva Maria Lasa, Alejandro Joral, Javier Ruiz-Hornillos, Candelaria Muñoz, Carmen Gómez Traseira, Carmelo Escudero, Jose María Olaguibel Rivera, Teresa Garriga-Baraut, David González-de-Olano, Ana Rosado, Silvia Sanchez-García, Socorro Pérez Bustamante, Maria Antonia Padial Vilchez, Patricia Prieto Montaño, Rocío Candón Morillo, Eva Macías Iglesia, Angélica Feliú Vila, Teresa Valbuena, Ana Lopez-Patiño, Antonio Martorell, Joaquín Sastre, María Teresa Audícana
BackgroundDiagnostic guidelines for penicillin allergy in children recommend cumbersome protocols based partially on data from adults, which may be suboptimal for pediatric use.ObjectiveTo assess the accuracy of tools for diagnosis of penicillin allergy in children.MethodsA prospective multicenter study was conducted in children with reported adverse events related to penicillin, excluding severe reactions. All patients underwent a uniform diagnostic protocol consisting of clinical history, skin tests, serum specific IgE, and, regardless of these results, drug provocation tests (DPT).Results732 children (mean 5.5 years; 51.2% males) completed the allergy work-up, including DPT. Amoxicillin triggered 96.9% of all reactions. None of the patients with an immediate index reaction (IR) developed a reaction on DPT. Penicillin allergy was confirmed in 35 subjects (4.8%): 6(17%) immediate and 29(83%) non-immediate reactions in the DPT. No severe reactions were recorded. The allergist diagnosis based upon the clinical history was not associated with the final outcome at DPT. In 30 of 33(91%) allergic patients, all skin tests and sIgE were negative. A logistic regression model identified the following to be associated with PNC allergy (p<0.05): a family history of drug allergy (OR=3.03; 95% confidence interval (CI): 1.33-6.89), an IR lasting >3 days vs ≤24 hours (OR=8.96; 95% CI: 2.01-39.86), and IR while receiving corticosteroids (OR=2.68; 95% CI: 1.30-5.54).ConclusionConventional predictors of allergy to penicillin performed weakly. The authors propose straightforward penicillin provocation testing in controlled, experienced centers for the diagnosis of non-severe penicillin allergy in children.
https://ift.tt/2s8Xgo6
The Efficacy of add-on Sublingual Immunotherapy for Adult Asthma patients: A Meta-analysis and Systematic Review
Source:Annals of Allergy, Asthma & Immunology
Author(s): Kan Xu, Zhi Deng, Dandan Li, Honglei Yuan, Cheng Liu, Zhihong Chen, Lei Zhu
https://ift.tt/2KUn3bi
Subcutaneous allergen immunotherapy may be a suitable treatment for exacerbator allergic asthma
Source:Annals of Allergy, Asthma & Immunology
Author(s): Flore AMAT, Lucile SESE, Marie HAYAT, Mélisande BOURGOIN-HECK, Jocelyne JUST
https://ift.tt/2LuX7En
Allergy and atopy from infancy to adulthood: Messages from the German birth cohort MAS,
Source:Annals of Allergy, Asthma & Immunology
Author(s): Susanne Lau, Paolo Maria Matricardi, Ulrich Wahn, Young Ae Lee, Thomas Keil
https://ift.tt/2KWYaMq
Dose counting and use of short-acting beta-agonist inhalers in emergency department patients with asthma exacerbation
Source:Annals of Allergy, Asthma & Immunology
Author(s): Sarah Kyuragi Luthe, Tadahiro Goto, Bradley E. Chipps, Daniel J. Pallin, Stanislav Stoyanov, Carlos A Camargo, Kohei Hasegawa
https://ift.tt/2J4cVzt
High-risk drug rashes
Publication date: Available online 25 May 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Sasha A. Alvarado, Diana Muñoz-Mendoza, Sami L. Bahna
ObjectiveProvide a brief overview of the clinical presentation, common offending agents, management, prognosis, and mortality of selected six high-risk drug rashes, namely Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), multiple drug hypersensitivity syndrome (MDH), acute generalized exanthematous pustulosis (AGEP), and drug-induced bullous pemphigoid (DIBP).Data sourcesReview of published literature using PubMed, supplemented with authors' clinical experience.Study selectionsThe most recent clinically relevant literature was chosen, as well as older seminal works.ResultsMost of the published data on these uncommon rashes was based on small observational series or case reports. SJS and TEN have specific genotypes association with certain drugs, have high morbidity and mortality, and require aggressive management by a team of multiple specialists. DRESS is a severe, prolonged multi-organ reaction, yet has a better prognosis than TEN. MDH is a syndrome of repeated reactions to unrelated drugs, often imposes diagnostic and management difficulties. AGEP consists of generalized sterile small pustules, usually mistaken for infection with subsequent inappropriate treatment. Bullous pemphigoid presents with tense pruritic bullae and characteristic linear basement membrane deposition of IgG and C3; DIBP has much better prognosis than the autoimmune variety.ConclusionIn such high-risk drug rashes, early recognition, immediate withdrawal of the suspected drug(s), prompt individualized management, and monitoring vital organs function are mandatory for reducing morbidity and mortality. The lack of reliable tests for identification of the causative agent imposes difficulty, particularly in patients receiving multiple medications.
