Thyroid, Ahead of Print.
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Παρασκευή 24 Αυγούστου 2018
Transcutaneous Recording During Intraoperative Neuromonitoring in Thyroid Surgery
Immune tumor board: integral part in the multidisciplinary management of cancer patients treated with cancer immunotherapy
Abstract
Recent progress in the understanding of immune responses to cancer and how tumor cells evade immune control have led to the successful introduction of cancer immunotherapy, in particular immune checkpoint inhibitors (ICI). Treatment of cancer patients with immunotherapy such as ICIs has led to new challenges, including starting and stopping rules for immunotherapy, the management of immune-related adverse events, and logistic issues for the production of cellular therapies and viral delivery vectors. These challenges are not disease- or organ-specific and several potential biomarkers to predict response to ICI are under investigation. We installed an interdisciplinary discussion platform for managing patient-specific challenges associated with cancer immunotherapy in our institution. Here, we describe an immune tumor board for the management of cancer patients treated with immunotherapy and provide an outlook on how such a platform could be potentially used in the future to discuss rational and personalized combination therapies, and how to improve the management of side effects occurring under immunotherapy.
https://ift.tt/2PzHXzH
Traumatic tibia shaft fractures caused by the impact of a golf ball: two case reports
As golf becomes increasingly popular, the number of injuries while playing golf also increases. We experienced two cases of traumatic tibia shaft fractures caused by the impact of a golf ball.
https://ift.tt/2P1CVuU
FDA OKs New Prophylactic Drug for Rare Hereditary Angioedema
Lanadelumab (Takhzyro) is the first monoclonal antibody to help prevent attacks of hereditary angioedema in patients age 12 years and older.
FDA Approvals
https://ift.tt/2LpEP61
5 tips to provide safe and effective ventilation
Assign someone to monitor the patient's airway visually and with capnography using these five tips
https://ift.tt/2LodaT7
AMPH-1 is a tumor suppressor of lung cancer by inhibiting Ras-Raf-MEK-ERK signal pathway
Abstract
Amphiphysin 1 (AMPH-1) is a nerve terminal-enriched protein and it is a 128-kD protein with three identified functional domains. Some studies found that AMPH-1 was a dominant autoantigen associated with breast cancer and melanoma. However, its function in lung cancer is unknown. Here, we showed that AMPH-1 knockdown dramatically increased cell proliferation, attenuated cell apoptosis, and promoted cell cycle progression in human lung cancer cells. In vivo xenograft studies confirmed that the AMPH-1-knockdown cells were more tumorigenic than the controls. Moreover, we demonstrated that silencing AMPH-1 markedly activated Ras-Raf-MEK-ERK signal pathway. In summary, our results identified the anti-oncogenic function of AMPH-1 in lung cancer in vitro and in vivo. It is proposed that AMPH-1 may have potential as a new therapeutic target in human lung cancer treatment.
https://ift.tt/2BKdjAM
Management of Long-Standing Flaccid Facial Palsy: Midface/Smile
Masseter and temporalis muscle transfer is an effective technique for restoring facial symmetry and commissure excursion in flaccid facial paralysis. Adherence to the principles and biomechanics of muscle transfer is essential for achieving optimal results. Muscle transfer has the advantage of being single staged with fast recovery of function. It is particularly useful in patients with low life expectancy or multiple comorbidities where a more complex, multiple stage procedure may be detrimental.
https://ift.tt/2wcDCdz
Photo-modulation of zinc phthalocyanine-treated breast cancer cell line ZR-75-1 inhibited the normal tumor activity in vitro
Abstract
Regarding post-complication of convenient therapies against breast cancer, the emergence of effective approaches is essential. Photodynamic therapy is touted as a novel invasive therapeutic approach by the application of a photosensitizer promoted by laser irradiation. This study aimed to investigate the combined regime of low-level laser irradiation with zinc phthalocyanine in human breast cancer ZR-75-1 cell line. Cells were treated with 0.01 and 5 μg/ml of ZnPc for 24 h and exposed to radiation (70 mW) for 60 s. Cell viability was evaluated by MTT and flow cytometry. Cell migration capacity was monitored by scratch test, Transwell migration insert, and gelatin zymography. The function of MDR in treated cells was examined by Rhodamine 123 exclusion test. The level of GALNT11 was measured by ELISA. The expression of Bax and Bcl-2 genes was evaluated by real-time PCR. Laser irradiation and zinc phthalocyanine induced cell cytotoxicity in a dose-dependent manner. Flow cytometry analysis showed the induction of apoptotic and necrotic changes in treated cells. We found a reduction in migration rate and MMP-9 activity in cells undergoing the experimental procedure (p < 0.05). Immunofluorescence imaging revealed the intracellular accumulation of Rhodamine 123 coincided with a reduction in the level of GALNT11 in treated cells, showing the reduction of MDR activity and tumor cell resistance. Similar to flow cytometry assay, the reduction of Bcl-2 (approximately twofold) and upregulation of Bax genes were found in treated cells. Photodynamic therapy could be as an effective and alternative method for the treatment of breast cancer in a human.
https://ift.tt/2BLPI2M
A Systematic Scoping Literature Review of Publications Supporting Treatment Guidelines for Pediatric Atopic Dermatitis in Contrast to Clinical Practice Patterns
Abstract
Introduction
Treatment guidelines endorse a variety of strategies for atopic dermatitis (AD) which may vary from published data and clinical practice patterns. The objective of this review was to quantify the volume of available medical literature supporting pediatric AD treatments and compare these patterns to those recommended by published guidelines and/or clinical practice patterns.
Methods
Searches of Embase (2005–2016) and abstracts from selected meetings (2014–2016) related to AD treatment in patients younger than 17 years of age yielded references that were assessed by study design, primary treatment, age groups, and AD severity.
Results
Published literature partially supports clinical guidelines, with emollients and topical medications being the most investigated. There were disproportionately more publications for topical calcineurin inhibitors (TCI) compared with topical corticosteroids (TCS); however, the search interval may have biased the results toward treatments approved near the beginning of the time frame. In contrast, publications documenting clinical practice patterns reflect greater use of emollients and TCS (over TCI), as well as systemic corticosteroids. Data is relatively limited for long-term and combination treatment, treatment of severe AD, and patients younger than 2 years of age, and completely lacking for systemic corticosteroids.
Conclusion
This scoping review demonstrates that available medical literature largely supports published guidelines for topical therapy; however, clinical practice patterns are less aligned. There is a lack of data for older, more frequently used generic treatments, including oral antihistamines, oral antibiotics, and systemic corticosteroids. Overall, literature is lacking for long-term treatment, treatment for patients younger than 2 years of age, and for systemic treatment for severe disease.
Funding
Regeneron Pharmaceuticals Inc.
https://ift.tt/2MvXVwJ
Treatment of Grade II and III Actinic Keratosis Lesions with a Film-Forming Medical Device Containing Sunscreen/Piroxicam 0.8% and a Retinoic Acid/Glycolic Gel: A Pilot Trial
Abstract
Introduction
Lesion and field-targeted treatments of actinic keratosis (AK) are commonly indicated for grade I and II type lesions. Grade III lesions are in general more difficult to treat. A film-forming medical device containing piroxicam 0.8% and sunscreen (SPF 50+) (PS) has been shown to be effective in the treatment of grade I and II AK lesions. Topical and oral retinoids have been utilized in AK and non-melanoma skin cancers. Topical glycolic acid promotes keratolysis and stimulates collagen synthesis for repair and skin rejuvenation and could be useful in AK treatment strategies. A gel containing retinoid acid (0.02%) and glycolic acid (4%) (RC) is commercially available. The objective of the study was to evaluate the efficacy and local tolerability of a combined treatment approach with PS and RC in subjects with multiple grade II and III AK lesions.
Methods
Twenty-two subjects (16 males and 6 females; mean age 68 years) with more than five AK lesions were enrolled after obtaining their informed consent in a 3-month trial. PS cream was applied twice daily every day and RC gel was applied twice daily for 2 consecutive days every week. The primary endpoint was the evolution of the AK mean number from baseline to the end of the trial. Secondary endpoints were the thickness of the target lesion (expressed in mm3) and the erythema score (hemoglobin content), evaluated using a standardized computer-based image acquisition analysis system (Anthera 3D).
