Dry skin manifestations in Sjögren syndrome and atopic dermatitis related to aberrant sudomotor function in inflammatory allergic skin diseases

Publication date: Available online 10 August 2018

Source: Allergology International

Author(s): Ichiro Katayama

Abstract

We have reported characteristic cutaneous manifestations of Sjögren syndrome (SS) with special references to autoimmune anhidrosis or hypoidrosis and related mucocutaenous manifestations in addition to annular erythema or cutaneous vasculitis. Although significance of cutaneous manifestations of SS has been gradually recognized in rheumatologists, sudomotor function has not been fully evaluated and recognized in the diagnosis of SS except for dermatologists. SS is a relatively underestimated collagen disease in contrast to SLE, systemic sclerosis, or dermatomyositis, special care should be needed not to make misdiagnosis of SS when we see the patients with common skin disease such as, drug eruption, infections skin disease or xerosis in the daily practice. In contrast to pathomechanisms of dry skin observed in SS, we recently reported that reduced sweating function and dry skin seen in atopic dermatitis (AD) are mediated by histamine or substance P, those are usually restored to normal levels after improvement of the dermatitis by topical corticosteroid ointment with or without oral anti-histamine. Therefore, xerotic skin lesions seen in SS and AD might be attributable to different pathomechanisms with similar dry skin manifestations. We recently reported that SS promotes dry skin when complicated with AD possibly due to acceleration of hypoidrosis. In this review, we would like to summarize our recent understanding of regulatory mechanism of impaired sweating function in allergic inflammatory skin diseases by introducing clinical presentations of AD/SS overlap cases as the model of hypoidrotic inflammatory skin diseases.

https://ift.tt/2KP3O2I

Rigid dilatation of pediatric laryngotracheal stenosis as an adequate alternative to balloon dilatation

Abstract

Introduction

Endoscopic balloon dilation (EBD) is the mainstay of endoscopic therapy for laryngotracheal stenosis (LTS), although there is no evidence that it achieves better results than traditional rigid laryngeal dilators. Rigid bougie dilators are less expensive and easier to use, and confer the advantage of providing tactile information about the stenosis to the surgeon. We analyzed the outcome of endoscopic rigid bougie dilatation of LTS in a large series of children and compared it to the reported results of EBD in the same setting.

Patients and methods

All cases of pediatric LTS treated by endoscopic rigid dilatation in a tertiary referral center between 2006 and 2015 were retrospectively studied. They were divided into a primary dilatation group (PDG) and a post-reconstruction dilatation group (PRG). The PDG children had no history of reconstructive airway surgery, and dilatation was the major treatment approach. The PRG children underwent dilatations after airway reconstruction surgery as part of routine postoperative management. A successful primary outcome was defined as improvement of dyspnea and achievement of a functional airway without reconstructive laryngotracheal surgery or need for a tracheostomy at final follow-up.

Results

Sixty-two children (68 cases, mean age 5.1 years, range 0.7–17.2) underwent 156 endoscopic rigid dilatations. Successful outcome was achieved in 48 cases (70.6%), 73.0% in the PDG and 67.7% in the PRG. There were no procedure-related adverse events.

Conclusions

Endoscopic rigid dilatation is a relatively inexpensive and efficacious tool in endoscopic management of pediatric LTS. Its success rates are in the same range as those of EBD.

https://ift.tt/2MCxr99

Rocuronium pharmacodynamic models for published five pharmacokinetic models: age and sex are covariates in pharmacodynamic models

Abstract

Purpose

Equilibration rate constant is necessary to calculate effect-site concentration, which is useful to control drug effect. We developed pharmacodynamic models for published five compartmental pharmacokinetic models published by Wierda, Szenohradszky, Cooper, Alvarez-Gomez, and McCoy.

Methods

We used 3848 train-of-four ratios from 15 male and nine female patients (21–76 years; 44–93 kg body weight; 148–181 cm height; and 17.3–29.8 kg/m² body mass index) as pharmacodynamic measures, which were collected at the start of 0.6 mg/kg rocuronium administration until the end of the surgery. Effect compartment was assumed to be connected to central compartment of the pharmacokinetic model with equilibration rate constant (k_e0). Sigmoid E_max model was fitted to describe the relationship between train-of-four ratio and effect-site concentration. Age, sex, and body mass index were assessed as possible covariates of the following model parameters: k_e0, effect-site concentration for half of maximum effect, and the steepness of the effect-site concentration versus effect relationship.

Results

The duration of neuromuscular monitoring was 69 (37–129) [median (range)] min. All pharmacodynamic models included age and three included sex as significant covariates. K_e0 values ranged between 0.0820 and 0.247 depending on the pharmacokinetic model. The time-courses of the effect-site concentration were similar among the pharmacodynamic models for Wierda, Cooper, and Alvarez-Gomez pharmacokinetic models, which were lower than that for the Szenohradszky pharmacokinetic model.

Conclusion

Each pharmacodynamic model with the corresponding pharmacokinetic model can be described the time course of rocuronium effect appropriately. The required effect-site concentration of rocuronium for a pharmacodynamic effect was depending on the applied models.

https://ift.tt/2nvhbfc

Outcomes of Reconstruction After Temporal Bone Resection for Malignancy

Publication date: Available online 11 August 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): Caitlin Bertelsen, Eli Simsolo, Dennis Maceri, Uttam Sinha, Niels Kokot

Summary

Reconstruction after temporal bone resection (TBR) is challenging due to the lack of consensus on an optimal approach. Records of the Keck Hospital of USC were searched to identify, collect and group data on patients who underwent TBR for malignancy. Chi-square analysis was used for categorical variables, and ANOVA was used for continuous variables. Forty TBR including 27 lateral (LTBR), 8 total (TTBR), and 5 subtotal (STBR) temporal bone resections were performed at our institution over a ten year time period (2003 to 2013) and reconstructed with free, regional, and local flaps and tissue grafts. TTBR was associated with postoperative complications as was presence of a dural defect, though other traditionally poor prognostic factors such as age, comorbidity status, and history of irradiation were not. Patients who underwent auriculectomy or parotidectomy were more likely to require free flap reconstruction. We conclude that TBR and reconstruction can be performed successfully on many patients including those who are older or who have more aggressive disease. We recommend free tissue transfer for the large defects created by TTBR, parotidectomy and auriculectomy.

https://ift.tt/2MhrPUQ

A Twenty-two-year Experience with Hymenoptera Venom Immunotherapy in a US Pediatric Tertiary Care Center: 1996-2018

Publication date: Available online 11 August 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Sultan Albuhairi, Kristel El Khoury, Christina Yee, Lynda Schneider, Rima Rachid

https://ift.tt/2P0vDZ6

A Phase 2a Study of Toreforant, a Histamine H4 Receptor Antagonist, in Eosinophilic Asthma

Publication date: Available online 11 August 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Alexa P. Kollmeier, Elliot S. Barnathan, Christopher O'Brien, Bin Chen, Yichuan (Karen) Xia, Bei Zhou, Matthew J. Loza, Philip E. Silkoff, Michelle Ge, Robin L. Thurmond

https://ift.tt/2B2gQdz

Nuclear loss and cytoplasmic expression of androgen receptor in penile carcinomas: role as a driver event and as a prognosis factor

Abstract

Androgen receptor (AR) is a member of the steroid and nuclear family receptor that acts as transcription factor. AR signaling plays pivotal role in the development and progression of prostate cancer. However, the role of AR in penile cancer (PeCa) is poorly explored. Our previous molecular studies unveiled frequent AR mRNA loss in PeCa, which was further predicted as a major driver alteration in this neoplasm. Herein, we assessed the AR protein expression in 59 usual PeCa tissues and 42 surrounding normal tissues (SNT) by immunohistochemistry using a tissue microarray. In a paired analysis, we found a total absence of nuclear AR expression in PeCa while 95.2% of SNT samples presented strong nuclear AR expression (P < 0.001). Interestingly, 17 of 42 PeCa presented weak or moderate cytoplasmic AR staining, contrasting with 5 of 42 SNT (P = 0.008). Increased levels of AR cytoplasmic expression were related with poor prognosis features including advanced clinical staging (P = 0.044), compromised surgical margins (P = 0.005), and pathological inguinal node status (P = 0.047). Furthermore, AR cytoplasmic expression was also related with shorter overall survival (P = 0.032). In conclusion, the frequent loss of nuclear AR protein levels suggests a potential function in PeCa development. Based on this result, the androgen deprivation therapy is not indicated for PeCa patients. In addition, the AR cytoplasmic expression found in a significant number of cases (40.5%) showed prognostic value and pathways activated by the non-genomic AR signaling may represent a promising therapeutic strategy.

https://ift.tt/2B2OEHq

School Absenteeism Associated with Asthma and Allergic Diseases in Korean School-Aged Children

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


https://ift.tt/2MGvfNy

Suicide: A Taboo Topic That We Must Talk About Now

Violence and Gender, Ahead of Print.


https://ift.tt/2MBtgdC

Analysis of Risk Factors for Unplanned Reoperation Following Free Flap Surgery of the Head and Neck

The Laryngoscope, EarlyView.


https://ift.tt/2nrEd6p

Smith–Lemli–Opitz syndrome presenting as acute adrenal crisis in a child: a case report

Smith–Lemli–Opitz syndrome is a rare autosomal recessive disorder of cholesterol biosynthesis which is characterized by multiple congenital malformations and global developmental delay. Here we report the case...

https://ift.tt/2OX3vWR

Trust in Police and Fear of Crime Among Young People from a Gender Perspective: The Case of Mexico

Violence and Gender, Ahead of Print.


https://ift.tt/2P05zgI

Outcomes of Reconstruction After Temporal Bone Resection for Malignancy

Reconstruction after temporal bone resection (TBR) is challenging due to the lack of consensus on an optimal approach. Records of the Keck Hospital of USC were searched to identify, collect and group data on patients who underwent TBR for malignancy. Chi-square analysis was used for categorical variables, and ANOVA was used for continuous variables. Forty TBR including 27 lateral (LTBR), 8 total (TTBR), and 5 subtotal (STBR) temporal bone resections were performed at our institution over a ten year time period (2003 to 2013) and reconstructed with free, regional, and local flaps and tissue grafts.

https://ift.tt/2AWcKU9

Free Gracilis Transfer and Static Facial Suspension for Midfacial Reanimation in Long-Standing Flaccid Facial Palsy

This article presents an approach to reanimation of the midface in long-standing flaccid facial palsy by means of functional free gracilis transfer and static facial suspension.

https://ift.tt/2vvgeb5

The Importance and Psychology of Facial Expression

Facial expression is of critical importance in interpersonal interactions. Thus, patients with impaired facial expression due to facial paralysis experience impaired social interactions. Numerous studies have shown that patients with facial paralysis and impaired facial expression suffer social consequences as demonstrated by being rated negatively with regards to attractiveness, affect display, and other traits. This has been demonstrated subjectively and objectively. Fortunately, reconstructive surgeries that restore the ability to express emotion can restore normalcy in these patients.

