Spotting Zika spots: descriptive features of the rash used in 66 published cases

Clinical and Experimental Dermatology, EarlyView.


https://ift.tt/2NEK476

Rituximab for the treatment of autoimmune subepidermal blistering diseases

Dermatologic Therapy, EarlyView.


https://ift.tt/2xagT1u

Developing a Clinical Prototype to Guide Surgeons for Intraoperative Label-Free Identification of Parathyroid Glands in Real Time

Thyroid, Ahead of Print.


https://ift.tt/2CLTtWd

Lichen planus and diabetes mellitus: systematic review and meta‐analysis

Oral Diseases, Volume 0, Issue ja, -Not available-.


https://ift.tt/2ND8HRQ

Oral leukoplakia; a diagnostic challenge for clinicians and pathologists

Oral Diseases, Volume 0, Issue ja, -Not available-.


https://ift.tt/2x5DegB

Gender as an Independent Risk Factor for the Components of Metabolic Syndrome Among Individuals Within the Normal Range of Body Mass Index

Metabolic Syndrome and Related Disorders, Ahead of Print.


https://ift.tt/2x6eHZN

A 2-year-old girl with chronic crackles after respiratory syncytial virus infection: a case report

Respiratory syncytial virus is the most common cause of lower respiratory tract infections in infants and young children. While the majority of infants display only mild upper respiratory tract infection or oc...

https://ift.tt/2NCxR2R

The effects of adenoidectomy on the smell perception of children

International Forum of Allergy &Rhinology, EarlyView.


https://ift.tt/2x7yyqL

Relevance of low specific IgE levels to egg, milk and peanut in infancy

Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2QnqmLC

Clinical and demographic characteristics of fatal anaphylaxis in Spain (1998‐2011): A comparison between a series from the hospital system and a national forensic series

Clinical &Experimental Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2x81Rt1

The "Italian way" to counteract obstructive sleep apnoea syndrome in children.

Related Articles

The "Italian way" to counteract obstructive sleep apnoea syndrome in children.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):393-394

Authors: Villa MP, Bellussi LM, De Benedetto M, Garbarino S, Passali D, Sanna A

PMID: 30197431 [PubMed - in process]

https://ift.tt/2OcwcOu

Multi-option therapy vs observation for small acoustic neuroma: hearing-focused management.

Related Articles

Multi-option therapy vs observation for small acoustic neuroma: hearing-focused management.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):384-392

Authors: Zanoletti E, Cazzador D, Faccioli C, Gallo S, Denaro L, D'Avella D, Martini A, Mazzoni A

Abstract
The current treatment options for acoustic neuromas (AN) - observation, microsurgery and radiotherapy - should assure no additional morbidity on cranial nerves VII and VIII. Outcomes in terms of disease control and facial function are similar, while the main difference lies in hearing. From 2012 to 2016, 91 of 169 patients (54%) met inclusion criteria for the present study, being diagnosed with unilateral, sporadic, intrameatal or extrameatal AN up to 1 cm in the cerebello-pontine angle; the remaining 78 patients (46%) had larger AN and were all addressed to surgery. The treatment protocol for small AN included observation, translabyrinthine surgery, hearing preservation surgery (HPS) and radiotherapy. Hearing function was assessed according to the Tokyo classification and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification. Sixty-one patients (71%) underwent observation, 19 (22%) HPS and 6 (7%) translabyrinthine surgery; 5 patients were lost to follow-up. Median follow-up was 25 months. In the observation group, 24.6% of patients abandoned the wait-and-see policy for an active treatment; the risk of switching from observation to active treatment was significant for tumour growth (p = 0.0035) at multivariate analysis. Hearing deteriorated in 28% of cases without correlation with tumour growth; the rate of hearing preservation for classes C-D was higher than for classes A-B (p = 0.032). Patients submitted to HPS maintained an overall preoperative hearing class of Tokyo and AAO-HNS in 63% and 68% of cases, respectively. Hearing preservation rate was significantly higher for patients presenting with preoperative favourable conditions (in-protocol) (p = 0.046). A multi-option management for small AN appeared to be an effective strategy in terms of hearing outcomes.

PMID: 30197430 [PubMed - in process]

https://ift.tt/2x8CZS0

Anatomical and functional results of ossiculoplasty using titanium prosthesis.

Related Articles

Anatomical and functional results of ossiculoplasty using titanium prosthesis.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):377-383

Authors: Lahlou G, Sonji G, De Seta D, Mosnier I, Russo FY, Sterkers O, Bernardeschi D

Abstract
Titanium ossicular chain replacement prosthesis is often used for rehabilitation of the columellar effect in otologic surgeries. This retrospective study aims to analyse the anatomical and functional results of surgeries in which a titanium prosthesis was used. Two hundred and eighty procedures in 256 patients operated on in a tertiary referral center were analysed. Aetiologies, preoperative audiograms, peroperative data and postoperative outcomes at 2 and 12 months postoperatively were reviewed. Chronic suppurative otitis media with or without cholesteatoma was the main aetiology (89%). There was no difference in anatomical results between partial and total ossicular replacement prosthesis, with an overall dislocation rate of 6%, and an overall extrusion rate of 3%. Regarding functional results, a postoperative air-bone gap ≤ 20 dB was achieved in 65% of cases, with a better result for partial compared to total ossiculoplasty (p = 0.02). A significant difference in air bone gap closure was found when comparing aetiologies, with a higher air-bone gap closure in malformation cases compared to chronic suppurative otitis media with cholesteatoma or retraction cases (p = 0.03). Ossiculoplasty using titanium prosthesis is a safe and effective procedure for rehabilitation of hearing loss, which allows reaching an air-bone gap ≤ 20 dB in the majority of patients.

PMID: 30197429 [PubMed - in process]

https://ift.tt/2CHUONS

MR imaging of endolymphatic hydrops in Ménière's disease: not all that glitters is gold.

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MR imaging of endolymphatic hydrops in Ménière's disease: not all that glitters is gold.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):369-376

Authors: Conte G, Lo Russo FM, Calloni SF, Sina C, Barozzi S, Di Berardino F, Scola E, Palumbo G, Zanetti D, Triulzi FM

Abstract
Ménière's disease (MD) is a chronic condition characterised by fluctuating hearing loss, intermittent vertigo, tinnitus and aural fullness. Its anatomical and pathological counterpart is represented by endolymphatic hydrops (EH). Recent development and progress in magnetic resonance (MR) imaging techniques has enabled visualisation of EH in living human subjects using a 3 Tesla (T) scanner and gadolinium-based contrast-agent (GBCA) via intravenous (IV) or intra-tympanic (IT) administration. Data emerging from the literature about MR imaging of EH in MD patients are limited, and we therefore reviewed the most common MR imaging findings in the study of the endolymphatic space in both MD and non-MD patients.

PMID: 30197428 [PubMed - in process]

https://ift.tt/2CUWhRh

Hearing threshold estimation by auditory steady state responses (ASSR) in children.

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Hearing threshold estimation by auditory steady state responses (ASSR) in children.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):361-368

Authors: Aimoni C, Crema L, Savini S, Negossi L, Rosignoli M, Sacchetto L, Bianchini C, Ciorba A

Abstract
Hearing threshold identification in very young children is always problematic and challenging. Electrophysiological testing such as auditory brainstem responses (ABR) is still considered the most reliable technique for defining the hearing threshold. However, over recent years there has been increasing evidence to support the role of auditory steady-state response (ASSR). Retrospective study. Forty-two children, age range 3-189 months, were evaluated for a total of 83 ears. All patients were affected by sensorineural hearing loss (thresholds ≥ 40 dB HL according to a click-ABR assessment). All patients underwent ABRs, ASSR and pure tone audiometry (PTA), with the latter performed according to the child's mental and physical development. Subjects were divided into two groups: A and B. The latter performed all hearing investigations at the same time as they were older than subjects in group A, and it was then possible to achieve electrophysiological and PTA tests in close temporal sequence. There was no significant difference between the threshold levels identified at the frequencies tested (0.25, 0.5, 1, 2 and 4 kHz), by PTA, ABR and ASSR between the two groups (Mann Whitney U test, p < 0.05). Moreover, for group A, there was no significant difference between the ASSR and ABR thresholds when the children were very young and the PTA thresholds subsequently identified at a later stage. Our results show that ASSR can be considered an effective procedure and a reliable test, particularly when predicting hearing threshold in very young children at lower frequencies (including 0.5 kHz).

PMID: 30197427 [PubMed - in process]

https://ift.tt/2O8VzRf

Frontal brain asymmetries as effective parameters to assess the quality of audiovisual stimuli perception in adult and young cochlear implant users.

Related Articles

Frontal brain asymmetries as effective parameters to assess the quality of audiovisual stimuli perception in adult and young cochlear implant users.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):346-360

Authors: Cartocci G, Maglione AG, Vecchiato G, Modica E, Rossi D, Malerba P, Marsella P, Scorpecci A, Giannantonio S, Mosca F, Leone CA, Grassia R, Babiloni F

Abstract
How is music perceived by cochlear implant (CI) users? This question arises as "the next step" given the impressive performance obtained by these patients in language perception. Furthermore, how can music perception be evaluated beyond self-report rating, in order to obtain measurable data? To address this question, estimation of the frontal electroencephalographic (EEG) alpha activity imbalance, acquired through a 19-channel EEG cap, appears to be a suitable instrument to measure the approach/withdrawal (AW index) reaction to external stimuli. Specifically, a greater value of AW indicates an increased propensity to stimulus approach, and vice versa a lower one a tendency to withdraw from the stimulus. Additionally, due to prelingually and postlingually deafened pathology acquisition, children and adults, respectively, would probably differ in music perception. The aim of the present study was to investigate children and adult CI users, in unilateral (UCI) and bilateral (BCI) implantation conditions, during three experimental situations of music exposure (normal, distorted and mute). Additionally, a study of functional connectivity patterns within cerebral networks was performed to investigate functioning patterns in different experimental populations. As a general result, congruency among patterns between BCI patients and control (CTRL) subjects was seen, characterised by lowest values for the distorted condition (vs. normal and mute conditions) in the AW index and in the connectivity analysis. Additionally, the normal and distorted conditions were significantly different in CI and CTRL adults, and in CTRL children, but not in CI children. These results suggest a higher capacity of discrimination and approach motivation towards normal music in CTRL and BCI subjects, but not for UCI patients. Therefore, for perception of music CTRL and BCI participants appear more similar than UCI subjects, as estimated by measurable and not self-reported parameters.

PMID: 30197426 [PubMed - in process]

https://ift.tt/2N7hT1o

Olfactory evaluation in obstructive sleep apnoea patients.