Results
At baseline, the mean (SD) lesion number was 7.7 (3) for grade II and 1.4 (1) for grade III AK. At the end of the study, a significant (P = 0.001) reduction was observed for both grade II (− 81%; from 7.7 to 1.5) and grade III (− 22%) lesions. Six grade III lesions out of 31 (20%), presented at baseline, completely disappeared at month 3. For grade III lesions, a significant mean thickness reduction of 51% was observed at month 3. The erythema score (all lesions) was reduced by 70%. Four patients out of 22 (18%) were completely free of AK lesions at month 3. No severe side effects were reported.
Conclusion
In this exploratory trial, a combined treatment with a cream containing piroxicam and sunscreen and a retinoic/glycolic gel was associated with a substantial reduction of both grade II and III AK lesions with good local tolerability.
Funding
Cantabria Labs Difa Cooper.
https://ift.tt/2P2RhLg
Basal Cell Carcinoma: A Patient and Physician’s Experience
Abstract
In this article, the first coauthor, a patient with a basal cell carcinoma on her upper lip, discusses her experience with Mohs micrographic surgery for the treatment of the skin cancer. The second coauthor, who is the patient's physician (a dermatologist who shares her last name but is not a relative), diagnosed her skin cancer and referred her for Mohs surgery. The third coauthor, who is the patient's son and not only a dermatologist, but also a dermatopathologist and a Mohs surgeon (and also shares her last name), summarizes the presentation and treatment of the basal cell carcinoma.
https://ift.tt/2MxBNlU
Squamous Cell Carcinomas in Two Cases of Nail Lichen Planus: Is There a Real Association?
Abstract
Lichen planus (LP) is a chronic inflammatory disease that affects the skin and oral mucosa. Although its etiology is unknown, its potential for cancerization has been confirmed. We herein report the cases of a brother and sister, both with a 15-year history of nail lichen planus of the fingers and toes, who developed squamous cell carcinomas of the nail bed and matrix. This article shows the potential for malignant transformation in lichen planus disease and highlights the importance of periodic clinical follow-up.
https://ift.tt/2LnwcJi
Building a Citizen Pscientist: Advancing Patient-Centered Psoriasis Research by Empowering Patients as Contributors and Analysts
Abstract
Introduction
To design and implement a novel cloud-based digital platform that allows psoriatic patients and researchers to engage in the research process.
Methods
Citizen Pscientist (CP) was created by the National Psoriasis Foundation (NPF) to support and educate the global psoriatic disease community, where patients and researchers have the ability to analyze data. Psoriatic patients were invited to enroll in CP and contribute health data to a cloud database by responding to a 59-question online survey. They were then invited to perform their own analyses of the data using built-in visualization tools allowing for the creation of "discovery charts." These charts were posted on the CP website allowing for further discussion.
Results
As of May 2017, 3534 patients have enrolled in CP and have collectively contributed over 200,000 data points on their health status. Patients posted 70 discovery charts, generating 209 discussion comments.
Conclusion
With the growing influence of the internet and technology in society, medical research can be enhanced by crowdsourcing and online patient portals. Patient discovery charts focused on the topics of psoriatic disease demographics, clinical features, environmental triggers, and quality of life. Patients noted that the CP platform adds to their well-being and allows them to express what research questions matter most to them in a direct and quantifiable way. The implementation of CP is a successful and novel method of allowing patients to engage in research. Thus, CP is an important tool to promote patient-centered psoriatic disease research.
https://ift.tt/2PCgugS
Untersuchung zur Inanspruchnahme einer HNO-Klinik im ländlichen Bereich: Elektive Patienten
Zusammenfassung
Hintergrund
Die ambulante medizinische Versorgung wird in Deutschland überwiegend von niedergelassenen Fachärzten für Allgemeinmedizin und anderer Fachrichtungen gewährleistet. Nur unter speziellen Auflagen stehen die Krankenhausambulanzen für Fälle auf Facharztüberweisung zur spezielleren Abklärung bzw. zur Behandlung und in definierten Ausnahmefällen wie nach § 116b zur Verfügung. Ziel der Untersuchung war die Evaluation der ambulanten elektiven Patienten.
Material und Methoden
Es handelt sich um eine prospektive Untersuchung über den Zeitraum eines Jahres. Es wurden bei allen elektiven, ambulanten Patienten neben den persönlichen bzw. medizinischen Daten Vorstellungszeitpunkt, -grund und Sinnhaftigkeit der Inanspruchnahme erfasst.
Ergebnisse
Insgesamt konnten 6463 Fälle in die Untersuchung einbezogen werden. Die junge und betagtere Patientengruppe war quantitativ stärker repräsentiert im Vergleich zu den Notfallpatienten. Unter Berücksichtigung des definierten Scores war die überwiegende Mehrheit der Vorstellungen (87 %) medizinisch sinnvoll, was positiv mit der Distanz des Anfahrtswegs der Patienten korrelierte.
Diskussion
Die Analyse unterstreicht, dass das duale fachärztliche Versorgungsprinzip in Deutschland zu einer medizinisch vernünftigen Inanspruchnahme der vorhandenen Ressourcen beiträgt, was für die Notfallpatienten mit freier Wahl der Anlaufstelle nicht zutrifft.
https://ift.tt/2wqGa7r
Three distinct genomic subtypes of head and neck squamous cell carcinoma associated with clinical outcomes
Publication date: October 2018
Source: Oral Oncology, Volume 85
Author(s): Dong Jin Lee, Young-Gyu Eun, Young Soo Rho, Eui Hyun Kim, Sun Young Yim, Sang Hee Kang, Bo Hwa Sohn, Gee Hwan Kwon, Ju-Seog Lee
Abstract
Objectives
Heterogeneity of head and neck squamous cell carcinomas (HNSCCs) results in unpredictable outcomes for patients with similar stages of cancer. Beyond the role of human papilloma virus (HPV), no validated molecular marker of HNSCCs has been established. Thus, clinically relevant molecular subtypes are needed to optimize HNSCC therapy. The purpose of this study was to identify subtypes of HNSCC that have distinct biological characteristics associated with clinical outcomes and to characterize genomic alterations that best reflect the biological and clinical characteristics of each subtype.
Materials and methods
We analyzed gene expression profiling data from pan-SCC tissues including cervical SCC, esophageal SCC, lung SCC, and HNSCC (n = 1346) to assess the similarities and differences among SCCs and to identify molecular subtypes of HNSCC associated with prognosis. Subtype-specific gene expression signatures were identified and used to construct predictive models. The association of the subtypes with prognosis was validated in two independent cohorts of patients.
Results
Pan-SCC analysis identified three novel subtypes of HNSCC. Subtype 1 had the best prognosis and was similar to cervical SCC, whereas subtype 3 had the worst prognosis and was similar to lung SCC. Subtype 2 had a moderate prognosis. The 600-gene signature associated with the three subtypes significantly predicted prognosis in two independent validation cohorts. These three subtypes also were associated with potential benefit of immunotherapy.
Conclusion
We identified three clinically relevant HNSCC molecular subtypes. Independent prospective studies to assess the clinical utility of the subtypes and associated gene signature are warranted.
https://ift.tt/2w9XP3M
Proton beam therapy for ameloblastic carcinoma of the maxilla: report of a rare case
Publication date: Available online 24 August 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Kenji Yamagata, Hitoshi Ishikawa, Takashi Saito, Hiroki Bukawa
Abstract
Ameloblastic carcinoma (AC) is a rare malignant odontogenic tumor that combines the histological features of ameloblastoma with cytological atypia. The standard treatment for this lesion is wide local excision. Proton beam therapy (PBT), which can deliver high irradiation doses to target while avoiding irradiation to surrounding normal tissues but no reports of PBT for AC have been published so far. We here report a case of a 70-year-old woman with a pathological diagnosis of maxillary AC who refused surgical resection, and received hypofractionated PBT at a total dose of 69 Gy in 23 fractions. She is still alive for more than 5 years after PBT without any evidences of recurrence and side effects. This is the first successful treatment case after curative radiation therapy for maxillary AC.
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Outcome of surgically treated fractures of the condylar process by an endoscopic assisted transoral approach
Publication date: Available online 24 August 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Blumer Michael, Guggenbühl Tobias, Wagner Maximilian, Rostetter Claudio, Rücker Martin, Gander Thomas
Abstract
Aim of the study: Fractures of the condylar process are frequent. Ideal management of these fractures, as discussed in literature, is controversial. Some recent meta-analyses favour open reduction and internal fixation using various approaches. A strict transoral approach is described to minimise scarring and the risk of facial nerve injury but has restricted visibility.
