Australasian Journal of Dermatology, EarlyView.
https://ift.tt/2lLCbgL
Κυριακή 1 Ιουλίου 2018
A retrospective analysis of surgical resection of large ear keloids
Histogram analysis of apparent diffusion coefficient maps for differentiating malignant from benign parotid gland tumors
Abstract
Purpose
To evaluate the diagnostic performance of histogram parameters derived from diffusion-weighted imaging (DWI) for differentiating malignant from benign parotid gland tumors compared with that of hotspot region of interest (ROI)-based apparent diffusion coefficient (ADC) measurement.
Methods
Our study retrospectively enrolled 60 patients with parotid gland tumors who had undergone DWI scan for pre-treatment evaluation. ADC measurements were performed using hotspot ROI (ADCHS-ROI)-based and histogram-based approach. Histogram parameters included mean (ADCmean), median (ADCmedian), 10th (ADC10), 90th (ADC90) percentiles, skewness and kurtosis of ADC. Mann–Whitney U test, Kruskal–Wallis test with post hoc Dunn–Bonferroni method and receiver operating characteristic (ROC) curve analyses were used for statistical analyses.
Results
ADCHS-ROI and ADC histogram parameters showed no significant differences between malignant and benign parotid gland tumors (All Ps > 0.05). Within the sub-group analyses, Warthin's tumors showed the lowest ADCHS-ROI, ADCmean, ADCmedian, ADC10 and ADC90 value, followed by malignant tumors and pleomorphic adenomas (All Ps < 0.05). ADC10 out-performed ADCHS-ROI in differentiating malignant tumors from pleomorphic adenomas (area under curve, 0.890 vs 0.821; sensitivity, 79.31 vs 82.76%; specificity, 90.91 vs 72.73%; P = 0.016), and improved the diagnostic performance in differentiating malignant tumors from Warthin's tumors (area under curve, 1.000 vs 0.965; sensitivity, 100.00 vs 90.91%), although the difference was not significant (P = 0.348).
Conclusions
ADC histogram analysis, especially ADC10, might be a promising imaging biomarker for characterizing parotid gland tumors.
https://ift.tt/2IJZlgn
Newborn Screening Saves Lives but Cannot Replace the Need for Clinical Vigilance
Newborn screening for cystic fibrosis (CF) enables early diagnosis and treatment leading to improved health outcomes for patients with CF. Although the sensitivity of newborn screening is high, false-negative results can still occur which can be misleading if clinicians are not aware of the clinical presentation of CF. We present a case of a young male with negative newborn screen diagnosed for CF. He was diagnosed at 3 years of age despite having symptoms indicative of CF since infancy. The delayed diagnosis resulted in diffuse lung damage and poor growth.
https://ift.tt/2IGodWw
Measurement Characteristics of the Knowledge Assessment of Renal Transplantation (KART)
Background Kidney transplant is the best treatment for most end-stage renal disease (ESRD) patients, but proportionally few ESRD patients receive kidney transplant. To make an informed choice about whether to pursue kidney transplant, patients must be knowledgeable of its risks and benefits. To reliably and validly measure ESRD patients' kidney transplant knowledge, rigorously tested measures are required. This paper describes the development and psychometric testing of the Knowledge Assessment of Renal Transplantation (KART). Methods We administered 17 transplant knowledge items to a sample of 1,294 ESRD patients. Item characteristics and scale scores were estimated using an item response theory (IRT) graded response model. Construct validity was tested by examining differences in scale scores between patients who had spent 1 hour receiving various types of transplant education. Results IRT modelling suggested that 15 items should be retained for the KART. This scale had a marginal reliability of 0.75 and evidenced acceptable reliability (>0.70) across most of its range. Construct validity was supported by the KART's ability to distinguish patients who had spent 1 hour receiving different types of kidney transplant education, including talking to doctors/medical staff [effect size (ES) = 0.61; p
https://ift.tt/2KEQZII
https://ift.tt/2KEQZII
Comparison of two Luminex Single-Antigen bead flow cytometry assays for detection of Donor Specific Antibodies after renal transplantation