Related Articles

Olfactory evaluation in obstructive sleep apnoea patients.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):338-345

Authors: Magliulo G, De Vincentiis M, Iannella G, Ciofalo A, Pasquariello B, Manno A, Angeletti D, Polimeni A

Abstract
The sense of smell has a high impact on the quality of life. The aim of the present study was to investigate olfactory dysfunction in patients with obstructive sleep apnoea syndrome (OSAS) and correlate the severity of disease with olfactory dysfunction. The relationships between nasal obstruction, nasal mucociliary cleareance and olfactory tests were also evaluated. Sixty patients with a diagnosis of OSAS were enrolled and underwent olfactory function evaluation. In all patients olfactory performance was tested with the Sniffin' Sticks method. Mucociliary transport times and anterior rhinomanometry were performed to identify eventual nasal obstruction and deficits in nasal mucociliary clearance. Olfactory dysfunction was present in 22 (36.6%) patients of the study group: of these, hyposmia was present in 19 (86.4%) and anosmia in 3 (13.6%). The mean TDI score in the study group was 30. A strong correlation between the olfactory dysfunction and severity of sleep apnoea measured using the AHI was found. Patients with OSA would seem to have a high incidence of olfactory dysfunction. The degree of olfactory dysfunction appears to be related to the severity of disease. However, other co-factors such as nasal obstruction and reduced mucociliary clearance might also play a role in of the aetiology of this condition.

PMID: 30197425 [PubMed - in process]

https://ift.tt/2O8UVTP

Extracorporeal septoplasty with internal nasal valve stabilisation.

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Extracorporeal septoplasty with internal nasal valve stabilisation.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):331-337

Authors: Tasca I, Compadretti GC, Losano TI, Lijdens Y, Boccio C

Abstract
Among various septoplasty techniques, the extracorporeal one is used for severe deformities of the caudal septum and consists essentially in removal of the nasal septum followed by correction of deformities. Reconstruction of the neo-septum is carried out by repositioning the septal fragments in a straight position. The disadvantages of this surgical technique are the septal haematoma, oedema of the mucosa in the valve area and some types of abnormalities of the middle third of the nose such as saddling of the dorsum. All of these conditions can be associated with various degrees of functional disorders. To prevent these possible complications, we developed a suture technique to fix the caudal portion of the neo-septum and avoid alterations or narrowing of the internal nasal valve. The purpose of this study is to describe extracorporeal septoplasty results with this suture technique in stabilising the internal nasal valve. From January 2011 to December 2013, a retrospective review of adult patients treated with extracorporeal septoplasty was performed at the ENT department of Imola Hospital. Pre- and post-operative evaluations were carried out by rhinomanometry and acoustic rhinometry. Statistical analysis was performed with commercially available software (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp). 133 cases fulfilled inclusion criteria and were enrolled. A significant improvement was evident after surgery based on the results of rhinomanometry and acoustic rhinology. Extracorporeal septoplasty with stabilisation of the internal nasal valve is an effective and reproducible surgical technique that yields optimal functional results.

PMID: 30197424 [PubMed - in process]

https://ift.tt/2N2lkWU

Effectiveness of endoscopic septoplasty in different types of nasal septal deformities: our experience with NOSE evaluation.

Related Articles

Effectiveness of endoscopic septoplasty in different types of nasal septal deformities: our experience with NOSE evaluation.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):323-330

Authors: Dell'Aversana Orabona G, Romano A, Abbate V, Salzano G, Piombino P, Farina F, Pansini A, Iaconetta G, Califano L

Abstract
Septal deviations are the most frequent cause of nasal obstruction, and represent a common complaint in rhinologic practice. Since the first description of Lanza et al. in 1991, the use of the endoscope for the correction of septal deformities is increasingly more frequent. The purpose of this study is to evaluate the effectivenes of the endoscopic septoplasty for the correction of each of the 7 types of septal deformities according to the Mladina's classification. A retrospective chart review was performed in 59 consecutive patients presenting to our Department for Endoscopic Septoplasty from February 2012 to August 2014. For each deviation, descriptive statistics (mean and standard deviation, significant increase/decrease) was used to asses the corrective capacity and time-dependent effects at follow-up. This study shows that the corrective power of endoscopic septoplasty is different according to the type of deviation. To our knowledge this is the first study that evaluates the corrective capacity of this technique for each deviation by analysing pre- and postoperative objective outcomes as well as subjective outcomes gathered from the validated NOSE questionnaire. Even if endoscopic septoplasty may now be considered a reliable alternative to the classic technique, it is essential to identify the right deformity preoperatively in order to provide the correct therapeutic choice.

PMID: 30197423 [PubMed - in process]

https://ift.tt/2N59ETn

Differential chemokine expression patterns in tonsillar disease.

Related Articles

Differential chemokine expression patterns in tonsillar disease.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):316-322

Authors: Mandapathil M, Beier UH, Graefe H, Kröger B, Hedderich J, Maune S, Meyer JE

Abstract
Expression profiles of CXC- and CC-chemokines in various forms of tonsillar disease were studied to evaluate whether certain chemokines play a predominant role in a specific subset of tonsillar disease. Total RNA was isolated from 89 biopsies (21 hyperplastic palatine tonsils, 25 adenoids, 16 chronic inflammatory palatine tonsils and 27 chronic inflammatory palatine tonsils with histological prove of acute inflammation), reverse transcribed and subjected to PCR amplifying IL-8, Gro-alpha, eotaxin-1, eotaxin-2, MCP-3, MCP-4 and RANTES. 2% agarose gel electrophoresis revealed a predominance of IL-8 in the chronic inflammatory palatine tonsil group compared to tonsillar hyperplasia. Furthermore, eotaxin-2 was strongly overexpressed in adenoid samples compared to chronic inflammatory specimens. Our data suggest that the majority of diseases related to adenoid formation are mediated via an eotaxin-2 expression, whereas chronic inflammatory tonsillitis is associated with IL-8 upregulation. These data imply that adenoids are related to a Th-2, and chronic inflammatory tonsillitis to a Th-1 based immune response.

PMID: 30197422 [PubMed - in process]

https://ift.tt/2O8wwOs

New frontiers and emerging applications of 3D printing in ENT surgery: a systematic review of the literature.

Related Articles

New frontiers and emerging applications of 3D printing in ENT surgery: a systematic review of the literature.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):286-303

Authors: Canzi P, Magnetto M, Marconi S, Morbini P, Mauramati S, Aprile F, Avato I, Auricchio F, Benazzo M

Abstract
3D printing systems have revolutionised prototyping in the industrial field by lowering production time from days to hours and costs from thousands to just a few dollars. Today, 3D printers are no more confined to prototyping, but are increasingly employed in medical disciplines with fascinating results, even in many aspects of otorhinolaryngology. All publications on ENT surgery, sourced through updated electronic databases (PubMed, MEDLINE, EMBASE) and published up to March 2017, were examined according to PRISMA guidelines. Overall, 121 studies fulfilled specific inclusion criteria and were included in our systematic review. Studies were classified according to the specific field of application (otologic, rhinologic, head and neck) and area of interest (surgical and preclinical education, customised surgical planning, tissue engineering and implantable prosthesis). Technological aspects, clinical implications and limits of 3D printing processes are discussed focusing on current benefits and future perspectives.

PMID: 30197421 [PubMed - in process]

https://ift.tt/2N3KlBc

Nitinol versus non-Nitinol prostheses in otosclerosis surgery: a meta-analysis.

Related Articles

Nitinol versus non-Nitinol prostheses in otosclerosis surgery: a meta-analysis.

Acta Otorhinolaryngol Ital. 2018 Aug;38(4):279-285

Authors: Reis LR, Donato M, Almeida G, Castelhano L, Escada P

Abstract
The aim of this study is to perform a systematic review and meta-analysis of observational studies in which hearing outcomes after primary stapes surgery have been reported. After the surgical procedure, the effectiveness of stapes surgery using nickel titanium (Nitinol) or other prostheses were systematically compared and evaluated using a meta-analytic method. A systematic search for articles before January 2017 in Embase, Medline and Cochrane Library databases was conducted. Only articles in English were included. Inclusion criteria for qualitative synthesis consisted of a population of otosclerosis patients, intervention with primary stapes surgery using the Nitinol heat-crimping prosthesis compared with other type of stapes stapedotomy prostheses, and hearing outcome. Inclusion criteria for quantitative analysis consisted of application of audiometry guidelines of the American Academy of Otolaryngology Head and Neck Surgery Committee on Hearing and Equilibrium for evaluation of conductive hearing loss. A postoperative air-bone gap (ABG) ≤ 10 dB was considered effective. A bias assessment tool was developed according to Cochrane guidelines. To evaluate the mean age of the samples we used the chi-square test. Of the 4926 papers identified through the electronic database search (3695 in Pubmed/Cochrane and 1231 in Embase), 540 studies matched the selection criteria (436 in Pubmed/Cochrane and 104 in Embase) after application of filters and elimination of duplicate articles. After analysis of the title and abstract, 459 were excluded (396 in Pubmed/Cochrane and 63 in Embase). Of the remaining 81 papers, 74 were excluded according to the study selection criteria. A total of seven eligible studies with 1385 subjects, consisting of 637 in the Nitinol group and 748 in the non-Nitinol group, were included in our study. There were statistically significant differences in the effectiveness of stapes surgery between the Nitinol and non-Nitinol prostheses; the data showed a combined odds ratio (OR) of 2.56 (95% CI 1.38-4.76, p = 0.003). There were no statistically significant differences in the mean pre-operative age between Nitinol and non-Nitinol prostheses (p = 0.931). Our results suggest that the effectiveness of Nitinol was higher than non-Nitinol prostheses, with superiority of the number of patients with ABG ≤ 10 dB.

PMID: 30197420 [PubMed - in process]

https://ift.tt/2Ohsinq

Introduction from the Editors

https://ift.tt/2Nz3vOM

Non-IgE-mediated food hypersensitivity

Non-immunoglobulin E (IgE)-mediated food hypersensitivity includes a spectrum of disorders that predominantly affect the gastrointestinal tract. This review will focus on the following more common non-IgE-medi...

https://ift.tt/2Mmpeor

Allergic rhinitis

Allergic rhinitis is a common disorder that is strongly linked to asthma and conjunctivitis. It is usually a long-standing condition that often goes undetected in the primary-care setting. The classic symptoms...

https://ift.tt/2NDozUj

An introduction to immunology and immunopathology

Beyond structural and chemical barriers to pathogens, the immune system has two fundamental lines of defense: innate immunity and adaptive immunity. Innate immunity is the first immunological mechanism for fig...

https://ift.tt/2MmpVy0

Anaphylaxis

Anaphylaxis is an acute, potentially fatal systemic allergic reaction with varied mechanisms and clinical presentations. Although prompt recognition and treatment of anaphylaxis are imperative, both patients a...

https://ift.tt/2NAi3xH

The effect of an oral care protocol and honey mouthwash on mucositis in acute myeloid leukemia patients undergoing chemotherapy: a single-blind clinical trial

Abstract

Objectives

The purpose of the study is to evaluate and compare the effectiveness of honey mouthwash and an oral care protocol on mucositis and weight loss in patients with acute myeloid leukemia receiving chemotherapy.