This retrospective study analyses outcomes of patients with unilateral mandibular condyle fractures who have been treated by an open reduction and internal fixation through an endoscopic assisted transoral approach.
Materials and Methods
This study included 40 patients who were operated on between January 2015 and December 2016. All patients were operated for a condylar process fracture using an endoscopic assisted transoral approach. Fracture classification, demographic, and outcome data were collected.
Results
Most condylar process fractures were caused by falls of under 3 m. The majority were condylar base fractures and classified after Spiessl and Schroll as classes I and II. Sixteen patients showed a preoperative malocclusion, whereas in just 2 cases a slight postoperative malocclusion was found. In cases where only 1 plate could be placed, the proximal fragment was shorter. With higher Spiessl and Schroll classification, a tendency towards longer operation times was noted. Postoperative outcomes revealed 1 temporary facial palsy as the worst complication (2.5 %), 2 cases with a minimal occlusional interference (5 %) and a deviation in mouth opening in 1 case (2.5 %). The ramus height was restored in all cases. No chronic pain could be found in any of the cases.
Discussion
It is feasible to treat condylar process fractures in a safe manner by a transoral approach with endoscopic assistance and angled instruments without facial scarring and at a low complication rate. The endoscope improves the reduced visibility of the transoral approach, although a learning curve is necessary. This applies especially to dislocated fractures or to fractures with a short proximal fragment.
https://ift.tt/2P3ZkHP
Is ultrasound a useful adjunct in the management of oral squamous cell carcinoma?
Publication date: Available online 24 August 2018
Source: Journal of Oral and Maxillofacial Surgery
Author(s): Nicholas Smiley, Yoshimi Anzai, Sarah Foster, Jasjit Dillon
Abstract
Purpose
Among patients with oral squamous cell carcinoma (OSCC), depth of tumor invasion (DOI) is correlated with prognosis. Tumor thickness (TT) is often used as a surrogate measure of DOI. The aim of this study was to estimate TT in a sample of OSCC patients using ultrasound sonography (USS), magnetic resonance imaging (MRI) and clinical assessment and compare these estimates to TT from the final surgical specimen.
Methods
The authors designed and implemented a prospective cohort study and enrolled patients presenting for the management of OSSC. Eligible subjects had biopsy proven OSSC and received clinical assessment, staging MRI, and USS. The predictor variable was measurement technique; clinical assessment, USS, or MRI. The primary outcome variable was maximal TT (cm) obtained from the final histopathological specimen. Appropriate uni- and bivariate statistics were computed.
Results
The sample included ten subjects with a mean age 62.7 + 13.6 years and 70% male. Two of the ten (20%) tumors were not adequately visualized with USS. Three of the ten (30%) tumors were not seen with MRI due to dental artifact. These three patient's tumors were visualized by USS. One of the ten (10%) tumors could not be palpated clinically. Three of the ten (30%) patients did not go to surgery and were treated with chemoradiation given high tumor stage and/or patient's health status. USS, MRI and clinical TT measures when compared to the specimen TT all underestimated, TT, -0.6cm, -0.5cm, and -0.3 cm, respectively (p=0.9).
Conclusion
All three measurement modalities clinical examination, MRI and USS underestimated OSCC TT compared with the final surgical specimen. There were no statistical differences of mean measurement or absolute value mean difference between measurement modalities. Notably, USS was able to visualize the OSCC in all three patients (30%) whose tumors were poorly visualized or not visualized with MRI.
https://ift.tt/2MvYRkT
Trial of Ibrutinib Combined With Nivolumab or Cetuximab to Treat Recurrent/Metastatic HNSCC
Conditions: Head and Neck Cancer; Squamous Cell Carcinoma of the Head and Neck
Interventions: Drug: Ibrutinib 560mg PO daily; Drug: Ibrutinib 560mg PO daily (Imbruvica); Drug: Cetuximab; Drug: Nivolumab
Sponsors: University of California, San Diego; Pharmacyclics LLC.
Not yet recruiting
https://ift.tt/2P3Ac3N
Interventions: Drug: Ibrutinib 560mg PO daily; Drug: Ibrutinib 560mg PO daily (Imbruvica); Drug: Cetuximab; Drug: Nivolumab
Sponsors: University of California, San Diego; Pharmacyclics LLC.
Not yet recruiting
https://ift.tt/2P3Ac3N
Study of the Feasibility of Radiofrequency Ablation of Benign Thyroid Nodules
Condition: Benign Thyroid Nodules
Intervention: Procedure: Radiofrequency ablation
Sponsor: University Hospital, Toulouse
Not yet recruiting
https://ift.tt/2MsTWB8
Intervention: Procedure: Radiofrequency ablation
Sponsor: University Hospital, Toulouse
Not yet recruiting
https://ift.tt/2MsTWB8
Oxygen Enhanced MRI Measurement in Head and Neck Cancer: Validation and Efficacy of Response.
Condition: Head and Neck Cancer
Intervention: Diagnostic Test: MRI scan
Sponsors: Sally Falk; University of Manchester
Not yet recruiting
https://ift.tt/2P5sqqr
Intervention: Diagnostic Test: MRI scan
Sponsors: Sally Falk; University of Manchester
Not yet recruiting
https://ift.tt/2P5sqqr
The Comparison of Single and Multi-incision MIE for Esophageal Cancer
Condition: Esophageal Cancer
Intervention: Procedure: Minimally invasive esophagectomy
Sponsor: National Taiwan University Hospital
Recruiting
https://ift.tt/2MsztMV
Intervention: Procedure: Minimally invasive esophagectomy
Sponsor: National Taiwan University Hospital
Recruiting
https://ift.tt/2MsztMV
Venous Thromboembolism and Bleeding Risk in Patients With Esophageal Cancer: a Retrospective Study
Conditions: Venous Thromboembolism; Esophagus Cancer; Bleeding; Chemotherapy Effect
Intervention: Other: Venous thromboembolic event, arterial thromboembolic event, bleeding events
Sponsor: Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Recruiting
https://ift.tt/2OY8HbY
Intervention: Other: Venous thromboembolic event, arterial thromboembolic event, bleeding events
Sponsor: Academisch Medisch Centrum - Universiteit van Amsterdam (AMC-UvA)
Recruiting
https://ift.tt/2OY8HbY
Prospective Pilot Study of Multi-actor Tolerance Evaluation Using the VIRARE Device (VIrtual Reality Assisted Rehabilitation) in Visually Impaired Patients
Condition: Visual Impairment
Intervention: Device: Virtual reality tests
Sponsor: Centre Hospitalier Universitaire de Nīmes
Not yet recruiting
https://ift.tt/2MtRpXm
Intervention: Device: Virtual reality tests
Sponsor: Centre Hospitalier Universitaire de Nīmes
Not yet recruiting
https://ift.tt/2MtRpXm
Study of Autologous Tumor Infiltrating Lymphocytes in Patients With Solid Tumors
Conditions: Metastatic Melanoma; Squamous Cell Carcinoma of the Head and Neck; Non-small Cell Lung Cancer
Interventions: Biological: Lifileucel; Biological: LN-145; Drug: Pembrolizumab
Sponsor: Iovance Biotherapeutics, Inc.
Not yet recruiting
https://ift.tt/2P06pco
Interventions: Biological: Lifileucel; Biological: LN-145; Drug: Pembrolizumab
Sponsor: Iovance Biotherapeutics, Inc.
Not yet recruiting
https://ift.tt/2P06pco
Dental fluorosis and a polymorphism in the COL1A2 gene in Mexican children
Publication date: Available online 23 August 2018
Source: Archives of Oral Biology
Author(s): Lizet Jarquín-Yañez, Jorge Alejandro Alegría-Torres, Claudia G. Castillo, José de Jesús Mejía-Saavedra
Abstract
Objective
To determine the allelic and genotypic frequencies of rs 412777 polymorphism in the Collagen type I alpha 2 chain (COL1A2) gene and the association with the severity of dental fluorosis in children between 6 and 12 years old in the State of San Luis Potosi, Mexico.