Background Defining the clinical relevance of Donor Specific HLA antibodies (DSA) detection by Luminex Single Antigen (LSA) flow beads assay is critical in monitoring posttransplant outcome. Methods Sera of kidney transplanted patients were tested by LSA1 and LSA2 with One Lambda Labscreen (test 1) and Immucor Lifecodes (test 2), at the time of a graft biopsy. The first group (G1, n=50) had a biopsy highly suggestive of humoral rejection and the second (G2, n=50) had no criteria of rejection. Positivity criteria for DSA was MFI >500 for test 1, while specificity assignation respected provider's recommendations for test 2. Results In G1, we identified at least 1 DSA in 44 patients with test 1, and in 39 patients with test 2. In G2, test 1 identified at least 1 DSA in 16 patients (32%) and test 2 in 7 patients (14 %). Sensitivity and specificity for ABMR diagnosis was 88% and 68% respectively with One Lambda, and 78% and 86% respectively with Immucor. Correlation and agreement were found in class I and II between intensity parameters of the 2 manufacturers. The use of the sum of the intensity of DSA (sDSA) improved the sensitivity and specificity of the 2 tests. Conclusions We report the first comparative study of the 2 Luminex assays available for detecting DSA in the post kidney transplant setting. Although there is a good correlation and reliability between the 2 assays, significant differences exist. Positivity criteria for DSA determination differ and interpretation should take these specificities into account. * Corresponding author: Dominique Bertrand, MD, Rouen University Hospital, 1 rue de Germont 76000 Rouen, France, dominique.bertrand@chu-rouen.fr Authorship: DB: performed research, collected data, analyzed data, and wrote the paper. FF, FHam, FHau: collected the data, performed research. DG: contributed to the revision and approval of the paper. All the others authors: collected data and contributed to the approval of the paper. Funding The authors have declared no funding. Disclosure: All of the authors of this manuscript have no conflicts of interest to disclose as described by Transplantation. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2KDewdj
https://ift.tt/2KDewdj
Quantifying the effect of transplanting older donor livers into younger recipients: the need for donor-recipient age matching
Background Increasing recipient and donor age are independently associated with survival after liver transplantation (LT). Whether donor age differentially impacts post-LT outcomes based on recipient age is unknown. Methods This was a retrospective cohort study using Organ Procurement and Transplantation Network data. All adult deceased-donor, single organ, primary LTs from 2002-2015 were included. Donor and recipient age were categorized as
https://ift.tt/2KGikxK
https://ift.tt/2KGikxK
PHARMACOKINETIC STUDY OF CONVERSION BETWEEN TWO FORMULATIONS OF ONCE-DAILY EXTENDED-RELEASE TACROLIMUS IN STABLE LUNG TRANSPLANT PATIENTS
BACKGROUND: The aim of this study was to compare the pharmacokinetic profile, tolerability, and safety of a novel once-daily extended-release formulation of tacrolimus (LCPT) with that of once-daily prolonged-release tacrolimus (ODT) in stable adult lung transplant (LT) recipients. METHODS: Phase II, open-label, single-arm, single-center, prospective pilot pharmacokinetic study. Study population comprised 20 stable LTR receiving ODT, mean age 55.9 (r: 38-67) years, 13 (65%) men. Patients were switched to LCPT in a 1:0.7 (mg/mg) conversion dose. Follow-up was 6 months, and cystic fibrosis patients were excluded. Two 24-hour pharmacokinetic profiles were obtained for each patient, the first on day -14 and the second on day +14 after switching to LCPT. Pharmacokinetic parameters and safety were compared. RESULTS: Mean (SD) AUC0-24 was 253.97 (61.90) ng/mL/h for ODT and 282.44 (68.2) ng/mL/h for LCPT. Systemic exposure was similar in both (Schuirmann two 1-sided test). Mean (SD) dose was 5.05 (1.67) mg in ODT and 3.36 (1.03) mg in LCPT (p: 0.0002). Time to maximum concentration was 125 minutes for ODT and 325 minutes for LCPT (p
https://ift.tt/2KF4ats
https://ift.tt/2KF4ats
Causes of Delayed Care Seeking for Chronic Suppurative Otitis Media at a Rwandan Tertiary Hospital
Background. Chronic suppurative otitis media causes serious lifelong consequences when treatment is delayed. Early detection and effective treatment result in a good outcome and possible complications are thus avoided. The aim of this study was to determine the factors resulting in delayed care seeking for treatment of CSOM. Method and Patient. The study was a cross-sectional survey conducted at a tertiary teaching hospital in Rwanda. A questionnaire was used to collect data of patients diagnosed with CSOM who attended ENT Department during the study period. We defined delayed care seeking as seeking treatment 6 months after onset of symptoms. Data was entered and analysed using SPSS 16.0. Result. This study enrolled 109 patients, 97 (88.9%) of whom had delays in care seeking. Majority were young adults ranging between 21 and 30 years (39.2%) while 58.8% were rural residents. Fifty-eight patients (56.9%) of those with delayed presentation used traditional medicine. The main reason for delayed care seeking was low knowledge of CSOM reported by 88 (90.7%) patients. Conclusion. This study shows that majority of patients with delayed care seeking are young adult patients. There is low knowledge concerning this disease and this significantly contributes to delayed care seeking.
https://ift.tt/2KHhZY0
An update on the NLRP3 inflammasome and influenza: the road to redemption or perdition?