https://ift.tt/2MyWOIN

The surgical management of extra-articular ankylosis in noma patients

Extraarticular ankylosis occurs frequently in children suffering from noma sequelae. Over 20years of operating on these patients, we observed high recurrence of mouth opening limitation. We therefore progressively changed our surgical strategy. This retrospective study compares the impact of different parameters (types of surgery, noma type, physiotherapy compliance, age and sex) on immediate and long-term mouth opening. It includes a series of 121 patients with extraarticular ankylosis operated on between 1990 and 2015.

https://ift.tt/2vWREiE

Mycosis fungoides presenting with pigmented purpuric rash

A 55-year-old woman presented with a pruritic rash existing for three months which was unresponsive to topical steroids. Dermatologic examination revealed generalized purpuric patches with unclear borders primarily localized on buttocks, abdomen, wrists and upper legs. Biopsy taken with diagnoses of pigmented purpuric dermatosis, pityriasis Rosea and mycosis fungoides, showed superficial and middermal lymphoid infiltrate with epidermotrophism and atypical large cerebriform cells as well as basaloid vacuolization, spongiosis and extravasated erythrocytes in the superficial dermis.

https://ift.tt/2vznQcB

Prospective pilot evaluation of the efficacy and safety of adjuvant topical ingenol mebutate gel for localized patch/plaque-stage mycosis fungoides

Introduction: Whether ingenol mebutate (IM) is effective as adjuvant topical treatment for mycosis fungoides (MF) remains undetermined.

https://ift.tt/2AXTzJJ

Paraneoplastic angiomatosis: A new entity

Paraneoplastic syndromes result from tumor secretion of hormones, peptides, or cytokines or from immunologic cross reactions between malignant and normal cells. Numerous organ systems may be affected by paraneoplastic conditions, including the skin. We report 2 cases of benign cutaneous vascular proliferations occurring in the setting of malignancy and propose the term paraneoplastic angiomatosis. Case 1: A 62-year-old man with multiple comorbidities presented with a large, irregular, blanching erythematous abdominal plaque.

https://ift.tt/2OZXqsE

Pilot evaluation of safety, efficacy, and tolerability of a new topical formulation for facial hyperpigmentation, combining ascorbyl tetraisopalmitate and crosslinked resilient hyaluronic acid

This study evaluated therapy of facial hyperpigmentation with a novel topical formulation combining two synergistic melanogenesis inhibitors: ascorbyl tetraisopalmitate (ATIP), the esterified form of vitamin C (concentration equivalent to 8% L-ascorbic acid), and crosslinked resilient hyaluronic acid (RHA). Vitamin C inhibits multiple oxidative steps during melanogenesis, diminishing tyrosinase activity. Clinical challenges with L-ascorbic acid include low skin penetrance, instability due to oxidation, and potential irritation.

https://ift.tt/2AXT9mD

No disclosure of support by ISDIN SA on poster

"Antiaging facial serum containing melatonin, bakuchiol, and ascorbyl tetraisopalmitate up-regulates antioxidant gene expression in medaka embryos"

https://ift.tt/2vBuBup

Predictors of response to tildrakizumab for moderate-to-severe chronic plaque psoriasis

Introduction: Efficacy of tildrakizumab (TIL), a high-affinity, humanized, IgG1/κ monoclonal antibody against IL-23p19, has been evaluated for chronic plaque psoriasis (Pso) in 2 phase 3 randomized controlled trials. The objective of this analysis was to determine predictors of response to TIL treatment in the 2 trials.

https://ift.tt/2AZXiWX

Pembrolizumab-induced bullous pemphigoid

Background: Bullous pemphigoid (BP) is an autoimmune blistering disorder characterized by autoantibody deposition at the epithelial basement membrane zone. It classically presents in elderly adults and can be idiopathic or drug-induced. The 2 major bullous pemphigoid antigens do not differ between the drug-induced and idiopathic variants of the disease, nor do the direct and indirect immunofluorescence (DIF and IIF) findings. Pembrolizumab is an anti–programmed cell death 1 (PD-1) antibody which inhibits the negative immune regulation caused by PD-1 receptor signaling resulting in reversal of T-cell suppression and induction of antitumor responses.

https://ift.tt/2vAhbyK

Omalizumab for chronic spontaneous urticaria in real-life practice

Background: Omalizumab has been shown to be highly effective in phase III clinical trials in treatment of chronic spontaneous urticaria (CSU).

https://ift.tt/2AZX9Tp

National trends in staphylococcal scalded skin syndrome

Background: Staphylococcal scalded skin syndrome (SSSS) is a potentially fatal superficial blistering disorder caused by infection with exfoliative toxin producing strains of Staphylococcus aureus.

https://ift.tt/2vwHPsw

Comparison of Er:YAG laser, short pulse-duration pulsed dye laser, and long pulse-duration pulsed dye laser in treating sebaceous hyperplasia

Background: Patients of sebaceous hyperplasia (SH) usually seek treatment due to cosmetic concern. A few nonsurgical ablative devices are effective in treating SH, including carbon dioxide laser and erbium-doped yttrium aluminium garnetlaser (Er:YAG) laser. But these options bear the considerable risk of postoperative discoloration and scar formation. Pulsed dye laser (PDL) has been reported effective in treating SH. However, only short pulse-duration PDL (SPDL) has been used in previous studies.

https://ift.tt/2B1VBby

Pseudomelanocytic nests leading to a misdiagnosis of lentigo maligna

Introduction: Dermoscopy of facial pigmented lesions is sometimes challenging and clinical-histologic correlation is essential.

https://ift.tt/2OXgUOt

Primary cutaneous mucinous carcinoma: Incidence and survival

Background: Primary cutaneous mucinous carcinoma (PCMC) is a rare eccrine carcinoma with a propensity to affect the head, especially the eyelid. It has the potential to be locally destructive with high rates of recurrence but low metastatic potential. Owing to its rarity, demographic and cancer-related data for PCMC are limited.

https://ift.tt/2B1VAV2

Poly-L-lactic injectable acid in the treatment of facial and extra facial flaccid areas: A case series

Poly-L-lactic acid (PLLA) is a synthetic, biocompatible and biodegradable polymer used as a sterile injectable solution to stimulate collagen production, leading to cutaneous filling, but do not act as a true volumizer. It has been used in facial and extrafacial areas to correct flaccidity, loss of volume, improve contour and skin elasticity. We report four female patients treated with PLLA, one vial per session. The final dilution was 10 cc for facial and 20 cc for extra facial injections. Case 1: 56 yo, treatment of medial region of the arms in 3 sessions.

https://ift.tt/2vycrty

Phase II study of KX2-391 ointment 1%, a novel field treatment for actinic keratosis, based on Src/tubulin polymerization inhibition

Background: KX2-391, a dual Src tyrosine kinase and tubulin polymerization inhibitor, inhibits the growth of human keratinocytes with IC50 of 32 nM and induces apoptosis in dividing cells. A phase I study demonstrated that KX2-391 ointment 1% reduced actinic keratosis (AK) lesion counts and was well tolerated following 3 or 5 days of treatment on the forearm. Aim: To determine the activity, safety and pharmacokinetics of KX2-391 ointment 1% (5 or 3 days) in adults with AK on the face or scalp.

https://ift.tt/2AXlQQE

Patient-reported global severity of atopic dermatitis is valid in adults

Atopic dermatitis (AD) is associated with a heterogeneous presentation and clinical course. There are many different patient-reported outcome measures available that measure different aspects of the disease. However, there are few simple, intuitive and validated severity assessments that are feasible for clinical practice and epidemiologic research. We sought to validate patient-reported global AD severity in adults. We performed a prospective dermatology practice-based study using questionnaires and evaluation by a dermatologist (n = 265).

https://ift.tt/2OWQzAh

Oral Polypodium leucotomos extract and its impact on visible light–induced pigmentation

Background: Visible light has multiple effects on the skin including erythema, DNA damage secondary to free radical production, and pigmentation. Few sunscreens protect against visible light, which can exacerbate photodermatoses. Polypodium leucotomos extract (PLE) has antioxidant, photoprotective, chemoprotective, antiinflammatory, and immunomodulatory properties that may offer protection against visible light induced effects.

https://ift.tt/2AWDUds

Objective assessment of dry skin roughness in a pediatric population

Introduction and objectives: Dry skin is a common condition during childhood. Clinical scoring of dry skin includes tactile evaluation of the skin surface to assess roughness. It also includes visual examination of the appearance of the skin and for severe cases the presence of dander. To our knowledge, no instrumental evaluation of roughness has ever been performed to objectively score skin dryness in a pediatric population, nor to document the clinical efficacy of skin care products specifically developed to address dry skin condition.

https://ift.tt/2vveNtd

Neurofibromatosis type 1 and birth size: A retrospective registry-based total population study in Finland

Neurofibromatosis type 1 (NF1) is the most common dominantly inherited cancer predisposition syndrome with prevalence of ∼1:2,000. It is caused by mutations in NF1 gene on chromosome 17. The protein product of NF1 gene is neurofibromin, which acts as a tumor suppressor protein inhibiting Ras signaling pathway. The hallmark signs of the disorder are found on the skin, but NF1 is a multisystem disorder with increased risk for e.g., cancer, pregnancy complications, osteoporosis and learning difficulties.

https://ift.tt/2BbvW0r

T-helper cell phenotype expression in cutaneous lesions of angioimmunoblastic T-cell lymphoma

Background: Angioimmunoblastic T-cell lymphoma (AITL) is a common type of peripheral T-cell lymphoma. AITL can be missed until lymphadenopathy develops in patients initially presenting with skin lesions, as skin biopsy may lack conclusive findings. The expression of follicular helper T-cell (THF) markers in the skin can be an important diagnostic clue. We present a case of AITL with skin lesions positive for CD10 and dim PD-1 T cells, with the purpose of highlighting the potential for diagnosing cutaneous AITL via skin biopsy.

https://ift.tt/2OZ06qk

A facewash containing specific plant-derived monoterpenes reduced Propionibacterium acnes burden and improved acne symptoms

The pathogenesis of acne is multifactorial, including increased sebum production, ductal epidermal proliferation, bacterial colonization and inflammation. While the sequence of events involved in acne pathogenesis have not yet been established, there is a strong corelationship between the presence of acne and growth of the microorganism Propionibacterium acnes (P. acnes) leading to suggestions that P. acnes is associated with acne. Recent studies have also shown an increased level of Staphylococcus epidermidis (S.

https://ift.tt/2AW4vrb

Feel the power: sample size and meaningful effects

There is, as the old saying goes, strength in numbers. We can look to numbers or statistics to help us interpret the evidence. Statistics can be used, for instance, to illustrate the safety and efficacy of interventions, to help establish treatment pathways, patients' satisfaction, and so on. However, we can be blinded by numbers; we can, according to the old trope, prove anything with statistics. Therefore, and at the risk of overstretching several metaphors, we must use statistics responsibly, otherwise there is the real risk that we end up like the Scottish poet Andrew Lang's (1844–1912) proverbial politician, using statistics like a drunk uses a lamp-post, in other words: to support rather than illuminate our arguments.

