Editorial Board

Publication date: June 2018
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 29, Issue 2





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Clinical comparison of liquid-based and conventional cytology of oral brush biopsies: a randomized controlled trial

Exfoliative cytology performed on oral brush samples can help dentists to decide, whether a given oral lesion is (pre-) malignant. The use of non-invasive brush biopsies as an auxiliary tool in the diagnosis o...

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A breath sound analysis in children with cough variant asthma

Publication date: Available online 29 May 2018
Source:Allergology International
Author(s): Mayumi Enseki, Mariko Nukaga, Hiromi Tadaki, Hideyuki Tabata, Kota Hirai, Masahiko Kato, Hiroyuki Mochizuki
BackgroundCough variant asthma (CVA) is characterized by a chronic cough and bronchial hyperresponsiveness without confirmation of wheezing. Using a breath sound analyzer, we evaluate the characteristics of breath sound in children with CVA.MethodsNine children with CVA (median age, 7.0 years) participated. The existence of breath sounds was confirmed by sound spectrogram. Breath sound parameters, the frequency limiting 50% and 99% of the power spectrum (F50 and F99), the roll-off from 600 to 1200 Hz (Slope) and spectrum curve indices, the ratio of the third and fourth area to the total area of the power spectrum (P3/PT and P4/PT) and the ratio of power and frequency at 50% and 75% of the highest frequency of the power spectrum (RPF75 and RPF50) were calculated before and after β2 agonist inhalation. A spirogram and/or forced oscillation technique were performed in all subjects.ResultsOn a sound spectrogram, wheezing was confirmed in seven of nine patients. All wheezing on the image was polyphonic, and they almost disappeared after β2 agonist inhalation. An analysis of the breath sound spectrum showed that PT, P3/PT, P4/PT, RPF50 and RPF75 were significantly increased after β2 agonist inhalation.ConclusionsChildren with CVA showed a high rate of inaudible wheezing that disappeared after β2 agonist inhalation. Changes in the spectrum curve indices also indicated the bronchial reversibility. These results may suggest the characteristics of CVA in children.



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Biochemical analysis and identification of linear B-cell epitopes from recombinant Sm21.7 antigen from Schistosoma mansoni

Publication date: September 2018
Source:Molecular Immunology, Volume 101
Author(s): Cíntia M.F. Rezende, Juliana B. Coitinho, Mariana Costa, Marina Rodrigues Silva, Mário Giusta, Roberta Oliveira-Prado, Rodrigo Corrêa-Oliveira, Ronaldo Nagem, Alfredo M. Goes
Schistosoma mansoni tegument is a dynamic host-interactive layer that is an essential source of parasite antigens and a relevant field for schistosome vaccine research. Sm21.7 is a cytoskeleton antigen found in S. mansoni tegument that engenders protection in experimental challenge infection. Because of its crucial role in the parasite tegument and its promising protective capability, Sm21.7 is an exciting target for the development of therapeutic strategies. The present study describes Sm21.7 structural and biophysical features using circular dichroism spectroscopy and identifies linear B-cell epitopes of Sm21.7 using in-silico methods and immunoassay. The Sm21.7 gene was cloned into the pETDEST42 vector, and the recombinant protein was overexpressed in Escherichia coli DE3. The soluble protein was purified by affinity chromatography followed by ion-exchange chromatography. Purified recombinant Sm21.7 was analyzed by circular dichroism spectroscopy which demonstrated that the rSm21.7 structure was comprised of approximately 38% α-helices and its conformation remains stable at temperatures of up to 60 °C. Prediction of rSm21.7 B-cell epitopes was based on amino acid physicochemical properties. Sixteen peptides corresponding to predicted epitopes were synthesized and immunoreactivity assessed by spot peptide array using pooled rSm21.7-immunized mice sera or patients' sera with different clinical forms of S. mansoni infection. Immunoassays revealed that sera from rSm21.7-immunized mice reacted predominantly with peptides located in the dynein-light chain domain (DLC) at the C-terminal region of rSm21.7. Comparative analysis of the antibody response of acute, intestinal and hepatosplenic patients' sera to the Sm21.7 peptides showed that a differential recognition pattern of Sm21.7-derived peptides by intestinal patients' sera might contribute to down-regulate the immune response in chronic intestinal patients. Together, the results may help the development of S. mansoni vaccine strategies based on the rSm21.7 antigen.



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Where Does Health Communication Technology Fit Into Allergy Practice?,

Publication date: Available online 29 May 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Bruce G. Bender




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When symptoms don’t fit: a case series of conversion disorder in the pediatric otolaryngology practice

Conversion disorder refers to functional bodily impairments that can be precipitated by high stress situations including trauma and surgery. Symptoms of conversion disorder may mimic or complicate otolaryngolo...

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The impact of chronic airway disease on symptom severity and global suffering in Canadian rhinosinusitis patients

Patients with Chronic Rhinosinusitis (CRS) can suffer from a significant decline in their quality of life. CRS patients have a high prevalence of comorbid conditions and it is important to understand the impac...

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Ablative fractional laser-assisted photodynamic therapy provides superior long-term efficacy compared to standard methyl aminolevulinate photodynamic therapy for lower extremity Bowen’s disease

Ablative fractional laser-assisted methyl aminolevulinate photodynamic therapy (AFL-MAL-PDT) has shown significantly higher efficacy and lower recurrence rates at 12 months than conventional methyl aminolevulinate photodynamic therapy (MAL-PDT) for the treatment of Bowen's disease (BD). However, long-term follow-up data are not available.

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Characterization of dermatitis after PD-1/PD-L1 inhibitor therapy and association with multiple oncologic outcomes: a retrospective case-control study

Cutaneous adverse events are common with Programmed Death (PD)-1/ PD-Ligand (L)1 inhibitors. However, the nature of the specific cutaneous adverse event of dermatitis has not been investigated across various PD-1/PD-L1 inhibitors. Oncologic outcomes potentially associated with dermatitis are not well characterized.

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A Step Toward Demystifying Melanomas of Unknown Primary Sites

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Management of primary cutaneous CD4+ small/medium pleomorphic T-cell lymphoma: A retrospective study

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The feasibility of an allergy management support system (AMSS) for IgE-mediated allergy in primary care

The allergy management support system (AMSS) was developed to assist general practitioners (GPs) to handle the increasing burden of allergic diseases and facilitates the diagnosis and management of allergy. Th...