https://ift.tt/2KTezkM
Cochlear implantation in patients with bilateral deafness caused by otitis media with ANCA-associated vasculitis (OMAAV): A report of four cases
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) without systemic symptoms but with initial symptoms related to the ear, such as hearing loss, otalgia, and dizziness, has recently been reported. We have categorized this condition as otitis media with AAV (OMAAV), and have recently proposed its diagnostic criteria.
https://ift.tt/2saIYnG
État scléreux révélant une porphyrie cutanée tardive
Publication date: Available online 24 May 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): A. Brunet, E. Hainaut
IntroductionLa porphyrie cutanée tardive (PCT) de type 1 est liée à une accumulation cutanée de porphyrines. Cette accumulation est due à un déficit en uroporphyrinogène décarboxylase strictement limité aux hépatocytes. Classiquement, elle se manifeste par une éruption bulleuse photo-distribuée.ObservationUne femme de 59 ans se présentait à la consultation de dermatologie pour des lésions scléreuses qui évoluaient depuis un an. Le reste de l'examen clinique et les explorations complémentaires n'orientaient pas vers une sclérodermie systémique. Le caractère photo-distribué des lésions conduisait à réaliser un dosage des porphyrines urinaires, qui étaient très élevées. Le taux sanguin d'uroporphyrinogène décarboxylase était en revanche normal, confirmant le diagnostic de PCT de type 1. La recherche d'une cause hépatique permettait de mettre en évidence une mutation hétérozygote H63D/C282Y du gène de l'hémochromatose. La patiente bénéficiait de saignées régulières, permettant une disparition complète de la sclérose cutanée.DiscussionLes lésions sclérodermiformes sont un mode de présentation inhabituel de la PCT, à l'origine de retards diagnostiques. L'accumulation d'uroporphyrines au niveau du derme stimulerait les fibroblastes, qui par la suite, synthétiseraient du collagène, expliquant la sclérose cutanée.BackgroundPorphyria cutanea tarda (PCT) is associated with cutaneous accumulation of porphyrins. This accumulation results from a deficiency of uroporphyrinogen decarboxylase occurring only in the liver. The classical presentation is blistering on sun-exposed areas.Patients and methodsA 59-year-old woman presented at the dermatology consultation for sclerotic lesions that had been present for one year. The remainder of the clinical examination and further investigations did not indicate systemic scleroderma. The sun-exposed nature of the lesions led us to perform an assay of urinary porphyrin, which was found to be elevated. Uroporphyrinogen decarboxylase levels were normal, confirming the diagnosis of type 1 PCT. Screening for a hepatic etiology revealed a heterozygous mutation H63D/C282Y of the hemochromatosis gene responsible for this clinical picture. The patient underwent regular bleeding, which led to complete disappearance of cutaneous sclerosis.DiscussionSclerodermatous lesions are an unusual presentation of PCT and cause delays in diagnosis. The accumulation of uroporphyrins in the dermis stimulates fibroblasts, which then synthesize collagen, resulting in cutaneous sclerosis.