https://ift.tt/2vzqcIg

A Twenty-two-year Experience with Hymenoptera Venom Immunotherapy in a US Pediatric Tertiary Care Center: 1996-2018

The severity of allergic reactions to insect stings ranges from mild, local reactions to systemic, life-threatening anaphylaxis.1, 2 Systemic reactions (SRs) to Hymenoptera stings can occur in 0.5-3.3% of adults in the US and 0.3-7.5% of adults in Europe.3, 4 In pediatric patients, the prevalence of SRs is lower, from 0.15-0.8%.5-8 In addition, in children, the majority of SRs from sting consist of exclusively cutaneous symptoms.9 Venom immunotherapy (VIT) is very effective in decreasing the SR risk after subsequent sting and is generally indicated in subjects with histories of SRs to Hymenoptera stings with extra-cutaneous symptoms.

https://ift.tt/2ntQhnC

A Phase 2a Study of Toreforant, a Histamine H4 Receptor Antagonist, in Eosinophilic Asthma

Histamine appears to play a role in the pathophysiology of asthma. In patients with allergic asthma, there is an increase in histamine in bronchoalveolar lavage fluid that is negatively correlated with airway function.1-6 In addition, histamine levels rapidly increase in the plasma of antigen-challenged patients,7 and plasma histamine levels are lowered by effective management of asthma.8

https://ift.tt/2vXcHBQ

Evaluation of the effect of pre-operative oral midazolam on post-operative oral fluid intake after tonsillectomy

Publication date: Available online 10 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Cynthia M. Schwartz, Kristen Honsinger, Beth A. Fischer, Charles A. Elmaraghy

Abstract

Introduction

The objective of this study was to determine if pre-operative oral midazolam administration decreased postoperative oral fluid intake after tonsillectomy with or without adenoidectomy.

Methods

A retrospective chart review identified 104 patients who were undergoing tonsillectomy with and without adenoidectomy who were not given midazolam preoperatively and 182 who were given midazolam preoperatively. Indications for tonsillectomy with or without adenoidectomy included obstructive sleep apnea, recurrent acute streptococcal pharyngotonsillitis, and, in selected cases, periodic fever with aphthous stomatitis, pharyngitis and adenopathy. All patients were evaluated in the pre-operative area by the attending anesthesiologist, who then determined whether or not he/she felt the patient would benefit from premedication with oral midazolam prior to surgery. Patients whom the attending anesthesiologist judged would benefit from midazolam were then given a 0.12 to 1.06 mg/kg dose (mean 0.35 mg/kg, STD 0.12), at the discretion of the anesthesiologist. Various methods were used to perform tonsillectomy, such as coblation and electrocautery, at the discretion of the otolaryngologist. Results were not stratified by surgical technique. Oral fluid intake was calculated by establishing the time of return to the floor from surgery and determining the documented oral fluid intake for the next 12 h. Oral fluid intake per kg per hour was then calculated. The amount of midazolam given was documented.

Results

There was no significant difference in oral fluid intake by group when adjusting for age and weight, F(1, 282)=.383, p=0.537. Also, there was no significant difference in ml/kg/hr by group when adjusting for age and weight, F(1, 282)=2.813, p=0.095.

Conclusions

There was no significant difference in oral fluid intake between the no midazolam and midazolam groups, indicating that clinicians can continue to use their judgement in administering midazolam to select anxious patients prior to tonsillectomy with or without adenoidectomy. Future work could include multi-center retrospective reviews or a randomized placebo-controlled trial to examine more carefully the effects of midazolam on postoperative oral fluid intake.

https://ift.tt/2vzhvhg

Predictive Factors Associated With Spontaenous Passage Of Coins: A Ten-Year Analysis Of Paediatric Coin Ingestion In Australia

Publication date: Available online 10 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Dr Narinder Singh, Dr Jessica Chong, Dr Joyce Ho, Dr Shruti Jayachandra, Dr Daron Cope, Dr Fred Azimi, Guy D. Eslick, Dr Eugene Wong

Abstract

Objectives

Coins are the commonest foreign body ingested in paediatric populations. Although most ingested coins are either spontaneously passed or retrieved with medical intervention without serious consequence, there is potential for serious morbidity and mortality related to paediatric coin ingestion. We performed a 10-year retrospective review of Australian denomination coin ingestion at a tertiary paediatric hospital in Sydney, Australia. We attempted to determine whether a relationship exists between coin size, patient age, coin ingestion and spontaneous passage.

Methods

Hospital records of all children presenting in a 10-year period to a paediatric tertiary care centre for coin ingestion were reviewed. Demographic information, coin denomination, previous history, symptoms, investigations, management, outcome and complications were recorded.

Results

241 cases were identified. The majority (55%) of cases occurred in children ≤3 years of age (range 7 months to 11 years, mean 3.39 years). The most common location where coins were identified was in the proximal third of the oesophagus or at the cricopharyngeus (65%). Spontaneous passage occurred in 84 cases (34.9%) while 167 cases (69.3%) required intervention. Children ≤3 years were more likely to ingest small coins (<22 mm) (OR: 2.44; 1.39-4.17) and children >3 years were more likely to ingest larger coins (22-26 mm) (OR: 2.17; 1.39-4.35).

Conclusions

Coin size, coin weight and age of the child appear to be predictors for both likelihood of ingestion and spontaneous passage in paediatric coin ingestion cases. A child with minimal symptoms, witnessed ingestion and radiographic identification of the coin in the lower oesophagus or more distal can often be safety observed for up to 24 h in anticipation of spontaneous passage.

https://ift.tt/2MEhten

Extramedullary Hematopoiesis of the Sphenoid Sinus Associated with Hereditary Spherocytosis: A Case Report

Publication date: Available online 10 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jaron Densky, Tirth Patel, Ashleigh Halderman, Prashant Malhotra

Abstract

Extramedullary hematopoiesis is a rare cause of a sinonasal mass that presents unique diagnostic and treatment challenges. While there are numerous reports of patients with hereditary spherocytosis developing extramedullary hematopoiesis in the posterior mediastinum, involvement in the paranasal sinuses has not previously been described. Here, we present the first case of a patient with hereditary spherocytosis developing extramedullary hematopoiesis in the sphenoid sinus.

https://ift.tt/2MgGvna

Editorial Board

Publication date: September 2018

Source: Clinical Immunology, Volume 194

Author(s):

https://ift.tt/2MBXLQC

Treatment of erythematotelangiectatic rosacea, facial erythema, and facial telangiectasia with a 577-nm pro-yellow laser: a case series

Abstract

Various lasers have been used for the treatment of erythematotelangiectatic rosacea (ETR), facial erythema (FE), and facial telangiectasias (FT). The assessment of the treatments of all of these conditions with a 577-nm pro-yellow laser has not been reported yet. The aim of this work was to assess the efficacy and safety of the 577-nm pro-yellow laser in ETR, FE, and FT. Forty patients suffering from ETR, FE, and FT (25 female and 15 male) were enrolled in this study. All of the patients were treated with 577-nm pro-yellow laser (QuadroStarPRO YELLOW® Asclepion Laser Technologies, Germany) at 4-week intervals, for one to four sessions. The assessment of the treatment was made based on the digital photographs and the percentage of fading of the erythema and telangiectasias in the lesions. Significant clinical improvement (80–100%) was observed in the first or second sessions of the treatment in FE and ETR patients and in second and fourth sessions of the treatment in FT patients. The treatment was very well tolerated. No side effect was observed except for a few patients who had mild to moderate erythema fading away in 12–24 h. This case series has shown that the pro-yellow laser is a very effective, safe, and well-tolerated treatment for ETR, FE, and FT.

https://ift.tt/2vW3olG

Geographic and demographic variations of inhalant allergen sensitization in Koreans and non-Koreans

Publication date: Available online 10 August 2018

Source: Allergology International

Author(s): Sang Chul Park, Chi Sang Hwang, Hyo Jin Chung, Munkhbaatar Purev, Salma Saud Al Sharhan, Hyung-Ju Cho, Joo-Heon Yoon, Chang-Hoon Kim

Abstract

Background

To diagnose and treat respiratory allergic diseases, it is important to identify the specific allergens involved. Many differences exist between common inhalant allergens depending on the residential environment and demographic factors. This study aimed to compare common inhalant allergens between Koreans and non-Koreans according to their residential region, age, and sex.

Methods

This study evaluated 15,334 individuals who underwent serum tests for multiple allergen-specific immunoglobulin E at a tertiary academic medical center between January 2010 and December 2016. The individuals included 14,786 Koreans and 548 non-Koreans. The AdvanSure™ Allostation assay (LG Life Science, Korea) was used to test for 33 inhalant allergens.

Results

The house dust mite (HDM) was the most common allergen in both Koreans and non-Koreans, although the proportion of individuals with HDM sensitization was greater among Koreans. High sensitization rates for various pollen types were detected among Koreans in Gangwon region, whereas Japanese cedar pollen was unique among Koreans in Jeju region. Grass pollen and animal dander were relatively common among individuals from the Americas, whereas weed and grass pollen accounted for the 10 most common allergens for individuals from Central Asia. The total sensitization rate, sensitization to HDM, and sensitization to animal dander peaked among adolescents and young adults, then subsequently decreased with age.

Conclusions

This large-scale study demonstrates that various regional and age-related differences exist in the allergen sensitization rates of Koreans and non-Koreans. These data could be useful for development of avoidance measures, immunotherapy for causative allergens, and policymaking regarding allergic diseases.

https://ift.tt/2MAK0Si

Molecular and cellular pathogenesis of heparin-induced thrombocytopenia (HIT)

Publication date: Available online 10 August 2018

Source: Autoimmunity Reviews

Author(s): Lubica Raouva, Gowthamy Arepally, Mortimer Poncz, Douglas B. Cines

https://ift.tt/2M8rILW

Rheumatic immune-related adverse events in patients on anti-PD-1 inhibitors: Fasciitis with myositis syndrome as a new complication of immunotherapy

Publication date: Available online 10 August 2018

Source: Autoimmunity Reviews

Author(s): Javier Narváez, Pablo Juarez López, Judit LLuch, José Antonio Narváez, Ramón Palmero, Xavier García del Muro, Joan Miquel Nolla, Eva Domingo-Domenech

Abstract

Objective

To evaluate the prevalence and type of rheumatic immune-related adverse events (IRAEs) in patients receiving programmed cell death protein-1 (PD-1) inhibitors.

Methods

This is a single-center prospective observational study, including all cancer patients receiving PD-1 inhibitors between January 2016 and January 2018.

Results

During the period analyzed, we evaluated a total of 11 patients. No patient had pre-existing rheumatic or autoimmune disease. In this period, a total of 220 patients were treated with PD1 inhibitors in our center; therefore, the estimated minimum prevalence of rheumatic IRAEs related to these therapies in our population was 5%.