Design
A cross-sectional study was designed; participants were 230 children from two rural communities of San Luis Potosí. Fluoride in drinking water and urine samples was quantified using a potentiometric method with a selective ion electrode. Dental fluorosis was diagnosed using the Thylstrup-Fejerskov index while the identification of the polymorphism was made by allelic discrimination, using allele-specific probes by real-time Polymerase chain reaction (PCR). Statistical analysis was carried out with Student's t-test and Chi-square and Odds Ratio (OR). A confidence interval of 95% and a value of p < 0.05 were considered.
Results
The concentration of fluoride in drinking water was 2.36 ± 0.02 mg/L in Ojo Caliente and 4.56 ± 0.07 mg/L in La Reforma, the concentration of fluoride in urine was 2.05 ± 0.62 mg/L and 2.99 ± 0.99 mg/L respectively. The prevalence of dental fluorosis was 100% and the frequency of alleles was 67% wild-type and 33% mutant allelic, alleles were found in Hardy-Weinberg equilibrium (X2 = 0.33, p = 0.89). The association between the degree of dental fluorosis and the evaluated polymorphism was statistically significant (OR = 7.10, 95% CI = 3.96-12.70, p < 0.05).
Conclusions
An association of rs 412777 polymorphism in the COL1A2 gene with dental fluorosis was found. Therefore, genetic variants represent a relevant risk factor to develop dental fluorosis, as it was proven in this study conducted in Mexican children.
https://ift.tt/2o8r02U
Dental fluorosis and a polymorphism in the COL1A2 gene in Mexican children
Publication date: Available online 23 August 2018
Source: Archives of Oral Biology
Author(s): Lizet Jarquín-Yañez, Jorge Alejandro Alegría-Torres, Claudia G. Castillo, José de Jesús Mejía-Saavedra
Abstract
Objective
To determine the allelic and genotypic frequencies of rs 412777 polymorphism in the Collagen type I alpha 2 chain (COL1A2) gene and the association with the severity of dental fluorosis in children between 6 and 12 years old in the State of San Luis Potosi, Mexico.
Design
A cross-sectional study was designed; participants were 230 children from two rural communities of San Luis Potosí. Fluoride in drinking water and urine samples was quantified using a potentiometric method with a selective ion electrode. Dental fluorosis was diagnosed using the Thylstrup-Fejerskov index while the identification of the polymorphism was made by allelic discrimination, using allele-specific probes by real-time Polymerase chain reaction (PCR). Statistical analysis was carried out with Student's t-test and Chi-square and Odds Ratio (OR). A confidence interval of 95% and a value of p < 0.05 were considered.
Results
The concentration of fluoride in drinking water was 2.36 ± 0.02 mg/L in Ojo Caliente and 4.56 ± 0.07 mg/L in La Reforma, the concentration of fluoride in urine was 2.05 ± 0.62 mg/L and 2.99 ± 0.99 mg/L respectively. The prevalence of dental fluorosis was 100% and the frequency of alleles was 67% wild-type and 33% mutant allelic, alleles were found in Hardy-Weinberg equilibrium (X2 = 0.33, p = 0.89). The association between the degree of dental fluorosis and the evaluated polymorphism was statistically significant (OR = 7.10, 95% CI = 3.96-12.70, p < 0.05).
Conclusions
An association of rs 412777 polymorphism in the COL1A2 gene with dental fluorosis was found. Therefore, genetic variants represent a relevant risk factor to develop dental fluorosis, as it was proven in this study conducted in Mexican children.
https://ift.tt/2o8r02U
Evaluation of routine magnetic resonance imaging of patients with chronic orofacial pain
Publication date: Available online 23 August 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): M. Devine, N. Rahman, S.E.J. Connor, J. Patel, T. Renton
Abstract
The aim of this study was to evaluate the reported presence of magnetic resonance imaging (MRI) pathologies (demyelination, space-occupying lesions, or trigeminal neurovascular contact within the transition zone) in patients with orofacial pain. Patient histories, demographic characteristics, and clinical features were compared between those with and without a reported MRI pathology. A retrospective service evaluation of all patients who had undergone MRI scanning to aid the diagnosis of orofacial pain conditions between 2012 and 2016 was conducted. Data were collected and statistical analyses (frequency and descriptive) performed. One hundred and twenty-five patients (34 male and 91 female) with a mean age of 50 years were included. MRI pathologies included space-occupying lesions (2.4%), trigeminal neurovascular contact (22.4%), other pathology including small vessel cerebrovascular disease (20%), pineal cyst (1.6%), sinus pathologies (1.6%), and degenerative changes to the cervical spine (0.8%). This study found that patients with a provisional diagnosis of trigeminal neuralgia or trigeminal autonomic cephalalgia, as well as patients with elicited pain, were more likely to have abnormal findings on MRI scanning.
https://ift.tt/2o86zmQ
Cone beam computed tomography evaluation of tooth injury after segmental Le Fort I osteotomy
Publication date: Available online 23 August 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): J. Hartlev, T. Klit Pedersen, S.E. Nørholt
Abstract
The purpose of this study was to explore the incidence of injuries to the teeth at the vertical osteotomy line after segmental Le Fort I osteotomy by examination of postoperative cone beam computed tomography (CBCT) images. Data for this retrospective case study were collected using CBCT images of 132 patients with an indication for Le Fort I osteotomy with three-piece segmentation of the maxilla. Twenty-two patients (17%, 95% confidence interval 10–23%) had dental injuries. No patient had more than one dental injury. Thirty-three patients (25%, 95% confidence interval 18–32%) had bone dehiscence of the teeth (defined as the osteotomy line passing through the periodontal ligament). Six patients had bone dehiscence involving two teeth and one patient had bone dehiscence involving three teeth. In the group in which dental injuries occurred, the preoperative interdental distance at the vertical osteotomy line was significantly shorter than the interdental distance in the group without dental injuries. In conclusion, this study demonstrated that a preoperative interdental distance of more than 2.5 mm significantly reduced the possibility of tooth injuries adjacent to the vertical osteotomy line during Le Fort I osteotomy with three-piece segmentation of the maxilla.
https://ift.tt/2BFZfbF
Response to the Letter to the Editor on “Comparison between flapless and open-flap implant placement: a systematic review and meta-analysis”
Publication date: Available online 23 August 2018
Source: International Journal of Oral and Maxillofacial Surgery
Author(s): C.A.A. Lemos, F.R. Verri, R.S. Cruz, J.M.L. Gomes, D.M. dos Santos, M.C. Goiato, E.P. Pellizzer
https://ift.tt/2o86uzy
Nomogram model to predict postoperative relapse after mandibular osteoradionecrosis surgery
Publication date: Available online 24 August 2018
Source: Journal of Cranio-Maxillofacial Surgery
Author(s): Zhonglong Liu, Yu'an Cao, Chunyue Ma, Jian Sun, Chenping Zhang, Yue He
Summary
Purpose
Osteoradionecrosis of the mandible (ORNM) is one of the most devastating complications following radiotherapy. Postoperative relapse (POR) occurs with high incidence even if a radical resection is performed. The current investigation was designed to identify prognostic factors for POR and to establish a nomogram model to estimate the risk for the onset of POR of ORNM.
Materials and Methods
A retrospective study was conducted in ORNM patients during the period from 2003 to 2016. Predictive factors for POR were preliminarily filtered by Kaplan-Meier analysis and were further confirmed by Cox regression model. A nomogram model was established to predict the risk for the onset of POR, and the performance was estimated by receiver operating characteristic (ROC) and calibration curve. POR was defined as the primary outcome variable and was measured using univariate and multivariate analyses.
Results
A total of 213 patients were analyzed, and the total incidence of POR was 24.4% (52/213). In the Cox regression analysis, radiation doses ≥80 Gy (versus＜80 Gy, OR=3.528, P＜0.001, 95% CI: 1.759-7.076), location of ORNM (lesion only in mandibular body versus that involving mandibular body, angulus and ramus versus, OR=2.900, P=0.007, 95% CI: 1.345-6.253), S classification (S2 versus S0, OR=8.926, P=0.001, 95% CI: 2.487-32.036), and surgical treatment (sequestretomy versus ER+reconstruction, OR=3.299, P=0.012, 95% CI: 1.294-8.411) were significantly associated with POR. The current nomogram model can effectively evaluate the hazard risk and survival rate of POR. The discrimination capability was tested by the ROC curve with an area under the curve of 0.813, revealing highly predictive abilities. The calibration curve showed sufficient fitness.