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Efficacy of a glycopolymer-based oral rinse upon pain associated with ulcerative and erosive lesions of the oral mucosa: A within subject pilot study

Publication date: Available online 29 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Joel B. Epstein, Diplomate ABOM, Dana C. Villines, Shenda Baker
ObjectivesThe purpose of this pilot study was to assess the magnitude of effect for a new topical rinse that may impact oral soreness and function in ulcerative oral mucosal lesions.Study DesignTwenty-five consecutive patients with ulcerative/erosion lesion and moderate pain visual analogue pain score (VAS>4) rated their mouth and throat soreness and oral symptoms at baseline, 24, 48 and 72 hours after open-label use of a chitosan-based, non-anesthetic oral rinse (Synvaza®) at least twice per day. No changes in prior therapy including analgesics were allowed during the trial.ResultsAll measures of oral soreness decreased in severity from baseline to 72 hours and overall oral soreness decreased 28% (p<0.01). Oral soreness associated with talking decreased 67% (p<0.01), drinking 62% (p<0.01), swallowing 56% (p=0.04), sleeping 51% (p=0.02) and eating 50% (p<0.01). The product was rated favorably for texture, flavor, soothing relief, mouth feel and burning/stinging with use.ConclusionOral rinsing with the study product reduced mucosal pain without anesthetic effect and improved oral function.



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An MRI evaluation of the effects of qat chewing habit on the temporomandibular joint

Publication date: Available online 29 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Abeer A. Almashraqi, Eman A. Ahmed, Nashwa S. Mohamed, Esam S. Halboub
ObjectiveTo investigate the effects of qat chewing habit (QCH) on the temporomandibular joint (TMJ) using magnetic resonance imaging (MRI).Study designSixty subjects were included: a study group (SG, 40 qat chewers) and a control group (CG, 20 non-chewers). Based on QCH duration, the SG was subdivided into three subgroups: subgroup I (5-10 years), subgroup II (11-15 years), and subgroup III (>15 years). Data on QCH were recorded and a standardized clinical examination was performed. Bilateral oblique sagittal MRI sections were obtained to evaluate disc displacement, osteoarthritis (OA), and joint effusion (JE).ResultsClicking and pain were diagnosed in 72.5% and 65.0% of SG subjects, respectively. Significant differences were discovered between SG and CG in OA and JE (P=0.003 and 0.002, respectively). Regarding QCH duration, there were differences between subgroup II and subgroup III versus CG in OA (P=0.004 and 0.001, respectively) and the three subgroups versus CG in JE (P=0.026, 0.004, and 0.001, respectively). Significant correlations were found between OA and clicking (P=0.006) and muscle pain (P≤0.044), and between JE and TMJ pain (P=0.006) and muscle pain (P≤0.046).ConclusionsQCH may be a risk factor for TMJ disorders with high percentage of OA and JE.



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Combination therapy improves immune response and prognosis in patients with advanced oral mucosal melanoma: a clinical treatment success

Publication date: Available online 29 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Jing Zhang, Mei Yu, Xiaolong Li, Xiaofeng Huang, Hua Wang
ObjectiveThis study was undertaken to analyse the disease response and the immune response to assess treatment effectiveness and success in patients with advanced oral mucosal melanoma (OMM) treated with cytokines injection, cryosurgery and adoptive cell transfer therapy(ACT).Study designTen patients were enrolled, and the relevant characteristics and immunological differences were evaluated.ResultsAll patients achieved an objective clinical response according to the Response Evaluation Criteria in Solid Tumors, including seven cases of continuing complete remission (55, 27, 87⁺, 58⁺, 58⁺, 45⁺ and 37⁺ months) and three cases of partial remission (30, 12 and 9 months). Five responders are currently alive. After combination therapy, we observed that the proportion of CD3+ lymphocytes and the secretion of IFN-γincreased, while IL-10 decreased. In the assay of improved cytokine-induced killer cells (iCIKs), CD4+CD25+ Treg (regulatory T) cells declined and NK (nature killer) cells up-regulated. Meanwhile, the proliferation rate of in vitro cultured iCIKs improved after courses of therapy.ConclusionCombination therapy of Cytokine injection, cryosurgery and iCIKs transfer may be a promising approach for OMM patients in the future.



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A pilot study of the effects of a vacuum sealing barrier method for photostimulable phosphor plates regarding plate damage and prevention of microbiological cross-contamination

Publication date: Available online 29 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Ilkay Peker, Enver Peker, Adil Basman, Gulcin Akca, Mesut Enes Odabas, Nur Haciosmanoglu, Bulent Altunkaynak, Zuhre Akarslan
ObjectiveTo evaluate the effectiveness of a new sealing method for preventing cross-contamination of photostimulable phosphor (PSP) plates.Study designTwelve new PSP plates were divided into three groups (PSP-a, PSP-b, and PSP- c) and placed in three different barriers (two different brands of envelopes and a vacuum sealing method). All plates were exposed to x-rays with an aluminum step wedge and the images were evaluated for the presence of any artifacts. After radiography, the PSP plates were removed from the barriers. The barriers and the PSP plates were disinfected and cultured to assess any microorganism burden. Subsequently, the PSP plates were coated again with all barriers. The barriers were then contaminated and microbiological specimens were collected. Subsequently, the barriers were wiped with alcohol. The PSP plates were removed, and microbiological specimens were obtained.ResultsNo artifacts were recorded on the radiographic images on the sensors in any group. Microorganisms were detected on the PSP plates placed in envelopes. No colonization of microorganisms was detected on the vacuum sealed PSP plates.ConclusionsThe new vacuum-sealing method may be useful in preventing cross-contamination of PSP plates during radiographic procedures.



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A SIMPL application to assess oral medicine residents' performance and level of autonomy

Publication date: Available online 29 May 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Revathi Shekar, Brian C. George, Jordan D. Bohnen, Alessandro Villa
ObjectivesTo evaluate a smartphone application, SIMPL, to optimize faculty guidance and oral medicine residents' performance, and measure resident-faculty agreement for performance and supervision levels.Study DesignRaters used the 5-level "Performance" scale to assess resident's readiness for independent practice and 4-level Zwisch scale to assess faculty guidance, between June 2016 and June 2017. Junior residents were trainees with less than 18 months of training and senior residents had more than 18 months of training. Descriptive statistics were used to analyze supervision and autonomy. Performance and supervision agreement was estimated as percentage-agreement and measured using Kappa and 95% confidence intervals.ResultsA total of 660 evaluations were performed by six residents and six faculty members. Senior residents received higher performance scores compared to junior residents (p for trend < 0.01). In terms of complexity of cases and level of supervision, there were no significant differences between juniors and seniors (p=0.69 and p=0.39, respectively). Residents were "Practice Ready" or above for 80.0% cases. Residents received meaningful autonomy for 64.8% cases. Faculty-resident concordance was 86.1% for performance (with kappa of 0.77 [95%CI 66.1% to 87.6%]) and 92.4% for supervision (with kappa of 0.84 [95%CI 80% to 88]).ConclusionSIMPL can feasibly be used for real-time assessment of residents' performance and autonomy.