The rheumatic IRAEs evaluated included 5 cases of oligo- or polyarthritis, 1 with a polymialgia rheumatica-type syndrome, 2 cases of immunotherapy-induced sicca syndrome, 2 patients who presented symptomatic inflammatory myositis with fasciitis in lower extremities, and 1 patient with a paraneoplastic acral vascular syndrome. The median time to IRAE after anti-PD1 exposure was 8 weeks (range: 2–24). In 5 patients, immunotherapy was discontinued (due to the adverse effect in three and cancer progression in two).

In general terms the symptoms resolved completely with symptomatic treatment. Disease-modifying antirheumatic drugs were needed for 2 patients.

Conclusion

Rheumatic IRAEs should be kept in mind during the follow-up and evaluation of patients treated with PD-1 inhibitors. The concomitant development of symptomatic inflammatory myositis with fasciitis in lower extremities appears to be a new adverse effect of anti-PD-1 immunotherapy. Additional studies are needed to determine how to adequately control and manage these complications.

https://ift.tt/2OlWQ7a

Clinical and immunological parameters of Sjögren's syndrome

Publication date: Available online 10 August 2018

Source: Autoimmunity Reviews

Author(s): Konstantia Psianou, Ioannis Panagoulias, Anastasios D. Papanastasiou, Anne-Lise de Lastic, Maria Rodi, Panagiota I. Spantidea, Søren E. Degn, Panagiotis Georgiou, Athanasia Mouzaki

Abstract

Sjögren's syndrome (SS) is a chronic autoimmune disease that primarily affects the exocrine glands, resulting in their functional impairment. In SS, lymphocytic infiltration of salivary and lacrimal glands, and deposition of several types of autoantibodies, mainly anti-SS-A (anti-Ro) and anti-SS-B (anti-La), lead to chronic inflammation, with xerostomia and keratoconjunctivitis sicca. In its primary form (pSS), SS does not involve additional connective tissue diseases, whereas in its secondary and more common form (sSS), SS presents in association with other rheumatic autoimmune diseases, mainly rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). As in most autoimmune diseases, environmental, hormonal and genetic factors are implicated in SS pathogenesis. In SS T cells predominate in mild lesions, whereas B cells predominate in advanced lesions. Th1, Th2, Th17, follicular helper T (Tfh) cells and regulatory cells (Tregs/Bregs), with their characteristic cytokine profiles, have been implicated in the pathogenesis of SS. It has been suggested that Th1 and Th17 cells initiate SS and, as the disease progresses, Th2 and Tfh cells predominate. It is assumed that, as in all autoimmune and inflammatory conditions, tolerance defects contribute to SS pathogenesis. It is intriguing that in SS it remains unclear which types of regulatory cells are functional and whether they ameliorate or worsen the disease. In this review we present a comprehensive update on SS with emphasis on immune system involvement, and suggest new insights into SS immunopathogenesis.

https://ift.tt/2M8rrbS

Letter to the Editor: New insights into the etiology of Hashimoto's Thyroiditis: the role of genetics and epigenetics

Publication date: Available online 10 August 2018

Source: Autoimmunity Reviews

Author(s): Massimo Ralli, Armando De Virgilio, Marco Artico, Lucia Longo, Marco de Vincentiis, Antonio Greco

https://ift.tt/2KJHh73

School Absenteeism Associated with Asthma and Allergic Diseases in Korean School-Aged Children

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


https://ift.tt/2Mc3Gj6

Immunogenicity of a Candidate Ebola Hemorrhagic Fever Vaccine in Mice Based on Controlled In Vitro Expression of Ebolavirus Glycoprotein

Viral Immunology, Ahead of Print.


https://ift.tt/2B7T0NA

Relationship Between Platelet Count and Insulin Resistance in Korean Adolescents: A Nationwide Population-Based Study

Metabolic Syndrome and Related Disorders, Ahead of Print.


https://ift.tt/2MczV0Z

Moisturizers vs. Barrier Repair in the Management of Atopic Dermatitis

Publication date: Available online 10 August 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Peter M. Elias, Jeffrey Sugarman

https://ift.tt/2nqIWVV

Shadow over abdomen

Description  

Male neonate was born by normal vaginal delivery at 38 weeks. He was antenatally diagnosed to have dextrocardia, congenitally corrected transposition of great arteries, moderate ventricular septal defect and pulmonary atresia. He was born in good condition and cried at birth. However, he was noted to have saturation of 65%–70% in air and started on continuous positive airway pressure and transferred to neonatal intensive care unit for further monitoring. Postnatal echocardiography confirmed the diagnosis, and he was started on prostaglandin E1 (PGE1) at 5 nanogram/kg/min.

On day 3 of life, he underwent a cardiac gated CT angiography (CTA) for further understanding of anatomy and confirmation of diagnosis. In view of need for PGE1 until transfer to tertiary cardiac surgical centre, a peripherally inserted central venous catheter was inserted in the following 12 hours. He underwent an abdominal X-ray to check long line position (figure 1).

...

https://ift.tt/2vB3LT3

Unexpected cause for eyelid swelling and ptosis: rigid gas permeable contact lens migration following a 28-year-old trauma

A patient presented with left upper eyelid swelling and ptosis. The MRI reported a cyst with proteinaceous content. On surgical excision of the cyst, a rigid gas permeable (RGP) contact lens was found. The RGP lens was encapsulated within the upper eyelid soft tissue. It was later revealed that the patient experienced childhood trauma while wearing RGP contact lenses 28 years previously. The patient assumed that the RGP lens fell out and was lost; however, it can be inferred that the lens migrated into the eyelid and resided there asymptomatically for 28 years.

https://ift.tt/2AZ0ylp

Kikuchi-Fujimoto disease: a rare cause of cervical lymphadenopathy and fever

A 28-year-old Pakistani man with previously treated latent tuberculosis (TB) presented with a 3-month history of productive cough, fever, drenching night sweats, anorexia, sore throat and tender left cervical lymphadenopathy. Extensive biochemical and microbiological tests, and imaging studies were all inconclusive. Lymph node biopsy revealed the diagnosis of Kikuchi-Fujimoto disease (KFD). He had persistent fever and anorexia during admission despite supportive measures which resolved quickly on starting prednisolone. He remained well after being weaned off steroids on 18 weeks' follow-up. KFD is a rare, self-limiting disease which can mimic several serious conditions such as TB and lymphoma. Prompt diagnosis with lymph node biopsy is paramount in addressing diagnostic uncertainty and avoids starting potentially toxic treatment on these patients.

https://ift.tt/2vz73pR

Bitter experience with liquorice sweetening agent resulting in apparent mineralocorticoid excess with periodic paralysis

Chronic liquorice ingestion is a rare cause of secondary hypertension and hypokalaemia with periodic paralysis. We report the case of a middle-aged Indian man who presented with hypertension and hypokalaemic alkalosis with recurrent bouts of periodic paralysis. Biochemical investigations revealed suppressed plasma renin and aldosterone concentrations with normal cortisol concentration. A detailed history revealed that he was addicted for the last 5 years to a form of chewing tobacco mixed with herbal preparations as a sweetening agent which on analysis revealed active principles of glycyrrhizin using the thin liquid chromatography method. The hypokalaemia resolved and hypertension control improved significantly after discontinuing liquorice consumption, and the patient was asymptomatic at 1-year follow-up. Long-term liquorice ingestion should be kept in mind as a reversible cause of hypokalaemic periodic paralysis, with a meticulous history and biochemical evaluation helping in identifying this recognisable and curable medical disorder.

https://ift.tt/2AWPPYE

Johanson-Blizzard syndrome with associated urogenital anomalies

We present a case of a child with pancreatic insufficiency and facial defects typical of Johanson-Blizzard syndrome (JBS), along with the more facultative anomalies of the JBS, such as those of the urogenital system including persistent urogenital sinus, urethral duplication and dysplastic kidneys. Fetal ultrasound in a 21-year-old G1P1 woman revealed ambiguous genitalia. Examination at birth revealed a phallic structure with urethral meatus, non-palpable gonads, two orifices in close proximity in the perineum, with the anterior being a common urogenital channel and the posterior, the rectum. A voiding cystourethrogram/genitogram showed bilateral high-grade vesicoureteral reflux and a common urogenital sinus extending 1.5 cm before dividing into three channels: the native urethra, an accessory urethra directed anteriorly towards the clitoris and a septate vagina with uterus didelphys. JBS was suspected by clinical presentation and confirmed by UBR1 molecular testing (46,XX). At 16 months of age, she underwent feminising genitoplasty and posterior sagittal anorectoplasty.

https://ift.tt/2vwlOtw

Post-traumatic bony impingement into vagina: a rare cause of urethrovaginal fistula

A 22-year-old woman met with road traffic accident 6 months back following which she underwent exploratory laparotomy with intraperitoneal bladder rupture repair. She presented with urethrovaginal fistula due to a fragment of fractured pubic bone impinging into the anterior vaginal wall. The findings were confirmed on CT scan and cystoscopy. The patient was managed with removal of the bony spicule and transvaginal repair of urethrovaginal fistula with Martius fat pad interposition.

https://ift.tt/2AZ0qlV

Mediastinal lipoblastoma: a rare entity discovered on physical exam

Description 

A 3-year-old male with no significant medical or surgical history presents to his paediatrician for annual examination. On auscultation, he was noted to have diminished left-sided breath sounds and heart sounds displaced to the right. The patient had no complaints of pain, difficulty swallowing, shortness of breath or dyspnoea on exertion. An initial chest X-ray was performed which demonstrated complete opacification of the left hemithorax with mediastinal shift towards the right. This was followed by a radiation dose reduced CT of the chest with intravenous contrast, which demonstrated a 7.8x7.4x13.3 cm fat density mass filling the majority of the left lung and extending to the pleura and mediastinum (figure 1A). The patient was optimised for the operating room and underwent a left lateral thoracotomy. Intraoperatively, the mass was identified and noted to have fusion to the pericardium and pleura in its superior margin with all other...

https://ift.tt/2vz5okb

Cross-leg free flap for limb salvage in the setting of radiation

Limb salvage in an irradiated patient with limited recipient vessels leaves few options for reconstruction. Cross-leg free flaps have been used to reconstruct defects that would otherwise lead to amputation in patients with no ipsilateral recipient vessels. We present the first documented case of a cross-leg free flap for limb salvage in a radiated bed after infection and tumour resection.

https://ift.tt/2AZ0m5F

Allergen-specific sublingual immunotherapy is dose- and duration-dependent in a murine allergic rhinitis model

Publication date: Available online 10 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Soichi Tofukuji, Kazufumi Katayama, Yoshiyuki Nakano, Satoru Ishida, Junji Tsuchida, Minako Tajiri, Yusuke Shimo, Hidekazu Tanaka, Michitaka Shichijo

https://ift.tt/2KI25vG

Immunoglobulin D-Activated Mast Cells Induce IgE Synthesis in B Cells in Nasal Polyps

Publication date: Available online 10 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Guan-Ting Zhai, Hai Wang, Jing-Xian Li, Ping-Ping Cao, Wen-Xiu Jiang, Jia Song, Yin Yao, Zhi-Chao Wang, Zhe-Zheng Wang, Meng-Chen Wang, Bo Liao, Qi-Miao Feng, Xiang Lu, Heng Wang, Peisong Gao, Zheng Liu

Abstract

Background

Although up-regulated expression of local IgD has been reported in chronic rhinosinusitis (CRS), its function is unclear.