Conclusion
The current nomogram model was effective in predicting the risk of POR in ORNM patients.
https://ift.tt/2wbcXOr
Immediate anaphylaxis due to beef intestine following tick bites
Publication date: Available online 23 August 2018
Source: Allergology International
Author(s): Michimasa Fujiwara, Tooru Araki
https://ift.tt/2MyEG5W
Central suppressant therapies in unexplained chronic cough patients whose sputum cultures yielded Bjerkandera adusta
Publication date: Available online 23 August 2018
Source: Allergology International
Author(s): Haruhiko Ogawa, Kazuya Tone, Masaki Fujimura, Koichi Makimura
https://ift.tt/2P5im0D
Defective TLR9-driven STAT3 activation in B cells of patients with CVID
Publication date: Available online 23 August 2018
Source: Clinical Immunology
Author(s): Arturo Borzutzky, Ingrid Rauter, Ari Fried, Rima Rachid, Douglas R. McDonald, Lennart Hammarstrom, Bodo Grimbacher, Roshini S. Abraham, Raif S. Geha
Abstract
B cell activation by Toll-like receptor 9 (TLR9) ligands is dependent on STAT3 and is important for optimal antibody responses to microbial antigens. B cells from patients with common variable immune deficiency (CVID) have impaired proliferation and differentiation in response to the TLR9 ligand CpG, despite normal levels of TLR9 expression. We demonstrate that CpG-driven STAT3 phosphorylation, but not activation of NFκB and p38, is selectively impaired in B cells from CVID patients. These results suggest that defective STAT3 activation contributes to the defective TLR9 and antibody response of B cells in CVID.
https://ift.tt/2BIdDjn
Recombinant chemotaxis inhibitory protein of Staphylococcus aureus (CHIPS) protects against LPS-induced lung injury in mice
Publication date: Available online 23 August 2018
Source: Clinical Immunology
Author(s): Youssif M. Ali, Abeer M. Abd El-Aziz, Maha Mabrook, Ahmed A. Shabaan, Robert B. Sim, Ramadan Hassan
Abstract
Acute lung injury (ALI) and/or acute respiratory distress syndrome (ARDS) are clinical conditions caused by trauma, lung infection or sepsis. ALI/ARDS is associated with massive recruitment of neutrophils into the lung with release of reactive oxygen species and excessive inflammatory response that damage alveolar tissue. Here we report the successful use of a potent chemotaxis inhibitory protein (rCHIPS) derived from Staphylococcus aureus in reducing the severity of ALI/ARDS. Treatment with rCHIPS reduces pulmonary inflammation and permeability in mice after intranasal administration of lipopolysaccharide (LPS). rCHIPS treatment significantly reduces lung myeloperoxidase (MPO) activity, pro-inflammatory cytokines, broncho-alveolar lavage fluid (BALF) protein content as well as histopathological changes. In addition, treatment with rCHIPS significantly diminishes neutrophils and leukocytes recruitment into lung tissue after LPS administration and hence protects mice from reactive oxygen species mediated lung injury. Our finding reveals potential therapeutic benefits of using rCHIPS for the treatment of ALI/ARDS.
https://ift.tt/2o6SAxm
Human cystatin SN is an endogenous protease inhibitor that prevents allergic rhinitis
Publication date: Available online 23 August 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Ayumi Fukuoka, Kazufumi Matsushita, Taiyo Morikawa, Takumi Adachi, Koubun Yasuda, Hiroshi Kiyonari, Shigeharu Fujieda, Tomohiro Yoshimoto
Background
Protease allergens disrupt epithelial barriers to exert their allergenicity. Cystatin SN (encoded by CST1) is an endogenous cysteine protease inhibitor upregulated in nasal epithelia in patients with allergic rhinitis (AR).
Objective
We sought to investigate the protective effect of human cystatin SN on AR symptoms using pollen-induced AR mouse models.
Methods
We performed an in vitro protease activity assay to evaluate the effect of recombinant human cystatin SN (rhCystatin SN) on Japanese cedar (JC) or ragweed proteases. A human nasal epithelial cell line, RPMI 2650, was used to examine tight junction (TJ) disruption in vitro. Mice were sensitized and nasally challenged with JC or ragweed pollens with or without rhCystatin SN to examine the effect of rhCystatin SN on AR symptoms and the epithelial barrier in vivo. Because mice lack CST1, we generated transgenic (Tg) mice expressing human CST1 under control of its genomic control region (hCST1-Tg mice) to examine the role of cystatin SN in physiologically expressed conditions.
Results
rhCystatin SN inhibited JC but not ragweed protease activities and prevented JC-induced but not ragweed-induced TJ disruption in vitro. Exogenous administration of rhCystatin SN ameliorated JC-induced but not ragweed-induced sneezing and nasal TJ disruption in vivo. Furthermore, hCST1-Tg mice showed decreased JC-induced but not ragweed-induced sneezing symptoms and nasal TJ disruption compared with wild-type mice.
Conclusion
Human cystatin SN suppresses AR symptoms through inhibiting allergen protease activities and protecting the nasal TJ barrier in an allergen-specific manner. We propose that upregulation of nasal endogenous protease inhibitors, including cystatin SN, is a novel therapeutic strategy for protease allergen–induced AR.
https://ift.tt/2BHgUzs
Impaired cytolytic activity of asthma-associated natural killer cells is linked to dysregulated transcriptional program in energy metabolism
Publication date: September 2018
Source: Molecular Immunology, Volume 101
Author(s): Haisi Wu, Jiacheng Bi, Gaohui Wu, Chaoyue Zheng, Zhen Lu, Lulu Cui, Xiaochun Wan
Abstract
Natural killer (NK) cells are a cytotoxic subset of the innate lymphoid cells, playing essential roles in host defense against tumors and infections, which, however, are usually functionally compromised in chronic diseases. Atopic diseases, such as allergic asthma, characterized by type 2 immune responses, are usually associated with chronic inflammations. Whether asthma -associated immune environment affects the cytolytic function of NK cells has not been elucidated. Here, YTS, a human NK cell line, was exposed to serum from healthy donors or asthma patients for analysis of its cytolytic function. We found that, serum from asthma patients reduced the cytolytic activity of YTS cells against Raji human B lymphoblasts, in comparison with normal serum. The impairment of cytolytic activity of these YTS cells was accompanied with decreased degranulation potentials, weakened conjugation formation with Raji cells, and premature termination of ERK phosphorylation upon stimulation. Meanwhile, apoptosis or cell death of YTS cells was not increased after exposure to serum from asthma patients. Importantly, such impairment of cytolytic activity of asthma -associated YTS NK cells was accompanied with aberrantly enriched genes involved in oxidative phosphorylation. Taken together, these results demonstrate that the serum of asthma patients directly suppresses the cytolytic function of NK cells, possibly through dysregulation of energy metabolism in NK cells.
https://ift.tt/2BKvvdG
Selection of immunodominant epitopes during antigen processing is hierarchical
Publication date: Available online 24 August 2018
Source: Molecular Immunology
Author(s): Scheherazade Sadegh-Nasseri, AeRyon Kim
Abstract
MHC II proteins present processed antigens to CD4 + T cells through a complex set of events and players that include chaperons and accessory molecules. Antigen processing machinery is optimized for the selection of the best fitting peptides, called 'immunodominant epitopes', in the MHC II groove to which, specific CD4 + T cells respond and differentiate into memory T cells. However, due to the complexity of antigen processing, understanding the parameters that lead to immunodominance has proved difficult. Moreover, immunodominance of epitopes vary, depending on multiple factors that include; simultaneous processing of multiple proteins, involvement of multiple alleles of MHC II that can bind to the same antigen, or competition among several suitable epitopes on a single protein antigen. The current dogma assumes that once an antigenic determinant is selected under a specific condition, it would emerge immunodominant wherever it is placed. Here we will discuss some established parameters that contribute to immunodominance as well as some new findings, which demonstrate that slight changes to antigen structure can cause a complete shift in epitope selection during antigen processing and distort the natural immunodominant epitope.