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Minimal Invasive Endoscopic Ear Surgery: A Two Handed Technique

Abstract

To evaluate the surgical outcome of two handed technique of endoscopic ear surgery with endoscope holder. Retrospective Non Randomized Clinical Study. A total of 547 endoscope holder (Justtach) assisted ear surgeries (331 cartilage tympanoplasties and 216 cholesteatoma surgeries) were operated with Justtach from July 2013 to April 2016 with a follow up period ranging from 12 to 45 months to evaluate its feasibility and results with the technique. The design of the endoscope holder, Justtach is described along with its functioning and maneuvering techniques. In the endoscopic tympanoplasty group, at 1 year follow up, the graft uptake was seen in 323 ears with three residual perforation and 5 recurrent perforations giving a success rate of 97.58%. At the 2 years follow up, the graft uptake was in 322 ears with 6 recurrent perforations and 3 residual perforations with a success rate of 97.28%. Whereas in case of endoscopic cholesteatoma surgery, there was residual cholesteatoma in 5 and recurrent in 6 out of 216 cases. The study reports the successful application and use of endoscope holder in two handed technique of endoscopic ear surgery.

Level of Evidence Level 4.

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Aural Atresia with Cholesteotoma and Its Management Strategies

Abstract

The term congenital aural atresia is used to describe failure of external auditory canal to open. Thus it results in conductive hearing loss. There are ways to improve the transmission of sound to the healthy inner ear, we have performed surgery to open the ear canal and restore the natural sound-conducting mechanism to the inner ear. Thus avoiding multiple surgeries. The study was conducted among patients aged between 12 and 24 years, our study included 8 patients with aural atresia with cholesteotoma. After a detailed examination of patients were subjected to surgery. In our study with the sample size of eight patients Where, all our patients underwent canal wall down mastoidectomy with simultaneous single stage reconstruction of ossicular chain. All our patients were discharge free and Had subjective improvement in hearing with the post operative period was well accomplished to < 35 dB. In our study all eight patients who underwent canal wall down mastoidectomy had good hearing outcome. As to avoid unnecessary recurrence and complications which are usually seen in intact canal wall down mastoidectomies, we suggest canal wall down and single stage reconstruction.

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Evaluation of a Dermoplasty Technique for the Control on Nasal Polyps

Abstract

To evaluate the efficacy of a dermoplasty technique in controlling nasal polyps comparing to the conventional endoscopic approach. Prospective observational study Tertiary private hospital. Twenty-nine patients underwent surgery for replacement of the middle meatus mucosa with skin. Some patients (41.4%) suffered from allergies, 44.8% from asthma, and 27.6% from aspirin intolerance. Polyps were staged according to the Lildholdt system, and patients completed a sino-nasal outcome test (SNOT-22) pre and post-operatively. Also, patients were interrogated as for medication relevant to the nose received pre and post-operatively. In twenty-six patients dermoplasty was applied in one nostril while the contralateral was treated with the conventional endoscopic technique allowing us to compare the two techniques in the same patient. Median follow-up period was 1.2 years (IQR 0.8, 2.0; range 0.4–5.8). Median drop in SNOT-22 score was 38.2 percentage units. Patients (79.3%) controlled symptoms by topical corticosteroids for 2.5–3 months per year at most. Seventy percent (70.8%) reported improvement in subjective olfaction. Results compare favorably to those reported in the literature after functional endoscopic approach. Lildholdt stage dropped post-operatively on both sides but significantly more (p value < 0.001) on the dermoplasty side comparing to the conventional endoscopic side. Dermoplasty appears to outbalance the conventional endoscopic removal of polyps and clearance of paranasal sinuses. No matter how extensive the removal of endonasal tissue, it is not sufficient for controlling nasal polyps unless mucosa is prevented from recovering the denuded areas by the use of a skin graft.

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Management of Unstable Middle Turbinate in Endoscopic Sinus Surgery

Abstract

To propose a simple technique for preservation, medialization and stabilization of the middle turbinate through a planned medial synechiae formation using suction electrocautery between middle turbinate and nasal septum. Study design is Case series. 150 cases of chronic rhino sinusitis who underwent ESS were selected and stabilization of the middle turbinate through a planned medial synechiae formation using suction electrocautery was done as last step and results studied. Adequate medialization was achieved in 141 cases with 94% success rate. This technique of medialization of middle turbinate through a planned medial synechiae formation using cautery between middle turbinate and nasal septum is simple, quick to perform, do not require any special or costly instrument, do not require any special training and thus can be easily done by beginners also and most importantly with good success rate and surgery outcome.

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Comparison of intravenous tramadol versus ketorolac in the management of postoperative pain after oral and maxillofacial surgery

Abstract

Background

The aim of this study was to assess the better postoperative analgesic, tramadol, and ketorolac, in patients with maxillofacial trauma and who had undergone maxillofacial surgery, i.e., open reduction internal fixation, under general anesthesia.

Materials and methods

After taking ethical approval from the institution and informed consent, 46 ASA grade I–II patients were block randomized (ABAB) based on inclusion and exclusion criteria and equally divided into two groups in which one group of patients was given intravenous tramadol 100 mg and another group of patients was given intravenous ketorolac 30 mg at the time of closure of skin and was repeated after 8 and 16 h following surgery. Pain using VAS at the 2nd, 4th, 6th, 12th, and 24th postoperative was assessed, and association of results was compared using Cramer's V test SPSS (Version 22). Vital signs and side effects were recorded.

Results

Although both drugs resulted in significant decrease in pain intensity from the 2nd to 24th postoperative hour, intravenous tramadol always resulted in better pain control than intravenous ketorolac at every postoperative hour (p value < 0.05) except at 2nd hour where changes are non-significant (p value > 0.05).