https://ift.tt/2IKaZNb
Comment on the quantitative assessment of the learning curve for cleft lip repair using LC-CUSUM
I found the article by Segna et al. to be very interesting and applaud the authors on their concern for resident education1. The operating room is a poor place to learn techniques that can be taught prior to the actual surgical procedure as this allows the trainee to concentrate on the intraoperative aspects of their education and improves patient outcome. In cleft lip the correct determination of the landmarks is the most crucial step as everything follows this and an error here is compounded as the procedure proceeds.
https://ift.tt/2GQBDOx
Substance-induced anxiety disorder after one dose of 3,4-methylenedioxymethamphetamine: a case report
In this report, we describe a case of a patient with substance-induced anxiety disorder occurring after a single dose of 3,4-methylenedioxymethamphetamine. Furthermore, we describe the use and efficacy of the ...
https://ift.tt/2s8b1nH
Can you use Botox under your eyes?
Botox is often used to treat lines and wrinkles around the eyes and mouth. Can it also reduce dark circles or bags under the eyes? Using Botox under the eyes is not approved in the U.S. and researchers are unsure how well it may work and what side effects may occur. Here, learn about the procedure and its alternatives.
https://ift.tt/2KVnoKK
Type 2 diabetes detection based on serum sample Raman spectroscopy
Abstract
In this work, we propose to the Raman spectroscopy as a new technique for the detection of the type 2 diabetes using blood serum samples. The serum samples were obtained from 15 patients who were clinically diagnosed with type 2 diabetes mellitus and 20 healthy volunteers. The average spectra showed equally intense peaks as, 695 cm−1, the doublet of tyrosine at 828 and 853 cm−1, phenylalanine at 1002 and 1028 cm−1, the phospholipid shoulder at 1300–1345 cm−1, and proteins (amide I) at 1654 cm−1. The major differences were found at 661 and 1404 cm−1 (glutathione), 714 (polysaccharides), 605 (Phe), 545 cm−1 (tryptophan), and the shoulder of amide III at 1230–1282 cm−1, where seem to disappear in the diabetes spectrum. On the contrary, the region that is more highlighted due to that diabetes peaks are clearly more intense was 897–955 cm−1. Principal component analysis and linear discriminate analysis were employed for developing discrimination method. The first three principal components provided a classification of the samples from healthy and diabetes patients with high sensitivity and specificity. In addition, when the first principal component was plotted as a function of the Raman shift, it revealed these shifts accounted for the greatest differences between control and diabetes samples, which coincided with the shifts of spectral differences shown by mean spectra. Our results demonstrated that serum sample Raman spectroscopy promises to become a non-invasive support tool of the currently applied techniques for type 2 diabetes detection, decreasing the false-positive cases.
https://ift.tt/2kqLVwo
Successful ventilation through a Rüsch intubation guide catheter in severe laryngotracheal stenosis
Abstract
Background
Providing adequate ventilation may remain complex in patients with severe proximal laryngotracheal stenosis, especially when the airway is shared with the surgeon during tracheal resection surgery. We describe an effective alternative to standard endotracheal intubation using a Rüsch flexible intubation guide catheter.
Methods
In two patients undergoing tracheal repair surgery, we failed to insert a 5.0 inner diameter endotracheal tube (6.9 mm outer diameter) or a 6.0 mm outer diameter endoscope through the laryngotracheal stenosis. However, using indirect laryngoscopy, a 6.0 outer diameter Rüsch flexible intubation guide catheter was passed successfully through the vocal cords and then through the stenosis. Controlled ventilation was achieved by means of the Rüsch guide, provided with its two large Murphy's eyes. When the trachea was opened, the Rüsch guide was removed just enough for the surgeons to place a Montandon tracheal tube, at that point taking over ventilation. A 7.0 inner diameter endotracheal cuffed tube had been inserted onto the Rüsch guide and left pending upstream from the vocal cords. Once the posterior tracheal wall was sutured, this endotracheal cuffed tube was slid along the Rüsch guide through the vocal cords with the cuff placed beyond the tracheal sutures.