Graphical abstract
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Salivary glucose levels and oral candidal carriage in Type 2 diabetics
Publication date: September–December 2018
Source: Journal of Oral Biology and Craniofacial Research, Volume 8, Issue 3
Author(s): Amritaksha Bhattacharyya, Shaleen Chandra, Anil Singh, Vineet Raj, Bhavana Gupta
Abstract
Background
To assess the correlation between salivary glucose and blood glucose levels in diabetics and non diabetics and to study the association between salivary glucose levels and oral candidal carriage in patients with Type 2 diabetes mellitus.
Material and method
The study sample was divided into two groups, control and study group. The study group was again divided into two separate groups controlled diabetics and uncontrolled diabetics. Blood and saliva samples (for fasting and postprandial) were taken from each individual.
Results
The salivary glucose levels, highly correlated with blood glucose levels in both diabetic as well as non diabetics subjects. Salivary candidal carriage was more in oral cavity of Type 2 diabetic subjects than control subjects.
Conclusion
Saliva has the potential to be used as a noninvasive tool to monitor glycemic status of diabetic patients.
https://ift.tt/2wmp0Yn
Initial findings of Shortwave Infrared Otoscopy in a Pediatric Population
Publication date: Available online 23 August 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Tulio A. Valdez, Jessica A. Carr, Katherine R. Kavanagh, Marissa Schwartz, Danielle Blake, Oliver Bruns, Moungi Bawendi
Abstract
Objective
To evaluate the feasibility of Shortwave infrared (SWIR) otoscopy in a pediatric population and establish differences with visible otoscopy
Methods
Pediatric patients 3 years of age and older seen in the otolaryngology clinic with an audiogram and tympanogram obtained within a week of the visit were recruited for video otoscopy using visible light otoscopy and SWIR otoscopy. Videos were rated by two otolaryngologists based on ability to identify the promontory, ability to identify the ossicular chain and presence or absence of middle ear fluid.
Results
A total of 74 video recordings of ears were obtained in 20 patients. We obtained interpretable images in 63/74 (85.1%) ears. There was no statistical significance between ability to perform SWIR otoscopy versus white light video otoscopy as indicated by a p-value of 0.376.
There was high inter-rater agreement for identification of both the promontory and the ossicular chain with Kappa values of 0.81 and 0.92 respectively. There was statistical significance between SWIR otoscopy and visible otoscopy in the ability to image the promontory (p =0.012) and the ossicular chain (p=0.010). Increased contrast of middle ear fluid was seen in SWIR otoscopy when compared to visible otoscopy.
Conclusion
SWIR otoscopy is feasible in a pediatric population and could offer some advantages over visible light otoscopy such as better visualization of the middle ear structures through the tympanic membrane and increased contrast for middle ear effusions.
https://ift.tt/2w9lK3o
Epistaxis health disparities in the United States pediatric population
Publication date: Available online 23 August 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Lindsay Yang, Kevin Hur, Jeffrey Koempel, Elisabeth H. Ference
Abstract
Objective
Despite epistaxis occurring in up to 60% of the population, few studies have investigated health status disparities in the pediatric epistaxis population. The aim of this study was to evaluate sociodemographic risk factors associated with epistaxis visits for pediatric patients.
Methods
Data were extracted from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey Outpatient Department from 2001-2010. Outpatient visits of children less than 18 years who received a primary, secondary, or tertiary diagnosis of epistaxis (ICD-9CM code 784.7X) were included. Bivariate and stepwise multivariate regressions were conducted to develop a final model for epistaxis visits described by sociodemographics.
Results
Epistaxis visits accounted for 5 ± 0.6 million visits in children less than 18 years. 51% and 33% of children presenting with epistaxis had private insurance and Medicaid, respectively (p=0.001). 69% of epistaxis visits were evaluated at a pediatric clinic, 18% at an ENT/surgery clinic, and 13% at a general/family medicine clinic (p<0.0001). After multivariate adjustment, epistaxis visits were associated with older age (p=0.006). Black children were more likely to present with epistaxis (95% CI 1.3-4.1, p=0.005) compared to white children. Allergic rhinitis, present in 11% of epistaxis visits, was a significant comorbidity associated with visits (95%CI 1.3-4.6, p=0.008). Patients were also more likely to present to an ENT/surgery clinic (95% CI 4.5-16.5, p<0.0001) compared to a general/family medicine clinic.
Conclusions
Epistaxis visits by children are associated with age, race, and specialty. Targeted interventions to help reduce this common presentation should be developed.
https://ift.tt/2LoW3jY
The effects of nasal decongestion on obstructive sleep apnoea
Publication date: Available online 23 August 2018
Source: American Journal of Otolaryngology
Author(s): Yunsong An, Yanru Li, Dan Kang, S.K. Sharama-adhikari, Wen Xu, Yunchuan Li, Demin Han
Abstract
Background
Many studies have indicated associations between impaired nasal breathing and sleep disorders. However, the precise nature of the relationship between nasal patency and sleep remains unclear.
Purpose
We analysed the effects of nasal patency on sleep architecture and breath in nasal obstruction-predominant obstructive sleep apnoea (NO-OSA) patients by applying nasal decongestant.
Material and methods
A randomized, placebo-controlled double-blind crossover study was performed in OSA patients with chronic nasal obstruction and without obvious pharyngeal narrowing. All OSA patients (confirmed by polysomnography) were recruited and completed 2 overnight studies (randomly applying oxymetazoline or placebo). Data collected after oxymetazoline or placebo treatments were compared. The ClinicalTrials.gov identifier is NCT03506178.
Results
Compared with placebo, oxymetazoline resulted in significant increase in rapid eye movement sleep (p = 0.027) and reduction of stage 1 sleep (p = 0.004), as well as arousal index (p = 0.002). Moreover, great improvements in apnoea/hypopnea index (AHI) were observed (p < 0.001); AHI in the supine position was significantly reduced (p = 0.001). Oxygen saturation during sleep was increased significantly [mean oxygen saturation (p = 0.005) and lowest oxygen saturation (p = 0.024)]. Oxygen desaturation index was significantly reduced (p < 0.001).
Conclusions
Improving nasal patency by decongestant could improve sleep quality, AHI, and oxygen saturation level during sleep.
https://ift.tt/2Ln44pR
Effectiveness of photopneumatic technology: a descriptive review of the literature
Abstract
Usage of photopneumatic technology has recently increased for treatment of different skin conditions such as acne, keratosis pilaris (KP), and rosacea. Photopneumatic devices combine gentle negative pressure with broad band pulsed light simultaneously to attack multiple targets in the skin for better treatment outcomes. In this literature review, we evaluate the efficacy of photopneumatic therapy on treatment of acne, keratosis pilaris (KP), and rosacea.
https://ift.tt/2wmuEKi
Changes in airway inflammation and remodeling in swimmers after quitting sport competition
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2MtbDAG
Tetrahydrocurcumin, a major metabolite of curcumin, ameliorates allergic airway inflammation by attenuating Th2 responses and suppressing the IL4Ra‐Jak1‐STAT6 and Jagged1/Jagged2 ‐Notch1/Notch2 pathways in asthmatic mice
Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.
https://ift.tt/2o3McHc
Issue Information
Oral Diseases, Volume 24, Issue 6, Page 871-872, September 2018.
https://ift.tt/2BI8RT6
Transcutaneous Baha Attract system: long‐term outcomes of the French multicenter study
Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2LnurMj
Facial nerve decompression
Purpose of review Facial nerve paralysis is a debilitating condition. Bell's palsy and temporal bone trauma are common causes of acute facial palsy, with recurrent idiopathic paralysis and Melkersson–Rosenthal syndrome accounting for a smaller subset of cases. Properly selected patients may benefit from facial nerve decompression. This article will review the relevant literature on facial nerve decompression. Recent findings The middle cranial fossa approach provides access to the primary site of lesion in Bell's palsy while preserving hearing. Patients with complete facial paralysis secondary to Bell's palsy or temporal bone trauma, more than 90% degeneration on electroneurography testing, and absent voluntary electromyography within 14 days of onset may benefit from facial nerve decompression. Facial nerve decompression may prevent future occurrences of recurrent forms of facial nerve paralysis. The return of facial nerve function following decompression will occur over weeks to months. Summary Appropriately selected patients with facial paralysis secondary to Bell's palsy or temporal bone trauma may benefit from facial nerve decompression. Patients should be counseled regarding the risks of decompression and that the return of maximal facial nerve function may be delayed up to 12 months. Correspondence to Marlan R. Hansen, MD, Departments of Otolaryngology – Head and Neck Surgery and Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA. Tel: +1 319 353 7151; fax: +1 319 356 3967; e-mail: marlan-hansen@uiowa.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
https://ift.tt/2MKPmh2
https://ift.tt/2MKPmh2
Treatments of uremic pruritus: A systematic review
Dermatologic Therapy, EarlyView.