Conclusion

Apart from first 2 h where the changes are non-significant, this study clearly demonstrates the advantage of the intravenous tramadol in the management of postoperative pain and ease of administration in postoperative patient through IV cannula. The side effects of both the drugs were insignificant and did not have any effect on the result.

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Bi-modal radiofrequency treatment for coexisting neuralgia and neuropathy in adjacent divisions of the trigeminal nerve

Trigeminal neuralgia and deafferentation neuropathic pain, or trigeminal neuropathy, are different symptomatologies, rarely reported to present together. The case of a 65-year-old gentleman suffering from trigeminal neuralgia of the maxillary and mandibular division is reported. He first underwent an infraorbital neurectomy that was complicated by deafferentation neuropathic pain, whilst his mandibular neuralgia continued. He was treated successfully for both the neuropathic and neuralgic symptoms in the same session using ultra-extended euthermic pulsed radiofrequency treatment for the maxillary division (V2) and radiofrequency thermocoagulation for the mandibular division (V3).

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Accuracy of Le Fort I osteotomy in bimaxillary splint-based orthognathic surgery: focus on posterior maxillary movements

This retrospective study was performed to verify the accuracy of horizontal and vertical repositioning of the maxilla in bimaxillary osteotomy with a focus on posterior vertical displacement. Data from 39 orthognathic patients undergoing bimaxillary surgery including a one-piece Le Fort I osteotomy with pitch rotation and advancement at the University Hospitals of Leuven (Belgium), between January 2015 and April 2016, were included in the study. Preoperative and 1-week postoperative lateral cephalograms were digitized and imported into cephalometric software.

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Effect of curcumin on bone tissue in the diabetic rat: repair of peri-implant and critical-sized defects

This study determined the effect of curcumin on bone healing in animals with diabetes mellitus (DM). One hundred rats were divided into five groups: DM+PLAC, DM+CURC, DM+INS, DM+CURC+INS, and non-DM (CURC, curcumin; PLAC, placebo; INS, insulin). Critical calvarial defects were created and titanium implants were inserted into the tibiae. Calvarial defects were analyzed histometrically, and BMP-2, OPN, OPG, RANKL, Runx2, Osx, β-catenin, Lrp-5, and Dkk1 mRNA levels were quantified by PCR. The implants were removed for a torque evaluation, the peri-implant tissue was collected for mRNA quantification of the same bone-related markers, and the tibiae were submitted to micro-computed tomography.

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Response to the Letter to the Editor regarding “Quantitative assessment of the learning curve for cleft lip repair using LC-CUSUM”

We are very honoured by the interest elicited by our study about cleft surgery education1. Satisfactory surgical training for rare diseases is a tricky task to achieve, and many educational surgical tools, from animal models to in silico training, have been proposed in the literature2. Schendel et al. report their experience with a three-dimensional (3D) virtual simulator for training in cleft lip repair3,4. In the last few years much interest has arisen around the use of 3D modelling, virtual reality, augmented reality and 3D printing in the field of surgical education5.

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Minimally invasive orthognathic surgery: a systematic review

Minimally invasive techniques are currently applied in many oral and maxillofacial surgical procedures, including orthognathic surgery. A systematic review on the application of potentially minimally invasive procedures in orthognathic surgery was performed to provide a clear overview of the relevant published data. Articles in English on minimally invasive orthognathic procedures, published in the scientific literature, were obtained from the PubMed, Embase, and Cochrane Library databases, and an additional manual search (revised 31 December 2016).

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Temporary Increased Dose of Inhaled Corticosteroids in Yellow Zone, Does It Work?

Pediatric Allergy, Immunology, and Pulmonology, Ahead of Print.


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Surgical plate fixation of multiple rib fractures: a case report

The healthcare system in developing countries is limited; particularly, medical specialties such as emergency and trauma medicine are underdeveloped. Consequently, trauma injuries sustained in traffic accident...

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AI Beats Dermatologists on Skin Lesion Images

Artificial intelligence (AI) has again been shown to outperform specialists in the diagnostic arena, this time in the detection of both benign and malignant skin lesions.
Medscape Medical News

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Alignment of Parent- and Child-Reported Outcomes and Histology in Eosinophilic Esophagitis Across Multiple CEGIR Sites

Publication date: Available online 29 May 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Seema S. Aceves, Eileen King, Margaret H. Collins, Guang-Yu Yang, Kelley E. Capocelli, J. Pablo Abonia, Dan Atkins, Peter A. Bonis, Christina L. Carpenter, Evan S. Dellon, Michael D. Eby, Gary W. Falk, Nirmala Gonsalves, Sandeep K. Gupta, Ikuo Hirano, Kendra Kocher, Jeffrey P. Krischer, John Leung, Jessi Lipscomb, Paul Menard-Katcher, Vincent A. Mukkada, Zhaoxing Pan, Jonathan M. Spergel, Qin Sun, Barry K. Wershil, Marc E. Rothenberg, Glenn T. Furuta
BackgroundPatient-reported outcome (PRO) metrics for eosinophilic esophagitis (EoE) have been developed and validated but not used in a multicenter pediatric population or systematically aligned with histology.ObjectiveWe sought to understand 1) the potential of care-giver report to predict patient self-reported symptoms and 2) the correlation of PRO domains with histology.MethodsSubjects with EoE (n=310) and their parents participating in the Consortium of Gastrointestinal Eosinophilic Disease Researchers (CEGIR) observational clinical trial were queried for baseline patient symptoms and quality of life (QOL) using the Pediatric Eosinophilic Esophagitis Symptom Score version 2 (PEESSv2.0), Pediatric QOL EoE module (PedsQL-EoE) and biopsies were analyzed using the EoE histology scoring system (EoEHSS).ResultsPEESSv2.0 parent and child report aligned across all domains (r=0.68-0.73, p<0.001). PedsQL-EoE reports correlated between parents and children across ages and multiple domains (r=0.48-0.79, p<0.001). There was a tight correlation between symptoms on PEESS2.0 and their impacts QOL both on self and parent report (p<0.001). Self-reported symptoms on PEESSv2.0 (positively) and PedsQL-EoE (inversely) showed a weak correlation with proximal, but not distal, peak eosinophil counts and features and architectural tissue changes on EoEHSS (p<0.05).ConclusionsParents of children with EoE aged 3-18 years old accurately reflected their children's disease symptoms and QOL. Self- and parent-reported symptoms correlate with proximal esophageal histology. Our data suggest that parent report in young children can function as an adequate marker for self-reported symptoms and that self-reported symptoms may reflect changes in tissue histology in the proximal esophagus. These findings should be considered during clinical trials for drug development.Clinical Implications.Parent report provides an accurate surrogate marker for self-reported symptoms and QOL in pediatric EoE. Self-reported symptoms may gauge proximal esophageal histology. This should be considered in clinical trial design.