Results
Controlled ventilation through the Rüsch flexible intubation guide catheter showed satisfying and stable ventilatory parameters in both patients. Inspiratory pressures of 25–30 mmHg were enough to reach adequate tidal volumes around 450 ml. End tidal CO2 was kept between 35 and 40 mmHg (PaCO2 showed similar values). Standard endotracheal intubation at the end of the tracheal resection was easy and safe thanks to the Rüsch guide still in place between the vocal cords.
Conclusions
We suggest an effective and reliable method using a Rüsch flexible intubation guide catheter for airway management in patients suffering from laryngotracheal stenosis in the setting of tracheal repair surgery.
https://ift.tt/2s8jirY
Pediatric septoplasty and functional septorhinoplasty: A quality of life outcome study
Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Alexander Manteghi, Hena Din, Nour Bundogji, Shelby C. Leuin
ObjectiveThis study assessed disease-specific quality-of-life outcomes among pediatric patients undergoing septoplasty or functional septorhinoplasty. The Nasal Obstruction Symptom Evaluation (NOSE) score was obtained pre- and post-operatively. Additional analyses determined whether demographics, nasal trauma, prior nasal surgery, or allergic rhinitis history affected NOSE scores.MethodsPatients undergoing septoplasty or functional septorhinoplasty were evaluated prospectively at a tertiary children's hospital. NOSE scores were assessed pre- and post-operatively. Change in NOSE score was analyzed using the Wilcoxon Signed Rank test, while multiple regression analysis evaluated factors associated with NOSE score change.Results136 patients (mean age 15.7 ± 2.1 years) were evaluated; 52 (38.2%) underwent septoplasty while 84 (61.8%) underwent functional septorhinoplasty. Mean follow-up was 3.6 ± 5.1 months. There was a statistically significant decrease in NOSE score from pre-operative septoplasty and functional septorhinoplasty: median = 75 to post-operative septoplasty: median = 20 (z = −5.9, p < 0.001) and functional septorhinoplasty: median = 15 (z = −7.9, p < 0.001). Gender, age, nasal trauma, prior nasal surgery, and allergic rhinitis did not have a significant effect on NOSE score change for either group. Additional surgery at the time of procedure was not a confounding variable in the relationship between surgery type and NOSE score. A NOSE Scale reliability analysis demonstrated high internal consistency with Cronbach's α of 0.83 across septoplasty and functional septorhinoplasty patients.ConclusionThere was significant improvement in disease-specific quality-of-life in pediatric patients undergoing septoplasty or functional septorhinoplasty. Gender, nasal trauma, prior nasal surgery, and allergic rhinitis did not significantly affect NOSE scores in either group.
https://ift.tt/2IJBoLc
Prevalence of otitis media and risk-factors for sensorineural hearing loss among infants attending Child Welfare Clinics in the Solomon Islands
Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Annette Kaspar, Obiga Newton, Joseph Kei, Carlie Driscoll, De Wet Swanepoel, Helen Goulios
ObjectivesThe present study aimed to assess the prevalence of otitis media and risk-factors for sensorineural hearing loss among infants in the Solomon Islands, in order to recommend an Infant Ear and Hearing Program that would be suitable to the Pacific Island context.MethodsEar examinations and the JCIH Risk-Factor Questionnaire were administered to 288 infants attending Child Welfare Clinics in the Solomon Islands.ResultsOverall, 150 infants (52.084%) presented with bilateral normal ear examinations and no risk-factors for SNHL. There were 73 infants (25.34%) with ear pathology in at least one ear, 13 (4.5%) of whom required referral to the ENT Clinic for medical management. The most common pathology was otitis media with effusion (OME) (21.87%). Infants aged 7-12 months were significantly more likely to present with OME (p<0.001) and a history of otitis media (p=0.017) than infants aged 0-6 months. There were 71 infants (24.65%) with at least one risk-factor for sensorineural hearing loss. The most common risk-factors were ototoxicity (8.3%), non-elective caesarean delivery (6.59%), and possible in-utero syphilis infection (5.55%).ConclusionsThe prevalence of otitis media and risk-factors for sensorineural hearing loss indicate the importance of initiating Infant Ear and Hearing Programs in the Solomon Islands. Program should facilitate early education on prevention of ear disease, as well as early diagnosis and management of children with hearing loss.