Objective

To explore the expression and function of soluble IgD in CRS, particularly CRS with nasal polyps (CRSwNP).

Methods

IgD levels in sinonasal mucosa were analyzed by RT-PCR and ELISA. The numbers and phenotypes of IgD⁺ cells were studied by immunohistochemistry, immunofluorescence, and flow cytometry. HMC-1 cells, a human mast cell line, and mast cells purified from eosinophilic polyps were culture alone or with naïve B cells purified from peripheral bloods. The antigen specificity of nasal IgD was investigated by ELISA.

Results

The mRNA expression of immunoglobulin heavy constant delta gene, the numbers of IgD⁺ cells, and the protein levels of secretory IgD in sinonasal mucosa were increased in CRS patients with or without nasal polyps compared to controls. The numbers of IgD⁺ plasmablasts were increased in both eosinophilic and non-eosinophilic polyps, whereas the numbers of IgD⁺ mast cells were only increased in eosinophilic polyps. Crosslinking IgD induced serum pre-incubated HMC-1 cells and polyp mast cells to produce B-cell activating factor, IL-21, IL-4 and IL-13, and to promote IgM, IgG, IgA, and IgE production from B cells. In eosinophilic polyps, the expression of those B cell-stimulating factors in mast cells and close contacts between mast cells and B cells were found. Moreover, positive correlations of total IgD with total IgE and eosinophilia, and up-regulation of specific IgD against house dust mites were discovered in eosinophilic polyps.

Conclusion

IgD-activated mast cells may facilitate IgE production and eosinophilic inflammation in CRSwNP.

https://ift.tt/2M9z1Dc

Low-level ozone has both respiratory & systemic effects in African-American adolescents with asthma despite asthma controller therapy

Publication date: Available online 10 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Michelle L. Hernandez, Radhika Dhingra, Allison J. Burbank, Krista Todorich, Ceila E. Loughlin, Marcia Frye, Kelly Duncan, Carole Robinette, Katherine Mills, Robert B. Devlin, David B. Peden, David Diaz-Sanchez

https://ift.tt/2KH3sep

Appropriateness of chronic asthma management and medication adherence in patients visiting ambulatory clinic of Gondar University Hospital: a cross-sectional study

Although asthma cannot be cured, appropriate management can ensure adequate control of the disease, prevent disease progression and even reverse the illness, enabling people to enjoy good quality of life. Pred...

https://ift.tt/2KGUX2Z

First Report of Klein-Waardenburg Syndrome in Iran and a Novel Pathogenic Splice Site Variant in PAX3 Gene

Publication date: Available online 10 August 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Mohammad Saberi, Zahra Golchehre, Hamzeh Salmani, Arezou Karamzade, Seyed Ziaeddin Tabatabaie, Mohammad Keramatipour

Abstract

Objectives

Waardenburg Syndrome (WS) as a congenital auditory-pigmentary syndrome is a clinically and genetically heterogeneous disorder. Based upon clinical manifestations, it can be classified into four types. Loss of function mutations in PAX3 gene cause WS1 and WS3 (Klein-Waardenburg syndrome). While WS2 and WS4 have locus heterogeneity with multiple causative genes. Here we report a novel splice site variant in a pedigree with multiple affected members. Based on diagnostic criteria, three of them are associated with WS3. The remained patients classified as type 1.

Methods

PCR amplification and Sanger sequencing were performed for all exons and all exon-intron boundaries of PAX3 (NM_181459) gene of the proband. Then available symptomatic and asymptomatic members were screened for the detected variant. Interpretation and classification of the variant were done based on ACMG guidelines.

Results

We identified a novel heterozygous splice site variant (c.586+2T>C) in donor site of intron 4 of PAX3 gene in our proband. Moreover, this variant was co-segregated with the disease in other available five affected members. Also, the detected variant was not detected in any of the investigated asymptomatic members. This variant was classified as a pathogenic variant based on the current guidelines for variant interpretation.

Conclusions

This study shows significant intra-familial clinical heterogeneity and absence of phenotype-genotype correlation in a pedigree with Waardenburg Syndrome. However, severity of phenotypes and additional symptoms in the patients can be related to alternative splicing and different levels of PAX3 expression. Detailed evaluation of more cases can shed light on this and case-reports are valuable traffic sign in the road. This article is the first report of Waardenburg syndrome type 3 in Iran.

https://ift.tt/2AZx479

Follow up for Patients With Thyroid Cancer Planed for Radioiodine Scan or Treatment

Condition:   Thyroid Cancer
Intervention:   Radiation: radioiodine
Sponsor:   Taichung Veterans General Hospital
Recruiting

https://ift.tt/2MAkNaH

Assessment of the Effects of Concussion on Adolescent Rugby Union Players

Conditions:   Concussion, Mild;   Concussion, Intermediate;   Concussion, Severe
Intervention:  
Sponsor:   Sports Surgery Clinic, Santry, Dublin
Recruiting

https://ift.tt/2Miq4qe

Feasibility & Efficacy of Durvalumab+Tremelimumab+RT and Durvalumab+RT in Non-resect. Locally Advanced HPVnegativ HNSCC

Condition:   Squamous Cell Carcinoma of the Head and Neck
Interventions:   Drug: Durvalumab;   Drug: Tremelimumab;   Radiation: Radiotherapy
Sponsors:   Ulrich Keilholz;   Charite University, Berlin, Germany;   AstraZeneca
Not yet recruiting

https://ift.tt/2MAxHoV

Combination Study With Soluble LAG-3 Fusion Protein Eftilagimod Alpha (IMP321) and Pembrolizumab in Patients With Previously Untreated Unresectable or Metastatic NSCLC, or Recurrent PD-X Refractory NSCLC or With Recurrent or Metastatic HNSCC

Conditions:   NSCLC;   HNSCC
Interventions:   Drug: Eftilagimod alpha;   Drug: Pembrolizumab
Sponsors:   Immutep S.A.;   Merck Sharp & Dohme Corp.
Not yet recruiting

https://ift.tt/2MilKY0

Complete lymph node dissection or observation in melanoma patients with multiple positive sentinel lymph nodes: A single‐center retrospective analysis

The Journal of Dermatology, EarlyView.


https://ift.tt/2MyOclm

Twice-daily red and blue light treatment for Candida albicans biofilm matrix development control

Abstract

Phototherapy has been proposed as a direct means of affecting local bacterial infections. However, the use of phototherapy to prevent fungal biofilm development has received comparatively less attention. This study aimed to determine the effects of red light treatment and blue light treatment, without a photosensitizer, on the development of Candida albicans biofilm. During the development of 48-h biofilms of C. albicans SN 425 (n = 10), the biofilms were exposed twice-daily to noncoherent blue and red light (LumaCare; 420 nm and 635 nm). The energy density applied was 72 J cm⁻² for blue light and 43.8 J cm², 87.6 J cm², and 175.5 J cm² for red light. Positive control (PC) and negative control (NC) groups were treated twice-daily for 1 min with 0.12% chlorhexidine (CHX) and 0.89% NaCl respectively. Biofilms were analyzed for colony forming units (CFU), dry-weight, and exopolysaccharides (EPS-soluble and EPS-insoluble). Data was analyzed by one-way ANOVA and Tukey post hoc test (α = 0.05). Dry-weight was lower than NC (p < 0.001) and approached PC levels with both red and blue light treatments. CFU were also lower in groups exposed to blue light and higher durations of red light (p < 0.05). EPS-soluble and EPS-insoluble measures were variably reduced by these light exposures. In conclusion, twice-daily exposure to both blue and red lights affect the biofilm development and physiology of polysaccharide production and are potential mechanisms for the control of C. albicans biofilm matrix development.

https://ift.tt/2MaWiVi

Evaluation of occlusal caries detection and assessment by visual inspection, digital bitewing radiography and near-infrared light transillumination

Abstract

Aim

This study compared the diagnostic outcomes of visual inspection (VI), digital bitewing radiography (BWR), and near-infrared light transillumination (NIR-LT, DIAGNOcam, KaVo, Biberach, Germany) for occlusal caries detection and assessment of posterior teeth.

Participants and methods

This study included 203 patients (mean age 23.0 years). All individuals received a meticulous VI. Additionally, BWR and NIR-LT images were collected. All BWR and NIR-LT images were blindly evaluated for the presence of enamel caries lesions (ECLs) and dentin caries lesions (DCLs). The descriptive statistical analyses included calculation of frequencies, cross tabulations, and pairwise comparisons using Pearson chi-square tests.

Results

The majority of ECLs/DCLs were detected by VI in this low-risk adult population. The additional diagnostic outcomes in terms of ECLs/DCLs amounted to 5.0% (BWR) and 6.8% (NIR-LT). The combined usage of VI/NIR-LT or VI/BWR identified 95.7 and 94.4% of all ECLs/DCLs on occlusal surfaces, respectively.

Conclusion

This comparative diagnostic study showed that VI detected the majority of occlusal caries lesions. Both additional methods showed limited benefits. Due to the valuable features of NIR-LT, i.e., X-ray freeness and clinical practicability, this method might be preferred over X-ray-based methods. Nevertheless, BWRs should be prescribed in clinical situations where insufficient fillings or multiple (deep) caries lesions are diagnosed or where there is a need to assess the caries extension in relation to the pulp.

Clinical relevance

VI has to be understood as caries detection method of choice on occlusal surfaces in low-risk adult population which may help to avoid multiple diagnostic testing, overdiagnosis, and overtreatment.

https://ift.tt/2AWYr1v

Evaluation of an ex vivo porcine model to investigate the effect of low abrasive airpolishing

Abstract

Objectives

Evaluation of an ex vivo porcine model to investigate the influence of periodontal instrumentation on soft tissue.

Material and methods

In each of 120 pig mandibles, one molar tooth was chosen at random and instrumented. For subgingival debridement, two different low abrasive airpolishing powders (glycine d₉₀ = 25 μm, erythritol d₉₀ = 14 μm, n = 30 teeth each), curets, and a piezoelectric ultrasonic scaler were used (n = 30 teeth each). Thirty teeth in 30 other mandibles served as the untreated control. Gingival biopsies were histologically assessed for destruction using a four-graded scale.

Results

The porcine model was deemed suitable for the planned investigation. Hand instrumentation and ultrasonic scaling caused higher tissue damage than both low abrasive airpolishing modes (Fisher's exact test, p = 0.0025). Glycine powder led to less, yet non-statistical noticeable gingival changes compared to erythritol-based powder (Fisher's exact test, p = 0.39).

Conclusion

An animal model using pig jaws may be used as a preliminary model to analyze histological effects of periodontal instrumentation in advance of studies performed in human tissues. Among the techniques assessed, low abrasive airpolishing (LAA) caused the smallest tissue damage.