Tate Michelle D | Mansell Ashley
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Slipping Rib Syndrome in a Female Adult with Longstanding Intractable Upper Abdominal Pain
Slipping rib syndrome is a rare cause of abdominal or lower chest pain that can remain undiagnosed for many years. Awareness among health care personnel of this rare but significant disorder is necessary for early recognition. Prompt treatment can avoid unnecessary testing, radiographic exposure, and years of debilitating pain. A 52-year-old female was evaluated for a 3-year history of recurrent abdominal and lower chest pain. Pain was sharp, primarily located in the lower chest and subcostal region left more than right, waxing and waning, nonradiating, and aggravates with specific movements. She underwent frequent physical therapies, treated with multiple muscle relaxants and analgesics with minimal improvement. Imaging modalities including CT scan, MRI, and X-rays performed on multiple occasions failed to signify any underlying abnormality. Complete physical examination was unremarkable except for positive hooking maneuver. Dynamic flow ultrasound of lower chest was performed which showed slipping of the lowest rib over the next lowest rib bilaterally left worse than right, findings consistent with slipping rib syndrome. Slipping rib syndrome is caused by hypermobility of the floating ribs (8 to 12) which are not connected to the sternum but attached to each other with ligaments. Diagnosis is mostly clinical, and radiographic tests are rarely necessary. Hooking maneuver is a simple clinical test to reproduce pain and can aid in the diagnosis. Reassurance and avoiding postures that worsen pain are usually helpful. In refractory cases, nerve block and surgical intervention may be required.
https://ift.tt/2KAIvm8
Cronkhite-Canada Syndrome: Sustained Clinical Response with Anti-TNF Therapy
Cronkhite-Canada syndrome (CCS) is a rare, nonfamilial syndrome that occurs in the sixth to seventh decades of life. It is characterized by acquired gastrointestinal polyposis with an associated ectodermal triad, including alopecia, onchodystrophy, and hyperpigmentation. CCS is characteristically a progressive disease, with a high mortality rate despite medical interventions. Disease complications are typically secondary to severe malnutrition, malignancy, GI bleeding, and infection. CCS is believed secondary to immune dysregulation; however, the underlying etiology remains to be determined. Treatment for CCS is largely anecdotal, and randomized controlled therapeutic trials are lacking due to the rarity of the disease. Aggressive nutritional support in conjunction with immunosuppression has been used previously with inconsistent results. In this report, we describe the presentation and diagnosis of a case of CCS and report encouraging treatment response with anti-TNF therapy.
https://ift.tt/2KlheI6
Asymptomatic progressive multifocal leukoencephalopathy: a case report and review of the literature
We report the development of asymptomatic progressive multifocal leukoencephalopathy in a patient with multiple sclerosis on natalizumab therapy. Progressive multifocal leukoencephalopathy often presents with ...
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Elaboration of an instrument to evaluate the recognition of Brazilian melodies in children
Publication date: Available online 30 June 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Maria Fernanda Capoani Garcia Mondelli, Ivan dos Santos José, Maria Renata José, Natália Barreto Frederigue Lopes
IntroductionThere is evidence pointing to the importance of the evaluation of musical perception through objective and subjective instruments. In Brazil, there is a shortage of instruments that evaluates musical perception.ObjectiveTo develop an instrument to evaluate the recognition of traditional Brazilian melodies and investigate the performance of children with typical hearing.MethodsThe study was developed after approval from the research ethics committee (1.198.607). The instrument was made in software format with website access, using the languages PHP 5.5.12, Javascript, Cascade style sheets and "HTML5"; database "MYSQL 5.6.17" on the "Apache 2.4.9" server. Fifteen melodies of Brazilian folk songs were recorded with piano synthesized timbre, with 12 seconds per melody reproduction and four second intervals between them. A total of 155 children, literate, aged eight to 11 years, of both sexes, with typical hearing participated in the study. The test was performed in a silent room with sound stimuli amplified by a sound box at 65dBNA, positioned at 0 azimuth, and at one meter from the participant, the notebook was used for children to play with on the screen on the title and illustration of the melody they recognized they were listening to. The responses were recorded on their own database.ResultsThe instrument titled "Evaluation of recognition of traditional melodies in children" can be run on various devices (computers, notebooks, tablets, mobile phones) and operating systems (Windows, Macintosh, Android, Linux). Access: https://ift.tt/2tIPQJS by login and password. The most easily recognized melody was "Cai, cai balão" (89%) and the least recognized was "Capelinha de melão" (25.2%). The average time to perform the test was 3′15″.ConclusionThe development and application of the software proved effective for the studied population. This instrument may contribute to the improvement of protocols for the evaluation of musical perception in children with hearing aid and/or cochlear implants users.