Materials and methods

In this single-blind clinical trial, 53 acute myeloid leukemia (AML) patients receiving chemotherapy were randomly assigned into three groups: honey mouthwash (n = 17), oral care (n = 17), and control (n = 19). The severity of mucositis and weights was examined blindly at the baseline and 4-week follow-up.

Results

The prevalence of grades of mucositis in the study groups was significant at the end of the third (p = 0.002) and fourth (p < 0.001) weeks. The mucositis severity decreased at the end of the third and fourth weeks in the honey mouthwash group (p < 0.05), whereas it increased in the control group (p < 0.001). The difference in the weight was significant between the honey mouthwash and the control groups (p < 0.05, MD = 1.95) at the end of the third week, and between the honey mouthwash group with the control (p < 0.01, MD = 2.92) and oral care groups (p < 0.05, MD = 1.95) at the end of the fourth week.

Conclusions

Honey mouthwash is effective in preventing and reducing the severity of mucositis, and weight loss and can be recommended for patients undergoing chemotherapy.

Clinical relevance

The results of this study suggest that honey mouthwash can reduce the incidence and severity of mucositis in patients, reduce or eliminate the possibility of weight loss in them, as well as encourage some weight gain. Compared to routine oral care, honey mouthwash is also easier to use and handle.

Trial registration

IRCT2015121419919N7

https://ift.tt/2x53YOh

The 10 fundamental principles of lay resuscitation: Recommendations by the German Resuscitation Council

No abstract available

https://ift.tt/2N9vuFi

Lung protection during one-lung ventilation: Another piece in the puzzle

No abstract available

https://ift.tt/2x9qCVO

An observational study of skill retention and practice adoption after a workshop on ultrasound-guided neuraxial anaesthesia

No abstract available

https://ift.tt/2N9vmpi

Protective ventilation during anaesthesia reduces major postoperative complications after lung cancer surgery: A double-blind randomised controlled trial

BACKGROUND Thoracic surgery for lung resection is associated with a high incidence of postoperative pulmonary complications. Controlled ventilation with a large tidal volume has been documented to be a risk factor for postoperative respiratory complications after major abdominal surgery, whereas the use of low tidal volumes and positive end-expiratory pressure (PEEP) has a protective effect. OBJECTIVE To evaluate the effects of ventilation with low tidal volume and PEEP on major complications after thoracic surgery. DESIGN A double-blind, randomised controlled study. SETTING A multicentre trial from December 2008 to October 2011. PATIENTS A total of 346 patients undergoing lobectomy or pneumonectomy for lung cancer. MAIN OUTCOME MEASURES The primary outcome was the occurrence of major postoperative complications (pneumonia, acute lung injury, acute respiratory distress syndrome, pulmonary embolism, shock, myocardial infarction or death) within 30 days after surgery. INTERVENTIONS Patients were randomly assigned to receive either lung-protective ventilation (LPV group) [tidal volume 5 ml kg−1 ideal body weight + PEEP between 5 and 8 cmH2O] or nonprotective ventilation (control group) (tidal volume 10 ml kg−1 ideal body weight without PEEP) during anaesthesia. RESULTS The trial was stopped prematurely because of an insufficient inclusion rate. Major postoperative complications occurred in 23/172 patients in the LPV group (13.4%) vs. 38/171 (22.2%) in the control group (odds ratio 0.54, 95% confidence interval, 0.31 to 0.95, P = 0.03). The incidence of other complications (supraventricular cardiac arrhythmia, bronchial obstruction, pulmonary atelectasis, hypercapnia, bronchial fistula and persistent air leak) was also lower in the LPV group (37.2 vs. 49.4%, odds ratio 0.60, 95% confidence interval, 0.39 to 0.92, P = 0.02).The duration of hospital stay was shorter in the LPV group, 11 [interquartile range, 9 to 15] days vs. 12 [9 to 16] days, P = 0.048. CONCLUSION Compared with high tidal volume and no PEEP, LPV combining low tidal volume and PEEP during anaesthesia for lung cancer surgery seems to improve postoperative outcomes. TRIALS REGISTRATION ClinicalTrials.gov number: NCT00805077.

https://ift.tt/2x213Ge

A comparison of the incidence of supraventricular arrhythmias between thoracic paravertebral and intercostal nerve blocks in patients undergoing thoracoscopic surgery: A randomised trial

BACKGROUND Postoperative supraventricular arrhythmias are common in patients after thoracoscopic lobectomy. Inadequate pain control has long been recognised as a significant risk factor for arrhythmias. The performance of ultrasound-guided (USG) thoracic paravertebral block (PVB) is increasing as an ideal technique for postoperative analgesia. OBJECTIVE We conducted this study to evaluate whether a single-shot USG thoracic PVB would result in fewer postoperative supraventricular tachycardias (SVT) than intercostal nerve blocks (ICNBs) after thoracoscopic pulmonary resection. DESIGN A randomised controlled study. SETTING A single university hospital. PATIENTS Sixty-eight patients undergoing thoracoscopic lobectomy were randomised into two equal groups of 34. INTERVENTIONS For postoperative pain control, all patients received a total of 0.3 ml kg−1 of a mixture containing 0.5% ropivacaine and 1/200 000 epinephrine after placement of needles for either a single thoracic PVB or two individual ICNBs, both guided by ultrasound. Data were obtained during the first 48 postoperative hours. MAIN OUTCOME MEASURES The primary outcome was the incidence of SVT after thoracoscopic pulmonary resection. RESULTS During the first 48 postoperative hours, the incidences of SVT and atrial fibrillation were lower in the USG thoracic PVB group (14.7 vs. 46.9%, P = 0.004 and 3.0 vs. 18.8%, P = 0.037, respectively). The requirement for β-receptor blockade was more frequent in the ICNBs group than in the PVB group (5.9 vs. 25%, P = 0.033). CONCLUSION After placement of the needle using ultrasound guidance, a single-shot thoracic PVB is a well tolerated and effective technique to reduce the incidences of postoperative SVT and atrial fibrillation in patients undergoing thoracoscopic pulmonary resection. TRIAL REGISTRATION https://ift.tt/2LGPFWU, registration number: ChiCTR-IOR-17010952.

https://ift.tt/2N9vftS

Improved lung recruitment and oxygenation during mandatory ventilation with a new expiratory ventilation assistance device: A controlled interventional trial in healthy pigs

BACKGROUND In contrast to conventional mandatory ventilation, a new ventilation mode, expiratory ventilation assistance (EVA), linearises the expiratory tracheal pressure decline. OBJECTIVE We hypothesised that due to a recruiting effect, linearised expiration oxygenates better than volume controlled ventilation (VCV). We compared the EVA with VCV mode with regard to gas exchange, ventilation volumes and pressures and lung aeration in a model of peri-operative mandatory ventilation in healthy pigs. DESIGN Controlled interventional trial. SETTING Animal operating facility at a university medical centre. ANIMALS A total of 16 German Landrace hybrid pigs. INTERVENTION The lungs of anaesthetised pigs were ventilated with the EVA mode (n=9) or VCV (control, n=7) for 5 h with positive end-expiratory pressure of 5 cmH2O and tidal volume of 8 ml kg−1. The respiratory rate was adjusted for a target end-tidal CO2 of 4.7 to 6 kPa. MAIN OUTCOME MEASURES Tracheal pressure, minute volume and arterial blood gases were recorded repeatedly. Computed thoracic tomography was performed to quantify the percentages of normally and poorly aerated lung tissue. RESULTS Two animals in the EVA group were excluded due to unstable ventilation (n=1) or unstable FiO2 delivery (n=1). Mean tracheal pressure and PaO2 were higher in the EVA group compared with control (mean tracheal pressure: 11.6 ± 0.4 versus 9.0 ± 0.3 cmH2O, P  0.99). Minute volume was lower in the EVA group compared with control (5.5 ± 0.2 versus 7.0 ± 1.0 l min−1, P = 0.02) with normoventilation in both groups (PaCO2 5.4 ± 0.3 versus 5.5 ± 0.3 kPa, P > 0.99). In the EVA group, the percentage of normally aerated lung tissue was higher (81.0 ± 3.6 versus 75.8 ± 3.0%, P = 0.017) and of poorly aerated lung tissue lower (9.5 ± 3.3 versus 15.7 ± 3.5%, P = 0.002) compared with control. CONCLUSION EVA ventilation improves lung aeration via elevated mean tracheal pressure and consequently improves arterial oxygenation at unaltered positive end-expiratory pressure (PEEP) and peak inspiratory pressure (PIP). These findings suggest the EVA mode is a new approach for protective lung ventilation.

https://ift.tt/2N44F5o

The feasibility of pressure measurement during an ultrasound-guided thoracic paravertebral block

No abstract available

https://ift.tt/2x9qANG

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 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/2N44wyS

Ultrasound-guided single injection versus continuous sciatic nerve blockade on pain management and mobilisation after total knee arthroplasty (CoSinUS trial): A randomised, triple-blinded controlled trial

BACKGROUND Combining continuous femoral nerve blockade with single injection sciatic nerve blockade is standard peripheral nerve block practice for total knee arthroplasty (TKA) during the first 24 postoperative hours. OBJECTIVES To assess the analgesic benefits and mobilisation capability of continuous sciatic blockade in conjunction with continuous femoral nerve blockade for 72 h after arthroplasty. DESIGN Randomised, triple-blinded controlled trial. SETTING Single-Centre, German University Hospital. PATIENTS In total, 50 patients receiving continuous femoral nerve blockade (5 ml h−1 ropivacaine 0.2%) for TKA under general anaesthesia. INTERVENTIONS Patients were randomised to receive a sciatic nerve catheter with an initial dose of 10 ml ropivacaine 0.2% followed by either continuous double-blinded application of 5 ml h−1 ropivacaine 0.2% (CO) or 5 ml h−1 saline infusion (SIN). MAIN OUTCOME Measures primary endpoint: cumulative morphine consumption until 48 h postoperatively. Further endpoints included morphine consumption, pain scores, mobilisation, dynamometry until postoperative day 3. RESULTS Median [25th to 75th percentiles] cumulative morphine consumption at postoperative day 2 differed significantly between groups (CO 15 mg [11 to 25] versus SIN, 43 mg [27 to 67.5, P 

https://ift.tt/2x86QKx

Assessing changes in tissue oxygenation by near-infrared spectroscopy following brachial plexus block for arteriovenous fistula surgery: A prospective observational pilot study