https://ift.tt/2LqXQFg
Dermatological manifestations in cardiofaciocutaneous syndrome: A prospective multicentric study of 45 mutation‐positive patients
British Journal of Dermatology, Volume 0, Issue ja, -Not available-.
https://ift.tt/2BIaUXh
Sleep disturbance in psoriasis: a case‐controlled study
British Journal of Dermatology, EarlyView.
https://ift.tt/2o4umE3
Association between bullous pemphigoid and psoriasis: Systematic review and meta‐analysis of case‐control studies
Australasian Journal of Dermatology, EarlyView.
https://ift.tt/2wksXwR
Oxygen Reserve Index: Validation of a New Variable
BACKGROUND: Pulse oximetry–derived oxygen saturation is typically >97% in normoxia and hyperoxia, limiting its clinical use. The new Oxygen Reserve Index (ORi), a relative indicator of the partial pressure of oxygen dissolved in arterial blood (PaO2) in the range of 100–200 mm Hg, may allow additional monitoring of oxygen status. METHODS: In this prospective validation intervention study, 20 healthy volunteers were breathing standardized oxygen concentrations ranging from mild hypoxia (fraction of inspired oxygen = 0.14) to hyperoxia (fraction of inspired oxygen = 1.0) via a tight-fitting face mask. ORi was measured noninvasively by multiwavelength pulse co-oximetry using 2 finger sensors. These ORi values (unitless scale, 0.00–1.00) were compared with measured PaO2 values. Repeated-measurements correlation analysis was performed to assess the ORi/PaO2 relationship. ORi trending ability was assessed using a 4-quadrant plot. The area under the receiver operating characteristics curve was calculated to assess the prediction of hypoxia (low-ranged PaO2,
https://ift.tt/2PDH0qe
https://ift.tt/2PDH0qe
Dexmedetomidine Pharmacokinetics and a New Dosing Paradigm in Infants Supported With Cardiopulmonary Bypass
BACKGROUND: Dexmedetomidine is increasingly used off-label in infants and children with cardiac disease during cardiopulmonary bypass (CPB) and in the postoperative period. Despite its frequent use, optimal dosing of dexmedetomidine in the setting of CPB has not been identified but is expected to differ from dosing in those not supported with CPB. This study had the following aims: (1) characterize the effect of CPB on dexmedetomidine clearance (CL) and volume of distribution (V) in infants and young children; (2) characterize tolerance and sedation in patients receiving dexmedetomidine; and (3) identify preliminary dosing recommendations for infants and children undergoing CPB. We hypothesized that CL would decrease, and V would increase during CPB compared to pre- or post-CPB states. METHODS: Open-label, single-center, opportunistic pharmacokinetics (PK) and safety study of dexmedetomidine in patients ≤36 months of age administered dexmedetomidine per standard of care via continuous infusion. We analyzed dexmedetomidine PK data using standard nonlinear mixed effects modeling with NONMEM software. We compared model-estimated PK parameters to those from historical patients receiving dexmedetomidine before anesthesia for urologic, lower abdominal, or plastic surgery; after low-risk cardiac or craniofacial surgery; or during bronchoscopy or nuclear magnetic resonance imaging. We investigated the influence of CPB-related factors on PK estimates and used the final model to simulate dosing recommendations, targeting a plasma concentration previously associated with safety and efficacy (0.6 ng/mL). We used the Wilcoxon rank sum test to evaluate differences in dexmedetomidine exposure between infants with hypotension or bradycardia and those who did not develop these adverse events. RESULTS: We collected 213 dexmedetomidine plasma samples from 18 patients. Patients had a median (range) age of 3.3 months (0.1–34.0 months) and underwent CPB for 161 minutes (63–394 minutes). We estimated a CL of 13.4 L/h/70 kg (95% confidence interval, 2.6–24.2 L/h/70 kg) during CPB, compared to 42.1 L/h/70 kg (95% confidence interval, 38.7–45.8 L/h/70 kg) in the historical patients. No specific CPB-related factor had a statistically significant effect on PK. A loading dose of 0.7 µg/kg over 10 minutes before CPB, followed by maintenance infusions through CPB of 0.2 or 0.25 µg/kg/h in infants with postmenstrual ages of 42 or 92 weeks, respectively, maintained targeted concentrations. We identified no association between dexmedetomidine exposure and selected adverse events (P = .13). CONCLUSIONS: CPB is associated with lower CL during CPB in infants and young children compared to those not undergoing CPB. Further study should more closely investigate CPB-related factors that may influence CL. Accepted for publication June 27, 2018. Funding: K.O.Z. is funded by grant KL2TR001115-03 from the Duke Clinical and Translational Science Awards and K23 grant HD091398 from the National Institutes of Health (NIH). H.W. received salary support from grant K23HD0785891 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) for completion of this project. M.L. receives support from the US government for work in neonatal clinical pharmacology, clinical trials, and cohort studies including Food and Drug Administration (FDA) R01 FD005101, Prinicipal Investigator (PI) M.L.; National Heart, Lung and Blood Institute (NHLBI) R34 HL124038, PI M.L.; the NIH Office of the Director, Environmental Influences on Child Health Outcomes (ECHO) Coordinating Center U2C OD023375, PI P.B.S., Duke University School of Medicine; the NICHD Pediatric Trials Network Government Contract HHSN267200700051C, PI Daniel Benjamin Jr, Duke University School of Medicine; and as the satellite site PI for the NICHD Neonatal Research Network NICHD U10 HD040492, PI C. Michael Cotten, Duke University School of Medicine. R.G.G. receives salary support for research from the NIH training grants (5T32HD043029-13), NIH awards (HHSN 275201000003I, HHSN 272201300017I), and from the FDA (HHSF223201610082C). P.B.S. receives salary support for research from the NIH (NIH-1R21HD080606-01ª1) and the National Center for Advancing Translational Sciences of the NIH (UL1TR001117), the NICHD (HHSN275201000003I), and the FDA (1R18-FD005292-01). C.P.H. receives salary support for research from the National Center for Advancing Translational Sciences of the NIH (UL1TR001117) and the US government for his work in pediatric and neonatal clinical pharmacology (Government Contract HHSN267200700051C, PI: Daniel Benjamin Jr under the Best Pharmaceuticals for Children Act). M.C.-W. receives support for research from the NIH (1R01-HD076676-01A1), the National Institute of Allergy and Infectious Disease (HHSN272201500006I and HHSN272201300017I), the NICHD (HHSN275201000003I), the Biomedical Advanced Research and Development Authority (HHSO100201300009C), and industry for drug development in adults and children (https://ift.tt/2PAHZY8). K.M.W. receives support from the Pediatric Critical Care and Trauma Scientist Development Program (5K12HD047349) and the NICHD (1K23HD075891) for his work in pediatric clinical pharmacology. The authors declare no conflicts of interest. 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/KegmMq). Reprints will not be available from the authors. Address correspondence to Kanecia O. Zimmerman, MD, MPH, Department of Pediatrics, Duke University School of Medicine, Box 3850, Durham, NC 27710. Address e-mail to Kanecia.obie@dm.duke.edu. © 2018 International Anesthesia Research Society
https://ift.tt/2wo5w5B
https://ift.tt/2wo5w5B
Process Optimization and Digital Quality Improvement to Enhance Timely Initiation of Epidural Infusions and Postoperative Pain Control
BACKGROUND: Although intraoperative epidural analgesia improves postoperative pain control, a recent quality improvement project demonstrated that only 59% of epidural infusions are started in the operating room before patient arrival in the postanesthesia care unit. We evaluated the combined effect of process and digital quality improvement efforts on provider compliance with starting continuous epidural infusions during surgery. METHODS: In October 2014, we instituted 2 process improvement initiatives: (1) an electronic order queue to assist the operating room pharmacy with infusate preparation; and (2) a designated workspace for the storage of equipment related to epidural catheter placement and drug infusion delivery. In addition, we implemented a digital quality improvement initiative, an Anesthesia Information Management System–mediated clinical decision support, to prompt anesthesia providers to start and document epidural infusions in pertinent patients. We assessed anesthesia provider compliance with epidural infusion initiation in the operating room and postoperative pain-related outcomes before (PRE: October 1, 2012 to September 31, 2014) and after (POST: January 1, 2015 to December 31, 2016) implementation of the quality improvement initiatives. RESULTS: Compliance with starting intraoperative epidural infusions was 59% in the PRE group and 85% in the POST group. After adjustment for confounders and preintervention time trends, segmented regression analysis demonstrated a statistically significant increase in compliance with the intervention in the POST phase (odds ratio, 2.78; 95% confidence interval, 1.73–4.49; P