Clinical relevance

To avoid gingival damage using LAA, histological observations of gingival tissue are needed. Since numerous powders for LAA have been developed and it may be expected that additional products will follow, it appears to be useful to establish ex vivo animal models to prove the powders safety.

https://ift.tt/2vvjGCs

Biological complications of removable dental prostheses in the moderately reduced dentition: a systematic literature review

Abstract

Objectives

The aim of the present study was a systematic review and subsequent meta-analysis on biological complications of removable prostheses in the moderately reduced dentition.

Materials and methods

A systematic literature search in established medical databases (MEDLINE, EMBASE, BIOSIS, SciSearch, Cochrane, FIZ Technik Web) and a hand search of relevant dental journals was conducted. The search terms were relevant MeSH terms, free search terms, and combinations of the two. The search included randomized controlled trials, prospective and retrospective studies with data on biological complications of removable dental prostheses in the moderately reduced dentition with at least 15 participants, an observation period of at least 2 years, and a drop-out rate of less than 25%. The selection of relevant publications was carried out at the title, abstract, and full-text level by at least two of the authors involved. The publications included were tabulated and analyzed.

Results

Of the original 12,994 matches, 1923 were analyzed by title, 650 by abstract, and 111 according to the full text. A total of 42 publications were ultimately included. The following parameters were evaluated.

Tooth loss

Results varied, depending on the observation period, between 0 and 18.1% for clasp-retained removable dental prostheses (RDPs), between 5.5 and 29% for attachment-retained RDPs, and between 5.5 and 51.7% for double crown-retained RDPs.

Caries

Results varied, depending on the observation period, between 0 and 32.7% for clasp-retained RDPs, between 1.8 and 29% for attachment-retained RDPs, and between 1.8 and 16.4% for double crown-retained RDPs.

Endodontic treatment

Results varied, depending on the observation period, between 3.5 and 19.2% for clasp-retained RDPs, between 6.9 and 16.4% for attachment-retained RDPs, and between 0.6 and 13.9% for double crown-retained RDPs.

Tooth fracture

Results varied, depending on the observation period, between 1.7 and 5.3% for clasp-retained RDPs, between 12.7 and 40% for attachment-retained RDPs, and between 0.4 and 4.4% for double crown-retained RDPs.

Tooth mobility

There were no changes or improvements for clasp-retained RDPs. The better the pre-treatment and supportive care is, the smaller the differences are. For double crown-retained RDPs, a slight increase was found in one study. The results for the parameters probing depth and radiological bone loss were inconclusive.

Gingival recession

Gingival recession seemed to be favored by a mandibular sublingual bar. Compared to fixed restorations, removable restorations seemed to be associated with a more pronounced need for dental treatment. Stringent pre-treatment and supportive care reduced the complication rates.

Conclusions

Heterogeneous study designs and data analyses rendered a meta-analysis impossible, so that an evaluation at the highest level of evidence could not be performed.

Clinical relevance

Within the limitations of this study, it would be correct to state that removable dental prostheses require intensive maintenance. Suitable pre-treatment and supportive care can lower the complication rates, in the absence of which they constitute trigger factors for (additional) biological complications.

https://ift.tt/2B0kvIM

Survival in sinonasal and middle ear malignancies: a population-based study using the SEER 1973–2015 database

The sinuses, nasal cavity, and middle ear represent a rarer location of head and neck malignancy than more common sites such as the larynx and oral cavity. Population-based studies are a useful tool to study t...

https://ift.tt/2Ou1dxp

Bildgebende radiologische Diagnostik und Verlaufsbeurteilung beim HCC

Zusammenfassung

Hintergrund

Die bildgebende radiologische Diagnostik ist heute aus den Untersuchungen beim hepatozellulären Karzinom (HCC) nicht mehr wegzudenken. Die Multidetektor-Computertomographie (CT) und Magnetresonanztomographie (MRT) spielen hierbei eine entscheidende Rolle. Die Kontrastmittelsonographie (CE-US, „contrast enhanced ultrasound") stellt zudem für die Charakterisierung des HCC bei einer in der B‑Bild-Sonographie zufällig entdeckten Leberläsion bei Hochrisikopatienten eine Alternative dar.

Methode

Es wurden eine Recherche und Analyse aktueller Literatur durchgeführt.

Ergebnisse

Die CT ist als schnell und universell verfügbare Bildgebungsmodalität eine wichtige Methode zur Diagnostik des HCC. Sie profitiert von den technischen Weiterentwicklungen der letzten Jahrzehnte, die sich neben reduzierter Strahlendosis v. a. in schnellerer Akquisition niederschlagen. Mit der MRT können noch weitere Diagnosekriterien für die Evaluation und Differenzialdiagnose von fokalen Leberläsionen in der zirrhotischen Leber herangezogen werden. Sie ist heute ausreichend robust, um bei den allermeisten Patienten adäquate Bilder zu generieren. Die CE-US ist in der aktuellen nationalen S3-Leitlinie zur Diagnostik und Therapie des HCC als alternatives bildgebendes Verfahren zur CT und MRT für die Charakterisierung des HCC empfohlen, wenn ein unklarer Leberrundherd unabhängig von seiner Größe in einer Hochrisikogruppe in der B‑Bild-Sonographie detektiert wird. Die Vorteile liegen in den geringen Kosten, der raschen Verfügbarkeit, der fehlenden Strahlenbelastung und der fehlenden Nephrotoxizität. Im klinischen Alltag hat sich die Responsebeurteilung mit den mRECIST-Kriterien beim HCC weitestgehend durchgesetzt.

https://ift.tt/2vxWSlH

Protease resistance of food proteins: a mixed picture for predicting allergenicity but a useful tool for assessing exposure

Susceptibility to pepsin digestion of candidate transgene products is regarded an important parameter in the weight-of-evidence approach for allergenicity risk assessment of genetically modified crops. It has ...

https://ift.tt/2AUsMOl

A Rapid and Cost-Effective Device for Testing Minimal Erythema Dose

Abstract

Introduction

We describe a novel device for rapid and economical minimal erythema dose testing in patients undergoing ultraviolet (UV) light phototherapy for treatment of skin diseases.

Methods

A minimal erythema testing device was designed and created using transparent plastic sheeting and printed patterns with increasing ink density, allowing for graded UV transmission of 100%, 80%, 60%, 40%, 20%, and 10% energy through six 10-mm square apertures. The plastic sheet was placed in a UV-impenetrable and Velcro-fitted adjustable sleeve, designed to fit easily onto a patient's arm. A pilot validation study was performed, comparing this device with a commercially available windowed device in which the dose is controlled by varying the UV exposure time through sequential opening of each window. The pilot was conducted on healthy skin of two human subjects with different Fitzpatrick skin types.

Results

In our subjects, tested with one device on each forearm, the minimal erythema dose (MED), judged visually, was identical. However, the test device allowed MED testing in 3 min compared with 15 min for the traditional device. The test device is equally effective for use with ultraviolet-A (UVA), narrowband ultraviolet-B (NB-UVB) and broadband ultraviolet-B (BB-UVB) wavelengths. The test device is economical, with manufacturing cost of less than US $2.

Conclusion

We designed an MED testing device that is quick, accurate, cost-effective, and easy to use in the setting of a busy phototherapy practice. This device therefore has many advantages over existing MED testing approaches.

https://ift.tt/2AZ6hrv

Temporal lobe injury patterns following intensity modulated radiotherapy in a large cohort of nasopharyngeal carcinoma patients

Publication date: October 2018

Source: Oral Oncology, Volume 85

Author(s): Lixia Lu, Yang Sheng, Guangshun Zhang, Yizhuo Li, Pu-Yun OuYang, Yaorong Ge, Tianyi Xie, Hui Chang, Xiaowu Deng, Jackie Q. Wu

Abstract

Objectives

To analyze the correlation between dose-volume-histograms (DVHs) with three patterns (edema, enhancement, and necrosis) of temporal lobe injury (TLI) in patients receiving intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC) and to determine optimal thresholds to predict the incidence of each TLI pattern, with particular emphasis on the relationship between edema volume and the risk of enhancement and necrosis.

Materials and methods

A cohort of 4186 NPC patients treated with IMRT was retrospectively reviewed with TLI presenting in 188 patients. The atlases of complication incidence (ACI) for each pattern were constructed using DVH curves of temporal lobes. Optimal threshold for predicting incidence of each pattern was determined using the point closest to top-left of the plot. The accuracy of using edema volume to predict enhancement and necrosis incidence was evaluated via area under curve (AUC) of receiver operator characteristics (ROC).

Results

All DVH parameters, D_mean, D_max, D_0.25cc, D_0.5cc, D_1cc, D_3cc, D_6cc, V_20Gy, V_30Gy, V_40Gy, V_50Gy, V_60Gy, and V_70Gy, except D_min showed statistically significant differences between subgroups of each pattern (p < 0.05). For predicting incidence of each pattern, optimal DVH thresholds over the range of D_0.25-D_1cc, D_mean and V₂₀-V₇₀ were derived. The optimal thresholds of edema volume for predicting enhancement were 0.96 and 2.2cc and for predicting necrosis were 0.94 and 11.5cc.

Conclusion

Optimal DVH thresholds were generated for limiting risk of each injury pattern. Edema volume was a strong predictor for risk of enhancement and necrosis, which could potentially be reduced by lowering edema volume below threshold.

https://ift.tt/2KGX9Hz

Health-related quality of life of parotid carcinoma patients—a comparative study with parotid adenoma patients and assessment of the influence of demographic, treatment, and pathological factors

Publication date: Available online 9 August 2018

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): D. Stodulski, R. Świątkowska-Stodulska, B. Mikaszewski, J. Kuczkowski

Abstract

The aim of this study was to compare the health-related quality of life (HRQoL) of patients treated for parotid carcinoma (PC) and parotid adenoma (PA). The impact of demographic, treatment, and pathological factors was analyzed within the PC group. The EORTC QLQ-C30 and QLQ-H&N35 questionnaires were completed by 45 PC patients and 46 PA patients. A number of HRQoL domains were significantly worse in the PC group than in the PA group: global health status, pain, insomnia, loss of appetite, mouth opening, swallowing problems, dry mouth, sticky saliva, problems with senses and speech, social eating, and cognitive functioning (P < 0.05). In the PC group, significantly worse scores were found for age >55 years, radical parotidectomy, neck dissection, radiotherapy, recurrence of the disease, pT3/T4 stage, pN+ status, and high-grade tumour (P < 0.05). Worse results were related to global health status, social contact, mouth opening, weight and appetite loss, physical, role, emotional, and social functioning, fatigue, speech problems, social eating, and financial difficulties. The study results demonstrate worse HRQoL in PC patients in comparison to PA patients. Older age, radical parotidectomy, neck dissection, radiotherapy, T3/T4 stage, pN+, high-grade tumours, and recurrence had a significant influence on HRQoL in PC patients.