Teaser

This study shows that parent report correlates with pediatric self-report of EoE symptoms and quality of life and that self-reported symptoms correlate with histologic changes. Parent report should be considered as a self-report surrogate for future clinical trials.


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A Natural Killer T cell subset that protects against airway hyperreactivity

Publication date: Available online 29 May 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Ya-Ting Chuang, Krystle Leung, Ya-Jen Chang, Rosemarie H. DeKruyff, Paul B. Savag, Richard Cruse, Christophe Benoit, Dirk Elewaut, Nicole Baumgarth, Dale T. Umetsu
BackgroundInfection of suckling mice with influenza virus expands a CD4^-CD8^- double negative (DN) Natural Killer T (NKT) cell subpopulation that protects the mice as adults against allergen-induced airway hyperreactivity (AHR). However, this NKT cell subset has not been characterized and the underlying mechanisms of protection remain unknown.ObjectiveWe characterized this specific NKT cell subpopulation that developed during influenza infection in neonatal mice and that suppressed the subsequent development of AHR.MethodsA cell surface marker was identified by comparing the mRNA expression profile of WT CD4⁺ NKT cells with that of suppressive Vα14 DN NKT cells. The marker-enriched NKT cell subset was then analyzed for its cytokine profile and its suppressive in vitro and in vivo abilities.ResultsWe showed that DN NKT cells with high CD38 expression produced IFN-γ, but not IL-17, IL-4 or IL-13, and inhibited the development of AHR through contact-dependent suppression of helper CD4 T cell proliferation. The NKT subset expanded in the lungs of neonatal mice after infection with influenza and also after treatment of neonatal mice with Nu-α-GalCer, which effectively increased DN-CD38^hi NKT cell numbers.ConclusionThese results suggest that early/neonatal exposure to infection or antigenic challenge affects subsequent lung immunity by altering the cellular composition of cells in the lung, and that some subsets of NKT cells suppress AHR. These results provide a possible mechanism by which prior infections may protect against the development of allergic asthma and may be further explore as a protective measure for young children.

Graphical abstract

Teaser

A novel NKT cell subset expands in mice after influenza infection that prevents asthma. This mechanism, which explains the protective effects afforded by childhood environmental exposures, can be reproduced by treatments that activate NKT cells.


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Molecular allergy diagnostics refines characterization of children sensitized to dog dander

Publication date: Available online 29 May 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Ulrika Käck, Anna Asarnoj, Hans Grönlund, Magnus P. Borres, Marianne van Hage, Gunnar Lilja, Jon R. Konradsen
BackgroundSensitization to dog dander is an important risk factor for rhino-conjunctivitis and asthma, but not sufficient for diagnosing dog allergy. Molecular allergy diagnostics offers new opportunities for refined characterization.ObjectivesTo study the association between sensitization to all presently known dog allergen components and clinical symptoms of dog allergy in children, evaluated by nasal provocation testing.Methods60 children (age 10-18 years) sensitized to dog dander extract, went through nasal provocation testing with dog dander extract. Measurement of IgE to dog dander and to Can f 1, Can f 2, Can f 3 and Can f 5 was performed with ImmunoCAP and to Can f 4 and Can f 6 with Streptavidin ImmunoCAP. An IgE level ≥ 0.1 kUA/L was considered positive.ResultsThere was an association between sensitization to an increasing number of dog allergen components and a positive nasal challenge (p=0.01). Sensitization to lipocalins (OR 6.0, CI 1.04-34.5), in particular Can f 4 (OR 6.80, CI 1.84-25.2) and Can f 6 (OR 5.69, OR 1.59-20.8) was associated with a positive nasal provocation test.Mono-sensitization to Can f 5 was related to a negative nasal provocation test (OR 5.78, CI 1.01-33.0).ConclusionSensitization an increasing number of dog allergen components, as well as sensitization to lipocalins is associated with dog allergy. Mono-sensitization to Can f 5 should not primarily be regarded as a marker for dog allergy.

Graphical abstract

Teaser

Molecular diagnostics refines characterization of dog dander sensitized children. The clinical impact of sensitization to dog allergen components was here for the first time evaluated by nasal provocation testing with dog dander extract.


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Identification of Galectin-3 as an Auto-Antigen in IgG4-Related Disease

Publication date: Available online 29 May 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): Cory A. Perugino, Sultan B. AlSalem, Hamid Mattoo, Emanuel Della-Torre, Vinay Mahajan, Gayathri Ganesh, Hugues Allard-Chamard, Zachary Wallace, Sydney B. Montesi, Johannes Kreuzer, Wilhelm Haas, John H. Stone, Shiv Pillai
BackgroundThe antigenic trigger that drives the expansion of circulating plasmablasts and CD4⁺ cytotoxic T cells (CD4⁺ CTLs) in patients with IgG4-Related Disease (IgG4-RD) is presently unknown.ObjectiveWe sought to sequence Ig genes from single cell clones of dominantly-expanded plasmablasts and generate recombinant human monoclonal antibodies to identify relevant antigens in IgG4-RD using mass spectrometry.MethodsPaired heavy and light chain cDNAs from dominant plasmablast clones were expressed as monoclonal antibodies (mAbs) and used to purify antigens using immunoaffinity chromatography. Affinity-purified antigens were identified by mass spectrometry and validated by ELISA. Plasma levels of the antigen of interest were also determined using ELISAResultsmAbs expressed from the two dominant plasmablast clones of a patient with multi-organ IgG4-RD stained human pancreatic tissue sections. Galectin-3 was identified as the antigen specifically recognized by both mAbs. Anti-galectin-3 autoantibody responses were predominantly of the IgG4 isotype (28% of the IgG4-RD cohort, p = 0.0001) and IgE isotype (11% of IgG4-RD cohort, p = 0.009). No significant responses were seen from the IgG1, IgG2 or IgG3 isotypes. IgG4 anti-galectin-3 autoantibodies correlated with elevated plasma galectin-3 levels (p=0.001), lymphadenopathy (p=0.04), total IgG elevation (p=0.05), and IgG4 elevation (p=0.03).ConclusionAffinity chromatography using patient-derived monoclonal antibodies identifies relevant auto-antigens in IgG4-RD. IgG4 galectin-3 autoantibodies are present in a subset of IgG4-RD patients and correlate with galectin-3 plasma levels. The marked elevations of circulating IgG4 and IgE observed clinically are, at least in part, due to the development of IgG4 and IgE specific autoantibody responses.