BACKGROUND Near-infrared spectroscopy (NIRS) can be used to measure tissue oxygen saturation (StO2) in different sites and in a wide range of clinical scenarios. Peripheral regional anaesthesia induces vascular changes causing increased arterial blood flow and venodilatation, but its effect on StO2 is still under debate. This is especially so for patients undergoing arteriovenous fistula surgery, wherein latest data suggest an improved outcome under brachial plexus block (BPB) compared with local anaesthesia, but no data are available. OBJECTIVE The aim of this study was to investigate changes in StO2 following BPB prior to arteriovenous fistula surgery using NIRS. DESIGN A prospective observational study. SETTING A secondary teaching hospital from August 2016 to March 2017. PATIENTS Fifteen patients undergoing arteriovenous fistula surgery. INTERVENTION Ultrasound-guided BPB in 15 patients undergoing arteriovenous fistula surgery. OUTCOME MEASURES StO2 at baseline and compared with baseline and the contralateral arm following BPB measured using NIRS of the thenar eminence (NIRSth). RESULTS Baseline values of StO2 assessed by NIRSth were 42.6 ± 7.7% in the arteriovenous fistula arm and 42.7 ± 9.7% in the contralateral arm. There was no significant difference between the two. Five minutes after BPB, there was a significant increase in StO2 of the blocked arm, compared with the control arm expressed as difference of absolute values (7.1 ± 9.7%). At 60 min, an absolute difference of 21.0 ± 13.5% was reached. The absolute increase in StO2 of the blocked arm compared with baseline reached significance after 5 min (8.8 ± 4.6%) and increased up to 23.2 ± 8.2% after 60 min. CONCLUSION NIRSth indicates that BPB significantly increases StO2 of the arteriovenous fistula arm in patients undergoing haemodialysis. TRIAL REGISTRATION: Clinicaltrials.gov: NCT03044496

https://ift.tt/2N44p6q

Removal of entrapped epidural catheter: role of muscle relaxation

No abstract available

https://ift.tt/2x9qAgE

Adding sufentanil to ropivacaine in continuous thoracic paravertebral block fails to improve analgesia after video-assisted thoracic surgery: A randomised controlled trial

BACKGROUND The benefit of adding opioid to a local anaesthetic for continuous thoracic paravertebral analgesia after video-assisted thoracic surgery (VATS) is unclear. OBJECTIVES To analyse the analgesic efficacy of ropivacaine and sufentanil in combination compared with ropivacaine alone after VATS. DESIGN A randomised, double-blinded, single-centre clinical trial. SETTING A tertiary university hospital between March 2010 and April 2014. PATIENTS Ninety patients were recruited, two were not included leaving 88 randomised into two groups. Eighteen patients were excluded from analysis and 70 completed the study. INTERVENTION To receive thoracic paravertebral analgesia with either 2 mg ml−1 ropivacaine and 0.25 μg ml−1 sufentanil (ropivacaine + sufentanil group) or 2 mg ml−1 ropivacaine alone (ropivacaine group) for 48 h postoperatively. Infusion rate was set at 0.15 ml kg−1 h−1 in both groups. MAIN OUTCOME MEASURES The primary endpoint was the mean total amount of self-administered morphine by the patients in each group at 48 h postoperatively. RESULTS The mean ± SD total amount of self-administered morphine was not significantly different between groups (53.1 ± 27.2 mg in the ropivacaine + sufentanil group vs. 58.8 ± 34.3 mg in the ropivacaine group; P = 0.72). No significant differences were found between the two groups in either pain scores at rest or during movement, in opioid-related adverse reactions, in patient satisfaction or length of hospital stay. CONCLUSION Adding 0.25 μg ml−1 sufentanil to 2 mg ml−1 ropivacaine in continuous thoracic paravertebral analgesia for VATS did not reduce morphine consumption or pain scores when compared with ropivacaine alone. We cannot recommend its use for routine clinical practice. Further studies analysing different concentrations and infusion rates of sufentanil are needed before a lack of efficacy can be confirmed. TRIAL REGISTRATION Clinical trial registrations: EudraCT: 2009-014832-38. ClinicalTrials.gov: NCT 01082744.

https://ift.tt/2N9uSQ0

Modified half-the-air technique for continuous pressure monitoring during lumbar plexus block

No abstract available

https://ift.tt/2x79ZKA

Spinal anaesthesia with chloroprocaine 1% versus total intravenous anaesthesia for outpatient knee arthroscopy: A randomised controlled trial

BACKGROUND Both general and spinal anaesthesia with short-acting local anaesthetics are suitable and reliable for knee arthroscopy as an ambulatory procedure. Chloroprocaine (CP) 1% seems to be the ideal spinal local anaesthetic for this indication. OBJECTIVE The aim of this study was to compare spinal anaesthesia using CP 1% with general for outpatient knee arthroscopy with regard to procedure times, occurrence of pain, patient satisfaction and recovery, and also costs. DESIGN A randomised controlled single-centre trial. SETTING University Medical Centre Mannheim, Department of Anaesthesiology and Surgical Intensive Care Medicine, Mannheim, Germany. April 2014 to August 2015. PATIENTS A total of 50 patients (women/men, 18 to 80 years old, ASA I to III) undergoing outpatient knee arthroscopy were included. A contra-indication to an allocated anaesthetic technique or an allergy to medication required in the protocol led to exclusion. INTERVENTIONS Either general anaesthesia with sufentanil, propofol and a laryngeal mask for airway-management or spinal with 40-mg CP 1% were used. We noted procedure times, patient satisfaction/recovery and conducted a 7-day follow-up. MAIN OUTOMES Primary outcome was duration of stay in the day-surgery centre. Secondary outcomes were first occurrence of pain, patient satisfaction, quality of recovery and adverse effects. In addition, we analysed treatment costs. RESULTS Spinal had faster recovery than general anaesthesia with patients reaching discharge criteria significantly earlier [117 min (66 to 167) versus 142 min (82 to 228), P = 0.0047]. Pain occurred significantly earlier in the general anaesthesia group (P = 0.0072). Costs were less with spinal anaesthesia (cost ratio spinal: general 0.57). Patients felt significantly more uncomfortable after general anaesthesia (P = 0.0096). CONCLUSION Spinal anaesthesia with 40-mg CP 1% leads to a significantly earlier discharge and is cheaper compared with general. TRIAL REGISTRATION German Clinical Trials Register, www.drks.de, identifier: DRKS00005989.

https://ift.tt/2N3iGQK

e-learning: the anaesthesiology media lab of Yale University School of Medicine

No abstract available

https://ift.tt/2x7CY0z

Nepotism in publication of medical literature! does it exist? may be it does!!

Mridul M Panditrao

Anesthesia: Essays and Researches 2018 12(3):609-610



https://ift.tt/2Nu4Zdh

Possible bias in the publication trends of high impact factor anesthesiology and gastroenterology journals –an analysis of 5 years' data

Basavana Goudra, Divakara Gouda, Gowri Gouda, Akash Singh, Alan Balu, Prabhakara Gouda

Anesthesia: Essays and Researches 2018 12(3):611-617

Background: We hypothesize that being an editorial board member (EBM) in a high impact factor specialty medical journal increases the chances of publishing in the same journal. Materials and Methods: The publication trends of the first five EBMs in the five highest impact factor Anesthesiology and Gastroenterology journals were analyzed. Preceding 5 years' publications appearing on PubMed were grouped into as follows: number of publications in the journal in which the EBM serves (N1), number of publications by the same author in the other four highest impact factor (IF) journals (N2) and number of publications in all the other journals (N3). We evaluated the probability of the observed distribution of publications in the five highest IF journals happening by chance alone, assuming that all the EBMs had the same opportunity of publishing in any of these journals. The probability of publishing in their own journal was assumed to be one fifth. Results: The EBMs published their manuscripts in their own journal at a very high frequency. Encompassing all ten journals, the calculated P value for such a distribution was <0.001. In two journals, Anesthesia and Analgesia and Anaesthesia, the EBMs' publications in their journal were more than twice the cumulative total in the remaining four journals. In three of the five gastroenterology journals analyzed, combined publications of the five EBMs were greater in their own journal than the remaining four journals combined. Conclusions: Despite proclaimed fair peer review process, EBMs seem to get preference in their own journals.

https://ift.tt/2OcqP1I

Role of lignocaine nebulization as an adjunct to airway blocks for awake fiber-optic intubation: A comparative study

Manish Khandelwal, Varun Kumar Saini, Sandeep Kothari, Gaurav Sharma

Anesthesia: Essays and Researches 2018 12(3):735-741

Context: Airway management is a crucial skill and area of concern for the anesthesiologist. Awake fiber-optic intubation (AFOI) remains the gold standard in managing difficult airway. Anaesthetizing the airway along with psychological assurance is the mainstay for Preparation of AFOI. Different topical and regional techniques have been developed to subdue reflexes and facilitate AFOI. Aim: This randomized controlled study was performed to evaluate the effectiveness of using lignocaine nebulization in addition to specific airway blocks for AFOI. Methodology: This was a comparative study conducted in 60 patients with difficult airway (LEMON score >2) and randomly allocated into two groups of 30 each. Group LB and Group NB received nebulization of 2% lignocaine 4 mL and 0.9% normal saline 4 mL, respectively. Both groups were then given airway blocks as bilateral superior laryngeal (2% lignocaine 1–2 mL each) and transtracheal (2% lignocaine 4 mL) block. Two puffs of 10% lignocaine to nose and postnasal space on each side were given in both groups. Fiber-optic bronchoscopy (FOB)-guided tracheal intubation was Performed. Vital parameters, side effects, bronchoscopy-guided intubation time and other parameters as intubation grading scale, patient comfort score, satisfaction score were recorded. Chi-square test and unpaired t-test were used for statistical analysis. Results: Statistically, no significant differences were found in hemodynamic parameters, demographics, intubation time, and intubation grading scale in both groups. However, overall patient comfort and satisfaction score was better in Group LB. Conclusion: Upper airway blocks provide adequate anesthesia for awake FOB, but when lignocaine nebulization is added to these blocks, it improves the quality of anesthesia and patient satisfaction.