https://ift.tt/2Mvjhq6

Mal d 1 and Bet v 1 sensitization pattern in children with Pollen Food Syndrome

Publication date: Available online 9 August 2018

Source: Allergology International

Author(s): Roberta Olcese, Michela Silvestri, Paolo Del Barba, Noemi Brolatti, Salvatore Barberi, Maria Angela Tosca, Giorgio Ciprandi

https://ift.tt/2vUa7wb

MicroRNA regulation of natural killer cell development and function in leukemia

Publication date: Available online 9 August 2018

Source: Molecular Immunology

Author(s): Jennifer N. Saultz, Aharon G. Freud, Bethany L. Mundy-Bosse

Abstract

MicroRNAs (miRNAs) are now recognized as important regulators of all cellular processes, including immune function and cancer survival. These evolutionary preserved, single-stranded, non-coding RNA molecules mediate important functional effects primarily through post-transcriptional regulation of protein expression. MiRNAs are known to mediate multiple oncogenic pathways in tumor cells, both tumor promoting and tumor suppressing. In addition to a direct tumor cell effect, miRNAs have also been shown to play a critical role in immune cell development, function and survival. Here we expand on previous reports to evaluate miRNA regulation in natural killer (NK) cells primarily in humans and focus on their influence on NK cell development and function in the setting of hematologic malignancies. In addition, we highlight the most recent miRNA discoveries in hematologic malignancies and discuss areas of future exploration relevant to the translational field of innate immunology and miRNA-based therapeutic intervention.

https://ift.tt/2MlPqDA

Novel systemic drugs in treatment of atopic dermatitis: results from phase II and phase III studies published in 2017/2018

Purpose of review The present review will give an update of recently published clinical studies on novel systemic treatment approaches in atopic dermatitis. Recent findings Until 2017 immunosuppressive drugs such as cyclosporine had to be used in atopic dermatitis when the disease could not sufficiently be treated with topical drugs. Several new substances specifically targeting inflammation in atopic dermatitis are currently studied. In 2017, dupilumab was approved in the United States and in Europe for first-line biologic treatment of moderate to severe atopic dermatitis in adults. The antibody blocks a subunit of the interleukin (IL)-4 and IL-13 receptor, thus inhibiting effects of two key cytokines in type 2 polarized inflammation. In addition to the studies on dupilumab recent clinical investigations on the effects on anti-IL-13 (lebrikizumab, tralokinumab), anti-IL-31 receptor (nemolizumab), anti-IL-22 (fezakinumab), and on small molecules targeting the histamine-4-receptor (ZPL389) and the Janus kinase inhibitor baricitinib have been published as full papers in the last 2 years. Summary A couple of promising novel therapeutical targets have recently been investigated and published in clinical trials on atopic dermatitis. Correspondence to Thomas Werfel, Abteilung Immundermatologie und experimentelle Allergologie, Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625 Hannover, Deutschland. Tel: +49 5115325092; fax: +49 5115328112; E-mail: werfel.thomas@mh-hannover.de Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Therapeutic efficacy of the Galletti–Contrino manoeuvre for benign paroxysmal positional vertigo of vertical semicircular canals in overweight subjects

Abstract

Objective

To compare the Galletti–Contrino manoeuvre with the more widely used Semont–Toupet in overweight subjects presenting with benign paroxysmal positional vertigo (BPBV) of vertical semicircular canals (posterior and anterior canals).

Study design

Prospective cohort study.

Patients

204 patients (BMI range 25–30) with a diagnosis of BPPV of vertical semicircular canals were randomly divided in two groups treated with two different maneuvers: Galletti–Contrino (Group A) and Semont–Toupet manoeuvre (Group B). The results were compared with those obtained from a control group (204 non-overweight subjects with BPV of vertical semicircular canals.)

Intervention

Galletti Contrino/ Semont Toupet manoeuvres.

Main outcome measure(s)

Liberatory nystagmus or vertigo after maximum 2 maneuvers. Vertigo and dizziness intensity scores (Visual analogue scale VAS 0–10) from day 0 to day 5 following the repositioning manoeuvre were also recorded in responsive patients.

Results

While in non-overweight subjects no significant difference comparing the effectiveness of the two manoeuvres was found, liberatory nystagmus and vertigo were more frequently observed after Galletti Contrino manoeuvre in overweight subjects; this difference was statistically significant when posterior canals were involved (P < 0.03). Vertigo and dizziness VAS scores reduced significantly from day 0 to day 5 after therapy in all groups. A more significant reduction of dizziness VAS was recorded in patients undergoing Galletti–Contrino manoeuvre at days 4–5 (P < 0.005).

Conclusion

Galletti–Contrino manoeuvre seems to be significantly more effective than Semont–Toupet manoeuvre in the treatment of BPPV of posterior semicircular canal and may be preferential in patients with limited body movements.

https://ift.tt/2Mayu3S

CXCR4 Antagonist Reduced the Incidence of Acute Rejection and Controlled Cardiac Allograft Vasculopathy in a Swine Heart Transplant Model Receiving a Mycophenolate-Based Immunosuppressive Regimen

Background CXCR4 blockade is pursued as an alternative to mesenchymal stem cell (MSC) treatment in transplantation based on our previous report that burixafor, through CXCR4 antagonism, mobilizes immunomodulatory MSCs. Here, we explored the efficacy of combining mycophenolate mofetil (MMF)-based immunosuppressants with repetitive burixafor administration. Methods Swine heterotopic cardiac allograft recipients received MMF and corticosteroids (control, n = 10) combined with burixafor as a 2-dose (burixafor2D, n = 7) or 2-dose plus booster injections (burixafor2D+B, n = 5) regimen. The efficacy endpoints were graft survival, freedom from first acute rejection, and the severity of intimal hyperplasia. Each specimen was sacrificed either at its first graft arrest or after 150 days. Results After 150 days, all specimens in the control group had died, but 28.5% of the burixafor2D group survived, and 60% of the burixafor2D+B group survived (P = 0.0088). Whereas the control group demonstrated acute rejection at a median of 33.5 days, the burixafor2D+B group survived without acute rejection for a median of 136 days (P = 0.0209). Burixafor administration significantly attenuated the incidence rate of acute rejection (P = 0.002) and the severity of intimal hyperplasia (P = 0.0097) at end point relative to the controls. These findings were associated with reduced cell infiltrates in the allografts, and modulation of C-reactive protein profiles in the circulation. Conclusions The augmentation of conventional MMF plus corticosteroids with a CXCR4 antagonist is potentially effective in improving outcomes after heart transplantation in minipigs. Future studies are warranted into optimizing the therapeutic regimens for humans. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. chiiminglee@ntu.edu.tw Authorship Participated in research design: Wan-Tseng Hsu, Hsiang-Yiang Jui, Chii-Ming Lee. Participated in the writing of the paper: Wan-Tseng Hsu, Chia-Tung Shun, Kenneth Kun-Yu Wu, Chii-Ming Lee. Participated in the performance of the research: Wan-Tseng Hsu, Cheng-Hsin Lin, Ya-Hsuan Tseng, Chii-Ming Lee. Contributed new reagents: Ming-Chu Hsu. Participated in data analysis: Wan-Tseng Hsu, Ya-Hsuan Tseng. Disclosure: M.C.H is the cofounder and a shareholder of TaiGen Biotechnology Co., Ltd., Taipei, Taiwan. All other authors indicate no potential conflicts of interest. Funding: This study was supported by research grants from National Health Research Institutes (NHRI-CS-102-PP-15, NHRI-CS-103-PP-15, and NHRI-CS-104-PP-15) as well as Ministry of Science and Technology (MOST103-2321-B-002-101). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Oxygen Perfusion (Persufflation) of Human Pancreata Enhances Insulin Secretion and Attenuates Islet Proinflammatory Signaling

Background All human islets used in research and for the clinical treatment of diabetes are subject to ischemic damage during pancreas procurement, preservation, and islet isolation. A major factor influencing islet function is exposure of pancreata to cold ischemia during unavoidable windows of preservation by static cold storage (SCS). Improved preservation methods may prevent this functional deterioration. In the present study, we investigated whether pancreas preservation by gaseous oxygen perfusion (persufflation) better preserved islet function versus SCS. Methods Human pancreata were preserved by SCS or by persufflation in combination with SCS. Islets were subsequently isolated, and preparations in each group matched for SCS or total preservation time were compared using dynamic glucose stimulated insulin secretion as a measure of β cell function and RNA sequencing to elucidate transcriptomic changes. Results Persufflated pancreata had reduced SCS time, which resulted in islets with higher glucose stimulated insulin secretion compared to islets from SCS only pancreata. RNA sequencing of islets from persufflated pancreata identified reduced inflammatory and greater metabolic gene expression, consistent with expectations of reducing cold ischemic exposure. Portions of these transcriptional responses were not associated with time spent in SCS and were attributable to pancreatic reoxygenation. Furthermore, persufflation extended the total preservation time by 50% without any detectable decline in islet function or viability. Conclusions These data demonstrate that pancreas preservation by persufflation rather than SCS prior to islet isolation reduces inflammatory responses and promotes metabolic pathways in human islets, which results in improved β cell function. Corresponding Author: Klearchos K. Papas, PhD, Institute for Cellular Transplantation, Department of Surgery, University of Arizona, Medical Research Building, 1656 E. Mabel Street, Room 122, Tucson, AZ 85724, Tel: (520) 626-5853, Fax: (520) 626-3770. E-Mail: kkpapas@surgery.arizona.edu Author Contributions K.K.P., A.C.K., K.E.S., S.W.L, and R.M.L. designed the study. Pancreas persufflation and islet isolations were conducted by C.G.M., J.J., K.E.S., N.D.P, D.S.M., I.G.G., T.L., C.P.H, S.P., W.E.S., D.M., J.A.S., D.O., T.K., G.L.S., A.M.P., P.G.S., T.K., W.J.S., B.P.W., and R.C.H. Functional islet assessments at the University of Arizona were conducted by K.E.S., C.W., W.G.P., C.G.M., D.S.M., and N.D.P. Technical aspects of sequencing and subsequent data analysis were conducted by A.C.K., A.M.C, L.E.C., F.M.M., R.M.L., and S.W.L. Traditional RNA quantification was conducted by A.C.K., K.E.S., L.E.C., M.J.A. All authors contributed to data interpretation, reviewed the manuscript and approved the final version. Funding This work was supported by the National Institutes of Health grants NIH/SBIR 5R44DK070400-04 (K.K.P., Co-Principal Investigator with Dr. Linda Templeman, Giner Inc.) and R01DK084842 (S.W.L., Principal Investigator) and NIH/NIDDK DP3 grant 1DP3DK106933-01 (K.K.P., Principal Investigator). Duality of Interest Klearchos K. Papas, PhD served as Consultant/ Chair SAB Giner Inc, is a co-inventor on pending patents related to persufflation with University of Minnesota and Giner Inc., and was the PI or co-PI on the NIH/NIDDK grants that partially funded the work. He is no longer affiliated with Giner Inc. "The remaining authors declare no conflicts of interest". Guarantee K.K.P. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Pectoral Block Failure May Be Due to Incomplete Coverage of Anatomical Targets: A Dissection Study