https://ift.tt/2xbSlbN
Utilization of diagnostic testing for pediatric sensorineural hearing loss
Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Carissa J. Wentland, Evette A. Ronner, Razan A. Basonbul, Sandeep Pinnapureddy, Leila Mankarious, Donald Keamy, Daniel J. Lee, Michael S. Cohen
Background/ObjectiveSensorineural hearing loss is a common diagnosis among children. The diagnostic workup varies widely among practitioners. This study's aim was to assess the utilization of diagnostic testing for SNHL and determine the yield of each test.Study designRetrospective chart review.SettingTertiary care center.Subjects827 patients with a diagnosis of SNHL from January 1, 2011 to January 1, 2015.Results746 patients met inclusion criteria. Temporal bone imaging was performed on 561 (75%) of patients with 224 (40%) having positive results that explained the etiology of the SNHL. Congenital SNHL was more likely to be associated with abnormal imaging than acquired SNHL (109/299 versus 106/316 respectively) (p = 0.001). Unilateral SNHL was more likely to be associated imaging abnormalities than bilateral SNHL (101/221 and 123/340 respectively) (p = 0.028). Genetic testing was performed on 244 (33%) patients, of which 94 (39%) had abnormalities. Positive genetics results were more common with bilateral than unilateral SNHL (82/191 and 12/53 respectively) (p = 0.007). There was no statistically significant difference in the utility of genetic testing for congenital and acquired SNHL (p = 0.0836). Cytomegalovirus (CMV) testing was available for 104 (14%) of patients with 13 (12.5%) being positive and consistent with congenital CMV. Electrocardiogram, urinalysis, and Lyme titers were less useful.ConclusionsImaging and genetic testing had the highest yield in the evaluation of children with SNHL and were the most commonly performed. CMV testing was valuable in neonates who failed newborn hearing screening.
https://ift.tt/2LwfEQK
A Safety and Tolerability Study of INCAGN02385 in Select Advanced Malignancies
Conditions: Cervical Cancer; Microsatellite Instability (MSI)-High Endometrial Cancer; Gastric Cancer (Including Stomach and Gastroesophageal Junction [GEJ]); Esophageal Cancer; Hepatocellular Carcinoma; Melanoma (Uveal Melanoma Excluded); Merkel Cell Carcinoma; Mesothelioma; MSI-high Colorectal Cancer; Non-small Cell Lung Cancer (NSCLC); Ovarian Cancer; Squamous Cell Carcinoma of the Head and Neck (SCCHN); Small Cell Lung Cancer (SCLC); Renal Cell Carcinoma (RCC); Triple-negative Breast Cancer; Urothelial Carcinoma; Diffuse Large B-cell Lymphoma
Intervention: Biological: INCAGN02385
Sponsor: Incyte Biosciences International Sàrl
Not yet recruiting
https://ift.tt/2xfjlHu
Intervention: Biological: INCAGN02385
Sponsor: Incyte Biosciences International Sàrl
Not yet recruiting
https://ift.tt/2xfjlHu
Management of oral and maxillofacial infections in a regional unit: a seven day service?
Publication date: Available online 24 May 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Marta Cabral, Farhana T. Kapasi, Phillip Ameerally
The provision of a seven-day National Health Service (NHS) has been proposed as a means to halt the weekend delay in treatment that has been described in some studies. We tested the emergency services in the Oral and Maxillofacial Surgery Department at Northampton General Hospital to find out whether they provided a seven-day service. Data were collected prospectively and retrospectively for all patients admitted to the Oral and Maxillofacial Department at Northampton General Hospital with infections of the head and neck during a period of 29months (January 2014–May 2016). Duration of hospital stay and waiting time for operation were compared for weekday and weekend admissions to find out if there were changes in either outcomes or waiting times. The severity of infection between the two periods was also assessed using the serum C reactive protein (CRP) concentration as a marker. A total of 293 patients were admitted with head and neck infections, and the mean (range) duration of stay for those admitted on weekdays was 3 (1–14) days and for patients admitted at a weekend was 3 (1–17) days (p=0.14). However, the waiting times for operation were significantly longer during the week (mean (range) 0.6 (0–8) days) than at the weekend (0.5 (0–3) days, p=0.04). We know of no other published studies about provision of a seven-day service in oral and maxillofacial surgery. Our results show that we are already working to that standard, and this raises the question of whether any changes are required to current practice in the NHS, with their associated costs and upheaval.