https://ift.tt/2NySqx8

Intraoperative meditation music as an adjunct to subarachnoid block for the improvement of postoperative outcomes following cesarean section: A randomized placebo-controlled comparative study

Madhuri S Kurdi, Vinod Gasti

Anesthesia: Essays and Researches 2018 12(3):618-624

Context: Music therapy is a nonpharmacological modality which can provide promising results for postcesarean section recovery. Aims: The aim of this study was to compare the effects of two types of intraoperative meditation music with control group on postcesarean section pain, anxiety, nausea, vomiting, and psychological maternal wellbeing. Settings and Design: A prospective, randomized, controlled study was conducted on 189 patients. Patients and Methods: The inclusion criteria were the American Society of Anaesthesiologists physical status classes 1E and 2E women aged over 18 years posted for emergency cesarean section under spinal anesthesia. The exclusion criteria were patients with hearing/ear abnormalities and psychiatric disorders. Patients were randomly allocated into three groups – soothing meditation music (M) group, binaural beat meditation music (B) group, and control (C) group – where no music was played. After intervention, data were collected and statistically analyzed. Statistical Analysis Used: Student's t-test was applied for calculation of normative distribution and Mann–Whitney U-test for nonnormative distribution. Nominal categorical data between the groups were compared using Chi-squared test. P <0.05 indicated a statistically significant difference. Results: Both intraoperative meditation music groups had statistically significant less postoperative pain and anxiety and a better overall psychological wellbeing as compared to the control. There was no statistically significant difference in the occurrence and severity of postoperative nausea and vomiting across all three groups. Conclusions: Intraoperative meditation music as good adjunct to spinal anesthesia can improve a cesarean section patient's postoperative experience by reducing postoperative pain, anxiety, and psychological wellbeing.

https://ift.tt/2ObhrM5

Comparative study between magnesium sulfate and lidocaine for controlled hypotension during functional endoscopic sinus surgery: A randomized controlled study

Mohamed Ahmed Hamed

Anesthesia: Essays and Researches 2018 12(3):715-718

Background: Intraoperative bleeding impairs surgical field visibility during functional endoscopic sinus surgery (FESS); several methods have been used to decrease blood loss and improve surgical field, one of them is usage of hypotensive anesthetic agents. Aim: We intended to compare magnesium sulfate with lidocaine, regarding their efficiency in inducing controlled hypotension and providing a better surgical field exposure during FESS and the influence of their usage on extubation time. Settings and Design: This study design was a prospective randomized controlled double-blinded clinical study. Patients and Methods: Eighty adult patients with patients' physical status ASA Classes I and II, aged 20–50 years scheduled for FESS were randomly divided into two study groups; each group contains 40 patients: Group L received lidocaine 2 mg/kg/h with maximum of 200 mg/h starting at induction of anesthesia and continuing until the end of surgery and Group M received an iv bolus of magnesium sulfate 50mg/kg in a total of 100ml saline over 10 min followed by infusion of 15mg/kg/h until the end of surgery; patients were observed for the quality of the surgical field, blood loss, and extubation time. Statistical Analysis Used: Student's t-test or Mann–Whitney's U, Chi-square, or Fisher's exact tests were used. Results: Group L showed a significant decrease in blood loss (P = 0.01), better surgical field clarity (P = 0.002), and shorter extubation time (P = 0.001) than Group M, but there was no statistically significant difference between the two study groups as regards hemodynamics. Conclusion: We concluded that both magnesium sulfate and lidocaine successfully induced controlled hypotension in patients undergoing FEES, but lidocaine provided better surgical field clarity and shorter extubation time.

https://ift.tt/2NE2jcQ

Fatty Acids in Pregnancy and Risk of Allergic Sensitization and Respiratory Outcomes in Childhood

Some observational studies have suggested associations of higher prenatal fish intake with protection against offspring asthma, attributing associations to greater exposure to marine n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFAs). Two recent randomized clinical trials have tested that hypothesis. Bisgaard and colleagues1 found that supplementation with n-3 LCPUFAs reduced the risk of persistent wheeze or asthma and lower respiratory tract infections, but not allergic sensitization or eczema, in offspring followed for the first 3 years of life.

https://ift.tt/2MlluDD

Association between itch and cancer in 16,925 pruritus patients: Experience at a tertiary care center

Pruritus has been associated with underlying malignancy. This article provides a comprehensive analysis of the association between pruritus and a diverse array of malignancies, with additional stratification by race, Knowledge of these associations can guide clinicians in pursuing malignancy workup for patients with unexplained pruritus

https://ift.tt/2QnQGVZ

Myofibroblastic sarcoma: Clinicopathologic features and experience from a sarcoma tertiary referral center

Background: Myofibroblastic sarcomas (MS) are rare malignancies characterized histologically by spindled cells with myofibroblastic differentiation. There is no common consensus on optimal management with surgery and adjuvant chemoradiotherapy yielding variable results.

https://ift.tt/2MlV30A

Oncological outcomes of early glottic carcinoma treated with transoral robotic surgery

Although glottic level is an off-label use of da Vinci system, the feasibility and early-term outcomes of transoral robotic surgery (TORS) for the treatment of early-stage (Tis, T1, T2) glottic carcinoma have been documented. But little is known about the oncological outcomes. We investigated the oncological outcomes of TORS in patients followed at least three years and mean follow-up time was over five years.

https://ift.tt/2OfmfA8

Comparison of Musculocutaneous and Fasciocutaneous Free Flaps for the Reconstruction of the Extensive Composite Scalp and Cranium Defects

Composite scalp and cranium defects, which require microsurgical reconstruction, result from tumor resection, radiation, trauma, severe burn injuries, and rarely vasculitic disorders. In the current study, the authors aim to compare the outcomes of the fasciocutaneous flaps and musculocutaneous free flaps used for the reconstruction of extensive composite scalp and cranium defects. From 2010 to 2017, 21 patients who underwent composite scalp and cranium defect reconstruction with a free flap were retrospectively identified. Eighteen patients had squamous cell carcinoma, 2 patients had meningioma, and 1 patient had Ewing sarcoma. Thirteen musculocutaneous free flaps including latissimus dorsi and vertical rectus abdominis flaps and 9 free fasciocutaneous flaps including radial forearm and anterolateral thigh flaps were used. Only 1 flap loss was encountered. No neurologic impairment in postoperative period was reported. The mean length of stay in the hospital, the duration of surgery, and total volume of blood transfusion for the fasciocutaneous flap group were significantly shorter than those for musculocutaneous flap group. No flap atrophy was reported in fasciocutaneous flap group. Reconstruction of the composite scalp and cranium defects with fasciocutaneous free flaps allows shorter hospitalization, less blood transfusion and less flap atrophy than those of musculocutaneous flaps. To this respect, their usage should be prioritized in such challenging patients. Address correspondence and reprint requests to Hakan Uzun, MD, Department of Plastic, Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, 06100 Sihhiye, Ankara, Turkey; E-mail: shakanuzuns@gmail.com Received 13 April, 2018 Accepted 17 August, 2018 This study was presented at the 4th Congress of Asian Pacific Federation of Societies for Microsurgery in Antalya, Turkey, May 9 to 13, 2018. The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2CJA5cn

Use of Recombinant Human Bone Morphogenetic Protein-2 Associated With Lyophilized Bovine Bone in Reconstruction of Atrophic Maxilla

Cases of severely atrophic edentulous maxilla require reconstruction techniques employing bone grafts to promote adequate bone dimension for the successful placement of dental implants for prosthetic rehabilitation that reestablishes the patient's function and aesthetics. This study aims to present a severely atrophic edentulous maxilla reconstruction with the off-label use of recombinant human bone morphogenetic protein type 2 (rhBMP-2) associated with lyophilized particulate bovine bone xenograft for the prosthetic rehabilitation with osseointegrable dental implants. The paper describes a case of severely atrophic edentulous maxilla in a 42-year-old woman referred to the dental school with complaint of failure in adaptating to the dentures. The patient reported 27 years of maxilla edentulism and consecutive treatment failures, so the proposed therapy was the reconstruction of the maxilla with an association of rhBMP-2 and lyophilized bovine bone xenograft for increasing bone volume and further prosthetic rehabilitation with osseointegrated dental implants. The present report illustrates a case of atrophic edentulous maxilla in which the off-label use of rhBMP-2 was successful and the patient's prosthetic rehabilitation could be concluded. The 8 dental implants received prosthetic functional load during 1 year of follow-up with no complications. Based on the case presented, the association between rhBMP-2 and a bovine bone xenograft could be considered a viable option for the reconstruction of atrophic edentulous maxilla. After a year of functional prosthetic load follow-up, the patient is asymptomatic and satisfactorily adaptated to the prosthesis, which restored her functional and aesthetic demands. Address correspondence and reprint requests to Leonardo Matos Santolim Zanettini, DDS, MSc, Avenida Ipiranga, 6681—Partenon, Porto Alegre, RS, Brazil; E-mail: leonardozanettini@hotmail.com Received 5 July, 2018 Accepted 17 August, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2NAXxgg

The Rules of Attractiveness: A Study on the Lower Facial Third

What is considered attractive may not fall into the "norm," and it can vary from culture to culture and depending on the historical time, for this reason the standard cephalometric and antropometric references may not be sufficient in these cases. Lately some techniques have arose to popularity that are aimed to changing the frontal and lateral aspect of the facial lower third, such as V-line or the Chin-Wing Osteotomy technique, but no reference system exists at the moment to define to which extent a modification of the lower third falls within what is considered beautiful, and everything is left to the patient's will or to the surgeon's sensitivity. The aim of this article is to study which antropometric value is considered attractive by the most for what concerns the frontal shape of the lower third of the face. Twenty-four female models were enrolled in this study and the angle taken into consideration was the one at the intersection between the 2 lines connecting the cutaneous gonial angle of each side of the face and the most external part of the chin on the same side. Measures were made on pictures in frontal view. Two hundred two random examiners were asked to see the pictures and rate them as attractive or nonattractive. Results were then paired with the angles values. Among the models the higher angle measured was 107.5° (found in 1 individual) while the lower angle was 76° (found in 1 individual), the average measure calculated was 88.3° while the median angle was 89.5°. According to the result the subjects considered more attractive were those with an angle between 84.5 and 91.5 (92 for male examiners). This could be an important starting point for studies who can evaluate attractiveness from a numerical point of view. Address correspondence and reprint requests to Gianmarco Saponaro, MD, Maxillo-Facial Surgery Unit, Policlinico Universitario "A Gemelli," Largo A. Gemelli 3 – 00168 Rome, Italy, E-mail: gianmarco.saponaro@gmail.com Received 26 February, 2018 Accepted 17 August, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

https://ift.tt/2CM4J54

Allergy diagnosis from symptoms to molecules, or from molecules to symptoms: a comparative clinical study