Background and Objectives The popularization of ultrasound-guided nerve blocks in cosmetic and reconstructive breast surgery calls for better anatomical understanding of chest wall innervation. When inserting subpectoral implants, pain from pocket dissection, stretching of muscle, and release of costal attachments may be relieved by blocking the pectoral nerves in the interpectoral (IP) space. We describe the variable anatomy of the pectoral nerves in the IP space in order to define the area to be covered for sufficient blockade, based on cadaver dissections. Methods Twenty-six fresh cadavers were dissected bilaterally. The number, location, and course of the pectoral nerves were recorded. Distances to surface landmarks (sternum, clavicle, and costae) and ultrasound landmarks (thoracoacromial artery [TAA] and pectoralis minor muscle [Pm]) were recorded. Results The lateral pectoral nerve and the TAA entered together into the IP space 8.9 cm (range, 8.0–12.0 cm) lateral to the midsternal line. The medial pectoral nerve (MPN) had between 1 and 4 branches that pierced the Pm, and 69% had additional branches lateral to the Pm. The muscle-piercing MPN branches were located 3.8 cm (range, 0.4–8.1 cm) and the lateral MPN branches 5.4 cm (range, 3.0–8.4 cm) from the lateral pectoral nerve. The IP course was 2.6 cm (range, 0.7–6.5 cm). All specimens were asymmetrical in location or number of MPN branches. Conclusions The MPN branches that innervate the lower part of the pectoralis major muscle are asymmetrical and variable in location and length; all located in a triangular area easily defined by sonographic landmarks, lateral to the TAA. Accepted for publication April 4, 2018. Address correspondence to: Lena F. Carstensen, MD, Department of Breast Surgery, Sydvestjysk Sygehus, 6700 Esbjerg, Denmark (e-mail: lena.carstensen@dadlnet.dk). The authors declare no conflict of interest. Preliminary results were presented at the poster session, Oncoplastic & Reconstructive Breast Surgery (ORBS) International Scientific Meeting, Nottingham, September 2015. Copyright © 2018 by American Society of Regional Anesthesia and Pain Medicine.

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Efficacy and safety of dexmedetomidine in peripheral nerve blocks: A meta-analysis and trial sequential analysis

BACKGROUND The duration of analgesia provided by nerve blocks is limited if local anaesthetics are administered alone. Therefore, several additives, including dexmedetomidine (DEX), have been investigated in order to prolong postoperative analgesia following single-shot regional anaesthesia. OBJECTIVES The aim of this meta-analysis was to assess the efficacy and safety of the addition of perineural DEX to local anaesthetics compared with local anaesthetics alone or local anaesthetics combined with systemic administration of DEX. DESIGN A systematic review of randomised controlled trials (RCT) with meta-analysis, trial sequential analysis and assessment of the quality of evidence by the GRADE approach. DATA SOURCES The databases MEDLINE, CENTRAL and EMBASE (to May 2017) were systematically searched. ELIGIBILITY CRITERIA All prospective RCTs investigating the efficacy and safety of perineural DEX combined with local anaesthetics compared with local anaesthetics alone or local anaesthetics in combination with systemic DEX in peripheral nerve blocks of adults undergoing surgery were included. RESULTS A total of 46 RCTs (3149 patients) were included. Patients receiving perineural DEX combined with local anaesthetics had a longer duration of analgesia than local anaesthetics alone [mean difference 4.87 h; 95% confidence interval (95% CI) 4.02 to 5.73; P 

https://ift.tt/2Os86zg

Effects of a single subanaesthetic dose of ketamine on pain and mood after laparoscopic bariatric surgery: A randomised double-blind placebo controlled study

BACKGROUND When administered as a continuous infusion, ketamine is known to be a potent analgesic and general anaesthetic. Recent studies suggest that a single low-dose administration of ketamine can provide a long-lasting effect on mood, but its effects when given in the postoperative period have not been studied. OBJECTIVE We hypothesised that a single low-dose administration of ketamine after bariatric surgery can improve pain and mood scores in the immediate postoperative period. DESIGN We performed a randomised, double-blind, placebo-controlled study to compare a single subanaesthetic dose of ketamine (0.4 mg kg−1) with a normal saline placebo in the postanaesthesia care unit after laparoscopic gastric bypass and gastrectomy. SETTING Single-centre, tertiary care hospital, October 2014 to January 2018. PATIENTS A total of 100 patients were randomised into the ketamine and saline groups. INTERVENTION Patients in the ketamine group received a single dose of ketamine infusion (0.4 mg kg−1) in the postanaesthesia care unit. Patients in the placebo groups received 0.9% saline. OUTCOME MEASURES The primary outcome was the visual analogue pain score. A secondary outcome was performance on the short-form McGill's Pain Questionnaire (SF-MPQ). RESULTS There were no significant differences in visual analogue pain scores between groups (group-by-time interaction P = 0.966; marginal group effect P = 0.137). However, scores on the affective scale of SF-MPQ (secondary outcome) significantly decreased in the ketamine group as early as postoperative day (POD) 2 [mean difference = −2.2 (95% bootstrap CI −2.9 to 1.6), Bonferroni adjusted P 

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Ultrasound assessment of gastric emptying time after a standardised light breakfast in healthy children: A prospective observational study

OBJECTIVES Current guidelines recommend 6 h of fasting for solids before anaesthesia. However, prolonged fasting may lead to discomfort, hunger, thirst, misbehaviour and lipolysis. To prevent this, a more liberal fasting regimen has been empirically implemented in our children's hospital, allowing a shorter fasting time of 4 h for a standardised light breakfast. AIM The aim of this study was to determine the gastric emptying time after a standardised light breakfast in healthy children. DESIGN A prospective observational noninterventional study. METHODS After fasting overnight, the children had a standardised light breakfast. Before and afterwards, ultrasound examinations of the gastric antrum were performed hourly to determine the gastric antral area (GAA), which is a surrogate parameter for gastric volume in children in the right lateral position (RLP). Demographic data and fasting times are presented as mean ± SD (range) and GAA as median (interquartile range). RESULTS Twenty-two children aged 7.8 (2.5 to 13.6) years volunteered for this study. After fasting overnight [735 ± 120 (467 to 930) min], the initial GAA was 3.06 (2.35 to 4.03) cm2 in RLP. After the light breakfast, GAA in RLP initially increased and decreased subsequently. After 4 h, GAA in RLP was lower than the initial value (median of differences −0.54, 95% confidence interval −1.00 to −0.07, P 

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Association of pre-operative troponin levels with major adverse cardiac events and mortality after noncardiac surgery: A systematic review and meta-analysis

BACKGROUND Circulating cardiac troponin levels are powerful predictors of prognosis in many clinical settings, but their association with outcomes after noncardiac surgery is unclear. OBJECTIVES The aim of this systematic review was to summarise current evidence on the association of pre-operative troponin elevation with postoperative major adverse cardiac events (MACE) and mortality in patients undergoing noncardiac surgery. DESIGN Systematic review of observational studies with meta-analysis. DATA SOURCES PubMed, EMBASE and Science Citation Index Expanded (ISI Web of Science) from their inception to 1 October 2017. ELIGIBILITY CRITERIA Observational studies reporting the associations between pre-operative troponin levels and MACE and all-cause mortality after noncardiac surgeries were included. RESULTS Ten studies met the eligibility criteria. The entire body of evidence addressing the research question was based on a total of 10 371 patients: 4.7 to 68.3% (median 23.8%) of patients had elevated troponin levels before surgery. Elevated pre-operative troponin was significantly associated with short-term MACE (seven studies, 5180 patients: odds ratio (OR) 6.92, 95% confidence interval (CI) 3.85 to 12.42), short-term mortality (five studies, 6103 patients: OR 4.23, 95% CI 2.27 to 7.89) and long-term mortality (two studies, 760 patients: OR 2.51, 95% CI 1.47 to 4.29). The associations remained significant when only multivariate-adjusted results were analysed. Overall, the reviewers' certainty about the summary estimates of the associations was very low. CONCLUSION Current evidence suggests that pre-operative high troponin levels are significantly associated with adverse cardiac events and mortality after noncardiac surgery. TRIAL REGISTRATION This systematic review was registered in the International Prospective Register of Systematic Reviews (Centre for Reviews and Dissemination 42017077837). Correspondence to Bing-Cheng Zhao, MD, Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou 510080, China E-mail: zhaobch@mail2.sysu.edu.cn Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (https://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Postanesthesia care by remote monitoring of vital signs in surgical wards

Purpose of review This narrative review summarizes recent insights into the role of remote monitoring of vital signs in the postoperative period in surgical wards. Recent findings Despite recent improvements in the safety of anesthesia and surgical procedures, postoperative complication rates are still unacceptably high. This is partly attributable to the intermittent provision of personal care to patients by nurses and ward physicians. Continuous remote monitoring of vital functions in the early postoperative period may reduce these complication rates. There are several medical-grade remote monitoring platforms available that integrate a biosensor signal with electronic patient records, enabling automated prediction or notification of patient deterioration. Most available platforms have technical limitations with respect to the accuracy of respiratory rate measurements. Of note, although the implementation of automated notifications of patient deterioration is associated with a reduced activation of acute response teams, the involvement of ward physicians in the early diagnosis and treatment of subtle changes in vital functions is increased. Summary Remote monitoring of vital signs in the surgical ward may contribute to prevention of severe complications and reduction in failure-to-rescue rates, although evidence for this association is still lacking. Anesthesiologists should contribute their knowledge and skills with respect to perioperative abnormalities in vital functions to improve patient safety during the postoperative period. Correspondence to Dr Christa Boer, Professor, Department of Anesthesiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands. Tel: +31 204443830; e-mail: c.boer@vumc.nl Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2vxGVff

Novel systemic drugs in treatment of atopic dermatitis: results from phase II and phase III studies published in 2017/2018

Purpose of review The present review will give an update of recently published clinical studies on novel systemic treatment approaches in atopic dermatitis. Recent findings Until 2017 immunosuppressive drugs such as cyclosporine had to be used in atopic dermatitis when the disease could not sufficiently be treated with topical drugs. Several new substances specifically targeting inflammation in atopic dermatitis are currently studied. In 2017, dupilumab was approved in the United States and in Europe for first-line biologic treatment of moderate to severe atopic dermatitis in adults. The antibody blocks a subunit of the interleukin (IL)-4 and IL-13 receptor, thus inhibiting effects of two key cytokines in type 2 polarized inflammation. In addition to the studies on dupilumab recent clinical investigations on the effects on anti-IL-13 (lebrikizumab, tralokinumab), anti-IL-31 receptor (nemolizumab), anti-IL-22 (fezakinumab), and on small molecules targeting the histamine-4-receptor (ZPL389) and the Janus kinase inhibitor baricitinib have been published as full papers in the last 2 years. Summary A couple of promising novel therapeutical targets have recently been investigated and published in clinical trials on atopic dermatitis. Correspondence to Thomas Werfel, Abteilung Immundermatologie und experimentelle Allergologie, Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625 Hannover, Deutschland. Tel: +49 5115325092; fax: +49 5115328112; E-mail: werfel.thomas@mh-hannover.de Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

https://ift.tt/2OtsbFl