Teaser

Using dominantly-expanded plasmablast clones, we have identified IgG4 and IgE anti-galectin-3 autoantibodies in IgG4-RD, which correlate with IgG4 levels, lymphadenopathy and over-expression of galectin-3.


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Study of Proton SBRT and Immunotherapy for Recurrent/Progressive Locoregional or Metastatic Head and Neck Cancer

Condition:   Head and Neck Cancer
Interventions:   Radiation: Proton Stereotactic Body Radiation Therapy (SBRT) (5 fractions; 3500-4500 cGy);   Radiation: Proton Stereotactic Body Radiation Therapy (SBRT) (3-5 fractions; various dose and fractionation regimens depending on treatment site).;   Drug: Nivolumab 3 mg/kg IV q2 weeks;   Radiation: Proton or Photon SBRT (3-5 fractions; various dose and fractionation regimens depending on treatment site).
Sponsor:   Mayo Clinic
Not yet recruiting

https://ift.tt/2L6ZKeK

A Phase Ib Trial of Cabozantinib in Combination With Durvalumab (MEDI4736) in Previously Treated Patients With Advanced Gastroesophageal Cancer and Other Gastrointestinal (GI) Malignancies (CAMILLA)

Conditions:   Gastric Cancer;   Esophageal Adenocarcinoma;   Hepatocellular Carcinoma;   Colorectal Cancer
Interventions:   Drug: Cabozantinib;   Drug: Durvalumab
Sponsors:   Anwaar Saeed;   AstraZeneca;   Exelixis
Not yet recruiting

https://ift.tt/2Je5tSn

Radiotherapy Concurrent With Apatinib in Advanced Soft Tissue and Bone Sarcomas of Head and Neck--RASS Study

Conditions:   Soft Tissue and Bone Tumor;   Head and Neck Cancer;   Sarcoma
Intervention:   Drug: Apatinib Mesylate
Sponsor:   Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University
Not yet recruiting

https://ift.tt/2L5l1W4

Dose Constraints for the Temporal Lobes of Intensity-modulated Radiotherapy Treatment Plans for Nasopharyngeal Carcinoma

Condition:   Injury; Temporal Region
Intervention:   Radiation: IMRT
Sponsors:   Jiangxi Provincial Cancer Hospital;   Sixth Affiliated Hospital, Sun Yat-sen University
Not yet recruiting

https://ift.tt/2ISMBcy

Reducing the exposure of the tonsillar fossa does not impact postoperative pain levels in children undergoing tonsillectomy: A double-blind randomized controlled trial

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Marco Aurélio Fornazieri, Edson Satoshi Miyazato, Henrique Massamiti Yamamoto, Paulo de Lima Navarro, Fábio de Rezende Pinna, Richard Louis Voegels
BackgroundIt is not established whether reducing the exposure of the tonsillar fossa would be an effective strategy for postoperative pain relief among the pediatric population submitted to tonsillectomy. We assessed the impact of closing this region using absorbable sutures on pain, on the resumption of normal diet and on the healing process until seven days after surgery.MethodsRandomized, double-blind, controlled trial comparing postoperative pain in 132 children between the ages of 5 and 12 years undergoing tonsillectomy having bilateral closure, unilateral closure or non-closure of the tonsillar fossa.ResultsNo differences in pain levels were reported both at discharge and on postoperative day 7. The day of resumption of normal diet was similar in all patients. Less granuloma and edema of the uvula were noted in patients with non-closure of the tonsillar fossa.ConclusionThese results showed that reducing the exposure of the tonsillar fossa after the removal of the palatine tonsils was not an effective method for postoperative pain relief in children. Moreover, its closure was associated with slower healing.



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Infection of the spheno-occipital synchondrosis: A morbid complication following adenoidectomy

Publication date: August 2018
Source:International Journal of Pediatric Otorhinolaryngology, Volume 111
Author(s): Amy E. Wagenaar, David M. Mirsky, Nicholas V. Stence, Todd M. Wine, Kenny H. Chan
Two 2-year-old males presented post-operatively following adenoidectomy with persistent fever and neck stiffness. After multiple office visits, both patients were admitted and found to have a widened spheno-occipital synchondrosis and other imaging findings indicative of skull base osteomyelitis. Treatment with antibiotics allowed for recovery with good long-term outcomes. Infection involving the spheno-occiptal synchondrosis is rare and its circuitous presentation of these two children no doubt led to delayed diagnosis.



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Evaluation of two internal fixation techniques for mandibular parasymphyseal fractures comparing conventional titanium miniplates with customised titanium CRB omega miniplates: a prospective study

Publication date: Available online 28 May 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): C.R. Bande, K.R. Kurawar, A. Mishra, A. Joshi, M. Goel, M.R. Mahajan
Our aim was to compare the efficacy and outcome of customised, titanium, CRB (Chandrashekhar Rushiji Bande), omega miniplates with those of conventional titanium miniplates in the management of parasymphyseal fractures of the mandible, with or without involvement of the mental nerve, after clinical and radiographic evaluation. A total of 252 parasymphyseal fractures in 200 patients were selected for the study over the period of seven years (January 2010–January2017) and divided randomly into two groups. The first group included 126 fractures treated with two conventional titanium miniplates (conventional group) and the second 126 fractures treated with one customised, titanium, CRB, omega miniplate (customised group). All operations were done by the same surgeon. Duration of operation (from placement of incision to closure of the defect) was recorded. Postoperative paraesthesia, infection, and acceptability of the plate to patients were also recorded. Postoperative healing was evaluated radiologically at one week and six months postoperatively. Operations were significantly shorter, and significantly fewer patients developed paraesthesia or infection, in the customised group. These patients were also happier with their miniplates, and had good radiological bony healing. In conclusion, a single customised, titanium, CRB, omega miniplate is an effective and economical alternative to two conventional titanium miniplates in the management of parasymphysis fractures of the mandible.



https://ift.tt/2smaIoJ

Cleft lip vermilion: below the red line

Publication date: Available online 28 May 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): M.Y. Mommaerts




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Enhanced chimeric antigen receptor T‐cell therapy: A novel approach for head and neck cancers

Oral Diseases, EarlyView.