Classical allergy diagnostic workup "from symptoms to molecules" comprises 1) clinical investigation, 2) skin prick- and IgE- testing, and recently, 3) molecular allergy testing. We aimed to examine the diagno...

https://ift.tt/2x36PrY

Effect of remifentanil on postoperative nausea and vomiting: a randomized pilot study

Abstract

Opioid-related postoperative nausea and vomiting should not occur following remifentanil administration because of its relatively short time to elimination. However, studies have indicated that the incidence of postoperative nausea and vomiting associated with remifentanil is similar to that with other opioids. Hence, we aimed to determine whether intraoperative remifentanil itself is associated with postoperative nausea and vomiting when postoperative pain is managed without opioid use. In this prospective pilot study, 150 patients who underwent unilateral upper limb surgery under general anesthesia with brachial plexus block were included. Patients in the remifentanil and control groups received 0.5 µg/kg/min remifentanil and saline, respectively. Postoperative pain was managed using a brachial plexus block, non-steroidal anti-inflammatory drugs, and acetaminophen. The presence of postoperative nausea and vomiting within the first 24 h after anesthesia was assessed by an evaluator blinded to patient allocation. Eight patients were excluded from the final analysis, resulting in 72 and 70 patients in the remifentanil and control groups, respectively. Postoperative nausea and vomiting within 24 h after surgery occurred in 11 and 9 patients in the remifentanil and control groups, respectively. These data suggest that remifentanil use only minimally affects the incidence of postoperative nausea and vomiting under sevoflurane anesthesia.

UMIN Clinical Trials Registry identification number: UMIN000016110.

https://ift.tt/2oWFH9A

Nimotuzumab for Recurrent Nasopharyngeal Carcinoma

Condition:   Recurrent Nasopharyngeal Carcinoma
Intervention:   Drug: Nimotuzumab
Sponsors:   Fujian Cancer Hospital;   Sun Yat-sen University;   Jiangxi Provincial Cancer Hospital;   Zhejiang Cancer Hospital;   Fujian Medical University Union Hospital
Recruiting

https://ift.tt/2x3xN1J

A First-in-human Study of ILDR2 (Immunoglobulin-like Domain Containing Receptor 2) Function-blocking Antibody BAY1905254

Condition:   Advanced Solid Tumor
Intervention:   Drug: BAY1905254
Sponsor:   Bayer
Not yet recruiting

https://ift.tt/2x1G9rJ

Immunotherapy +/- EGFR Inhibitor In Advanced/Metastatic cSCC: Tackling Primary And Secondary Resistance

Condition:   Skin Neoplasm
Interventions:   Drug: Pembrolizumab;   Drug: Cetuximab
Sponsors:   Fondazione IRCCS Istituto Nazionale dei Tumori, Milano;   Merck Sharp & Dohme Corp.
Not yet recruiting

https://ift.tt/2x91KxI

Pathophysiological Mechanism Behind Prolonged Whiplash Associated Disorders

Condition:   Whiplash Injuries
Intervention:   Other: Exercises
Sponsor:   Linkoeping University
Not yet recruiting

https://ift.tt/2x0J6sA

A Safety and Tolerability Study of NC318 in Subjects With Advanced or Metastatic Solid Tumors

Conditions:   Advanced or Metastatic Solid Tumors;   Head and Neck Squamous Cell Carcinoma;   Non-Small Cell Lung Cancer;   Ovarian Cancer
Intervention:   Drug: NC318
Sponsor:   NextCure, Inc.
Not yet recruiting

https://ift.tt/2x91xKW

PROFESSOR ALBERT K. OEHLING: Allergology reference in the 20th century

Allergy, Volume 0, Issue ja, -Not available-.


https://ift.tt/2NCLcIo

Perforation of small intestine due to metastatic lung carcinoma

Description 

A 66-year-old woman with a history of 40 pack-year cigarette smoking and type II diabetes mellitus presented to the emergency department with unexplained weight loss and cough for a few weeks. These complaints constituted her first clinical manifestation. Physical examination was notable for diffuse abdominal tenderness. Chest and abdominal films (figure 1) revealed a prominent round opaque lesion in the right lung (arrow) and a large amount of free air under diaphragms with air-fluid levels.

Figure 1

Upright chest (left) and abdominal (right) films demonstrating round opaque lesion (arrow) and free air under diaphragms and levels of fluid in the stomach and intestine.

The patient underwent an urgent laparotomy for pneumoperitoneum. Perforation of the small intestine due to a malignant metastasis was detected. The patient underwent a wide resection of the small intestine with closed loop anastomosis. The biopsy specimen was consistent with...

https://ift.tt/2OahiIO

Posterior urethral valve presenting with impacted prostatic urethral calculus: a diagnostic challenge

Description 

A 5-year-old boy presented with complaints of difficulty in micturition for the last 3 days and acute urinary retention for 1 day. History revealed symptom of occasionally crying during voiding since birth for which no medical advice was taken in the past. There was no history of any lithuria, haematuria or recurrent episodes of fever. The general physical examination was unremarkable. The routine blood investigations and urine culture were also normal. Urine routine microscopy showed 4–5 pus cells/HPF. Ultrasonography of the abdomen revealed thickening of the bladder wall with normal upper tracts. Further evaluation with X-ray pelvis and voiding cystourethrogram (VCUG) showed a radiopaque shadow in the prostatic urethra along with dilated posterior urethra as shown in figure 1. The patient was subsequently taken for cystopanendoscopy which revealed posterior urethral valve type one along with a dilated posterior urethra as shown in figure 2....

https://ift.tt/2x1KtqU

Pseudovascular squamous cell carcinoma: A review of the published work and reassessment of prognosis

The Journal of Dermatology, EarlyView.


https://ift.tt/2O9es6R

Use of immune checkpoint inhibitors prolonged overall survival in a Japanese population of advanced malignant melanoma patients: Retrospective single institutional study

The Journal of Dermatology, EarlyView.


https://ift.tt/2N61OsL

The Pivotal Role of Pediatric Psychology in Chronic Pain: Opportunities for Informing and Promoting New Research and Intervention in a Shifting Healthcare Landscape

Abstract

Purpose of Review

In the context of new efforts to formulate more comprehensive diagnostic and treatment processes for chronic pain conditions, this review aims to provide an overview of some of the most salient developments in the diagnosis and clinical treatment of pediatric chronic pain and to delineate the current and future role of clinical pediatric psychologists in these efforts.

Recent Findings

The acceptance and promotion of the multidisciplinary approach to pediatric pain management has had an especially significant impact on the field of pediatric psychology. Though chronic pain was historically conceptualized as a biomedical problem, psychology is increasingly viewed as a routine, integral, and component part of treatment. With this evolving biopsychosocial paradigm, pediatric psychology is poised to help shape the development of this field, contributing to emerging conceptual and diagnostic frameworks via consultation, research, clinical care, and education.

Summary

This review discusses the role of pediatric psychologists as collaborators in emerging diagnostic and assessment frameworks, leaders in pain-related research, drivers of clinical care, and educators for providers, patients, and the lay public. With increased opportunities to enhance the conceptualization and treatment of pediatric pain, pediatric psychologists have an important role to play in reducing the prevalence and persistence of pediatric pain.

https://ift.tt/2MkhLGv

Pivotal role of innate myeloid cells in cerebral post-ischemic sterile inflammation

Abstract

Inflammatory responses play a multifaceted role in regulating both disability and recovery after ischemic brain injury. In the acute phase of ischemic stroke, resident microglia elicit rapid inflammatory responses by the ischemic milieu. After disruption of the blood-brain barrier, peripheral-derived neutrophils and mononuclear phagocytes infiltrate into the ischemic brain. These infiltrating myeloid cells are activated by the endogenous alarming molecules released from dying brain cells. Inflammation after ischemic stroke thus typically consists of sterile inflammation triggered by innate immunity, which exacerbates the pathologies of ischemic stroke and worsens neurological prognosis. Infiltrating immune cells sustain the post-ischemic inflammation for several days; after this period, however, these cells take on a repairing function, phagocytosing inflammatory mediators and cellular debris. This time-specific polarization of immune cells in the ischemic brain is a potential novel therapeutic target. In this review, we summarize the current understanding of the phase-dependent role of innate myeloid cells in ischemic stroke and discuss the cellular and molecular mechanisms of their inflammatory or repairing polarization from a therapeutic perspective.

https://ift.tt/2MlXmRe

A novel noise filtered and occlusion removal: navigational accuracy in augmented reality-based constructive jaw surgery

Abstract

Purpose

Augmented reality-based constructive jaw surgery has been facing various limitations such as noise in real-time images, the navigational error of implants and jaw, image overlay error, and occlusion handling which have limited the implementation of augmented reality (AR) in corrective jaw surgery. This research aimed to improve the navigational accuracy, through noise and occlusion removal, during positioning of an implant in relation to the jaw bone to be cut or drilled.

Method

The proposed system consists of a weighting-based de-noising filter and depth mapping-based occlusion removal for removing any occluded object such as surgical tools, the surgeon's body parts, and blood.

Results

The maxillary (upper jaw) and mandibular (lower jaw) jaw bone sample results show that the proposed method can achieve the image overlay error (video accuracy) of 0.23~0.35 mm and processing time of 8–12 frames per second compared to 0.35~0.45 mm and 6–11 frames per second by the existing best system.

Conclusion

The proposed system concentrates on removing the noise from the real-time video frame and the occlusion. Thus, the acceptable range of accuracy and the processing time are provided by this study for surgeons for carrying out a smooth surgical flow.

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Giant cell arteritis and inflammatory bowel disease – Is there a connection? Results from a population-based study

Publication date: Available online 11 September 2018

Source: Autoimmunity Reviews

Author(s): Yarden Yavne, Shmuel Tiosano, Dana Ben-Ami, Abdulla Watad, Adi Guy, Doron Comaneshter, Arnon D. Cohen, Howard Amital

Abstract

Background

Giant cell arteritis (GCA) is an autoimmune disorder which primarily affects large vessels, whilst inflammatory bowel diseases (IBD) mainly target the gut. Co-existence of the two maladies has been reported sporadically in the literature; therefore the purpose of this study was to assess the authenticity of such an association in a large, cross-sectional study.

Methods

Utilizing data derived from the Clalit Health Services' registry, the largest health maintenance organization in Israel, we compared the proportion of CD and UC in GCA patients with age- and gender-matched controls. Univariate analysis was performed using Chi-square and student t-test and a multivariate analysis was performed using a logistic regression model.