https://ift.tt/2IJrrNQ
Ichthyosis molecular fingerprinting shows profound Th17-skewing and a unique barrier genomic signature
Publication date: Available online 24 May 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Kunal Malik, Helen He, Thy Nhat Huynh, Gary Tran, Kelly Mueller, Kristina Doytcheva, Yael Renert-Yuval, Tali Czarnowicki, Shai Magidi, Margaret Chu, Yeriel D. Estrada, Huei-Chi Wen, Xiangyu Peng, Hui Xu, Xiuzhong Zheng, James G. Krueger, Amy S. Paller, Emma Guttman-Yassky
BackgroundIchthyoses are a group of rare skin disorders lacking effective treatments. Although genetic mutations are progressively delineated, comprehensive molecular phenotyping of ichthyotic skin could suggest much-needed pathogenesis-based therapy.ObjectiveTo profile the molecular fingerprint of the most common orphan ichthyoses.MethodsGene, protein, and serum studies were performed on skin and blood samples from 29 patients (congenital ichthyosiform erythroderma/CIE, n=9; lamellar ichthyosis/LI, n=8; epidermolytic ichthyosis/EI, n=8; and Netherton syndrome/NS, n=4), as well as age-matched healthy controls (n=14), psoriasis (n=30), and atopic dermatitis/AD (n=16) patients.ResultsUsing fold-change>2 and false-discovery-rate<0.05 criteria, 132 differentially expressed genes/DEGs were commonly shared among all ichthyoses, including many IL-17 and TNFα co-regulated genes, considered hallmarks of psoriasis (DEFB4A, KYNU, VNN3). While striking up-regulation of Th17 pathway genes (IL17F, IL36B/G), resembling psoriasis, was common to all ichthyoses in a severity-related manner, NS showed greatest T-cell activation (ICOS) and a broader immune phenotype with Th1/IFNγ, OASL, and Th2/IL4R/IL5 skewing, albeit less than AD (all P<0.05). Ichthyoses lacked the epidermal differentiation and tight junction alterations of AD (LOR, FLG, CLDN 1), but showed characteristic alterations in lipid metabolism genes (ELOVL3, GAL), with parallel reductions in extracellular lipids and corneocyte compaction in all ichthyoses except EI, suggesting phenotypic variations. TEWL, a functional barrier measure, significantly correlated with IL-17-regulated genes (IL-17F, IL-36α/IL-36β/IL-36γ).ConclusionSimilar to AD and psoriasis where cytokine dysregulation and barrier impairment orchestrate disease phenotypes, psoriasis-like immune dysregulation and lipid alterations characterize the ichthyoses. These data support the testing of IL-17/IL-36-targeted therapeutics for ichthyosis patients, similar to psoriasis.