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Chronic Rhinosinusitis in Children: Pathophysiology, Evaluation, and Medical Management

Abstract

Purpose of Review

Pediatric chronic rhinosinusitis (CRS) is a common disorder that carries significant morbidity. The diagnosis requires sinus symptoms that persist despite standard medical therapy greater than 3 months. Viral infections, allergies, and anatomic differences in children lead to chronic obstruction of the osteomeatal complex.

Recent Findings

Chronic rhinosinusitis as a diagnosis is a conglomeration of multiple phenotypes and endotypes. As such, the diagnosis and management are complex. New survey studies provide some consensus on prevalence and management of this disease in children.

Summary

In this review, we highlight the differential diagnosis of pediatric CRS, including non-eosinophilic/infectious variants, eosinophilic variants with and without nasal polyps, allergic fungal sinusitis, aspirin-exacerbated respiratory disease, primary immunodeficiency, and disorders of mucociliary clearance. Further, we detail treatment options that should be considered. Finally, we feature emerging potential treatment options of CRS, including anti-immunoglobulin E, interleukin-5, and interleukin-4 receptor alpha subunit.

https://ift.tt/2kwGbkz

Transwindow Suture Technique for Pseudocyst of Pinna

Abstract

Pseudocyst or seroma of the pinna is the accumulation of serous fluid between the perichondrium and cartilage of pinna. Though there are several surgical techniques in the treatment of seroma, recurrence is common. The aim and objective of this preliminary study is to present and discuss a novel technique of treating pseudocyst of pinna which is practiced at Karwar Institute of Medical sciences. A prospective study was done with a novel procedure "Transwindow suture technique" for the treatment of pseudocyst of pinna in four patients. Three of the four patients had a very good results without any recurrence. One patient had a small quantity of recollection due to premature closure of the skin window which was successfully corrected. In this preliminary study we had encouraging results in the treatment of pseudocyst of pinna. A large scale prospective study would demonstrate the effectiveness of this procedure.

https://ift.tt/2xojhFd

Editorial Board

https://ift.tt/2IUDaF7

Thoracic oesophageal cancer as a cause of stridor: a literature review

An 83-year-old woman, with a background of treated squamous cell oesophageal cancer, presented with a 3-week history of stridor. Of note, the patient had no risk factors for oesophageal cancer other than age. Clinical examination was unremarkable apart from stridor. Laboratory investigations, including arterial blood gas on room air, were unremarkable. Radiological examination revealed a 4.5x3.5x3.6 cm mass involving the posterior trachea and invading the tracheal orifice. Oesophagogastroduodenoscopy and rigid bronchoscopy confirmed an extensive tumour arising from the lower oesophagus and invading the trachea, causing 90% airway obstruction for a 6 mm length ending 1.5 cm above the carina. Biopsy revealed a poorly differentiated carcinoma with foci of squamous cell carcinoma. Unfortunately, the patient passed away 2 months after palliative tracheal stent placement.

https://ift.tt/2L3hmI9

Benign acute myositis in an adult patient

The benign acute childhood myositis presents as a marked and painful oedema of leg muscles in the days following a viral illness. This disease is often considered as occurring only in children. We report the case of a 32-year-old patient who presented with severe pain and oedema of both legs associated with motor deficit of lower extremities. He suffered from a grippal syndrome for 4 days. Creatine kinase blood level rose up to 39 394 IU/L (n<200) and a muscle biopsy of left tibialis anterior found necrosisand regeneration of myocytes without inflammatory infiltrates. All clinical and paraclinical abnormalities spontaneously disappeared in a few days. This case illustrates that a disorder similar to benign acute childhood myositis may occur in adult patients. Muscle biopsy might be avoided in typical cases because of the favourable evolution.

https://ift.tt/2LFRvHh

Keratinising squamous cell metaplasia: when is it safe to stop looking?

Keratinising squamous cell metaplasia (KSCM) is an uncommon diagnosis in the West. Patients typically present with lower urinary tract symptoms: haematuria (visible and non-visible), dysuria, urgency and frequency. Investigation is rigid cystoscopy. Abnormal bladder wall tissue should be resected and biopsies sent for histopathology to confirm KSCM. This is a preneoplastic condition with strong associations with squamous cell carcinoma. Due to a significant lag time, annual cystoscopy with multiple biopsies is recommended.

https://ift.tt/2L3hlE5

Acute non-cardiogenic pulmonary oedema due to contralateral pulmonary re-expansion after thoracentesis: an uncommon complication

Description 

An 82-year-old man presented with hypoxaemic respiratory insufficiency due to left-sided pneumonia and lung atelectasis, with a large, long-standing (>7 days) ipsilateral pleural effusion (figure 1A,B). Four hours after draining 1500 mL of transudative pleural fluid, the patient had worsening hypoxaemia and increasing supplemental oxygen necessity (fractional inspired oxygen 60% with high-flow face mask). The left lung had expanded, as noted by normal vesicular lung sounds, while diffuse crackles were exhibited on the right side. The chest radiograph (figure 1C) shows asymmetrical diffuse alveolar opacity in the right lung field, which in this setting relates to non-cardiogenic pulmonary oedema after contralateral pulmonary re-expansion. After 12 days of conservative treatment, the patient was well, his left lung was expanded and his right-sided oedema had completely resolved (figure 1D), with no need for supplemental oxygen.

Figure 1

(A) Chest X-ray showing a left-sided pneumonia and...

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Gastric duplication cyst with elevated CEA level: a case report

Abstract

Gastrointestinal tract duplications are congenital malformations rarely seen in adulthood. Gastric duplications (GD) represent 2–9% of it. Malignant transformation of GD is a rare complication described in the literature. We present the case of a 43-year-old man, who presented an abdominal mass and an elevated CEA level. A total gastrectomy was performed and the histological examination described a gastric duplication cysts (GDC) without malignant transformation. It is not the first case of elevation of CEA in GDC without evidence of malignancy described in the literature. Some authors think that GDC are premalignant lesions that envolve with the time to carcinomas. It is recommend that once the GDC is diagnosed to remove surgically the entire cyst even if the patient is asymptomatic.

https://ift.tt/2IUh1He

Bleb formation in small unruptured intracranial aneurysm as a predictor of early rupture