Results

The study included 3938 GCA patients and 21,623 age- and gender-matched controls. GCA patients had a significantly increased proportion of both CD and UC in comparison with controls (0.79% vs. 0.12% and 0.84% vs. 0.21%, P-value < .001, respectively). The strength of the association between GCA and IBD was negatively correlated with the patients' age; thus the association was more robust amongst middle-aged patients (ages 50–69, OR = 8.13) than in elderly patients (ages 70–85, OR = 3.81). The association between GCA and IBD remained significant when evaluated independently of confounding factors (OR = 2.63, P-value < .001).

Conclusions

The probability that GCA patients also suffer from IBD is increased in comparison with age- and gender-matched controls. Our findings indicate that this association is more prominent in middle-aged patients (50–69 years of age). Screening for IBD amongst GCA patients in this age group may be warranted.

https://ift.tt/2wZyrgO

Novel immunological based classification of rheumatoid arthritis with therapeutic implications

Publication date: Available online 11 September 2018

Source: Autoimmunity Reviews

Author(s): Dennis McGonagle, Abdulla Watad, Sinisa Savic

Abstract

The classical autoimmunity paradigm in rheumatoid arthritis (RA) is strongly supported by immunogenetics suggesting follicular helper T-cell responses driving high titre specific autoantibodies that pre-dates disease onset. Using the immunological disease continuum model of inflammation against self with "pure" adaptive and innate immune disease at opposite boundaries, we propose a novel immune mechanistic classification describing the heterogeneity within RA. Mutations or SNPs in autoinflammatory genes including MEFV and NOD2 are linked to seronegative RA phenotypes including some so called palindromic RA cases. However, just as innate and adaptive immunity are closely functionally integrated, some ACPA+ RA cases have superimposed "autoinflammatory" features including abrupt onset attacks, severe attacks, self-limiting attacks, relevant autoinflammatory mutations or SNPs and therapeutic responses to autoinflammatory pathway therapies including colchicine and IL-1 pathway blockade. An emergent feature from this classification that non-destructive RA phenotypes, both innate and adaptive, have disease epicentres situated in the extracapsular tissues. This mixed innate and adaptive immunopathogenesis may be the key to understanding severe disease flares, resistant disease subsets that are unresponsive to standard therapy and for therapies that target the autoinflammatory component of disease that are not currently considered by expert therapeutic recommendations.

https://ift.tt/2NB1RfE

The role of dietary sodium on autoimmune diseases: The salty truth

Publication date: Available online 11 September 2018

Source: Autoimmunity Reviews

Author(s): Kassem Sharif, Howard Amital, Yehuda Shoenfeld, MaACR

Abstract

Autoimmune diseases are a group of heterogeneous condition that occur secondary to the intrinsic loss of tolerance to self- antigens. In genetically susceptible individuals, the complex interplay of environmental factors and epigenetic deregulations have been proposed to drive disease etiopathogenesis. Various environmental variables have been identified including viral infections, exposure to pollutants, stress and dietary factors. Sodium, a major constituent of salt is essential for mammalian physiology. However, high salt intake may play a role in the development of autoimmune diseases. Several lines of evidence point toward the role of high sodium intake in reversing the suppressive effects of Regulatory T cells (Tregs) and instead promote cellular shift toward T-helper (Th)-1 and Th17 pro-inflammatory phenotypes. These effects have been attributed to cascade of events that ultimately results in downstream activation of serum glucocorticoid kinase 1 (Sgk1). In vivo, various autoimmune animal models have confirmed the role of high sodium diet in the emergence and the exacerbation of autoimmune conditions including for instance Experimental Autoimmune Encephalomyelitis model for multiple sclerosis, MRL/lpr mouse model for lupus nephritis, collagen induced arthritis model for rheumatoid arthritis, and dextran sulfate sodium induced colitis, and TNBS-induced colitis models for Crohn's disease. Clinical epidemiological studies are scarce. High sodium intake was associated with increased risk of rheumatoid arthritis disease emergence. In multiple sclerosis, some studies suggest a relation to clinical exacerbation rates however other studies did not corroborate these results.

Taken together, high dietary salt intake plays a role in the spectrum of autoimmune disease etiology. Further research is warranted to better characterize such relationship and assist in identifying individuals that would benefit from dietary salt restriction.

https://ift.tt/2wZb4nq

How can autoantibodies predict the long-term outcome of patients with interstitial lung disease? Results from a retrospective cohort study

Publication date: Available online 11 September 2018

Source: Autoimmunity Reviews

Author(s): Christos F. Kampolis, Aliki I. Venetsanopoulou, Foteini Karakontaki, Vlasis Polychronopoulos, Panayiotis Vlachoyiannopoulos, Athanasios G. Tzioufas

Abstract

Objectives

This study aimed to investigate whether positive serum autoantibodies (AAbs) have any impact on survival and time evolution of radiological findings and pulmonary function indices in patients with interstitial lung disease (ILD).

Patients and methods

Ninety four patients with regular clinical, functional and high resolution computed tomography (HRCT) imaging follow-up for at least 12 consecutive months and complete testing for a panel of AAbs most commonly associated with ILD were enrolled in this retrospective two-center study. Eligible patients were divided into two groups based on the presence [ILD/AAb(+)] (n = 69) or absence [ILD/AAb(−)] (n = 25) of positive serum AAbs. All-cause mortality and longitudinal indicators of ILD progression such as a sustained decrease from baseline in absolute measurements of forced vital capacity (FVC) of ≥10% or single-breath diffusion capacity (DLCO_SB) of ≥15% were the primary study endpoints. DLCO_SB < 40% predicted on at least two consecutive measurements and progression of HRCT findings were our secondary endpoints. Kaplan–Meier (K-M) survival analysis and multivariate Cox proportional-hazards (PH) model were used to evaluate the prognostic significance of positive AAbs in the outcome of patients with ILD.

Results

ILD/AAb(+) patients were predominantly female (71% vs 32%), were significantly younger (54.8 ± 14.6 vs 66.8 ± 10.1 years), and had longer duration of follow-up (78.1 ± 53.1 vs 41.6 ± 26.7 months), compared with ILD/AAb(−) patients (p < .01 for each comparison). Baseline measurements of FVC (% pred.) and DLCO_SB (% pred.) did not differ significantly between the two groups. At the end of follow-up, mortality rates and the percentage of patients with a sustained FVC decrease were lower in the ILD/AAb(+) group (p < .05 for each comparison). With the exception of DLCO_SB < 40% pred., ILD/AAb(+) patients had a longer median time-to-event for each of the other studied outcomes (p < .01 for each K-M analysis). In addition, Cox PH models adjusted for age, smoking status, baseline pulmonary function tests and morphological pattern of ILD remained statistically significant in favor of the ILD/AAb(+) group (p < .05 for each comparison).

Conclusions

AAb(+) patients with ILD seem to have a more favorable prognosis regarding all-cause mortality, long-term deterioration in lung function parameters and progression of HRCT findings than their AAb (−) counterparts.

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Food intolerance in patients with manifest autoimmunity. Observational study

Publication date: Available online 11 September 2018

Source: Autoimmunity Reviews

Author(s): Francis Coucke

Abstract

In the professional medical and scientific world, there is not many interest in the correlation of food intolerance and autoimmune diseases. However there is a lot of evidence that e.g. gluten or gliadine can induce autoimmmune diseases: example the interest in coeliac disease and autoimmunity. There is however a lot of informationavailable about leaky gut and autoimmunity.

We performed an observational study in our data base;, where we selected 100 patients with manifest autoimmune disease with clear symptoms and autoimmune antibodies in the form of positive anf more tehn 160 titer. These patients were compared with 25 control patients without any autoimmunity.

We could clearly find a difference in food intolerance profiles when we compared AI patients with people without any AI. Overall there is a much greater reaction to several food epitopes, which can be observed on the level of specific antibodies tot he food epitopes. These igG levels for specific food antibodies are significantly higher in the patient group then in the control group. We can also see that some food epitopes provocate a very pronounced reaction, while other show no increased level of igG. Among the most reactive food epitopes are caseine, cow milk, wheat, gliadine, white of egg and rice. A variable reaction can bes een on nuts e.g.; walnuts and almonds. Almost no antibody reaction is noticed on vegetables, fish and meat products, who seem tob e immunologially very neutral.

We conclude that food intolerance test is very important tool in patients with AI disease, and should be performed in each patient to tailor an individual diet program, which if properly followed, could relieve symptoms and probably stop or slow the the progression of the autoimmune disease.

Also interesting for global research in AI disease is the fact that food is probably an important trigger for autoimmunity in vulnerable patients. More research on great scale and multicenter around this topic is mandatory and urgent.

https://ift.tt/2wZyoBE

Osteoarthritis and its management - Epidemiology, nutritional aspects and environmental factors

Publication date: Available online 11 September 2018

Source: Autoimmunity Reviews

Author(s): Alessandra Bortoluzzi, Federica Furini, Carlo A. Scirè

Abstract

Osteoarthritis (OA) is the most prevalent chronic rheumatic diseases worldwide, with a strong impact on individual and population health. OA is a clinically heterogeneous disease presenting with different clinical phenotypes recognising systemic and local risk factors. The pathogenesis is multifactorial including constitutive features of the joint, non-modifiable and modifiable risk factors. Epidemiological studies highlight the link between metabolic syndrome and OA and the effect of interplay between immunological and metabolic processes is getting increasing emphasis because of to the discovery that metabolic syndrome is implicated in OA pathogenesis and progression. In addition, recent findings suggest a potential role of dietary factors in susceptibility and progression of OA. In this review, we summarise the most robust evidence on epidemiology and classical risk factors OA, also exploring the most recent evidence on metabolic changes and Mediterranean diet for OA as a possible target to impact on the natural history of the disease.

https://ift.tt/2NBjDzh

The Mediterranean Diet, fish oil supplements and Rheumatoid arthritis outcomes: evidence from clinical trials

Publication date: Available online 10 September 2018

Source: Autoimmunity Reviews

Author(s): Petersson Sara, Philippou Elena, Rodomar Carrie, Nikiphorou Elena

Abstract

The impact of dietary interventions such as specific types of diet or nutritional supplements in rheumatoid arthritis (RA) has been subject to increased attention in recent years. The recognition of the unmet need to better understand the effects of specific dietary interventions on disease outcomes in RA, along with the growing patient interest on lifestyle interventions beyond pharmacotherapy, have informed the undertaking of this narrative literature review. The benefits of the Mediterranean Diet (MD) have been shown in various studies, although only a limited number of trials focus specifically on RA. Based on the studies reviewed, the MD may provide benefits in reducing pain and swollen and tender joints in RA patients. There is more and better evidence that n-3 polyunsaturated fat (PUFA) supplementation has the potential to reduce inflammation and provide clinical benefit, possibly slowing progression to pharmacotherapy. Yet, many of these studies to date are limited in their methodology; this being partly a reflection of the complexity of the research questions being addressed. Consequently, the conclusions that can be robustly drawn from their results are restricted. With a focus on clinical trials on the MD and fish oil supplementation, this review critically appraises the evidence, discussing the findings of studies in the wider context of impact on RA outcomes, methodological challenges and practical points to consider as part of the routine care of RA patients.