https://ift.tt/2yWC8s0
Genetic Variants with Gene Regulatory Effects are Associated with Diisocyanate Asthma
Publication date: Available online 30 June 2018
Source:Journal of Allergy and Clinical Immunology
Author(s): David I. Bernstein, Zana L. Lummus, Banu Kesavalu, Jianbo Yao, Leah Kottyan, Daniel Miller, André Cartier, Maria-Jesús Cruz, Catherine Lemiere, Xavier Muñoz, Santiago Quirce, Susan Tarlo, Joaquin Sastre, Louis Philippe Boulet, Matthew T. Weirauch, Kenneth Kaufman
BackgroundIsocyanates are major causes of occupational asthma but susceptibility and mechanisms of Diisocyanate Asthma (DA) remain uncertain.ObjectiveThe aim of this study is to identify DA-associated functional genetic variants via next generation sequencing (NGS), bioinformatics, and functional assays.MethodsNGS was performed in 91 workers with DA. Fourteen loci with known DA associated single nucleotide polymorphisms (SNPs) were sequenced and compared to data from 238 unexposed subjects. Ranking of DA associated SNPs based on their likelihood to affect gene regulatory mechanisms in the lung yielded 21 prioritized SNPs. Risk (R) and non-risk (NR) oligonucleotides were tested for binding of nuclear extracts from A549, BEAS 2B, and IMR-90 lung cell lines by electrophoretic mobility shift assays (EMSA). DNA constructs were cloned into a pGL3-promoter vector for luciferase gene reporter assays.ResultsNGS detected 130 risk variants associated with DA (3.1 x10-6 – 6.21x10-4), of which 129 were located in non-coding regions. The 21 SNPs prioritized by functional genomic data sets were in or proximal to five genes: CDH17 (n=10), ATF3 (n=7), FAM71A (n=2), TACR1 (n=1), and ZBTB16 (n=1). EMSA detected allele-dependent nuclear protein binding in A549 cells for 8 of 21 variants. In the luciferase assay, 4 of the 21 SNPs exhibited allele-dependent changes in gene expression. DNA affinity precipitation and mass spectroscopy of rs147978008 revealed allele-dependent binding of H1 histones, which was confirmed by Western blot.ConclusionsWe identified five DA associated potential regulatory SNPs. Four variants exhibited effects on gene regulation (ATF rs11571537, CDH17 rs2446824, rs2513789, and TACR1 rs2287231). A fifth variant (FAM71A rs147978008) showed non-risk allele preferential binding to H1 histones. These results demonstrate that many DA-associated genetic variants likely act by modulating gene regulation.
Teaser
This study advances knowledge of genetic mechanisms of occupational asthma by identification of a role for regulatory genetic variants associated with diisocyanate-induced asthma.https://ift.tt/2KnZCvo
Evaluation of food allergy candidate loci in the Genetics of Food Allergy Study
Source:Journal of Allergy and Clinical Immunology
Author(s): Ingo Marenholz, Sarah Grosche, Franz Rüschendorf, Birgit Kalb, Katharina Blumchen, Rupert Schlags, Neda Harandi, Mareike Price, Gesine Hansen, Jürgen Seidenberg, Songül Yürek, Georg Homuth, Carsten O. Schmidt, Markus M. Nöthen, Norbert Hubner, Bodo Niggemann, Kirsten Beyer, Young-Ae Lee
Teaser
A recent genome-wide association study suggested novel candidate loci for food allergy. Apart from the established locus at 11q13, these revealed no association with food allergy in the Genetics Of Food Allergy Study.https://ift.tt/2MCmgN6
Postoperative temporomandibular dysfunction in patients with fractures of the zygomatic complex: a prospective follow-up study
Publication date: Available online 30 June 2018
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): H. Rajantie, J. Snäll, H. Thorén
The aim of this prospective follow-up study was to clarify the incidence and characteristics of dysfunction of the temporomandibular joint (TMJ) in patients treated surgically for fractures of the zygomatic complex. Patients were evaluated on presentation and six months after injury to assess the function of the masticatory system using the Helkimo index, which incorporates two complementary subindices: the subjective symptomatic (anamnestic) index (Ai) and the objective clinical dysfunction index (Di). Forty-five patients (12 women and 33 men, mean (range) age 44 (21-83)years) completed the study. Six patients developed subjective symptoms of dysfunction of the TMJ during follow-up, in four of whom they were severe. Clinical findings were noted in 38 patients but without significant association with subjective symptoms.Dysfunction of the TMJ is common six months after surgical treatment of a fracture of the zygomatic complex, and patients with such fractures should be evaluated for temporomandibular dysfunction during follow-up and referred for treatment when necessary.