Abstract

Small unruptured aneurysms are thought to have a low risk of rupture, but the management of such lesions is still controversial. A 73-year-old man with a small anterior communication artery aneurysm, 4 mm in diameter, while on follow-up, developed an aneurysmal subarachnoid hemorrhage 2 weeks after the detection of a newly emerged bleb on the surface of the aneurysm. In conclusion, the formation of a bleb should be considered as a warning sign of an impending rupture, and treatment should be provided even for patients with small aneurysms.

https://ift.tt/2IUYtuo

Metastatic lobular breast carcinoma to the pancreas: a case report

Abstract

We report a case of a 72-year-old female, with an extensive breast cancer history, who presented with abdominal pain to her general practitioner. Cross-sectional imaging demonstrated a lesion in the head of pancreas, which was not amenable to curative resection. Percutaneous biopsy was obtained, which demonstrated metastatic lobular breast cancer. This rare case highlights how previous medical histories may assist in final pathological diagnosis.

https://ift.tt/2J055Ub

Pharmacobezoar—a rare case presented as gastric outlet obstruction

Abstract

BEZOARS are retained concretions of indigestible foreign material that accumulate and conglomerate in the gastrointestinal tract, most commonly in the stomach. Prevalence of bezoar is 0.4%. Bezoars are classified in four categories: phytobezoars; trichobezoars; pharmacobezoars; lactobezoars. A 58-year-old man admitted with complains of pain abdomen and recurrent vomiting since last 3 months. Upper GI endoscopic biopsy reported—chronic gastritis with very occasional non-caseating epitheloid granuloma in lamina propria, no evidence of neoplasia? Crohn's disease. Keeping Crohn's as diagnosis patient was given mesalamine 400 mg tid by gastrophyscian. But patient did not respond so the patient was advised surgical management. Repeat UGI endoscopy revealed multiple pills (mesalamine) in the stomach with gastric outlet obstruction (GOO). Around 40 pills were extracted with the help of flower basket, and then patient develope GOO and underwent Laparoscopic gastrojejunostomy and truncal vagotomy.

https://ift.tt/2LF04Cv

Rare case of bleeding nipple hemangioma in a lactating mother

Abstract

Hemangiomas of nipple of the breast are rare lesions and are limited to case reports in the literature. Such pathology in a lactating mother are clearly a hindrance preventing the child from breastfeeding with its benefits. We report a rare case of a bleeding nipple hemangioma in a 24 years old lactating mother with the clinical, imaging and histopathological findings.

https://ift.tt/2xom8OF

Biliary pancreatitis in a duplicate gallbladder: a case report and review of literature

Abstract

Duplicated gallbladder is a rare congenital anomaly that require special attentions due to its clinical, surgical and diagnostic difficulties. We present a case of a 39-year-old female patient with a duplicated gallbladder who presented with an acute biliary pancreatitis, a case to our knowledge is the first in the literature. A double gallbladder in an abdominal ultrasonography was doubtful, thus a computed tomography scan, a magnetic resonance cholangiopancreatography and an endoscopic retrograde cholangiopancreatography were done that confirmed the double gallbladder. A laparoscopic cholecystectomy with an intraoperative cholangiography was performed safely two months after the acute attack. The histopathological report revealed a Y-shaped type 1 double gallbladder according to the Harlaftis et al. classification.

https://ift.tt/2LEmQdM

Effects of Progressive Additional Lenses on Binocular Vision in Children with Pseudophakia

Binocular vision may be compromised in children after unilateral cataract surgery because the distances at which clear vision is present are different for the two eyes. We believe that wearing progressive additional lenses can be effective in improving the binocular vision in children with pseudophakia.
Case Rep Ophthalmol 2018;9:304–309

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Establishment of adoptive cell therapy with tumor infiltrating lymphocytes for non-small cell lung cancer patients

Abstract

Adoptive cell therapy (ACT) of tumor infiltration lymphocytes (TIL) yields promising clinical results in metastatic melanoma patients, who failed standard treatments. Due to the fact that metastatic lung cancer has proven to be susceptible to immunotherapy and possesses a high mutation burden, which makes it responsive to T cell attack, we explored the feasibility of TIL ACT in non-small cell lung cancer (NSCLC) patients. Multiple TIL cultures were isolated from tumor specimens of five NSCLC patients undergoing thoracic surgery. We were able to successfully establish TIL cultures by various methods from all patients within an average of 14 days. Fifteen lung TIL cultures were further expanded to treatment levels under good manufacturing practice conditions and functionally and phenotypically characterized. Lung TIL expanded equally well as 103 melanoma TIL obtained from melanoma patients previously treated at our center, and had a similar phenotype regarding PD1, CD28, and 4-1BB expressions, but contained a higher percent of CD4 T cells. Lung carcinoma cell lines were established from three patients of which two possessed TIL cultures with specific in vitro anti-tumor reactivity. Here, we report the successful pre-clinical production of TIL for immunotherapy in the lung cancer setting, which may provide a new treatment modality for patients with metastatic NSCLC. The initiation of a clinical trial is planned for the near future.

https://ift.tt/2kvptSF

Comparison of Duke Activity Status Index with cardiopulmonary exercise testing in cancer patients

Abstract

Purpose

The Duke Activity Status Index (DASI), a patient-administered questionnaire, is used to quantify functional capacity in patients undergoing cancer surgery.

Methods

This retrospective cohort study assessed whether the DASI was accurate in predicting peak oxygen consumption (pVO₂) that was objectively measured using cardiopulmonary exercise testing (CPET) in 43 consecutive patients scheduled for elective major cancer surgery at a tertiary cancer centre. The primary outcome measured the limits of agreement between DASI-predicted pVO₂ and actual measured pVO₂.

Results

The study population was elderly (median 63 years, interquartile range 18), 58% were male, with the majority having intraabdominal cancer surgery. Although the DASI scores were statistically related to the measured pVO₂ (N = 43, adjusted R² = 0.20, p = 0.002), both the bias (8 ml kg^− 1 min^− 1) and 95% limits of agreement (19.5 to − 3.4 ml kg^− 1 min^− 1) between the predicted and measured pVO₂ were large. Using some of the individual components, recalibrating the intercept and regression coefficient of the total DASI score did not substantially improve its ability to predict the measured pVO₂.

Conclusion

In summary, both the limits of agreement and bias between the measured and DASI-predicted pVO₂ were substantial. The DASI-predicted pVO₂ based on patient's assessment of their functional status could not be considered a reliable surrogate of measured pVO₂ during CPET for the population of patients pending major cancer surgery and cannot, therefore, be used as a triage tool for referral to CPET centres for objective risk assessment.

https://ift.tt/2kup2rI