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Impact of micronutrient deficiency & malnutrition in systemic sclerosis: Cohort study and literature review

Publication date: Available online 10 September 2018

Source: Autoimmunity Reviews

Author(s): Romain Dupont, Mélanie Longué, Anne Galinier, Christel Cinq Frais, Cécile Ingueneau, Léonardo Astudillo, Philippe Arlet, Daniel Adoue, Laurent Alric, Grégoire Prévot, Bastien Cabarrou, Laurent Sailler, Grégory Pugnet

Abstract

Objectives

The purpose of our study was to determine the prevalence and risk factors associated with malnutrition, and selenium (Se) and vitamin C (vitC) deficiencies in systemic sclerosis (SSc) patients.

Methods

We included adult SSc patients fulfilling the 2013 ACR/EULAR criteria from the Toulouse University Hospital cohort who underwent a micronutrient workup (including vitC, Se or thiamine levels) between 2011 and 2016. Results: 82 patients were included, mostly women (76%), with a median age of 60 years. SSc was limited in 76% of the cases, with Scl-70 and centromere antibodies in 32% and 44%, respectively. Median disease duration was 7.4 years. Cardiac involvement was noticed in 19% and gastrointestinal tract in and 95%; 9% had pulmonary artery hypertension (PAH) and 63% had interstitial lung disease. Overt malnutrition was present in 14 (17%) patients. Micronutrient deficiencies included Se (35%), vitC (31%) and/or thiamine (6%). Malnourished patients had significantly a higher summed Medsger disease severity scales (7.5 vs. 5, P = .003), lower hemoglobin (10.6 vs. 12.9 g/dL, P < .0001) and vitC levels (3.6 vs. 10.6 mg/L, P = .003). Cardiac involvement was significantly associated with Se deficiency (OR 6.2, IC 95%[1.48–32.70], P = .05). The factors associated with vitC deficiency were malnutrition (OR 8.57, IC 95%[2.16–43.39], P = .003), modified Rodnan skin score ≤ 14 (OR 0.33, IC95[0.11–1], P = .05), PAH (27% in deficient vs. none in non-deficient patients, P = .0006) and esophagitis or Barrett's mucosa (OR 4.05, IC95[1.27–13.54], P = .02).

Conclusions

Se testing should be considered as soon as cardiac involvement is suspected. VitC testing should be considered in malnourished SSc patients, especially if skin involvement is extensive.

https://ift.tt/2NAwn9j

Are we really what we eat? Nutrition and its role in the onset of rheumatoid arthritis

Publication date: Available online 10 September 2018

Source: Autoimmunity Reviews

Author(s): Philippou Elena, Nikiphorou Elena

Abstract

Accumulating research evidence suggests that individual dietary factors and dietary patterns might be implicated in the risk of development of rheumatoid arthritis (RA). This narrative review aims to present this evidence and provide nutritional recommendations for reducing RA risk in susceptible individuals. Overall, a 'Western' type diet rich in energy intake, total and saturated fat, an unbalanced ratio of n-3 to n-6 fatty acids, high in refined carbohydrates and sugar and low in fiber and antioxidants might increase the risk of RA both directly through increasing inflammation and indirectly through increasing insulin resistance and obesity, with the latter being a known risk factor for RA. On the contrary, consumption of long-chain omega-3 polyunsaturated fatty acids, derived from fish and fish oil, is associated with a reduced risk of RA probably due to their anti-inflammatory properties. The Mediterranean diet (MD), rich in plant-based foods such as wholegrains, legumes, fruit, vegetables, extra-virgin olive oil and low in red meat consumption, might have the potential to reduce the risk of RA. Based on current research evidence, it is suggested that adherence to the MD enhanced with an increased consumption of fatty fish, reduced consumption of sugar-sweetened drinks and maintenance of a normal body weight, contributes to reducing the risk of RA. Further research on RA susceptibility will allow for more specific dietary recommendations to be made.

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Autoimmune Hunger Games – a brief outline of the expanding role of nutrition in the aggravation and attenuation of autoimmune and rheumatic diseases.

Publication date: Available online 10 September 2018

Source: Autoimmunity Reviews

Author(s): Yahel Segal

https://ift.tt/2NylRzv

Nutritional recommendations for gout: An update from clinical epidemiology

Publication date: Available online 10 September 2018

Source: Autoimmunity Reviews

Author(s): Sabrina Mai Nielsen, Kristian Zobbe, Lars Erik Kristensen, Robin Christensen

Abstract

Objective

To present the evidence for nutritional lifestyle changes recommended for gout patients; an explicit focus will be on the evidence for weight loss in overweight gout patients based on a recent systematic review and to describe methodological details for a coming weight loss trial.

Methods

We did a pragmatic but systematic search in MEDLINE for current guidelines that had made an attempt to make nutritional recommendations for gout. The quality of the evidence for the nutritional recommendations was evaluated based on the guidelines' own ratings and converted into a common simple version based on the GRADE system. The recently published systematic review on weight loss for gout, was based on six databases from which longitudinal studies that had quantified the effects following weight loss were included. The internal validity was assessed with the ROBINS-I tool and the quality of the evidence was assessed with the GRADE approach. Based on the results of the systematic review, a trial was designed, adhering to the principles of evidence based research.

Results

We included 17 guidelines. Most guidelines recommend avoiding or limiting alcohol intake (15; i.e. 88%), lose weight if relevant (12; 71%), and reduce fructose intake (11; 65%). The majority of the evidence for the nutritional recommendations was rated Moderate/Low or Very Low quality. Our recent systematic review on weight loss included 10 studies and found that the available evidence indicates beneficial effects of weight loss for overweight and obese gout patients, but the evidence is of low to moderate quality. As a consequence, researchers from the Parker Institute are launching a randomized trial to explore the short-term effects related to a diet-induced weight loss in obese gout patients.

Conclusions

The nutritional recommendations for gout are generally based on low quality evidence. In terms of weight loss as a management strategy, the available evidence is in favor of weight loss for overweight/obese gout patients. However, since the current evidence consists of only a few studies (mostly observational) of low methodological quality, the Parker Institute are now initiating a rigorous exploratory randomized trial. Similar efforts are needed for other nutritional management strategies for gout.

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Probiotics and Autoimmunity: Current Evidence

Publication date: Available online 10 September 2018

Source: Autoimmunity Reviews

Author(s): Oded Shamriz

https://ift.tt/2x5haTw

Characteristics of breath sound in infants with risk factors for asthma development

Publication date: Available online 10 September 2018

Source: Allergology International

Author(s): Hiromi Shioya, Hiromi Tadaki, Fusae Yamazaki, Manabu Miyamoto, Shigemi Yoshihara, Mayumi Enseki, Hideyuki Tabata, Kota Hirai, Hiroyuki Furuya, Masahiko Kato, Shuichi Ito, Hiroyuki Mochizuki

Abstract

Background

Breath sound parameters have been suggested as biomarkers of the airway narrowing in children. Using a commercially available breath sound analyzer, the characteristics of the airway condition were investigated in infants with the risk factors for asthma development.

Methods

A total of 443 infants (mean age, 9.9 months; range, 3–24 months) were included in the present study. The breath sound parameters of the frequency limiting 99% of the power spectrum (F₉₉), the roll-off from 600 to 1200 Hz (Slope) and spectrum curve indices, the total area under the curve of the dBm data (A₃/A_T) and the ratio of power and frequency at 50% and 75% of the highest frequency of the power spectrum (RPF₇₅ and RPF₅₀), were evaluated. Using an ATS-DLD based original Japanese questionnaire, we examined the characteristics of airway condition of infants.

Results

Finally, 283 infants in good health were included in the present study. The RPF₇₅, RPF₅₀, Slope and F₉₉ in infants with positive results of allergy and atopic dermatitis were significantly increased more than those in the infants with negative result.

Conclusions

Our data highlight the characteristics of breath sounds in infants with risk factors for asthma. The breath sound analysis may be useful for assessing the airways of infants for asthma development.

https://ift.tt/2O6dsAh

The rare and unusual presentation of a gastric perforation in the setting of a large diaphragmatic hernia: a case report and literature review

Abstract

Diaphragmatic hernias are either congenital or acquired defects in the diaphragm that permit passing of abdominal contents into the chest cavity. Individuals with large diaphragmatic hernias associated with a gastric perforation have rarely been reported in literature and can have serious mortality rates. Herein, we present a case of gastric perforation in the setting of a significant sized diaphragmatic hernia. The value of the current report compared to previously published cases is the sub-acute nature and lack of any indicative features on initial presentation which can lead to misdiagnosis and serious morbidity later in life.

https://ift.tt/2x3Pmit

Usage of the HINTS exam and neuroimaging in the assessment of peripheral vertigo in the emergency department

Dizziness is a common presenting symptom in the emergency department (ED). The HINTS exam, a battery of bedside clinical tests, has been shown to have greater sensitivity than neuroimaging in ruling out stroke...

https://ift.tt/2CGocny

Adaptive radiotherapy for head and neck cancer: Are we ready to put it into routine clinical practice?

Publication date: November 2018

Source: Oral Oncology, Volume 86

Author(s): Michael F. Gensheimer, Quynh-Thu Le

Abstract

Patients with head and neck cancer who are treated with radiotherapy often have significant weight loss or tumor regression during treatment. Adaptive radiotherapy refers to acquiring new imaging during treatment and changing the parameters of the radiation plan based on the new imaging findings. There is accumulating evidence that adaptive radiotherapy can reduce toxicity and improve tumor control, though it is not yet known which patients benefit most. For patients with profound tumor regression, there is also uncertainty about how much to shrink the region receiving high radiation dose. Another form of adaptive radiotherapy uses advanced imaging such as positron emission tomography to visualize changes in tumor biology during treatment. Tumor regions that are thought to be more radioresistant can then be treated to a higher radiation dose, and vice-versa. Studies employing this strategy to boost radiation dose have shown a high rate of late toxicity, specifically the development of persistent mucosal ulcers. Therefore, this sort of adaptive radiotherapy is currently confined to the research setting.

https://ift.tt/2Ml6bed