Teaser
DNA alterations are progressively understood in ichthyoses. However, comprehensive phenotyping could direct much-needed targeted therapeutics. Our molecular fingerprinting highlights IL-17/IL-36 responses and unique associated barrier alterations in ichthyoses, advocating for IL-17/IL-36-directed antagonism for these patients.https://ift.tt/2krieLz
Aspergillosis, Eosinophilic Esopagitis, and allergic rhinitis in STAT3 Haploinsufficiency
Source:Journal of Allergy and Clinical Immunology
Author(s): Mukil Natarajan, Amy P. Hsu, Michael A. Weinreich, Yuan Zhang, Julie E. Niemela, John A. Butman, Stefania Pittaluga, Janyce Sugui, Amanda L. Collar, Jean K. Lim, Tirdad Zangeneh, Tara Carr, Andrew J. Oler, Morgan Similuk, Lindsey B. Rosen, Jigar V. Desai, Alexandra F. Freeman, Steven M. Holland, Kyung J. Kwon-Chung, Joshua D. Milner, Michail S. Lionakis
Teaser
STAT3 haploinsufficiency caused by a novel STAT3 splice site mutation is associated with elevated IgE, allergic rhinitis, eosinophilic esophagitis, and invasive aspergillosis. This case expands our understanding of the spectrum of disease associated with STAT3 mutations.https://ift.tt/2xaLFKZ
Evaluation of complications and flap losses in mandibular reconstruction with microvascularized fibula flap
Abstract
The mandibular defects caused by mandibulectomies can involve esthetic and functional sequelae in patients. The fibula presents positive aspects and can be used as an option for mandibular reconstruction after tumor resections or extensive traumas. Furthermore, this retrospective study of the patients who have passed through a mandibular reconstruction with a microvascular fibular flap over the last 17 years describes the experience of the Oral and Maxillofacial SurgeryService at the ErastoGaertner Hospital, Curitiba/PR. The use of this flap type has a complication rate of 32.3%, which includes the fixation material exposure, flap resorptions, fistulas, pathological fractures, tumor recurrence, infections, seromas, and thrombocytopenia. Most of them are associated with patients who have received radiotherapy and/or chemotherapy. These data suggest a high frequency of complications when a reconstruction plate fixation is used. Minor complications are usual and they should not be overlooked because they can lead to devastating consequences.
https://ift.tt/2INEbyU
Calcifying odontogenic cyst, dentinogenic ghost cell tumor, and ghost cell odontogenic carcinoma: A systematic review
Journal of Oral Pathology &Medicine, EarlyView.
https://ift.tt/2Lsqkje
Efficacy of low-level laser therapy in management of recurrent herpes labialis: a systematic review
Abstract
Recurrent herpes labialis (RHL) is a highly prevalent viral infection that affects the oro-facial region. Current treatment options have limited efficacy in reducing healing time and recurrence rate of the disease. Recently, low-level laser therapy has been proposed as a potential treatment alternative for the management of RHL with no side effects. This systematic review aims to evaluate the effectiveness of laser therapy in the management and prevention of RHL. A comprehensive search of Medline/PubMed, Scopus, and Web of Science was carried out to identify published clinical trials comparing laser intervention to active and/or non-active controls for the treatment of RHL. Due to marked heterogeneity of available data, studies were assessed qualitatively, and no statistical analysis was performed. Of the retrieved 227 articles, six clinical trials met the eligibility criteria. The wavelengths, the power output, and energy density ranged between 632.5–870 nm, 5–80 W, and 2.04–48 J/cm2, respectively. All included studies found laser to be effective in the management and prevention of RHL, without any side effects. The findings of this review suggest that laser is potentially a safe and effective treatment alternative for the management of RHL. However, due to high variability in study designs and inconsistency in laser parameters among the included studies, more well-designed randomized clinical trials with standardized laser parameters are highly warranted.
https://ift.tt/2GPvC4M
Regulatory NK1.1 − CD4 + NKG2D + subset induced by NKG2DL + cells promotes tumor evasion in mice
Abstract
Regulatory T cells play critical roles in self-tolerance and tumor evasion. CD4+NKG2D+ cells with regulatory activity are present in patients with NKG2DL+ tumors and juvenile systemic lupus erythematosus. We previously showed that TGF-β-producing CD4+NKG2D+ T cells are present in pCD86-Rae-1ε transgenic mice. Here, we performed both ex vivo and in vivo studies on pCD86-Rae-1ε transgenic mice and an MC38 tumor-bearing mouse model and show that NK1.1−CD4+NKG2D+ T cells have regulatory activity in pCD86-Rae-1ε transgenic mice. Furthermore, this T-cell subset was induced in mice transplanted with NKG2DL+ tumor cells and produced TGF-β and FasL, and secreted low amounts of IFN-γ. This T-cell subset downregulated the function of effector T cells and dendritic cells, which were abolished by anti-TGF-β antibody. In vivo, adoptive transfer of NK1.1−CD4+NKG2D+ T cells promoted TGF-β-dependent tumor growth in mice. We further found that ex vivo induction of NK1.1−CD4+NKG2D+ T cells was dependent on both anti-CD3 and NKG2DL stimulation. Furthermore, regulatory NK1.1−CD4+NKG2D+ T cells did not express Foxp3 or CD25 and expressed intermediate levels of T-bet. Western-blotting showed that STAT3 signaling was activated in NK1.1−CD4+NKG2D+ T cells of MC38 tumor-bearing and pCD86-Rae-1ε transgenic mice. In conclusion, we describe a regulatory NK1.1−CD4+NKG2D+ T-cell population, different from other regulatory T cells and abnormally elevated in pCD86-Rae-1ε transgenic and MC38 tumor-bearing mice.