https://ift.tt/2KwLr6j
Clinical analysis of second primary gingival squamous cell carcinoma after radiotherapy
Source:Oral Oncology, Volume 84
Author(s): Xiaoyan Fu, Shuwei Chen, Weichao Chen, Zhongyuan Yang, Ming Song, Hao Li, Huayong Zhang, Fan Yao, Xuan Su, Tianrun Liu, An-Kui Yang
IntroductionClinically, we have observed that some oral cancer patients have a history of radiotherapy for head and neck cancer; we have named this condition radiotherapy-associated cancer (RAC). Gingival cancer, which is usually juxtaposed with other oral cancer subtypes, is seldom reported individually, and there are few reports on the association between the incidence of oral cancer and history of radiation therapy. Therefore, this study aimed to elucidate the clinicopathological features and prognosis of second primary gingival squamous cell carcinoma after head and neck radiotherapy.Materials and methodsThe data collected included 450 patients diagnosed with gingival squamous cell carcinoma from 1964 to 2012 at Sun Yat-sen University Cancer, among whom 52 patients had a history of radiotherapy for head and neck cancer. We retrospectively analysed the differences in the clinicopathological characteristics and prognosis between sporadic gingival squamous cell carcinoma and radiation-associated gingival carcinoma, with an emphasis on gingival carcinoma.ResultsSporadic gingival squamous cell carcinoma is less likely to have more advanced T stage, and the second primary tumour is more likely to be located in the molar area of the maxillary gingiva than in the mandibular gingiva (75.6% vs 24.4%, P < 0.05). The 5-year overall survival of patients with second primary gingival carcinoma was influenced by age distribution, T classification, N classification, clinical TNM stage, histological grade and radiation history in head and neck. Mandibular gingival carcinoma was more likely to have an increased neck lymph node metastasis than maxillary gingival carcinoma (P = 0.001), but there was no significant difference in 5-year overall survival between these two groups (P = 0.828). The main therapy for gingiva carcinoma is surgery or comprehensive treatment based on surgery.ConclusionsSecond primary gingival squamous cell carcinoma after radiotherapy demonstrated particular clinicopathologic features, such as prominent sites and TNM stage; and there was statistically significant difference in 5-year overall survival and prognosis between second primary gingival carcinoma after radiotherapy and sporadic gingival carcinoma.
https://ift.tt/2KnoBPs
Case 20-2018: A 64-Year-Old Man with Fever, Arthralgias, and Testicular Pain
Presentation of Case. Dr. Jaime L. Schneider (Medicine): A 64-year-old man was admitted to this hospital with a 2-week history of fever, chills, arthralgias, abdominal and testicular pain, and leukocytosis. Twenty-five years before the current admission, while the patient was living in China, he…
https://ift.tt/2KmoaEW
Case 19-2018: A 15-Year-Old Girl with Acute Kidney Injury
Presentation of Case. Dr. Helen I. Healy (Pediatrics): A 15-year-old girl was admitted to this hospital during the summer because of acute kidney injury. The patient had been well until 8 days before admission, when painful cramping in the lower abdomen and bloody diarrhea developed. Bowel…
https://ift.tt/2KznoUo
CTLA-4 regulates human Natural Killer cell effector functions
Source:Clinical Immunology
Author(s): Vassilios Lougaris, Giovanna Tabellini, Manuela Baronio, Ornella Patrizi, Luisa Gazzurelli, Noriko Mitsuiki, Maria Rosa Pozzi, Bodo Grimbacher, Silvia Parolini, Alessandro Plebani
https://ift.tt/2MBUi3Z
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