https://ift.tt/2PxLPBj
https://ift.tt/2PxLPBj
Update on Perioperative Acute Kidney Injury
Acute kidney injury (AKI) in the perioperative period is a common complication and is associated with increased morbidity and mortality. A standard definition and staging system for AKI has been developed, incorporating a reduction of the urine output and/or an increase of serum creatinine. Novel biomarkers may detect kidney damage in the absence of a change in function and can also predict the development of AKI. Several specific considerations for AKI risk are important in surgical patients. The surgery, especially major and emergency procedures in critically ill patients, may cause AKI. In addition, certain comorbidities, such as chronic kidney disease and chronic heart failure, are important risk factors for AKI. Diuretics, contrast agents, and nephrotoxic drugs are commonly used in the perioperative period and may result in a significant amount of in-hospital AKI. Before and during surgery, anesthetists are supposed to optimize the patient, including preventing and treating a hypovolemia and correcting an anemia. Intraoperative episodes of hypotension have to be avoided because even short periods of hypotension are associated with an increased risk of AKI. During the intraoperative period, urine output might be reduced in the absence of kidney injury or the presence of kidney injury with or without fluid responsiveness. Therefore, fluids should be used carefully to avoid hypovolemia and hypervolemia. The Kidney Disease: Improving Global Outcomes guidelines suggest implementing preventive strategies in high-risk patients, which include optimization of hemodynamics, restoration of the circulating volume, institution of functional hemodynamic monitoring, and avoidance of nephrotoxic agents and hyperglycemia. Two recently published studies found that implementing this bundle in high-risk patients reduced the occurrence of AKI in the perioperative period. In addition, the application of remote ischemic preconditioning has been studied to potentially reduce the incidence of perioperative AKI. This review discusses the epidemiology and pathophysiology of surgery-associated AKI, highlights the importance of intraoperative oliguria, and emphasizes potential preventive strategies. Accepted for publication July 17, 2018. Funding: A.Z. received lecture fees from Baxter, Astute Medical, Fresenius, Braun, and Ratiopharm and unrestricted research grants from Fresenius, German Research Foundation, Astellas, and Astute Medical. J.L.K. reports receiving consulting fees from Astute Medical, Sphingotec, and Pfizer and research funds from Astute Medical, Bioporto, Nxstage, Satellite Healthcare, and the National Institutes of Health. J.A.K. reports consulting fees and grant support from Astute Medical. E.A.J.H. received a travel grant from AM Pharma, a speaker's fee from Astute Medical, and a research grant from Bellco. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Alexander Zarbock, MD, Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Bldg A1, 48149 Münster, Germany. Address email to zarbock@uni-muenster.de. © 2018 International Anesthesia Research Society
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https://ift.tt/2wnRnpd
Randomized, Double-Blind, Placebo-Controlled Study of Intravenous Amisulpride as Treatment of Established Postoperative Nausea and Vomiting in Patients Who Have Had No Prior Prophylaxis
BACKGROUND: Postoperative nausea and vomiting (PONV) occurs commonly in surgical patients despite widespread prophylactic antiemetic use. Rescue options are currently limited. 5HT3 antagonists are most frequently used for prophylaxis, but if they fail, additional doses are not effective as rescue medication. Intravenous (IV) amisulpride, a well-studied D2/D3 antagonist, has been shown in trials to prevent PONV. This study was designed to determine if amisulpride could be used to treat established PONV in patients at low-to-moderate risk of PONV who had not received any prior prophylaxis. METHODS: Men and women aged over 18 years were permitted to enroll if they were to undergo general inhalational anesthesia, expected to last at least 1 hour, for an outpatient or inpatient surgical procedure. Patients who then suffered PONV were randomized equally to 1 of 3 single-dose IV regimens: placebo or 5 or 10 mg amisulpride. The primary end point was complete response, defined as no emesis in the period 30 minutes to 24 hours after study drug treatment and no use of rescue medication in the entire 24-hour period. RESULTS: One thousand nine hundred eighty-eight patients were enrolled preoperatively, of whom 560 were randomized to a treatment arm. Complete response occurred in 39 of 181 patients (21.5%) in the placebo group compared to 60 of 191 patients (31.4%; P = .016) and 59 of 188 patients (31.4%; P = .016) in the amisulpride 5 and 10 mg groups, respectively. The adverse event profile of amisulpride at either dose was similar to placebo. CONCLUSIONS: IV amisulpride at 5 and 10 mg was safe and efficacious in the treatment of established PONV in surgical patients undergoing general anesthesia with no prior PONV prophylaxis. Accepted for publication July 3, 2018. Funding: This work was supported by Acacia Pharma Ltd, Cambridge, United Kingdom. Conflicts of Interest: See Disclosures at the end of the article. Clinical trial registry number: ClinicalTrials.gov NCT2449291. Reprints will not be available from the authors. Address correspondence to Keith A. Candiotti, MD, Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Jackson Memorial Hospital, (C-302), 1611 NW 12th Ave, Miami, FL 33136. Address e-mail to kcandiotti@miami.edu. © 2018 International Anesthesia Research Society
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https://ift.tt/2wlNCR1
Anesthesiologists’ Overconfidence in Their Perceived Knowledge of Neuromuscular Monitoring and Its Relevance to All Aspects of Medical Practice: An International Survey
BACKGROUND: In patients who receive a nondepolarizing neuromuscular blocking drug (NMBD) during anesthesia, undetected postoperative residual neuromuscular block is a common occurrence that carries a risk of potentially serious adverse events, particularly postoperative pulmonary complications. There is abundant evidence that residual block can be prevented when real-time (quantitative) neuromuscular monitoring with measurement of the train-of-four ratio is used to guide NMBD administration and reversal. Nevertheless, a significant percentage of anesthesiologists fail to use quantitative devices or even conventional peripheral nerve stimulators routinely. Our hypothesis was that a contributing factor to the nonutilization of neuromuscular monitoring was anesthesiologists' overconfidence in their knowledge and ability to manage the use of NMBDs without such guidance. METHODS: We conducted an Internet-based multilingual survey among anesthesiologists worldwide. We asked respondents to answer 9 true/false questions related to the use of neuromuscular blocking drugs. Participants were also asked to rate their confidence in the accuracy of each of their answers on a scale of 50% (pure guess) to 100% (certain of answer). RESULTS: Two thousand five hundred sixty persons accessed the website; of these, 1629 anesthesiologists from 80 countries completed the 9-question survey. The respondents correctly answered only 57% of the questions. In contrast, the mean confidence exhibited by the respondents was 84%, which was significantly greater than their accuracy. Of the 1629 respondents, 1496 (92%) were overconfident. CONCLUSIONS: The anesthesiologists surveyed expressed overconfidence in their knowledge and ability to manage the use of NMBDs. This overconfidence may be partially responsible for the failure to adopt routine perioperative neuromuscular monitoring. When clinicians are highly confident in their knowledge about a procedure, they are less likely to modify their clinical practice or seek further guidance on its use. Accepted for publication July 3, 2018. A. F. Kopman is now retired. Funding: S.J.B. has received research funding from Merck & Co, Inc (Kenilworth, NJ) (funds to Mayo Clinic). Conflicts of Interest: See Disclosures at the end of the article. 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/KegmMq). M. Naguib and S. J. Brull contributed equally to this work and share first authorship. Reprints will not be available from the authors. Address correspondence to Mohamed Naguib, MD, MSc, FCARCSI, Department of General Anesthesia, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave, NE6-306, Cleveland, OH 44195. Address e-mail to naguibm@ccf.org. © 2018 International Anesthesia Research Society
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https://ift.tt/2PAGiKi
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