https://ift.tt/2Lo5mlH
Evaluation of complications and flap losses in mandibular reconstruction with microvascularized fibula flap
Abstract
The mandibular defects caused by mandibulectomies can involve esthetic and functional sequelae in patients. The fibula presents positive aspects and can be used as an option for mandibular reconstruction after tumor resections or extensive traumas. Furthermore, this retrospective study of the patients who have passed through a mandibular reconstruction with a microvascular fibular flap over the last 17 years describes the experience of the Oral and Maxillofacial SurgeryService at the ErastoGaertner Hospital, Curitiba/PR. The use of this flap type has a complication rate of 32.3%, which includes the fixation material exposure, flap resorptions, fistulas, pathological fractures, tumor recurrence, infections, seromas, and thrombocytopenia. Most of them are associated with patients who have received radiotherapy and/or chemotherapy. These data suggest a high frequency of complications when a reconstruction plate fixation is used. Minor complications are usual and they should not be overlooked because they can lead to devastating consequences.
https://ift.tt/2INEbyU
Primary adrenal diffuse large B cell lymphoma: a clinicopathological and molecular study from China
Abstract
Primary adrenal lymphoma is a rare entity that, in most cases, is derived from B cells. The most commonly seen primary adrenal lymphoma is diffuse large B cell lymphoma (DLBCL). To better understand the clinicopathological and molecular features of these tumors, we studied 14 Chinese patients with DLBCL who initially presented with an adrenal tumor. The clinicopathological features of the 14 primary adrenal DLBCL cases were retrospectively reviewed using immunohistochemistry, immunoglobulin gene rearrangement analysis, evaluation of Epstein-Barr virus status, and fluorescence in situ hybridization. Patient age ranged from 43 to 69 years, with a mean age of 58 years. The patients most commonly presented with abdominal pain and adrenal mass. Ten patients exhibited bilateral adrenal masses, and four had unilateral adrenal masses (three left, one right). Thirteen of 14 DLBCLs were DLBCL not otherwise specified, and one was an intravascular large B cell lymphoma. According to the algorithm of Hans et al. (Blood 103:275–282, 2004), 13 and 1 cases were classified as the non-germinal center B-cell-like subtype and the germinal center B-cell-like subtype, respectively. The Ki-67 index ranged from 35 to 80%. Epstein-Barr virus-encoded RNA was detected by in situ hybridization in 6 of the 12 available cases. Two patients showed BCL-6 rearrangements. The follow-up period ranged from 1 to 87 months. During the follow-up period, four patients died of the disease, five were alive with the disease, four were alive without disease, and one was lost during the follow-up period. In summary, most primary adrenal lymphomas are non-germinal-center B-cell-like subtype DLBCLs, which have high proliferative activity and a poor prognosis.
https://ift.tt/2xaBOoy
When your patient's parent asks: “My child's alopecia areata is not getting better. Should he or she get tested for celiac disease?”
Pediatric Dermatology, EarlyView.
https://ift.tt/2x8hNPr
“To screen or not to screen”: Comparing the health and economic benefits of early peanut introduction strategies in five countries
Allergy, EarlyView.
https://ift.tt/2GLT1UQ
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